Application Of Multimodal Ultrasound Imaging In Synovium Of Rheumatoid Arthritis

Objective:To explore the application value of common Gray-scale ultrasound imaging,Power Doppler ultrasound imaging,Elastography ultrasound and Contrast-enhanced ultrasound perfusion imaging in rheumatoid synovium.Methods:1.Convenient sampling method was used to select 44 patients with rheumatoid arthritis who were hospitalized in the Department of Hematology and rheumatology of our hospital from November 2018 to December 2020.12.Collect the synovial thickness and area in GSUS mode,dynamic image of blood flow signal in PDUS mode,ultrasonic elastic image in ultrasound elastography mode,SWV value in VTIQ mode,synovial thickness and area in contrast-enhanced ultrasound perfusion mode,dynamic image in contrast-enhanced ultrasound perfusion mode,TIC quantitative perfusion parameters,and collect relevant pathological diagnosis results.3.SPSS 20.0 software was used for statistical analysis.The measurement data was expressed by mean±standard deviation（x±s),and the relative number of count data was expressed.Paired t test was used to compare the two mean numbers.Spearman rank correlation analysis was used to analyze the correlation between rank variables and continuous variables.The receiver operating characteristic(ROC)curve was drawn with the pathological results of synovial tissue as the gold standard;the test levelα=0.05.Results:1.Before and after contrast-enhanced ultrasound,the synovial thickness was 0.99±0.27cm and 1.53±0.32cm,and the synovial area was 0.86±0.50cm~2 and 1.35±0.65cm~2,respectively.The differences were statistically significant(p<0.05).2.The results of correlation analysis between TIC quantitative perfusion parameters and CEUS grading,PDUS grading showed that CEUS grading and PDUS grading were correlated with peak intensity(PI)and area under curve(AUC)in quantitative perfusion parameters(p<0.05);CEUS grading and PDUS grading were positively correlated(r=0.932,p<0.05).3.The correlation analysis of CEUS,PDUS,SWV value of synovium with some serological indexes and DAS score showed that there was a significant positive correlation between SWV of synovium and DAS28(r=0.609,p=0.000);CEUS score was correlated with ESR,CRP,DAS28 score(r=0.633,p<0.001,r=0.544,p=0.002,r=0.460,p<0.001,respectively).PDUS grading was correlated with ESR,CRP and DAS28 scores(r=0.485,p=0.007,r=0.531,p<0.003,r=0.380,p=0.038,respectively).4.VTIQ elastography has characteristic features of proliferative synovial tissue,which can reflect the soft and hard degree of synovial tissue in RA patients.5.The AUC under ROC curve of CEUS,PDUS and SWV were 0.987,0.969 and 0.805 respectively(p<0.05),and the AUC under ROC curve of combined method was 0.995.The order of diagnostic efficacy was combined method>CEUS score>PDUS score>SWV,and the differences were statistically significant(p<0.05).Conclusion:1.Compared with GSUS,CEUS can effectively identify lower echo synovial tissue and better indicate the depth of joint effusion in RA patients.2.This study found that PDUS and CEUS semi quantitative grading had a good correlation with the quantitative parameters PI and AUC of synovial TIC perfusion after contrast enhancement,indicating that these three ultrasound diagnostic modes can well reflect the situation of vascular proliferation in synovium and indicate the severity of synovitis.This study concluded that several modes(SWV,CEUS,PDUS)had certain correlation with DAS score and serological indexes(ESR,CRP)of RA patients.SWV,CEUS and PDUS can evaluate the synovitis and disease activity of RA patients.3.VTIQ imaging technology can be superimposed on the GSUS mode color spectrum and real-time measurement of synovial SWV value,which can qualitatively and quantitatively indicate the tissue hardness of wrist synovitis,and provide a clinical indication of synovial state of RA patients.4.Compared with PDUS,CEUS and SWV,multimodal ultrasound imaging combined diagnosis is more effective in the diagnosis of RA synovitis activity.It provides an efficient and noninvasive diagnostic method for evaluating synovitis activity,and can be recommended for clinical use.