The Value Of Superb Microvascular Imaging In The Detection Of Synovial Inflammation In Patients With Gouty Arthritis

Objective:To compare the diagnostic performance of Super microvascular imaging(SMI)and Power Doppler imaging(PDI)in patients with non-acute gout attack under different synovial thickness,and to explore the correlation between synovial blood flow grade and laboratory inflammatory index and resistance index(RI).Methods:A total of 65 patients with non-acute gout who were admitted to our hospital from November 2021 to December 2022 were collected.The bilateral knee joint,ankle joint and first metatarsophalangeal joint of patients with gout were detected by two-dimensional,PDI and SMI mode,and the synovial thickness and synovial blood flow were evaluated by Szkudlarek four-stage semi-quantitative scoring system.The detection rate and synovial blood flow grade of PDI and SMI were compared,and the correlation between synovial blood flow grade and laboratory inflammatory index was analyzed.For joints with synovial blood flow grade 1 or above,Pulsed-wave Doppler(PW)was used to measure RI in the areas with good flow signal,and the correlation between RI and synovial blood flow grade was analyzed.Results:(1)There was no significant difference in age,body mass index(BMI),uric acid(UA),erythrocyte sedimentation rate(ESR),urea(BUN)and creatinine(Cr)between different synovial thickness groups(P>0.05),while C-reactive protein(CRP)was significantly different(P=0.015).(2)In the group with grade 1 synovial thickness,SMI had a significantly higher detection rate of synovial blood flow than PDI mode(P=0.016).There was no significant difference in the detection rate of synovial blood flow between SMI and PDI in synovial thickness grade 2 and grade 3(P > 0.05).(3)With the same synovial thickness classification,the number of patients with high grade(grade 2 and grade 3)detected by SMI mode was more than that of PDI mode,and the number of patients with low grade(grade 0 and grade 1)was less than that of PDI mode.The difference was statistically significant.(Z=-3.317,P=0.001;Z=-3.464,P=0.001;Z=-2.828,P=0.005).(4)The synovial blood flow grade in SMI was positively correlated with ESR and CRP(r=0.204,P=0.028;r=0.205,P=0.027),while there was no correlation between PDI synovial blood flow grading and ESR or CRP(P>0.05).(5)RI was negatively correlated with SMI synovial blood flow grade and PDI synovial blood flow grade(r=-0.646,P<0.001;r=-0.526,P<0.001).Conclusion:SMI can show the micro-vessels and low velocity blood flow in synovium,and it is more sensitive than PDI to evaluate synovial lesions in patients with gout.SMI synovial blood flow grading is positively correlated with ESR and CRP,and negatively correlated with RI.It can monitor the condition of patients with gout and provide imaging information for the diagnosis of disease activity.