Diagnostic accuracy of grayscale, power Doppler and contrast-enhanced ultrasound compared with contrast-enhanced MRI in the visualization of synovitis in knee osteoarthritis. Issue 133 (December 2020)

• Record Type: Journal Article
• Authors: de Vries, Bas A.; Breda, Stephan J.; Meuffels, Duncan E.; Hanff, David F.; Hunink, M.G. Myriam; Krestin, Gabriel P.; Oei, Edwin H.G.
• Is Part Of: European journal of radiology. Issue 133(2020)
• Publication Date: 2020-12
• Subjects: AUC area under the curve -- BMI body mass index -- CE-MRI contrast-enhanced MRI -- CEUS contrast-enhanced ultrasound -- GSUS grayscale ultrasound -- IQR interquartile range -- KL Kellgren & Lawrence -- MRI magnetic resonance imaging -- OA osteoarthritis -- PDUS power Doppler ultrasound -- ROC receiver operating characteristic; Osteoarthritis -- Knee -- Synovitis -- Ultrasonography -- Magnetic resonance imaging -- Inflammation; Medical radiology -- Periodicals; Radiology -- Periodicals; Radiologie médicale -- Périodiques; Medical radiology; Periodicals; 616.075705
• DOI: 10.1016/j.ejrad.2020.109392
• Languages: English
• ISSNs: 0720-048X

Abstract

Highlights: Ultrasound has limited overall accuracy in detecting synovitis in knee OA. Correlation between GSUS and CE-MRI for severity of synovitis is only moderate. GSUS combined with PDUS/CEUS improves diagnostic performance for mild synovitis. In moderate and severe synovitis, PDUS and CEUS provide no additional value to GSUS. Abstract: Purpose: To assess the diagnostic accuracy of grayscale (GSUS), power Doppler (PDUS) and contrast-enhanced ultrasound (CEUS) for detecting synovitis in knee osteoarthritis (OA). Method: Patients with different degrees of radiographic knee OA were included prospectively. All underwent GSUS, PDUS, CEUS, and contrast-enhanced magnetic resonance imaging (CE-MRI), on which synovitis was assessed semi-quantitatively. Correlations of synovitis severity on ultrasound based techniques with CE-MRI were determined. Receiver operating characteristic (ROC) analysis was performed to assess diagnostic performance of GSUS, PDUS, and CEUS, for detecting synovitis, using CE-MRI as reference-standard. Results: In the 31 patients included, synovitis scoring on GSUS and CEUS was significantly correlated (ρ = 0.608, p < 0.001 and ρ = 0.391, p = 0.033) with CE-MRI. For detecting mild synovitis, the area under the curve (AUC) was 0.781 (95 %CI 0.609−0.953) for GSUS, 0.788 (0.622−0.954) for PDUS, and 0.653 (0.452−0.853) for CEUS. Sensitivity and specificity were 0.667 (0.431−0.845) and 0.700 (0.354−0.919) for GSUS, 0.905 (0.682−0.983) and 0.500 (0.201−0.799) for PDUS, and 0.550 (0.320−0.762) and 0.700 (0.354−0.919) for CEUS, respectively. The AUC of GSUS increased to 0.862 (0.735−0.989), 0.823 (0.666−0.979), and 0.885 (0.767−1.000), when combined with PDUS, CEUS, or both, respectively. For detecting moderate synovitis, the AUC of GSUS was higher (0.882 (0.750−1.000)) and no added value of PDUS and CEUS was observed. Conclusions: GSUS has limited overall accuracy for detecting synovitis in knee OA. When GSUS is combined with PDUS or CEUS, overall diagnostic performance improves for detecting mild synovitis, but not for moderate synovitis.