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Objectives No clear-cut guidelines exist for the use of imaging procedures for the diagnosis of idiopathic inflammatory myopathies (IIM). The aim of the present study was to assess the diagnostic accuracy of power Doppler ultrasonography (PDUS) score in IIM patients compared with a control group and its usefulness during follow-up. Methods All patients evaluated in the Vasculitis and Myositis Clinic, Rheumatology Unit, University of Siena were prospectively collected. All patients underwent US examination of both thighs in axial and longitudinal scans, which were also performed twice (T1) or three times (T2). Results Forty-five patients with IIM (median [interquartile range] age 55 [45–66] years; 35 female) were enrolled. Receiver operating characteristic curves distinguished patients and controls based on ∑power Doppler (PD), ∑oedema, ∑atrophy and CRP. The best cut-off value for ∑PD was 0.5, ∑oedema 1.5, ∑atrophy 0.5 and CRP 0.22 mg/dl. In a logistic regression analysis, the variables that most influenced diagnosis of IIM were ∑PD and ∑oedema (P  = 0.017 and P  = 0.013, respectively). ∑Oedema was lower at T1 (P  = 0.0108) and T2 (P  = 0.0012) than at T0. Likewise, ∑PD was lower at T1 (P  = 0.0294) and T2 (P  = 0.0420) than at T0. Physician global assessment was lower at T1 (P  = 0.0349) and T2 (P  = 0.0035) than at baseline. Conclusion Our findings show that PDUS is a reliable diagnostic tool in the differential diagnosis between inflammatory and non-inflammatory myopathies. Moreover, PDUS can be employed also during the follow-up of patients with IIM. A reduction in disease activity, measured by physician global assessment, led to a concomitant decrease in both oedema and PD, which was directly correlated with their rate of change. This underlines the close link between clinical assessment and PDUS findings, not only at diagnosis but also during monitoring. [ABSTRACT FROM AUTHOR]

Background: Rheumatoid arthritis (RA) is a systemic autoimmune chronic inflammatory condition that may impact a variety of organs and tissues, but mostly targets flexible (synovial) joints. Objective: The aim of the current study was to assess influence of power Doppler ultrasound (PDUS) and high-resolution ultrasonography (US) in estimation of ankle joints abnormalities in patients suffering RA with or without ankle joint pain. Patients and Methods: A cross sectional study was conducted on 100 participants presented with clinical diagnosis of RA, from the Rheumatology and Rehabilitation outpatient clinic of Al-Azhar University Hospitals. Participants were subjected to a comprehensive history, clinical examination by the referral to rheumatologist, laboratory tests, and high-resolution US and PDUS examination. Results: Patients with symptoms had a considerably higher Disease Activity Score in 28 joints (DAS 28) than those without symptoms (P<0.001). Patients without symptoms had a considerably greater prevalence of low DAS 28 scores (P<0.001), but high score was considerably greater in symptomatic individuals (P=0.007). Conclusion: US enables rapid identification and precise detection of joint and/or tendon inflammatory involvement at ankle level in individuals with RA. Clinicians should be recommended to utilize US more often to identify pathological ankle problems. [ABSTRACT FROM AUTHOR]

Objective: High-volume injections (HVIs) are thought to target neovascularization in chronic midportion Achilles tendinopathy (AT), yet the mechanism has not been clarified. Therefore, we aim to evaluate whether a HVI decreases ultrasonographic Doppler flow in patients with chronic midportion AT. Design: A double-blind, randomized, placebo-controlled clinical trial. Setting: Sports medicine department at a district general hospital. Patients: Sixty-two patients with clinically diagnosed chronic midportion AT were included and randomized into the intervention group (HVI-group, n = 30) and placebo group (n = 32). Intervention: A daily calf-muscle exercise program combined with either (1) a HVI (HVI-group: 50 mL) or (2) a placebo-injection (placebo-group: 2 mL) with a mixture of saline and lidocaine. Main Outcome Measures: Primary outcome was the surface area quantification (SAQ) score (%) of the Doppler flow during a 24-week follow-up period. Secondary outcome was the association between SAQ scores and symptoms [Victorian Institute of Sports Assessment–Achilles (VISA-A)]. Outcomes were measured before, directly after, and 1 hour after the injection and at 2, 6, 12, and 24 weeks of follow-up. Results: There was no significant between-group difference at 24 weeks [−0.1%; 95% confidence interval (CI), −4.9 to 4.7] or at any of the other time points. Change in SAQ score did not correlate with the change in VISA-A score (P = 0.93). Conclusion: A HVI does not affect Doppler flow in patients with chronic midportion AT. Also, changes in Doppler flow were not associated with the clinical outcome. These findings challenge the theoretical basis of a HVI. Trial registration: NCT02996409. [ABSTRACT FROM AUTHOR]

Background and Objectives: Although the ultrasound-guided technique is used in caudal epidural injections, severe complications can happen if ultrasound cannot identify the occurrence of intravascular injection. To determine intraepidural and intravascular injection during caudal epidural injections, we used power Doppler ultrasonography (PDU) when injecting medications into the epidural space. Materials and Methods: This is a retrospective study that enrolled a total of 277 patients with refractory low back pain or degenerative disc from January 2019 to December 2019. The injectate flow of caudal epidural injections was examined with the assistance of PDU and confirmed by fluoroscopy. Four flow patterns were identified by PDU in our study: the "Earthworm sign," the "Patch sign," the "Tubular sign" and the "Absent flow sign." The accuracy of PDU in identifying intraepidural and intravascular injections was determined by fluoroscopy images recorded during each injection. Results: We evaluated 277 patients (mean age, 68.6 ± 13.2 years; 106 men). The "Patch sign" showed a sensitivity of 88.76% and a specificity of 80% in predicting epidural injection without intravascular injection. The "Earthworm sign" demonstrated a sensitivity of 70% and a specificity of 100% in detecting intravascular injection. The "Tubular sign" showed a specificity of 100% and a sensitivity of 9.4% in predicting successful epidural injection. The absence of a flow signal showed a sensitivity of 1.87% and a specificity of 90% in predicting successful epidural injection. Conclusions: Ultrasound-guided caudal epidural injection can accurately determine intraepidural and intravascular injections with the assistance of PDU and is thus a good alternative technique to fluoroscopy-guided caudal epidural injection. [ABSTRACT FROM AUTHOR]

Background: Inflammatory bowel disease (IBD) is closely associated with spondylarthritis (SpA) and enthesitis, as an important feature of SpA, is a common extraintestinal manifestation of IBD. Enthesitis may be clinically silent in a high proportion of patients with IBD without clinical signs or a diagnosis of SpA.Objectives: The aim of this study was to compare the prevalence of ultrasound (US) verified enthesitis in IBD patients with and without SpA, with patients with irritable bowel syndrome (IBS) and healthy subjects (HC) serving as controls.Methods: IBD patients with or without SpA, patients with IBS and HC were prospectively recruited and clinically assessed. Ultrasound examination was performed at 14 entheses. The ultrasound abnormalities were scored according to the Madrid Ankylosing Spondylitis Enthesitis Index (MASEI).Results: We included 33 IBD patients without SpA, 14 IBD patients with SpA, 26 IBS patients and 18 HC. Higher MASEI scores were found in patients with IBD without SpA [median 21.0 range (8.0–53.0)] and IBD associated SpA [33.0 (8–50)] than in IBS patients [10.5 (0–42.0)-p < 0.001 for both comparison] and HC [12.0 (2.0–38.0)-p < 0.01]. PD, enthesophytes and erosions were more common in patients with IBD with or without SpA as compared to IBS patients and HC. IBD patients with SpA compared to IBD without SpA demonstrated significant higher prevalence of erosion and structural irregularity and consequently significant higher MASEI (p < 0.05 for all comparison).Conclusions: Ultrasound verified enthesitis is more common in patients with IBD with or without SpA as compared to patients with IBS or HC.

Background and Objectives: Although the ultrasound-guided technique is used in caudal epidural injections, severe complications can happen if ultrasound cannot identify the occurrence of intravascular injection. To determine intraepidural and intravascular injection during caudal epidural injections, we used power Doppler ultrasonography (PDU) when injecting medications into the epidural space. Materials and Methods: This is a retrospective study that enrolled a total of 277 patients with refractory low back pain or degenerative disc from January 2019 to December 2019. The injectate flow of caudal epidural injections was examined with the assistance of PDU and confirmed by fluoroscopy. Four flow patterns were identified by PDU in our study: the “Earthworm sign,” the “Patch sign,” the ”Tubular sign” and the “Absent flow sign.” The accuracy of PDU in identifying intraepidural and intravascular injections was determined by fluoroscopy images recorded during each injection. Results: We evaluated 277 patients (mean age, 68.6 ± 13.2 years; 106 men). The “Patch sign” showed a sensitivity of 88.76% and a specificity of 80% in predicting epidural injection without intravascular injection. The “Earthworm sign” demonstrated a sensitivity of 70% and a specificity of 100% in detecting intravascular injection. The “Tubular sign” showed a specificity of 100% and a sensitivity of 9.4% in predicting successful epidural injection. The absence of a flow signal showed a sensitivity of 1.87% and a specificity of 90% in predicting successful epidural injection. Conclusions: Ultrasound-guided caudal epidural injection can accurately determine intraepidural and intravascular injections with the assistance of PDU and is thus a good alternative technique to fluoroscopy-guided caudal epidural injection.

Purpose Urinary tract infection (UTI) is one of the common infectious diseases in children. Several imaging modalities can be used to confirm the presence of acute pyelonephritis (APN). Among them the 99mTcdimercaptosuccinic acid renal scan (DMSA scan) is used as a gold standard for diagnosis. Ultrasonography technology is evolving. Therefore, in this study, we investigated the sensitivity and specificity of Power Doppler ultrasonography (PDU) compared to the results from the previous study. Methods There were 260 patients included in this study, aged between 1 and 12 months old. The patients were admitted to the Yeungnam University Medical Center between January 2008 and December 2015. All patients underwent both DMSA scan and PDU within 5days of admission. Voiding cystourethrography (VCUG) was performed in 195 patients with abnormal DMSA scan or PDU. Results The diagnostic sensitivity of APN using PDU was 45.5% and specificity was 85.5% in 260 patients following detection of a defect on DMSA scan that was defined as APN. The diagnostic sensitivity and specificity of PDU for VUR were 65.5% and 60.1%, respectively. The diagnostic sensitivity and specificity of DMSA scan for VUR were 95.7% and 14.1%, respectively. Conclusion PDU has a high specificity but low sensitivity, so there are limitations in using it to replace a DMSA scan for the diagnosis of APN in children. DMSA scan and PDU have different sensitivity and specificity in diagnosis of VUR, respectively. Therefore, we suggest that the sensitivity and specificity of each test can be helpful in diagnosing APN and VUR when used in conjunction.

Introduction Vascular endothelial growth factor (VEGF) is a potent proangiogenic factor that acts selectively on endothelial cells, promoting angiogenesis. Angiogenesis plays a critical role in the pathogenesis of inflammatory arthritis, including juvenile idiopathic arthritis (JIA). Power Doppler ultrasonography is a noninvasive valuable technique that provides a reliable image of synovial angiogenesis that helps in evaluation of disease activity. Aim To evaluate serum VEGF in patients with JIA and correlate it with disease activity and ultrasonographic (US) findings and power Doppler of arthritic joints. Patients and methods A total of 50 patients with JIA were subjected to full history taking, clinical examination, routine laboratory investigations, measuring serum VEGF level, and musculoskeletal US examination. Moreover, 25 apparently healthy children were enrolled as controls. Results There was no statistically significant difference regarding serum VEGF between patient and control groups. No statistically significant correlation was found between VEGF and disease activity or US findings in patients with JIA. Conclusion The possible role of VEGF in disease activity of JIA remains unclear and needs further research. [ABSTRACT FROM AUTHOR]

Objective: In this study, we tried to assess whether power Doppler ultrasonography (PDU) evaluation along with transrectal ultrasound (TRUS) has an additional benefit in the diagnosis of prostate cancer in patients with prostate-specific antigen (PSA) levels of 4-10 ng/mL, when combined with the other methods proposed for this range of PSA. Materials and Methods: Fifty-six patients with PSA values of 4-10 ng/mL were included in the study. Digital rectal examinations, evaluation of total and free PSA, and PDU assessments were done simultaneously with TRUS and eight-core systematic prostate biopsies. Along with the latter, additional biopsies were taken from the suspicious areas detected on PDU. The free/total PSA ratios, PSA density values, TRUS, PDU findings, and biopsy results of 56 patients were recorded and evaluated. Results: Specificity and positive predictive values in detecting prostate cancer in patients with PSA range of 4-10 ng/mL, calculated using the criteria of free/total PSA values <15%, PSA density values >15%, and PDU findings, were 94.87% and 75%, respectively. These values were significantly higher than those of 89.75% and 69.73%, respectively, defined for the criteria of free/total PSA values <15% and PSA density values >15%. Conclusion: The results of this study highlighted that PDU may be useful to detect prostate cancer, and decrease the number of unnecessary biopsy recommendations in patients with PSA values of 4-10 ng/mL, when used in combination with free/total PSA ratio and PSA density. [ABSTRACT FROM AUTHOR]

BACKGROUND: Musculoskeletal ultrasound has the advantages of non-invasiveness, real-time dynamics and good repeatability, and has been gradually used in the diagnosis of lateral epicondylalgia. However, its diagnosis accuracy has not been confirmed. OBJECTIVE: To explore the accuracy of musculoskeletal ultrasound in the diagnosis of lateral epicondylalgia for providing evidence for clinical practice. METHODS: The trials about musculoskeletal ultrasound in the diagnosis of lateral epicondylalgia were searched in the databases of PubMed, EMbase, The Cochrane Library(Issue 6, 2018), CNKI, CBM and WanFang from inception to June 1, 2018. Two researchers independently screened literatures according to inclusion and exclusion criteria, extracted data, and assessed the risk of bias of included studies by using the Quality Assessment of Diagnostic Accuracy Studies tool. Then meta-analysis was performed by using Meta-Disc 1.4 software and Stata 12.0 tool. RESULTS AND CONCLUSION: Seventeen articles were included. The random effects model was used to analyze the heterogeneity among the results of studies. The subgroup results of meta-analysis showed that the pooled sensitivity, specificity for gray-scale ultrasonography diagnosis lateral epicondylalgia was 0.81(95%CI 0.76 to 0.85), 0.79(95%CI 0.73 to 0.85), respectively. The pooled sensitivity, and specificity for gray-scale ultrasonography combined power Doppler ultrasonography diagnosis lateral epicondylalgia was 0.69(95%CI 0.64 to 0.73), and 0.82(95%CI 0.76 to 0.86), respectively. In summary, gray-scale ultrasonography holds high sensitivity and specificity in the diagnosis of lateral epicondylalgia. But it still needs more studies to validate the result because the limitation of quality and quantity of the included studies. [ABSTRACT FROM AUTHOR]

Objectives: In the ULTIMATE study with an open label extension, we assessed the long-term effect of secukinumab at tissue level on synovitis and enthesitis, and across all psoriatic arthritis (PsA) manifestations, using both clinical evaluations and power Doppler ultrasonography (PDUS)., Methods: This randomised, placebo-controlled, Phase 3 study (ULTIMATE) included biologic-naïve patients with PsA with active PDUS synovitis and clinical enthesitis, and inadequate response to conventional synthetic disease-modifying antirheumatic drugs. The study consisted of 3 treatment periods; in the first period (baseline to week 12) patients were randomised to receive subcutaneous secukinumab (150 mg or 300 mg according to severity of skin psoriasis) or placebo every week until week 4 and once every 4 weeks up to week 12. In the second period (weeks 12-24) all patients received open-label secukinumab with placebo patients switching to secukinumab (150 mg or 300 mg). The third period (weeks 24-52) was an extended open-label treatment period. The long-term responsiveness of the Global EULAR-OMERACT Synovitis Score (GLOESS), clinical enthesitis and global PDUS-detected enthesitis score (using two candidate definitions of activity) at patient level, together with clinical efficacy across key manifestations of PsA and safety were assessed., Results: Of the 166 patients enrolled, 144 completed week 52. A significant reduction in GLOESS was demonstrated in the secukinumab group vs placebo at week 12, followed by a stable reduction of synovitis until week 52 in the secukinumab group while placebo switchers from week 12 reached a similar level of reduction at week 24 with stability thereafter. Likewise, a significant reduction in the Spondyloarthritis Research Consortium of Canada (SPARCC) enthesitis index was shown in the secukinumab group vs placebo at week 12 with sustained improvement to week 52. Global OMERACT PDUS enthesitis scores were numerically lower in secukinumab vs placebo switchers in the first two treatment periods, with some stability in the third period in both groups. Improvements in clinical responses were also observed across all key domains of PsA up to week 52 in both treatment groups with no new or unexpected safety signals., Conclusions: ULTIMATE showed consistent improvements in clinically and ultrasound-assessed synovitis and enthesitis and sustained clinical efficacy through week 52 in patients with PsA treated with secukinumab and placebo switched to secukinumab., Competing Interests: Declaration of Competing Interest MAD'A reports speaker or consultant fees from Sanofi, Novartis, BMS, Janssen, Celgene, Roche, AbbVie, UCB, and Eli Lilly. PC reports research grants from UCB, MSD and Pfizer; speaker fees or consultant fees from Pfizer, MSD, Novartis, Bristol Myers Squibb, AbbVie, UCB, Eli Lilly, Gilead and Celgene Corporation. CG is a stockholder of Novartis and BMS and an employee of Novartis. PGC reports speaker fees or consultant fees from AbbVie, AstraZeneca, Eli Lilly, Galapagos, Merck, Novartis, Pfizer, Stryker and UCB. EN reports speaker fees from AbbVie, Roche, BMS, Pfizer, UCB, Lilly, Novartis, Janssen, and Celgene GmbH; honoraria for clinical trials from AbbVie, Novartis and BMS; research grants from Eli Lilly. AL reports speaker or consultant fees from Eli Lilly, Novartis, Janssen, Roche, all GSK and UCB. LS reports research grants, speaker fees, consultant fees and honoraria for clinical trials from AbbVie, Bristol-Myers Squibb, Celgene Corporation, Eli Lilly, Gilead, Merck Sharp and Dohme, Mylan, Novartis, Pfizer, Roche, Sanofi, Sandoz, Sobi, Takeda, and UCB. RB has received honoraria for speaking from Novartis. PH has nothing to disclose. IP has nothing to disclose. TC has nothing to disclose. MSS reports speaker or consultant fees or grants from AbbVie, MSD, Pfizer, Roche and UCB. MB reports speaker or consultant fees or grants from AbbVie, Amgen, BMS, Galapagos, Johnson, MSD, Novartis, Pfizer, Roche and UCB. GM reports speaker or consultant fees or grants from AbbVie, BMS, Celgene, Lilly, Novartis and Pfizer. WB and PG are employees of Novartis. MB is a consultant for Novartis, received speaker fees from Pfizer and provided expert testimony for Celltrion. GS reports speakers’ honoraria from AbbVie, BMS, Celgene, Janssen, Lilly, Novartis, Roche and UCB., (Copyright © 2023. Published by Elsevier Inc.)

Abstract Background Evaluation of remission in Rheumatoid Arthritis (RA) largely relies on composite scores based on clinical and laboratory assessments however, patients can fulfill clinical remission criteria as defined by composite scores, yet still have evidence of synovitis detectable on imaging. Aim of the work To evaluate hand and wrist joints in patients with RA in clinical remission using power Doppler (PD) ultrasonography and to study the association between ultrasonographic findings and composite index scores. Patients and methods This study was conducted on 50 RA patients in clinical remission. Ten matched healthy subjects were included as control. The modified health assessment questionnaire (MHAQ) was assessed in the patients; disease activity was calculated using a composite index score including disease activity score (DAS28) and clinical disease activity index (CDAI). Ultrasonographic assessment of the hand and wrist joints was performed. Results The mean age of the patients was 50.9 ± 9.2 years, disease duration was 10.6 ± 5.5 years and were 38 females and 12 males. The mean DAS28 was 2.3 ± 0.3. On ultrasonographic examination, 14 (28%) patients had normal synovium, while 18 (36%) showed synovial hypertrophy without evidence of inflammation and 18 (36%) had PD signals. DAS28 was higher in patients with PD signals (2.36 ± 0.3) compared to those without synovitis (2.3 ± 0.28). There was a significant correlation between PD activity and CDAI (p = 0.005), MHAQ (p = 0.002) and disease duration (p = 0.023). Conclusion Power Doppler ultrasound can detect residual inflammation in RA patients in clinical remission and its scores were signficantly associated with the clinical disease activity index and functional status. [ABSTRACT FROM AUTHOR]

Objectives To characterize hand synovial manifestations assessed by power Doppler ultrasonography (PDUS) in a cohort of unselected patients fulfilling the 2013 ACR/EULAR classification criteria for SSc and to evaluate the associations of these synovial manifestations with the main general clinical and biological features of SSc. Methods One hundred and three SSc patients were consecutively included and underwent PDUS evaluation of both hands assessing synovial and tenosynovial manifestations according to the OMERACT definitions. Clinical, biological and immunological SSc characteristics were recorded at the same time. Results Thirty-three patients (32%) had ultrasonographic synovial/tenosynovial involvement. The two main PDUS features were Doppler-positive/inflammatory synovitis (n = 18, 17.5%) and sclerosing tenosynovitis (TS) (n = 19, 18.4%). Inflammatory synovitis was more frequent in the wrist and MCP joints. Sclerosing TS was more frequent in men [odds ratio (OR) = 6.32, 95% CI: 2.17, 18.41; P = 0.001] and was associated with anti-RNA polymerase III antibodies (OR = 10.93, 95% CI: 1.84, 65.12; P = 0.01), diffuse SSc (OR = 18.24, 95% CI: 4.80, 69.32; P < 0.0001), interstitial lung disease (OR = 6.09, 95% CI: 1.86, 19.98; P = 0.001) and inflammatory arthralgia (OR = 14.64, 95% CI: 2.58, 83.10; P = 0.002). Inflammatory TS or synovitis were associated with CRP levels >5 mg/l (OR = 5.50, 95% CI: 1.81, 16.70; P = 0.001), pericarditis (OR = 7.81, 95% CI: 1.58, 38.71; P = 0.017) and inflammatory arthralgia (OR = 15.96, 95% CI: 2.80, 91.02; P = 0.002). Inflammatory synovitis and sclerosing TS were not significantly associated within an individual patient (OR = 2.77, 95% CI: 0.88, 8.70; P > 0.05). Conclusions Ultrasonographic synovial involvement is frequent in patients fulfilling the 2013 ACR/EULAR classification criteria and PDUS may have a part to play in a more accurate and precise description of musculoskeletal manifestations of the disease, especially as the question of a treat-to-target approach is arising for SSc. [ABSTRACT FROM AUTHOR]

Aim: Comparative evaluation of direct current and steroid iontophoresis treatments in patients with active wrist synovitis with rheumatoid arthritis. Material and Methods: Rheumatoid arthritis (RA) is a chronic, inflammatory disease that causes pain, swelling and limitation of motion, keeping wrist and hand joints symmetrical. In this study, we examined the efficacy of steroid iontophoresis with direct current to the wrists of active RA patients. 20 active patients with RA and wrist synovitis were included in the study. Steroid iontophoresis applied in one wrist of these patients, direct current to the other wrist (control). Patients' number of painful joints (NPJ), number of swollen joints (SJN), hand grip strength (HG), lateral grip strength (LG), Hand Functional Evaluation (HFE), Health Assessment Questionnaire (HAQ), Disease Activity Score-28 (DAS-28) and power Doppler ultrasonography (PDUS) were compared. Results: Clinical and laboratory parameters were significantly improved according to pre-treatment (Pr-T) and post-treatment (Pst-T). We found significant improvement in Pr-T and Pst-T in the cases of HG, LG, HFE, SJN and NPJ in the wrist in treatment and control, but there was no significant difference between the control wrist and the treated wrist. There were no changes in Pr-T and Pst-T in grades, if any, resistive index (RI) and pulsatility index (PI) values of PDUS with pannus and current in hand wrist. Conclusions: Our results showed no difference between the steroid iontophoresis and direct current therapy in patients with RA who were active and have wrist synovitis in Pr-T and Pst-T. [ABSTRACT FROM AUTHOR]

Purpose and Hypothesis: Mid-portion Achilles tendinopathy is characterized by a proliferation of small vessels, called neovascularization, which can be demonstrated by power Doppler sonography (PD). Neovascularization can be correlated with diagnosis and consequent therapies focused on vascular supply. Published data regarding the relationship between neovascularisation and symptoms, such as pain and disability, are contradictory. The hypothesis that contrast-enhanced ultrasound (CEUS) could detect with more sensibility than PD the new vessel ingrowth in human degenerated Achilles tendons and therefore the correlation of neovascularization with pain and disability, was evaluated.Methods: Thirty consecutive patients of recalcitrant Achilles tendinopathy were studied with ultrasound greyscale (US), PD, CEUS and magnetic resonance imaging. Neovascularization was recorded as percentage on the whole extension of examined area. The vascularization time was recorded as venous and arterial type. Imaging data were classified both concurrently with the examination and in a secondary blinded assessment; any difference in the subjective assessment was discussed and a consensus view formed. Pain and disability were assessed by Western Ontario McMaster Universities Arthritis Index (WOMAC) and EuroQuality of life 5-dimension-5-level questionnaire and visual analogue scale (EQ-VAS). All results were analysed with suitable statistical methods.Results: 76.7% of cases were degenerated; 23.3% had also partial discontinuity of the fibres. PD detected vascularization in 54% of cases, whereas CEUS in 83% of cases: in 13 cases, PD did not detect vascularization. The vascularization time was rapid (< 20 s, arterial type) in 60% of cases. WOMAC pain mean value is 6.4 and SD 3.4; WOMAC total score mean value is 21.6 and SD 12.8. EQ-VAS mean value is 56 and SD 18.3. No statistically significant correlation emerged between vascularization and pain/disability.Conclusions: CEUS showed a greater ability to detect neovessels than PD in chronic Achilles tendinopathies. Nevertheless in 30 consecutive tendinopathies, no correlation between pain/disability and neovascularization was found: the role of multiple neovessels continue to be unclear. The possibility to discriminate arterial from venous vessels ('vascularization time') could be useful to understand the pathophysiology of tendinopathies and its healing process.Study Type: Diagnostic study.Level Of Evidence: II. [ABSTRACT FROM AUTHOR]

Background & objectives: It has been shown that joint damage due to subclinical synovitis progresses despite apparent clinical remission in rheumatoid arthritis (RA). Hence, finding more objective methods to investigate subclinical synovitis has become a current issue. Ultrasonography (US) has been among the most investigated methods. This study was conducted to detect whether there was subclinical inflammation in RA patients in clinical remission by power Doppler ultrasonography (PDUS) and to evaluate the effects of this inflammation on upper extremity function. Methods: Forty five RA patients fulfilled the remission criteria of disease activity score 28 using erythrocyte sedimentation rate (DAS28-ESR), were enrolled in the study. Bilateral wrist, 2nd and 3th metacarpophalangeal and proximal interphalangeal joints and 2nd and 5th metatarsophalangeal joints were examined by PDUS. Upper extremity function was assessed with Michigan Hand Outcomes Questionnaire (MHQ) and handgrip strength. The pain was evaluated by visual analogue scale (VAS). Results: In 29 of 45 RA patients in clinical remission, synovitis was detected by PDUS at least in one joint. VAS and DAS28-ESR scores were significantly lower and total MHQ, some subgroup scores of MHQ (overall hand function, activity of daily living and work performance) and grip strength of the dominant hand were higher in patients with PD signal negativity. Interpretation & conclusions: PDUS showed a crucial role in determining the subclinical synovitis. Subclinical synovitis negatively affects the upper extremity function. Ultrasound-defined remission may be considered for good functional status and real remission in patients with RA. [ABSTRACT FROM AUTHOR]

The sensitivity of lymph node core-needle biopsy under imaging guidance requires validation. We employed power Doppler ultrasonography (PDUS) to select the lymph node most suspected of malignancy and to histologically characterize it through the use of large cutting needle. Institutional review board approval and informed consent were obtained for this randomized clinical trial. In a single center between 1 January 2009 and 31 December 2015, patients with lymph node enlargement suspected for lymphoma were randomly assigned (1:1) to biopsy with either standard surgery or PDUS-guided 16-gauge modified Menghini needle. The primary endpoint was the superiority of sensitivity for the diagnosis of malignancy for core-needle cutting biopsy (CNCB). Secondary endpoints were times to biopsy, complications, and costs. A total of 376 patients were randomized into the two arms and received allocated biopsy. However, four patients undergoing CNCB were excluded for inadequate samples; thus, 372 patients were analyzed. Sensitivity for the detection of malignancy was significantly better for PDUS-guided CNCB [98.8%; 95% confidence interval (CI), 95.9-99.9] than standard biopsy (88.7%; 95% CI, 82.9-93; P < 0.001). For all secondary endpoints, the comparison was significantly disadvantageous for conventional approach. In particular, estimated cost per biopsy performed with standard surgery was 24-fold higher compared with that performed with CNCB. The presence of satellite enlarged reactive and/or necrotic lymph nodes may impair the success of an open surgical biopsy (OSB). PDUS and CNCB with adequate gauge are diagnostic tools that enable effective, safe, fast, and low-cost routine biopsy for patients with suspected lymphoma, avoiding psychological and physical pain of an unnecessary surgical intervention. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to determine the prevalence of subclinical enthesopathy in patients with psoriasis using power Doppler ultrasonography (PDUS) and its association with other disease parameters. Material and Methods: A total of 50 patients with psoriasis (31 females) aged 19-70 years underwent a thorough clinical examination that included assessment of body mass index (BMI) and psoriasis area and severity index (PASI) score. Measurements of inflammatory markers, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), serum uric acid, and plain radiography of the heels, knees, and sacroiliac joints were performed for all patients. Patients without clinical evidence of arthritis or enthesitis underwent an ultrasonographic (US) examination. According to the US examination, patients were classified into group I (patients with enthesitis) and group II (patients without enthesitis). Results: In group I, Achilles enthesis was the most common site of US enthesitis (33.3%), followed by distal patellar enthesis (22.2%), proximal patellar enthesis (16.7%), quadriceps enthesis (16.7%), and plantar aponeurosis enthesis (11.1%). There was a statistically significant positive correlation between the occurrence of enthesitis and the patient's age, disease duration, PASI score, BMI, and hyperuricemia (p<0.05 for each). In contrast, there was no significant correlation between enthesitis and sex or radiographic sacroiliitis (p>0.05 for each). Conclusion: In addition to the importance of PDUS as a complimentary tool for examining enthesis in patients with psoriasis, the presence of high PASI score, increased BMI and hyperuricemia, and a long disease duration can be considered as predictive parameters for the presence of psoriatic enthesitis. [ABSTRACT FROM AUTHOR]

Urinary tract infections are common in children. The available gold standard method for diagnosis, Tc-99m dimercaptosuccinic acid scan is expensive and exposes patients to considerable amount of radiation. This study was performed to compare and assess the efficacy of Power Doppler Ultrasound versus Tc-99m DMSA scan for diagnosis of acute pyelonephritis. A quasi experimental study was conducted on 34 children with mean age of 2.82.7 years who were hospitalized with their first episode of febrile urinary tract infection. All children were evaluated in the first 3 days of admission by Doppler Ultrasound and Tc-99m DMSA scan. Patients with congenital structural anomalies were excluded. Each kidney was divided into three zones. The comparison between efficacy of Doppler Ultrasound and DMSA scan was carried out based on number of patients and on classified renal units. Based on the number of patients enrolled; the sensitivity, specificity, positive and negative predictive values and accuracy of Doppler Ultrasound were 89%, 53%, 70%, 80% and 74%, respectively but based on the renal units, it was 66%, 81%, 46%, 91% and 79% , respectively. Although Doppler Ultrasound has the potential for identifying acute pyelonephritis in children, but it is still soon to replace DMSA scan.

The aim of this study was to investigate the compatibility of the visual evaluation result of the blood flow characteristics and the blood flow measurements of the CL and the predictability of the responses given by corpora lutea with varying levels of blood flow to an induction of luteolysis by a PGF 2α injection and to determine the possibility of increase in serum estrogen and progesterone concentrations in parallel with increased luteal blood flow (LBF). The cows, bearing a CL (n = 60; postpartum 35 days), were injected with PGF 2α and were monitored for signs of estrous following the first injection. The cows, which did not show estrous signs, were examined for the presence of a CL on Day 14, whereas those that showed signs of estrous were examined on Day 10 following the onset of estrous. The level of LBF was visually graded as + (low; GI), ++ (medium; GII), +++ (high; GIII), and ++++ (very high; GIV). Immediately after the examination of LBFs, a second intramuscular injection of PGF 2α was injected. In the cows, which were determined to be in estrous, the diameter of the Graafian follicles was measured by B-mode ultrasonography. Subsequently, these animals were artificially inseminated. The animals, which did not show estrous after the second injection, were examined as previously described and monitored for signs of estrous. A strong correlation (r = 0.654; P < 0.001) was determined to exist between the results of the visual examination of the images and the results obtained for the LBF area with the use of the Pixel Flux software. GIII (0.83 ± 0.15 cm 2 ) and GIV (1.03 ± 0.48 cm 2 ) were found to differ from GI (0.47 ± 0.23 cm 2 ) and GII (0.51 ± 0.12 cm 2 ) for the size of the LBF (P < 0.001). Serum progesterone levels in groups (GI, GII, GIII, and GIV) were determined to be 4.44 ± 2.42 ng/mL, 6.03 ± 2.37 ng/mL, 7.01 ± 2.94 ng/mL, and 7.17 ± 1.69 ng/mL, respectively. The comparative evaluation of the study groups showed that the groups did not statistically differ for the period between PGF 2α injection and the onset of estrous, mean Graafian follicle size and estrogen levels. No direct correlation existed between these reproductive parameters and LBF. [ABSTRACT FROM AUTHOR]

This study was undertaken to evaluate the usefulness of vascular pattern analysis on microvascular ultrasonography in distinguishing metastatic lymphadenopathy from tuberculous lymphadenitis, compared with conventional power Doppler ultrasonography, and to evaluate inter-observer agreement for microvascular ultrasonography. Thirty-four patients with metastatic lymphadenopathy and 27 patients with tuberculous lymphadenitis were included. The level of inter-observer agreement was excellent or good for all aspects of vascular pattern analysis on both ultrasonographic examinations. Vascular distribution, internal vascularity and internal vascular features of lymph nodes on microvascular ultrasonography differed significantly different (p ≤ 0.002) between metastatic lymphadenopathy and tuberculous lymphadenitis. A central vascular pattern with displacement was prevalent in metastasis, and an avascular pattern was more frequent in tuberculosis. Internal vascularity of metastasis was higher than that of tuberculosis. Vascular patterns on power Doppler ultrasonography did not differ significantly. Vascular pattern analysis using microvascular ultrasonography can be helpful in differentiating metastatic lymphadenopathy from tuberculous lymphadenitis with good inter-observer agreement. [ABSTRACT FROM AUTHOR]

Purpose: Following Achilles tendon rupture, running is often allowed after 6 months. However, tendon healing is slow and the metabolic status of the tendon at this point is unknown. The purpose of this study was to investigate tendon metabolism (glucose uptake) and vascularization at 3, 6 and 12 months after Achilles tendon rupture as measured using PET and power Doppler ultrasonography (PDUS). Methods: The study group comprised 23 patients with surgically repaired Achilles tendon rupture who were investigated at 3 months ( n = 7), 6 months ( n = 7) and 12 months ( n = 9) after surgery. The triceps surae complex was loaded over 20 min of slow treadmill walking while a radioactive tracer (F-FDG) was administered prior to PET. Vascularization was measured in terms of PDUS flow activity, and patient-reported outcomes were scored using the Achilles tendon rupture score (ATRS) and sports assessment (VISA-A) questionnaire. Results: Relative glucose uptake (F-FDG) was higher in repaired tendons than in intact tendons at all time-points (6, 3 and 1.6 times higher at 3, 6 and 12 months, respectively; P ≤ 0.001), and was also higher in the tendon core than in the periphery at 3 and 6 months ( P ≤ 0.02), but lower at 12 months ( P = 0.06). Relative glucose uptake was negatively related to ATRS at 6 months after repair ( r = −0.89, P ≤ 0.01). PDUS flow activity was higher in repaired tendons than in intact tendons at 3 and 6 months ( P < 0.05 for both), but had normalized by 12 months. Conclusion: These data demonstrate that the healing process as determined by metabolic activity and vascularization continues for 6 months after injury when large loads are typically allowed on the tendon. Indeed, metabolic activity remained elevated for more than 1 year after injury despite normalized vascularization. The robust negative correlation between tendon metabolism and patient-reported outcome suggests that a high metabolic activity 6 months after the injury may be related to a poor clinical healing outcome. [ABSTRACT FROM AUTHOR]

Urinary tract infections are common in children. The available gold standard method for diagnosis, Tc-99m dimercaptosuccinic acid scan is expensive and exposes patients to considerable amount of radiation. This study was performed to compare and assess the efficacy of Power Doppler Ultrasound versus Tc-99m DMSA scan for diagnosis of acute pyelonephritis. A quasi experimental study was conducted on 34 children with mean age of 2.82.7 years who were hospitalized with their first episode of febrile urinary tract infection. All children were evaluated in the first 3 days of admission by Doppler Ultrasound and Tc-99m DMSA scan. Patients with congenital structural anomalies were excluded. Each kidney was divided into three zones. The comparison between efficacy of Doppler Ultrasound and DMSA scan was carried out based on number of patients and on classified renal units. Based on the number of patients enrolled; the sensitivity, specificity, positive and negative predictive values and accuracy of Doppler Ultrasound were 89%, 53%, 70%, 80% and 74%, respectively but based on the renal units, it was 66%, 81%, 46%, 91% and 79% , respectively. Although Doppler Ultrasound has the potential for identifying acute pyelonephritis in children, but it is still soon to replace DMSA scan.

The aim of this study was to evaluate the feasibility of using power Doppler ultrasound (PDUS) to detect changes in the sacroiliac joint regions after infliximab (an anti-TNF-α blocker) treatment in active axial ankylosing spondylitis (AS) patients. A total of 110 sacroiliac joints in 55 patients with active AS were detected by PDUS before and after the infliximab treatment. The color flow signals inside the sacroiliac joints were observed, and the resistance index (RI) was measured. The clinical condition of the AS patients was improved compared with their condition before the infliximab treatment. Before the treatment, color flow signals were observed in 103 joints, and the mean RI value was 0.56 ± 0.06. Three months after the first infliximab treatment, color flow signals were observed in 50 joints, and the mean RI value was 0.87 ± 0.11. There were more blood flow signals in the sacroiliac joints before the infliximab treatment in patients with active AS ( p < 0.01), and the mean RI value was higher after the infliximab treatment ( p < 0.01). The blood flow signals in the sacroiliac joints became weaker or even disappeared and the RI values increased in patients with active sacroiliitis after infliximab treatment. This result shows that PDUS can be used in the follow-up of patients with axial AS. [ABSTRACT FROM AUTHOR]

Abstract: In recent studies, both tumor morphology and vascularity played an important role in differentiating breast tumors. In this article, a computer-aided diagnosis (CAD) system was proposed to quantify the tumor morphology of vascularity on three-dimensional (3-D) power Doppler breast ultrasound (PDUS) images. We segmented the tumor margin by the level set method and skeletonized vessels by the 3-D thinning algorithm from 3-D PDUS data to capture the B-mode and vascularity features. The B-mode features including texture, shape and ellipsoid fitting and the vascularity features containing volume, complexity, length, radius and tortuosity were used to differentiate breast tumors. In the experiment, 82 biopsy-verified lesions including 41 benign and 41 malignant lesions were used to test the performance of the proposed system. The proposed method performed well, achieving accuracy, sensitivity, specificity and Az values of 85.37% (70/82), 85.37% (35/41), 85.37% (35/41) and 0.9104, respectively. [Copyright &y& Elsevier]

Abstract: Introduction: Lymph node (LN) in rheumatoid arthritis (RA) has been the focus of recent research work; as it is implicated in disease pathogenesis. Power Doppler ultrasonography (PD-US) is increasingly used for imaging of lymph nodes in conditions other than arthritis. Aim of the work: To assess the axillary LN in RA using PD-US, and to correlate the findings to disease activity. Patients and methods: Fourteen Consecutive RA patients were subjected to clinical examination and PD-US of axillary LNs, metacarpophalangeal joints (MCPJs) and wrist joints of the ipsilateral sides. LNs were assessed for cortex/hilum (CH) area ratio, longitudinal/transverse (LT) axis ratio and PD signal type. Joints were assessed for grey scale (GS) score and PD score. GS and PD signals were assigned to each joint in accordance with semi-quantitative 0–3 scales for each. DAS28 score was used for disease activity assessment. Results: PD-US detected subclinical LN changes in 24/28 of the examined axillae in RA patients. Changes included hypertrophy mainly of the cortical area and amplification of vascularity of the central type. LN changes did not correlate to DAS28 score; rather correlated to GS and PD scores of ipsilateral wrist and MCPJs as assessed by PD-US. Conclusion: PD-US detects subclinical axillary LN changes in RA patients. These changes do not correlate to DAS28. Axillary LN changes associate signs of synovitis in ipsilateral wrist and MCPJs as assessed by PD-US. Owing to the small number of patients enrolled, results presented in this work should be considered preliminary. [Copyright &y& Elsevier]

Purpose: Power Doppler ultrasonography (PD-US) is a motion-sensitive modality that can display flow characteristics regardless of the direction. This increased motion sensitivity can be used as a parameter to show the tissue motion on artificially generated fremitus images. This study aimed to confirm any signs of incarceration in abdominal wall hernias proven by herniorrhaphy by examination with dynamic PD-US (during manual compression-decompression maneuvers). Methods: Twenty-seven patients with anterior abdominal wall hernia with a narrow neck (<1 cm in diameter) were examined firstly with gray-scale ultrasonography (GS-US), and then with dynamic PD-US. Two independent radiologists, who were blinded to the real-time images showing the orientation and motion of the hernia neck, completed the examinations. These images were evaluated for any signs of incarceration, as well as the orientation of the hernia neck. Results: Orientations of the hernia neck were not described on GS-US images in 13 lesions and on dynamic PD-US images in 3 lesions. While the GS-US examination revealed incarcerated hernia in four of the patients, the dynamic PD-US examination revealed an additional seven patients with symptoms associated with incarceration. Conclusion: Dynamic PD-US may show the orientation of the hernia neck and any sign of incarceration more accurately and clearly than conventional GS-US. Being informed about these features preoperatively is of utmost importance. Thus, anterior abdominal wall hernias should be examined by dynamic PD-US. [ABSTRACT FROM AUTHOR]

Abstract- Urinary tract infections are common in children. The available gold standard method for diagnosis, Tc-99m dimercaptosuccinic acid scan is expensive and exposes patients to considerable amount of radiation. This study was performed to compare and assess the efficacy of Power Doppler Ultrasound versus Tc-99m DMSA scan for diagnosis of acute pyelonephritis. A quasi experimental study was conducted on 34 children with mean age of 2.8±2.7 years who were hospitalized with their first episode of febrile urinary tract infection. All children were evaluated in the first 3 days of admission by Doppler Ultrasound and Tc-99m DMSA scan. Patients with congenital structural anomalies were excluded. Each kidney was divided into three zones. The comparison between efficacy of Doppler Ultrasound and DMSA scan was carried out based on number of patients and on classified renal units. Based on the number of patients enrolled; the sensitivity, specificity, positive and negative predictive values and accuracy of Doppler Ultrasound were 89%, 53%, 70%, 80% and 74%, respectively but based on the renal units, it was 66%, 81%, 46%, 91% and 79%, respectively. Although Doppler Ultrasound has the potential for identifying acute pyelonephritis in children, but it is still soon to replace DMSA scan. [ABSTRACT FROM AUTHOR]

Objectives: To compare quantitative magnetic resonance imaging (MRI) and power Doppler ultrasonography (PDUS) with conventional measures of disease activity in rheumatoid arthritis (RA) patients treated with the anti-interleukin 6 (anti-IL 6) receptor antibody tocilizumab in terms of responsiveness at a few months to disease activity and ability to predict structural damage at 1 year.Methods: A cohort of patients with RA (n = 29) was evaluated clinically including disease activity score 28 (DAS28) and by semiquantitative (SQ-) and quantitative (Q-) PDUS (bilateral metacarpophalangeal joints) and MRI (one hand and wrist) at initiation of treatment with anti-IL 6 receptor antibody agents and after 2 and 5 months. Conventional radiography for both hands and wrists was performed at baseline and at 12 months. Responsiveness was assessed by standardized response means (SRM). Areas under the curve (AUC) for measures at baseline, 2 and 5 months were correlated with structural damage at 1 year.Results: Among the laboratory and clinical parameters, DAS28-ESR was the most responsive with a large effect size of SRM. Structural damage progressions for radiography and MR erosion were correlated with AUC of MR bone erosion and Q-PDUS, respectively.Conclusions: In the evaluation of disease activity in RA patients in the first few months after starting anti-IL 6 receptor antibody tocilizumab treatment, the semiquantitative MR bone erosion score of the hand and quantitative value for power Doppler signal in the finger joint were both responsive and predictive of structural damage progression at 1 year. [ABSTRACT FROM AUTHOR]

We report a case of rheumatoid arthritis in which the earliest symptom was bilateral paratendonitis of the Achilles tendons, followed by paratendonitis of a finger extensor. A series of musculoskeletal ultrasonograms revealed a progression from paratendonitis of the extensor tendon to erosive synovitis of the adjacent metacarpophalangeal joint. High-resolution ultrasonography combined with power Doppler imaging seems to be a useful and convenient tool both for diagnosing paratendonitis early and for closely monitoring the progressing inflammation. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To illustrate ultrasound (US) and power Doppler US (PDUS) aspects of neurogenic heterotopic ossification (NHO) in consecutive patients with severe acquired brain injury, to evaluate the role of bedside US and PDUS in early diagnosis of NHO, to study incidence and outcome of NHO in this neurorehabilitative setting. Methods: Ninety-two consecutive patients with severe acquired brain injury underwent clinical and laboratory screening to pose suspect of NHO. In 6/92 patients bedside US examination confirmed the clinical suspect of NHO. US diagnosis of NHO was then confirmed by other imaging methods. All affected patients started therapy with indometacin, disodium etidronate, 6-methylprednisolone and they were followed-up for 1 year to evaluate the outcome. Results: The incidence of NHO in this setting was 6.5% (only one patient with multifocal involvement). In hip NHO US demonstrated the classical pattern of zone phenomenon, and PDUS demonstrated vascular signals within mineralized NHO and in the outer hypoechoic area. No vascular signal was observed in the central hypoechoic core. In knee and elbow NHO only a heterogeneously hypoechoic mass or hyperechoic mineralized mass were respectively evident, with vascular signals within the lesions at PDUS. Spectral wave analysis (SWA) demonstrated low resistance vessels in NHO. After 1 year of therapy only one patient showed a severe ankylosis of the hips. Conclusions: Bedside US is a safe, cheap and useful tool in diagnosis of NHO and it allows to start therapy in early stages of NHO formation. PDUS adds data about neoangiogenetic activity of early NHO. [Copyright &y& Elsevier]

Objective: Our aim was to evaluate whether capsular artery resistive index measured by transrectal power Doppler ultrasonography (US) can be used as a dynamic parameter to determine the severity of benign prostate hyperplasia and the efficiency of the treatment. Material and methods: Fifty patients aged between 40 and 80 years who applied for lower urinary track symptoms or follow-up were included in the study. International Prostate Symptom Score (IPSS), uroflowmetry, and prostate specific antigen (PSA) were evaluated. Prostate volume and capsular artery resistive index were measured with transrectal power Doppler US. Alfuzosin XL 10 mg was given to 34 patients with lower urinary track symptoms for a month. IPSS, uroflowmetry and capsular artery resistive index values were reevaluated at the end of one month. Results: The mean resistive index value was 0.69±0.07. There was no relationship between resistive index and age (r=0.23, p>0.05). There were significant relationships between resistive index and IPSS, PSA or prostate volume (r=0.57, p<0.05; r=0.35, p<0.05; and r=0.32, p<0.05, respectively). Significant relationships of resistive index with maximum and mean urinary flow rate (r=-0.51, p<0.05 and r=-0.49, p<0.05) were also noted. The mean resistive index value of 34 patients treated for lower urinary track symptoms was 0.72±0.06 before medication and decreased significantly to 0.66±0.04 after the treatment (p<0.05). Decrease in IPSS and increase in uroflow rates were also noted after treatment. Conclusion: Capsular artery resistive index can be used as a dynamic parameter in the estimation of the severity of benign prostate hyperplasia and efficiency of the treatment. [ABSTRACT FROM AUTHOR]

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Power Doppler ultrasonography (PD-US) has proved to be a useful technique to measure synovial vascularity due to its capability to provide data that can be used to evaluate the level of joint inflammation and assess rheumatoid arthritis (RA). We have developed a novel PD-US finger joint scoring method that introduces quantitative measurements into the conventional PD-US assessment method. A comparison of the two methods revealed that our novel PD-US method strongly correlates with the conventional method in terms of RA assessment. We performed finger joint PD-US on 69 patients with RA and 70 patients who had multiple joint pain but showed no evidence of inflammatory diseases (non-inflammatory disease, NI) and measured the synovial vascularity of the metacarpophalangeal joints 1–5 and proximal interphalangeal (PIP) joints 1–5 for each patient. We analyzed the data with receiver operating characteristic analysis and, based on the results for the total vascularity of 20 finger joints, defined a cut-off value of 36% as discriminating between RA and NI. This cut-off value was found to be a valuable tool in screening for RA. We conclude that our finger joint PD-US scoring system is both useful and applicable for diagnosing RA. [ABSTRACT FROM AUTHOR]

Background: Power Doppler ultrasonography is widely used to examine neovascularization in midportion Achilles tendinopathy. The reliability of the grading of the degree of neovascularization has not been examined previously. Hypothesis: Power Doppler ultrasonography can be performed with a high interobserver reliability to determine the neovascularization score in patients with midportion Achilles tendinopathy. Study Design: Case control study (diagnosis); Level of evidence, 4. Methods: Thirty-three symptomatic and 17 asymptomatic Achilles tendons from 25 consecutive patients were included for ultrasound examination. Victorian Institute of Sport Assessment-Achilles score was used to assess the severity of the Achilles tendinopathy. Each tendon was scored twice by different radiologists using the modified Öhberg score for neovascularization. Results: The intraclass correlation coefficient for interobserver reliability was 0.85. Neovascularization was observed in 70% (23/33) of the symptomatic tendons and in 29% (5/17) of the asymptomatic tendons. The Spearman correlation coefficient between the Victorian Institute of Sport Assessment-Achilles score and the degree of neovascularization was -0.16 (P = .10). Conclusion: An excellent interobserver reliability was found for determining the degree of neovascularization on power Doppler ultrasonography examination. Neovessels were present in a majority of symptomatic tendons. The severity of symptoms was not correlated with the neovascularization score. Clinical Relevance: Power Doppler ultrasonography is widely used to evaluate tendinopathy without knowledge of the difference in observations between several testers. Interobserver reliability of the evaluation of the degree of neovascularization in chronic midportion Achilles tendinopathy is excellent. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: A clinically manifested acute rejection is associated with graft dysfunction and with some ultrasound findings. The aim of our study was to determine the potential of ultrasound evaluation in the detection of subclinical acute rejective changes diagnosed in stable grafts by protocol biopsy. Methods: Gray-scale evaluation, color Doppler imaging (CDI) and power Doppler imaging (PDI) was performed before each of 184 protocol graft biopsies in 77 patients in the third week, third month and first year after transplantation. The group was divided into four subgroups—normal histological finding, borderline changes, subclinical acute rejection of IA grade, and a clinically manifested acute rejection of IA grade. The sonographic findings were compared with individual groups. Results: Detection of parenchymal edema using gray-scale imaging significantly differentiated borderline changes and subclinical acute rejection of IA grade from normal histological findings in the third week and in the third month (P =0.013, P =0.002 and P =0.024, P <0.001), respectively. A similar finding could be recorded in the latter group in the first year after transplantation (P =0.024). The presence of edema and reduced peripheral parenchymal perfusion in PDI significantly more often indicated a clinically manifested acute IA rejection (P =0.019, P =0.004, P =0.044). Parenchymal CDI hyperperfusion had a high specificity (89.5%) but a low sensitivity (60%) in the detection of the subclinical form of acute IA rejection. Conclusion: A composite gray-scale, PDI and CDI evaluation provide a significant differentiation of groups with borderline changes and subclinical acute rejection and groups with normal histological finding and clinically manifested acute rejection. [Copyright &y& Elsevier]

Abstract: Purpose: The aim of the study is to increase clinical awareness of torsion of wandering spleen (WS) in childhood and the need of a rapid diagnosis. Methods: Four cases operated for torsion of WS are retrospectively reviewed. Ages at presentation were, respectively, 30 months, 5 years, 4 years, and 3 years, without sex preference. All subjects led a history of abdominal pain and a mass on physical examination. Results: Torsion of WS should be suspected in any child presenting with acute abdomen. Moreover, in case of acute abdomen and intermittent abdominal pain, we suggest studying spleen position with ultrasound. Conclusions: Ultrasonography with color Doppler is the best choice for diagnosis of torsion of WS. Computed tomography is a good complementary examination, but it needs to submit young patients to a general anesthesia and delays an emergency situation. [Copyright &y& Elsevier]

The aim of this study was to characterize the pathological conditions of symptomatic ankles in patients with rheumatoid arthritis (RA) using power Doppler sonography (PDS). We analyzed 17 consecutive ultrasonography (US) records of RA patients with symptomatic ankles who underwent B-mode ultrasonography (BUS) combined with PDS of their ankles in our department because of clinical need. Correlations between US findings and clinical and serological data were assessed. The diagnostic capabilities of BUS and PDS were also compared. Common US findings were talocrural synovitis (76%), subtalar synovitis (71%), and talonavicular synovitis (59%). Tenosynovitis around the ankle was detected in ten patients (59%), including several cases of tenosynovitis of tibialis posterior (41%) and tenosynovitis of peroneus longus and brevis (35%). Achilles tendon enthesitis was detected in six patients, and retrocalcaneal bursitis was detected in five. Compared with BUS, PDS offers demonstrably superior diagnostic capability for the detection of rheumatoid ankle diseases, especially subtalar joint synovitis and peroneal tenosynovitis. Rheumatoid factor (RF) levels were significantly higher in patients with tenosynovitis than in patients without tenosynovitis. PDS is an excellent modality for diagnosing both intra- and extracapsular synovitis in rheumatoid ankles. Using PDS, we found positive association between ankle tenosynovitis and RF levels in RA patients. [ABSTRACT FROM AUTHOR]

Enthesopathy is the pathologic change of the insertion of tendons, ligaments and joint capsules on the bone. It is a cardinal feature of spondyloarthropathies (SpA), but it can occur in other rheumatic disease. Recent studies using magnetic resonance imaging (MRI) and ultrasonography (US) have demonstrated that enthesopathy can often be asymptomatic, in both the axial and peripheral skeleton. Therefore, a systematic US study of peripheral entheses could be useful in the diagnostic process of patients with rheumatic diseases, in particular SpA. Recently, power Doppler US (PDUS) has been proved to be useful for differentiating mechanical/degenerative and inflammatory enthesopathy and for monitoring the efficacy of therapy. This article reviews the main histopathologic aspects of enthesopathy and describes the normal US features of enthesis and the basic US features of enthesopathy, in its various stages. The usefulness of US and PDUS in the diagnosis and assessment of enthesopathy is discussed on the basis of the literature and our experience. [ABSTRACT FROM AUTHOR]

Abstract: Our aim was to evaluate the effect of arthroscopic lysis and lavage of the temporomandibular joint (TMJ) on synovial microvascularisation by comparing preoperative and postoperative grades measured by power Doppler ultrasonography (US). We studied 22 patients with hypomobility, clicking, and pain in the TMJ. Power Doppler US were obtained preoperatively to assess the presence of synovial microvascularisation, and arthroscopic lysis and lavage were done after conservative treatment had proved unsuccessful. The severity of synovitis was assessed arthroscopically. The postoperative power Doppler US scans were obtained 2 months later. Other arthroscopic variables were roofing, adhesions, chondromalacia, clicking, and pain. Arthroscopic synovitis with varying degrees of synovial vascularisation was detected in all patients. Pain scores decreased considerably during the postoperative period. We conclude that power Doppler US is a good technique for the assessment of synovial changes by microvascularisation. Arthroscopy of the TMJ reduces synovial vascularisation. [Copyright &y& Elsevier]

The placenta is fundamental for fetal development. It combines the functions of an endocrine organ, kidneys, lungs and intestines, purifying catabolites, oxygenating and nourishing the conceptus. Its fetal portion is the largest part develops from the chorionic sac. The maternal portion, which is smaller, is originated in the endometrium, more specifically in the decidua basalis. The placenta starts its function closer to the fourth week of gestation, when anatomical arrangements for the physiological exchanges are already established. The circulatory function of the placenta appears at an early stage of embryo-placental development and it is strongly related to fetal growth, to the placental size and to uterine and umbilical blood flows. Therefore, an adequate placental angiogenesis is critical for the establishment of a normal placental vascularization with consequent normal development of the fetus. In this review article, the authors discuss about placental ontogeny, focusing on the main aspects of its normal development, and about the recent advances in ultrasonography for the study of the vascular architecture of the placenta through three-dimensional power Doppler ultrasonography. [ABSTRACT FROM AUTHOR]

PTK787/ZK 222584 is an inhibitor of the vascular endothelial growth factor (VEGF) receptor tyrosine kinases. In this study, the effectiveness of PTK787/ZK 222584 and radiation on canine oral melanoma xenografts was assessed. Xenografts were treated with radiotherapy (4 x 6 Gy), or with PTK787]ZK 222584, or with a combination of both. Treatment efficacy was assessed using a tumour growth delay assay, serial power Doppler and pO2 measurements during and after therapy. There was a significant growth delay for the group treated with radiation alone and for the combined treatment group. However, tumour growth delay was similar in both groups. Turnouts were hypoxic before irradiation and no significant re-oxygenation occurred during therapy. In all tumours, vascularity and perfusion were significantly lower at the end of the study but no significant differences in perfusion, vascularity and oxygenation status were observed between and within treatment groups. The combination of PTK787/ZK 222584 and radiotherapy did not perform better than radiotherapy alone in this model. [ABSTRACT FROM AUTHOR]

Urinary tract infection is common in children. The available gold standard methods for diagnosis, Tc-99m dimercaptosuccinic acid (DMSA) scan and computed tomography (CT) are invasive and expensive. This study was performed to assess the role of power Doppler ultrasound (PDU) for diagnosis of acute pyelonephritis (APN) compared with Tc-99m DMSA scan. A prospective study was conducted in 34 children with the mean age of 2.8±2.7 years who were hospitalized with the first episode of febrile urinary tract infection. All children were examined in the first 3 days of admission by PDU and Tc-99m DMSA scan. Patients with congenital structural anomaly were excluded. Each kidney was divided into three zones. The comparison between PDU and DMSA scan was performed on the basis of patients and renal units. According to the patient’s number, sensitivity, specificity, positive and negative predictive values, and accuracy of PDU were 89%, 53%, 70%, 80%, and 74%, respectively, but based on the renal units, changed to 66%, 81%, 46%, 91%, and 79%, respectively. Although PDU has the potential for identifying APN in children, it is still soon to replace DMSA scan. [ABSTRACT FROM AUTHOR]

Objective: To compare three-dimensional (3D) power Doppler ultrasonography (PDUS) with contrast enhanced magnetic resonance imaging (MRI) in their capability to visualize synovial vascularity in inflamed wrists of patients with rheumatoid arthritis (RA).Methods: Nine patients with RA showing clinically active arthritis of the wrist as determined by tenderness and swelling were examined by contrast enhanced MRI and 3D PDUS. Vascularity close to and inside the joint capsule was visualized by conventional power Doppler mode. In a region with high Doppler signal intensity (=region of interest/ROI) a 3D blood vessel tree was obtained by a free-hand sweep. 3D images were evaluated with regard to the number of blood vessels in the intra- and peri-articular region. MRI examinations were performed using a 1.5 T Scanner. In MRI, time resolved coronal contrast enhanced T1-weighted sequences with fat suppression were acquired during an 8 min period to assess tissue enhancement. Relative enhancement was calculated and compared to 3D PDUS findings.Results: A 3D vascular tree consisting of peri- and intra-articular blood vessels could be demonstrated in the same anatomical ROI in which an increased gadolinium enhancement was measured by MRI in all examined RA patients. The number of penetrating vessels into the joint capsule, the number of intra-articular vessels and a semiquantitative estimation of the strength of blood flow were used to generate a 3D score for the intensity of synovial vascularity.Conclusion: When compared with clinical symptoms and the gold standard dynamic MRI, 3D PDUS is a reliable imaging technique for assessing synovial vascularity in inflamed wrists of RA patients. [ABSTRACT FROM AUTHOR]