The Value Of High-Frequency Ultrasound And Contrast-Enhanced Ultrasound In The Assessment Of Rheumatoid Arthritis Disease Activity

Objective: To observe the characteristics of high-frequency ultrasound and contrast-enhanced ultrasound in patients with rheumatoid arthritis.And the relation between quantitative parameters of contrast-enhanced ultrasound with clinical and laboratory indicators was analyzed.To explore the value of high-frequency ultrasound and contrast-enhanced ultrasound in the assessment of rheumatoid arthritis disease activity.Methods: According to disease activity score(DAS28),totally 45 patients diagnosed with Rheumatoid arthritis(RA)were divided into remission group(DAS28<2.6,n=8),moderate activity group(3.2<DAS28<5.1,n=17)and high activity group(DAS28>5.1,n=20).A total of 1260 joints were scanned by high-frequency ultrasound(HFUS),and the synovial thickness and blood flow signals were recorded.Contrast-enhanced ultrasound(CEUS)was performed at the thickest synovium and the place with relatively rich blood flow of the knee joint.Obtain Time-intensity curve(TIC)and record the quantitative parameters including Peak intensity(PI),peak time(TTP),slope(S),average perfusion time(MTT),area under curve(AUC)and so on.Synovial thickness classification,synovial blood flow classification,CEUS enhancement mode and quantitative parameters were compared among each groups.And the correlation between quantitative parameters with disease activity score(DAS28),erythrocytic sedimentation rate(ESR),hypersensitive C-reactive protein(CRP),rheumatoid factor(RF)and anti-cyclic citrate peptide antibody(anti-CCP)were analyzed.Results: The main manifestations of high-frequency ultrasound in RA patients were synovium thickening,and blood flow signals could be detected in the thickened synovium.The proportion of synovial thickness grade and synovial blood flow signal grade with high score increase as the increase of disease activity,while the proportion of low score decrease in different groups.The total score of synovial thickness and the total score of synovial blood flow signal in the high activity group was statistical significance Compared with the remission group and the moderate activity group(P < 0.05).CEUS defines active synovitis as the presence of enhanced signals in the synovial membrane.The enhancement pattern of CEUS in the remission group was statistically significant compared with the moderate activity group and the high activity group(P < 0.05).In comparison of quantitative parameters of CEUS,PI,S and AUC in the remission group were lower than those in the highly active group,while TTP was higher than that in the highly active group,the difference was statistically significant(P < 0.05).Correlation analysis showed that PI and S were positively correlated with DAS28,ESR,CRP,RF and anti-CCP(P < 0.05).TTP was negatively correlated with DAS28,ESR,CRP,RF and anti-CCP(P <0.05).Conclusion: High-frequency ultrasound can clearly show the thickness of synovial membrane and the synovial blood flow.CEUS can qualitatively and quantitatively evaluate synovial blood flow,which can complement insufficient with each other and provide a more meaningful reference basis for the evaluation of RA disease activity and has certain clinical application value.