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Rheumatology Advance Access originally published online on September 14, 2007
Rheumatology 2007 46(11):1736; doi:10.1093/rheumatology/kem226
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© The Author 2007. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Three-dimensional power Doppler sonography in short-term therapy monitoring of rheumatoid synovitis

G. Meenagh, E. Filippucci1, T. Abbattista2, P. Busilacchi2 and W. Grassi1

Department of Rheumatology, Weston General Hospital, Weston-super-Mare, Bristol, UK, 1Cattedra di Reumatologia, Università Politecnica delle Marche, Ancona, Italy and 2Unità Operativa di Radiologia e Diagnostica per Immagini, Ospedale Civile, Senigallia, Italy

Correspondence to: E. Filippucci, MD, Cattedra di Reumatologia, Università Politecnica delle Marche, Ospedale "A. Murri", Via dei Colli, 52, 60035 Jesi (Ancona), Italy. E-mail: emilio_filippucci{at}yahoo.it

SIR, Ultrasound (US) is an invaluable tool in the assessment of the expression of the inflammatory process since it is able to detect minimal amounts of fluid collection, synovial proliferation and bone erosion. Moreover, coupling grey-scale and power Doppler sonography (PDS) it is also possible to evaluate soft tissue perfusion. This kind of information can play a key role in short-term therapy monitoring and appears to be one of the more fascinating fields of research in rheumatology. Standardizing grey-scale US is not an easy task and even more challenging with PDS due to the scattered distribution of synovial hyperaemia.

Three-dimensional (3D) US generates volumetric images containing the entire PDS signal within the acoustic window representing the summation of a virtually infinite number of conventional two-dimensional (2D) images.

The peculiar automatic process of acquisition in 3D US minimizes the margin for error, and therefore renders it a promising imaging tool for the monitoring of synovial perfusion in inflammatory arthritis [1–2]. Figure 1 shows an obvious short-term change in synovial perfusion as depicted by 3D PDS in a patient with severe rheumatoid arthritis receiving biological therapy (adalimumab). These kinds of images can be obtained in a few seconds, even by an unskilled operator, due to the automatic sweep of the transducer.


Figure 1
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  		FIG. 1. 3D PDS assessment of the second metacarpophalangeal joint at baseline (A'-D') and 6 weeks therapy (A''-D'') using a Voluson 730 EXPERT (Kretz, General Electric Medical Systems, Milwaukee, WI, USA) equipped with a volumetric probe (RSP6-12), composed of a broadband (6–12 MHz) linear array that electronically moves during the acquisition process lasting 6 s. Power Doppler settings were standardized with a pulse repetition frequency of 1 kHz and a colour mode frequency of 7.5 MHz. Wall filters were set at the lowest value, while colour gain was increased to the highest value not generating power Doppler signal under the bony cortex. Conventional 2D longitudinal and transverse views (A and B). Coronal view, unobtainable using conventional 2D US (C). 3D- rendered view (D). m, metacarpal head; p, proximal phalanx; arrowhead, bone erosion.

 
Disclosure statement: The authors have declared no conflicts of interest.


   References
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 References
 

  1. Downey DB, Fenster A, Williams JC. Clinical utility of three-dimensional US. Radiographics (2000) 20:559–71.[Abstract/Free Full Text]
  2. Strunk J, Strube K, Klingenberger P, Muller-Ladner U, Lange U. Two- and three-dimensional Doppler sonographic evaluation of the effect of local cryotherapy on synovial perfusion in wrist arthritis. Rheumatology (2006) 45:637–40.[Free Full Text]
Accepted 26 July 2007


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This Article
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46/11/1736    most recent
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