Development and ex-vivo assessment of a novel patient specific guide and instrumentation system for minimally invasive total shoulder arthroplasty.

OBJECTIVE: To develop and assess a novel guidance technique and instrumentation system for minimally invasive short-stemmed total shoulder arthroplasty that will help to reduce the complications associated with traditional open replacement such as poor muscle healing and neurovascular injury. We have answered key questions about the developed system including (1) can novel patient-specific guides be accurately registered and used within a minimally invasive environment?; (2) can accuracy similar to traditional techniques be achieved? METHODS: A novel intra-articular patient-specific guide was developed for use with a new minimally invasive posterior surgical approach that guides bone preparation without requiring muscle resection or joint dislocation. Additionally, a novel set of instruments were developed to enable bone preparation within the minimally invasive environment. The full procedure was evaluated in six cadaveric shoulders, using digitizations to assess accuracy of each step. RESULTS: Patient-specific guide registration accuracy in 3D translation was 2.2±1.2mm (RMSE±1 SD; p = 0.007) for the humeral component and 2.7±0.7mm (p<0.001) for the scapula component. Final implantation accuracy was 2.9±3.0mm (p = 0.066) in translation and 5.7-6.8±2.2-4.0° (0.001

Initial assessment of femoral proximal fracture and acute hip arthritis using pocket-sized ultrasound: a prospective observational study in a primary care setting in Japan.

BACKGROUND: Acute hip pain caused by femoral proximal fractures or acute hip arthritis requires imaging for accurate diagnosis. Although pocket-sized ultrasound (PsUS) offers several advantages over other imaging modalities, there is limited information regarding its use in diagnosing femoral proximal fractures or acute hip arthritis. Thus, we aimed to validate the diagnostic accuracy of PsUS for both disorders. METHODS: In this prospective observational study, outpatients with acute hip pain were diagnosed according to a fixed procedure of the PsUS probe handling. We verified the diagnostic accuracy of PsUS findings (cortical discontinuity and joint fluid retention) and compared it with that of radiography, computed tomography, and magnetic resonance imaging. RESULTS: Our study included 52 outpatients (mean age, 78.0 years; female, 88.5%). Of 26 patients diagnosed with femoral proximal fractures, 14 had femoral neck fractures and 12 had femoral trochanteric fractures. The sensitivity and specificity for identifying cortical discontinuity in femoral proximal fractures were 0.96 and 0.92, respectively. The sensitivity for identifying either cortical discontinuity or joint fluid retention in femoral proximal fractures or acute hip arthritis was 0.97. CONCLUSIONS: Negative PsUS findings of cortical discontinuity and joint fluid retention in the hip are useful for ruling out femoral proximal fractures and acute hip arthritis. PsUS and radiography have comparable diagnostic accuracies, and PsUS could aid in the initial assessment of acute hip pain among the elderly in primary care settings.

Ultrasonographic assessment of femoral cartilage thickness in patients with and without uveitis in Behçet's disease.

The objective for this study is to evaluate the femoral cartilage thickness in patients with/without uveitis in Behçet's disease (BD). Patients with BD aged 18-70 years were included. The demographic and clinical characteristics of the patients were recorded. The thickness of femoral articular cartilage was measured with musculoskeletal ultrasound. Cartilage thickness was measured bilaterally from the central points of medial condyle (MFC), lateral condyle (LFC), and intercondylar area (ICA). 20 patients with uveitis [uveitis (+)] and 20 patients without uveitis [uveitis (-)] were included. Both right and left MFC and LFC had statistically significant thinner cartilage in uveitis (+) group (p < 0.05). For the ICA, uveitis (+) patients had thinner femoral cartilage than uveitis (-) patients; however, in the left side, statistically significance could not be detected. Femoral cartilage was thinner in uveitis (+) patients than in uveitis (-) patients in BD. This relationship between uveitis and femoral cartilage thickness may be helpful in the prevention and early treatment of cartilage degeneration.

Clinical applications of nuclear medicine in the diagnosis and assessment of musculoskeletal sports injuries. / Aplicaciones clínicas de la medicina nuclear en el diagnóstico y evaluación de las lesiones deportivas musculoesqueléticas.

Increased participation in sports and physical exercise are widely promoted as an approach to a physically active lifestyle which has a positive effect on healthy aging, in patients and athletes of all ages, beginners and experts, including amateur athletes and professional athletes. Unfortunately, this has caused a higher incidence of sports-related injuries. In the sports context, the early and accurate diagnosis of injuries is of the utmost importance in order to enable early treatment to achieve a full recovery. Imaging techniques are increasingly important for the successful diagnosis and management of the patient. The nuclear medicine techniques with bone tracers provide physiological and metabolic information in the early phases of musculoskeletal injuries, which often precede anatomical changes and they reflect changes in bone turnover. This allows early diagnosis, along with evaluation of the activity and phase of the injury. In this article, the applications of nuclear medicine techniques, focusing on bone scintigraphy, alongside the important contribution of hybrid studies (SPECT/CT), in the diagnosis of bone and soft tissue sports injuries, will be described. In addition, we explain their usefulness in the expression of the pathophysiology of these lesions and their scintigraphic patterns. The article will also describe biomechanical and physiopathological aspects, injury mechanisms and clinical presentations of bone and joint sports injuries, knowledge of this is essential for the correct diagnostic assessment of imaging studies.

Correlation Between Cone-Beam Computed Tomography and High-Resolution Peripheral Computed Tomography for Assessment of Wrist Bone Microstructure.

High-resolution peripheral quantitative computed tomography (HR-pQCT) is considered as the best technique to measure bone microarchitecture in vivo. However, a breakthrough for medical applications is inhibited because of the restricted field of view (∼9 mm) and a relatively long acquisition time (∼3 minutes). The goal of this study was to compare the accuracy of cone-beam computed tomography (CBCT) and HR-pQCT and to determine the agreement between CBCT and HR-pQCT in quantifying bone structural parameters. Nineteen trapezia of arthritic patients were scanned four times ex vivo: 1) CBCT (NewTom 5G, Cefla, at 75 µm); 2) HR-pQCT (XTremeCT-I, Scanco, at 82 µm); 3) HR-pQCT (XTremeCT-II, Scanco, at 60.7 µm); and 4) microCT (SkyScan1172, Bruker, at 19.84 µm). XTremeCT-I and XtremeCT-II were reconstructed, segmented, and analyzed following the manufacturer's guidelines. CBCT was reconstructed with in-house developed software and analyzed twice: once with an adaptive segmentation technique combined with a direct analysis method (AT-DM) and once with a Laplace-Hamming filtering technique combined with an indirect analysis method (LH-IM). Parameters of interest included bone volume fraction (BV/TV) and trabecular thickness (Tb.Th), separation (Tb.Sp), and number (Tb.N). The analyses of the CBCT data showed that the AT-DM analysis correlated better with microCT for BV/TV, Tb.Sp, and Tb.N, whereas the LH-IM technique correlated better for Tb.Th. Evaluated over all parameters, the coefficient of determination for XtremeCT-I, XtremeCT-II, and CBCT were higher as R2 = 0.68, 0.72, and 0.67, respectively. For CBCT, the correlations improved when three samples with very thin trabeculae close to each other were excluded and became similar to those for XtremeCT-I and XtremeCT-II. Interesting for clinical practice is that those bones could be identified automatically with the CBCT scanner. We conclude that CBCT produced similar accuracy as HR-pQCT in bone morphometric analyses of trapezia. The broader range of application, larger field of view, and shorter acquisition time make CBCT a valuable alternative to HR-pQCT. © 2019 American Society for Bone and Mineral Research.

Laser Doppler-based measurements of periarticular blood flux can be utilized for assessment of arthritis pain: A hypothesis.

Arthritis often presents with serious pain of the affected joints. The pain results mainly from underlying inflammatory processes initiated by the immune response to the degenerative structural changes within the joints and is associated with microvascular vasodilation that increases articular blood flow. Laser Doppler-based methods facilitate reliable quantification of microvascular perfusion. We hypothesize that laser Doppler-based measurements of periarticular blood flux can be utilized for assessment of arthritis pain in patients.

Light Emitting Diodes based Photoacoustic Imaging and Potential Clinical Applications.

Using low cost and small size light emitting diodes (LED) as the alternative illumination source for photoacoustic (PA) imaging has many advantages, and can largely benefit the clinical translation of the emerging PA imaging technology. Here, we present our development of LED-based PA imaging integrated with B-mode ultrasound. To overcome the challenge of achieving sufficient signal-to-noise ratio by the LED light that is orders of magnitude weaker than lasers, extensive signal averaging over hundreds of pulses is performed. Facilitated by the fast response of the LED and the high-speed driving as well as the high pulse repetition rate up to 16 kHz, B-mode PA images superimposed on gray-scale ultrasound of a biological sample can be achieved in real-time with frame rate up to 500 Hz. The LED-based PA imaging could be a promising tool for several clinical applications, such as assessment of peripheral microvascular function and dynamic changes, diagnosis of inflammatory arthritis, and detection of head and neck cancer.

Joint involvement in systemic lupus erythematosus: From pathogenesis to clinical assessment.

OBJECTIVE: In the present review, the different phenotypes, clinimetric and imaging tools able to assess joint involvement in patients affected by Systemic Lupus Erythematosus (SLE) have been described and summarized. Furthermore, the current knowledge about the pathogenic mechanism and the potential biomarkers of this feature is reported. METHODS: A literature search was done in PubMed, accessed via the National Library of Medicine PubMed interface (http://www.ncbi.nlm.nih.gov/pubmed). Firstly, PubMed was searched using the term "systemic lupus erythematosus" OR "lupus" in combination with (AND) "joint" OR "articular".Secondly, the same PubMed research was combined with other terms, such as "pathogenesis" OR "genetic" OR "antibodies" OR "biomarkers" OR "cytokines" OR "imaging" OR "ultrasonography" OR "magnetic resonance" OR "clinimetry". RESULTS: After a stringent selection, we evaluated in the present review 13 papers concerning clinical phenotypes of SLE joint involvement, 14 concerning clinimetric assessment, 20 concerning imaging, and finally, 28 concerning pathogenesis and biomarkers. Further relevant data were obtained from the reference lists of articles returned using these search terms and from authors own experience and knowledge of the literature. CONCLUSION: Despite the prevalence and severity of SLE joint involvement, more awareness and a deeper evaluation of the clinical heterogeneity of this manifestation are mandatory. Moreover, longitudinal studies are needed to assess the progression of this manifestation and to provide standard definitions and examination/recording protocols.

The assessment of lesions of the Achilles tendon by ultrasound imaging in inflammatory arthritis: A systematic review and meta-analysis.

OBJECTIVE: Ultrasound (US) is a highly sensitive, reliable and non-invasive tool, which allows for the assessment of lesions of tendons and entheseal sites. The aim of this systematic review and meta-analysis is to identify differences in US lesions of the Achilles tendon (AT) between people with inflammatory arthritis (IA) and healthy controls. METHODS: An electronic literature search was performed on Medline, CINAHL, SportDiscus and The Cochrane Library. Methodological quality was assessed using a modified Quality Index. Odds ratios with 95% confidence intervals (CI) were determined. Meta-analysis was conducted on those studies that were considered to be homogenous. RESULTS: A total of 13 high-to-medium quality studies met the inclusion criteria. The majority of studies reported US lesions in spondyloarthropathy (SpA), with limited evidence for other forms of IA. US lesions were not consistently defined with regard to Outcome Measures in Rheumatology Clinical Trials (OMERACT) definitions, and numerous scoring systems were used across the majority of studies. The mean AT thickness at the enthesis in people with SpA was 0.54mm thicker (95% CI: 0.10-0.97mm) with more frequent erosions in people with SpA (odds ratio = 7.43, 95% CI: 1.99-27.77, P = 0.003) and rheumatoid arthritis (RA) (odds ratio = 9.60, 95% CI: 1.23-74.94, P = 0.03), compared to controls. There was no significant difference in the frequency of enthesophyte formation in people with SpA compared to the controls (odds ratio = 2.48, 95% CI: 0.64-9.70, P = 0.19). CONCLUSIONS: The systematic review identified that a majority of studies reporting US lesions were in SpA, but limited evidence relating to other forms of IA. Consistent application of the OMERACT US definitions and scoring of US lesions is required in future studies of AT disease in IA. Further work is also required to distinguish between US lesions reflective of inflammation and structural damage.

Bone scintigraphy in axial seronegative spondyloarthritis patients: role in detection of subclinical peripheral arthritis and disease activity.

AIM: To detect subclinical peripheral arthritis and disease activity in axial seronegative spondyloarthritis (SpA) patients using bone scintigraphy. METHODS: Seronegative SpA patients with an established diagnosis and no clinically evident arthritis at the time of the study were included. After excluding symptomatic cases, 20 patients were recruited; 18 with ankylosing spondylitis (AS) and another two with psoriatic arthritis (PsA). Conventional bone scintigraphy was performed to detect the distribution of increased uptake, blood vascular pool (vascularity) and activity. RESULTS: The peripheral joints in all the patients were asymptomatic with no signs of arthritis on clinical examination. Disease activity was higher in those with hypervascularity and activity (75%) detected by scintigraphy. Scintigraphic activity of the sacroiliac joints was found in 10 patients (50%) with a mean sacroiliac joint index of 2.4 ± 0.6. Subclinical involvement of the hips, knees, shoulders, ankles, small joints of the hands, ankles and sternoclavicular joints, as well as the small joints of the feet were detected with descending frequencies (25%, 25%, 20%, 20%, 15%, 10% and 10%, respectively). Dorsal spine increased uptake was found in 35% and hypervascularity of the skull in two cases. Avascular necrosis of the hip was present in one case with hypovascularity. CONCLUSION: The spectrum of joint involvement in seronegative SpAs should not be limited to sacroiliitis. Bone scintigraphy provides a cost-effective method for detecting the extent of involvement in this group of autoimmune systemic diseases (axial SpA) without clinical evidence of peripheral arthritis.

Axillary view: arthritic glenohumeral anatomy and changes after ream and run.

BACKGROUND: The technique and results of shoulder arthroplasty are influenced by glenohumeral pathoanatomy. Although some authors advocate a routine preoperative CT scan to define this anatomy, ordering a CT scan substantially increases the cost and the radiation exposure for the patient. QUESTIONS/PURPOSES: We asked whether measurements of arthritic shoulders on a standardized axillary view are reliable; if postoperative radiographs can reliably show the changes in glenoid anatomy and glenohumeral relationships after shoulder arthroplasty, and if the axillary view can show differences in glenohumeral pathoanatomy in the different sexes and disease types. METHODS: These questions were addressed using cross-sectional studies of 344 shoulders with different types of arthritis and of 128 osteoarthritic shoulders having a ream and run arthroplasty (a glenohumeral arthroplasty that combines a noncemented humeral hemiarthroplasty with concentric reaming of the glenoid bone without implantation of a prosthetic glenoid component). Measurements of glenoid type, glenoid version, and glenohumeral contact were made on standardized axillary radiographs. Interobserver reliability was calculated, preoperative and postoperative measurements were compared, and morphologic differences were compared as stratified by sex and disease type. RESULTS: The measurements on axillary views showed a high degree of interobserver reliability and sensitivity to the changes effected by arthroplasty. The ream and run substantially corrected the glenoid type and point of glenohumeral contact. Male shoulders and shoulders with osteoarthritis had more type B glenoids (ie, those with posterior erosion and biconcavity of the glenoid), more retroversion, and a greater degree of posterior displacement of the point of glenohumeral contact. CONCLUSIONS: The axillary view provides a practical method of characterizing glenohumeral anatomy before and after surgery that is less costly and exposes the patient to less radiation than a CT scan. LEVEL OF EVIDENCE: Level IV, diagnostic study. See the Instructions for Authors for a complete description of levels of evidence.

Interobserver reliability of the radiographic assessment of cement fixation in total hip arthroplasty.

BACKGROUND: The objective of this work is to evaluate the performance of a modified quantitative Barrack Cement grading in primary THA. Previous studies demonstrated both poor intraobserver and interobserver reliability which may be due to the qualitative nature of the scale. METHODS: Interobserver reliability of the Barrack Cement Grading System in its original format and then in combination with a quantitative measurement of implant/cement lengths was evaluated on 50 immediate post-operative radiographs of primary cemented arthroplasties. Intraobserver reliability was also assessed on a sub-sample of radiographs. Three evaluators with different skill levels and specialty participated: an arthroplasty surgeon, an orthopaedic resident and a radiologist. Reliability was measured using a weighted kappa coefficient for paired comparisons among the evaluators. RESULTS: Interobserver reliability was poor (κ < 0.10) for all pairings of the Barrack System. The modified quantitative system achieved slight (κ < 0.20) to poor reliability. Intraobserver reliability was dependent on the skill and specialty of the evaluator with maximal values achieved for the experienced arthroplasty surgeon using the modified quantitative system (κ = 0.62). CONCLUSION: Use of the modified scale may improve the reliability of ratings when used by individual experienced arthroplasty surgeons.

Inflammation assessment in patients with arthritis using a novel in vivo fluorescence optical imaging technology.

BACKGROUND: Indocyanine green (ICG)-enhanced fluorescence optical imaging (FOI) is an established technology for imaging of inflammation in animal models. In experimental models of arthritis, FOI findings corresponded to histologically proven synovitis. This is the first comparative study of FOI with other imaging modalities in humans with arthritis. METHODS: 252 FOI examinations (Xiralite system, mivenion GmbH, Berlin, Germany; ICG bolus of 0.1 mg/kg/body weight, sequence of 360 images, one image per second) were compared with clinical examination (CE), ultrasonography (US) and MRI of patients with arthritis of the hands. RESULTS: In an FOI sequence, three phases could be distinguished (P1-P3). With MRI as reference, FOI had a sensitivity of 76% and a specificity of 54%, while the specificity of phase 1 was 94%. FOI had agreement rates up to 88% versus CE, 64% versus greyscale US, 88% versus power Doppler US and 83% versus MRI, depending on the compared phase and parameter. FOI showed a higher rate of positive results compared to CE, US and MRI. In individual patients, FOI correlated significantly (p<0.05) with disease activity (Disease Activity Score 28, r=0.41), US (r=0.40) and RAMRIS (Rheumatoid Arthritis MRI Score) (r=0.56). FOI was normal in 97.8% of joints of controls. CONCLUSION: ICG-enhanced FOI is a new technology offering sensitive imaging detection of inflammatory changes in subjects with arthritis. FOI was more sensitive than CE and had good agreement with CE, US in power Doppler mode and MRI, while showing more positive results than these. An adequate interpretation of an FOI sequence requires a separate evaluation of all phases. For the detection of synovitis and tenosynovitis, FOI appears to be as informative as 1.5 T MRI and US.

Imaging assessment of the postoperative arthritic wrist.

Wrist arthritis is a common disease entity that can result in severe pain, swelling, and decreased wrist motion, leading to the impairment of daily activities and vocational functions. Nonsurgical treatment for wrist arthritis can improve function and provide pain relief in some cases. With disease progression, however, conservative therapy may become ineffective, and surgical treatment may be required. The three main surgical options for wrist arthritis are arthrodesis, carpectomy, and arthroplasty. Because of the high prevalence of wrist arthritis, radiologists will commonly encounter images that were obtained in patients who have undergone one or more of these surgical options. All three options are common in contemporary orthopedic practice and have evolved in recent years, making it imperative that radiologists understand current procedures and stay abreast of advances in techniques and hardware. In addition, familiarity with both normal and abnormal postoperative imaging findings can aid in the assessment of complications and early failure.

Ultrasound imaging for the rheumatologist XXXIII. Sonographic assessment of the foot in early arthritis patients.

OBJECTIVES: To investigate the ability of ultrasonography (US) to detect synovitis in metatarsophalangeal joints (MTP) in patients with suspicion of early arthritis, and to discriminate between diagnoses. METHODS: Patients referred to early arthritis clinics for differential diagnosis were enrolled, and clinical and laboratory measures were recorded. Ultrasonography of MTPs was performed searching for synovial hypertrophy (SH), joint effusion (JE) and power Doppler (PD), graded from 0 to 3 on a semi-quantitative scale. Patients were classified according to definite classification criteria, or as undifferentiated arthritis or non-inflammatory pathology. US findings were compared across different diagnoses and diagnostic accuracy was calculated taking clinical diagnosis as reference. RESULTS: Out of 427 patients (71% rheumatoid arthritis (RA), 20% undifferentiated arthritis (UA), 15% spondyloarthritides (SpA), 13% non-inflammatory), 307 (71.9%) showed SH, 120 (25.5%) JE, 77 (18.0%) PD. RA patients had median JE, SH and PD scores significantly higher than non-inflammatory and other diseases. Patient with UA and SpA had higher scores of SH and JE compared to non-inflammatory, no significant differences were present among different diagnosis. In RA, SH and JE were more frequently detected in the second MTP, and PD in the fifth. Crystal-related arthritis showed a tendency towards a more frequent involvement of the first MTP. The diagnostic accuracy of single US measures was moderate, but the detection of a PD of 2 or more provided a high specificity for the diagnosis of RA. CONCLUSIONS: US can be used as additional information in patients evaluated in an early arthritis setting. High scores of JE, SH and PD, together with the pattern of involvement are suggestive of RA.

Noninvasive quantitative assessment of synovial pannus angiogenesis by contrast-enhanced gray-scale sonography in antigen-induced arthritis in rabbits.

RATIONALE AND OBJECTIVES: The aim of this study was to evaluate the value of contrast-enhanced gray-scale sonography in quantitative assessment of synovial pannus angiogenesis in antigen-induced arthritis in rabbits. MATERIALS AND METHODS: Twenty-four adult New Zealand White rabbits were divided into two groups. Inflammatory arthritis was induced by intra-articular injection of ovalbumin into right knee joints with 4 mg in low-dose group (LD, n = 12) and 8 mg in high-dose group (HD, n = 12). The left side of the knee on each rabbit was used as normal control. Contrast-enhanced gray-scale sonography with time intensity curve (TIC) was performed on the synovia of suprapatellar bursa and posterior capsules 4 weeks after the injection. Immunohistochemical examinations of synovia were applied to assess the microvessel density and the expression of vascular endothelial growth factor. Correlation analysis between sonographic and immunohistochemical findings was performed. RESULTS: Contrast-enhanced gray-scale sonography of all right knees demonstrated intra-articular hypoechoic lesions with enhanced blood flow and no abnormal findings on all left knees. Parameters of TIC, including ascending curve (A), derived peak intensity (DPI), and area under curve (AUC) on arthritis joints were significantly higher in HD group compared to LD group (P < .05). Positive correlation was found between immunohistochemical findings and parameters of A, DPI, and AUC (P < .05). However, no correlation was found between other parameters (slope of descending rate, time to peak, time to rise, and initial intensity) and immunohistochemical findings. CONCLUSIONS: Contrast-enhanced gray-scale sonography with TIC measurement could provide reliable method for noninvasive quantitative assessment of synovial pannus angiogenesis of arthritis in clinical settings.

A randomized controlled trial of the cost-effectiveness of ultrasound-guided intraarticular injection of inflammatory arthritis.

OBJECTIVE: We studied whether sonographic needle guidance affected the outcomes of intraarticular (IA) injection for inflammatory arthritis. METHODS: Joints with inflammatory arthritis (n = 244; 76% rheumatoid arthritis, 3% small joints, 51% intermediate, and 46% large) were randomized to injection by conventional palpation-guided anatomic injection (120 joints) or sonographic image-guided injection enhanced with a 1-handed reciprocating procedure device mechanical syringe (124 joints). A 1-needle, 2-syringe technique was used. After IA placement and synovial space dilation were confirmed by sonography, a syringe exchange was performed, and triamcinolone acetonide was injected with the second syringe through the indwelling IA needle. Baseline pain, procedural pain, pain at outcome (2 weeks and 6 months), responders, therapeutic duration, reinjection rates, total cost, and cost per responder were determined. RESULTS: Relative to conventional palpation-guided methods, sonographic guidance for injection of inflammatory arthritis resulted in an 81% reduction in injection pain (p < 0.001), 35% reduction in pain scores at outcome (p < 0.02), 38% increase in the responder rate (p < 0.003), 34% reduction in the non-responder rate (p < 0.003), 32% increase in therapeutic duration (p = 0.01), 8% reduction ($7) in cost/patient/year, and a 33% ($64) reduction in cost/responder/year for a hospital outpatient (p < 0.001). CONCLUSION: Sonographic needle guidance improves the performance, clinical outcomes, and cost-effectiveness of IA injections for inflammatory arthritis. (Clinical Trial Identifier NCT00651625).

The assessment of bee venom responses in an experimental model of mono-arthritis using Tc-99m DPD bone scintigraphy.

OBJECTIVES: Several recent studies have shown that bee venom (BV) has an anti-nociceptive and anti-inflammatory effect on arthritis. However, objective methods for evaluation of the therapeutic effect of BV is insufficient in animal studies and clinical trials. Our purpose was to determine the usefulness of bone scintigraphy using Tc-99m DPD (3,3-diphosphono-1,2-propan-dicarbonacid) about effects of BV applied to carrageenan-induced mono-arthritis (CIA) model. METHODS: Mono-arthritis was induced by an intra-articular injection of carrageenan in Sprague-Dawley rats. Administration of BV (0.8 mg/kg) was performed at 30 min before and at 4 h after the induction of mono-arthritis. We assigned rats to BV-before, BV-after, control-before and control-after groups and compared the results of each group by the weight-loading test and bone scintigraphy. The rats received an intravenous injection of 37 MBq of Tc-99m DPD by the tail vein and then scanning was performed at 4 and 24 h after the injection. Visual assessment and quantitative analysis were performed for both knees. RESULTS: The BV-before and BV-after groups were more improved than the control groups on the weight load test (p < 0.05). Bone scintigraphy showed lower activity in the BV-before group than in the control-before group (p < 0.05) on the 4 h imaging. However, a significant difference in the BV-before and BV-after groups was not observed on the 24 h imaging. CONCLUSIONS: BV had therapeutic effects by anti-nociceptive and anti-inflammatory activity in the CIA and bone scintigraphy performed on 4 h imaging provided visual and quantitative information for the assessment of the therapeutic response to BV as an objective method in mono-arthritis model.

Reliability of different Doppler ultrasound quantification methods and devices in the assessment of therapeutic response in arthritis.

OBJECTIVE: To evaluate the metric qualities of power Doppler ultrasound (PDUS) for different quantification methods and devices in the assessment of arthritis during anti-inflammatory treatment. METHODS: Twenty-four patients with active arthritis and first-time treatment with the TNF-alpha inhibitor adalimumab underwent sequential clinical, laboratory and US examination at baseline, weeks 2, 6 and 12. 2D and 3D PDUS was performed by two independent investigators. The images and movies were scored from 0 to 3 and the amount of colour pixels and voxels was calculated. In addition, the resistance index of a synovial artery was measured. Thirteen patients were examined with a second US machine. RESULTS: Treatment response was already observed at week 2 with a significant reduction of 2D (P < 0.01) and 3D scores (P < 0.001). A moderate correlation to 28-joint disease activity score was found for 3D voxel count (r(s) = 0.35, P < 0.001). Interobserver agreement was kappa or ICC >or= 0.8 for all methods except the resistance index (ICC = 0.60). Intermachine agreement was kappa = 0.57 for 2D PDUS score. CONCLUSIONS: The study demonstrates good to excellent interobserver and moderate intermachine reliability of different PDUS assessment methods in a longitudinal open-label study.