Session Information
Date: Sunday, November 8, 2015
Title: Imaging of Rheumatic Diseases Poster I: Ultrasound, Optical Imaging and Capillaroscopy
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose:
Power Doppler Ultrasound (PD) is widely used to assess the activity of rheumatic diseases (especially in Rheumatoid Arthritis). Up to now a series of qualitative / semiquantitative scales have been proposed in order to facilitate a reliable evaluation of a PD image most of them in two to four steps. A true quantitative assessment of PD image is rarely done; in most of the cases it is performed by manual selection of the worst case scenario frame (i.e. the frame with the highest amount of Doppler signal) from a recorded cine-loop. The feasibility of this technique is questionable: in a previous work we demonstrated the inferiority of manual vs. computerized selection both in terms of quality of the process and the time spent. However the independent software solutions for quantitative analysis of Doppler image (i.e. the analysis of the total number of colorized pixels from a region of interest) are now available; we are able to measure in a timely manner not just the ratio between the colorized and grey pixels (CTR) from a certain region in a single frame but all CTRs of all frames captured in a cine-loop (Continuous Quantitative Assessment – CQA). The objective of our study was to assess the ability of CQA technique to identify changes of PD signal earlier than the classical semiquantitative assessment.
Methods:
24 cases of active RA have been examined according to AIUM guidelines for dorsal aspect of radiocarpal and midcarpal joints. A cine-loop of 4 seconds has been recorded for each case before the administration of an i.v. dose of dexamethasone and after 0.5, 1, 2, 6 and 24 hours. All the recordings have been evaluated independently both in semiquantitative (SQ) and in CQA technique (by using a registred software (RETINA®). For CQA we computed mean and peak CTRs. C-reactive protein was measured before and after 24 hour of therapeutical intervention: a 20% decrease defined the reponders. A one-way repeated measures ANOVA was conducted to determine whether there were statistically significant differences between SQ and CQA scores. Responsiveness of SQ and CQA scores was calculated using Relative Reduction (RR) over time.
Results: 23 cases presented a 20% decrease of CRP level and have been included in the analysis. The therapeutic intervention elicited statistically significant changes in SQ and CQA scores for synovitis (tenosynovitis was not included in this study) as described in the table.
|
Timepoint |
No of responders identified by SQ |
No of responders identified by Mean CQA |
No of responders identified by Peak CQA |
P (SQ vs Mean CQA) |
|
0 |
NA |
NA |
NA |
NA |
|
0.5 |
0 |
2 |
2 |
<0.05 |
|
1 |
1 |
4 |
5 |
<0.05 |
|
2 |
1 |
7 |
8 |
<0.05 |
|
6 |
2 |
9 |
9 |
<0.05 |
|
24 |
4 |
12 |
15 |
<0.05 |
The responsiveness of SQ was inferior to any CQA score (p<0.05). However the mean and peak CQA scores correlated well (0.78 for p<0.001) – no separate scores seems to be needed.
Conclusion:
To the best of our knowledge, this is the first study to document the difference between semiquantitative and continuous quantitative PD assessment techniques. The CQA seems to offer the opportunity to identify the therapeutic response earlier than the current approach. The method should be tested in different therapeutic scenarios and in larger groups, too.
To cite this abstract in AMA style:
Berghea F, Vlad V, Bojinca M, Enache L, Ionescu R. Power Doppler Continuous Quantitative Assessment Techniques Is Faster Than Semiquantitative Assesment in Identification of Therapeutic Response [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/power-doppler-continuous-quantitative-assessment-techniques-is-faster-than-semiquantitative-assesment-in-identification-of-therapeutic-response/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/power-doppler-continuous-quantitative-assessment-techniques-is-faster-than-semiquantitative-assesment-in-identification-of-therapeutic-response/