Deep learning-based automatic scoring models for the disease activity of rheumatoid arthritis based on multimodal ultrasound images.

OBJECTIVES: We aimed to investigate the value of deep learning (DL) models based on multimodal ultrasonographic (US) images to quantify RA activity. METHODS: Static greyscale (SGS), dynamic greyscale (DGS), static power Doppler (SPD) and dynamic power Doppler (DPD) US images were collected and evaluated by two expert radiologists according to the EULAR-OMERACT Synovitis Scoring system. Four DL models were developed based on the ResNet-type structure, evaluated on two separate test cohorts, and finally compared with the performance of 12 radiologists with different levels of experience. RESULTS: In total, 1244 images were used for the model training, and 152 and 354 for testing (cohort 1 and 2, respectively). The best-performing models for the scores of 0/1/2/3 were the DPD, SGS, DGS and SPD models, respectively (Area Under the receiver operating characteristic Curve [AUC] = 0.87/0.95/0.74/0.95; no significant differences). All the DL models provided results comparable to the experienced radiologists on a per-image basis (intraclass correlation coefficient: 0.239-0.756, P < 0.05). The SPD model performed better than the SGS one on test cohort 1 (score of 0/2/3: AUC = 0.82/0.67/0.95 vs 0.66/0.66/0.75, respectively) and test cohort 2 (score of 0: AUC = 0.89 vs 0.81). The dynamic DL models performed better than the static ones in most of the scoring processes and were more accurate than the most of senior radiologists, especially the DPD model. CONCLUSION: DL models based on multimodal US images allow a quantitative and objective assessment of RA activity. Dynamic DL models in particular have potential value in assisting radiologists to improve the accuracy of RA US-based grading.

Image features and clinical analysis of retroperitoneal pelvic schwannoma: a case report.

BACKGROUND: Schwannomas are benign usually encapsulated nerve sheath tumors derived from the Schwann cells, and affecting single or multiple nerves. The tumors commonly arise from the cranial nerves as acoustic neurinomas but they are extremely rare in the pelvis and the retroperitoneal area. Retroperitoneal pelvic schwannomas often present with non-specific symptoms leading to misdiagnosis and prolonged morbidity. CASE PRESENTATION: We report the case of a 59-year-old woman presenting with a feeling of heaviness in the lower abdomen who was found to have a retroperitoneal pelvic schwannoma originating from the right femoral nerve. She had a history of two resections of peripheral schwannomas at four different sites of limbs. After conducting magnetic resonance imaging, this pelvic schwannoma was misdiagnosed as a gynecological malignancy. The tumor was successfully removed by laparoscopic surgery. Pathological analysis of the mass revealed a benign schwannoma of the femoral nerve sheath with demonstrating strong, diffuse positivity for S-100 protein. CONCLUSIONS: Although retroperitoneal pelvic schwannoma is rare, it should be considered in the differential diagnosis of pelvic masses, especially in patients with a history of neurogenic mass or the presence of neurogenic mass elsewhere.

Solid-State Photochemical Cascade Process Boosting Smart Ultralong Room-Temperature Phosphorescence in Bismuth Halides.

Molecular ultralong room-temperature phosphorescence (RTP), exhibiting multiple stimuli-responsive characteristics, has garnered considerable attention due to its potential applications in light-emitting devices, sensors, and information safety. This work proposes the utilization of photochemical cascade processes (PCCPs) in molecular crystals to design a stepwise smart RTP switch. By harnessing the sequential dynamics of photo-burst movement (induced by [2+2] photocycloaddition) and photochromism (induced by photogenerated radicals) in a bismuth (Bi)-based metal-organic halide (MOH), a continuous and photo-responsive ultralong RTP can be achieved. Furthermore, utilizing the same Bi-based MOH, diverse application demonstrations, such as multi-mode anti-counterfeiting and information encryption, can be easily implemented. This work thus not only serves as a proof-of-concept for the development of solid-state PCCPs that integrate photosalient effect and photochromism with light-chemical-mechanical energy conversion, but also lays the groundwork for designing new Bi-based MOHs with dynamically responsive ultralong RTP.

Synovial Oxygenation at Photoacoustic Imaging to Assess Rheumatoid Arthritis Disease Activity.

Background Synovial hypoxia is a hallmark of rheumatoid arthritis (RA). Photoacoustic (PA) imaging, based on the use of laser-generated US, can detect the oxygenation status of tissue in individuals with RA. However, large studies are lacking, with few investigating the correlation between oxygenation status and disease activity. Purpose To measure synovial oxygenation status in participants with RA by using a multimodal PA US imaging system and to determine the correlation between PA imaging-measured oxygen saturation (SO2) and disease activity. Materials and Methods In this prospective observational cohort study, multimodal PA US imaging examinations were performed on small joints of consecutive participants with RA, who were treated at two outpatient rheumatology clinics from 2019 to 2021, and healthy controls. The SO2 values of the synovium were measured with dual-wavelength PA imaging and classified into three categories-hyperoxia, intermediate oxygenation status, or hypoxia-based on the signal coloration and clustering analysis of the SO2 values. The correlations of oxygenation status with power Doppler US (PDUS) scoring and clinical disease activity index were evaluated with one-way analysis of variance and the Kruskal-Wallis test with Bonferroni correction. Results A total of 118 participants with RA (median age, 55 years [IQR, 41-62 years]; 92 women) and 15 healthy control participants (median age, 37 years [IQR, 33-41 years]; 11 women) were included. The wrist synovium was categorized as hyperoxic in 36 participants with RA, of intermediate oxygenation status in 48 participants, and hypoxic in 34 participants. All control participants had hyperoxic synovial tissues. For participants with RA, hyperoxic synovium had more affluent Doppler US-depicted vasculature than those with hypoxia and intermediate oxygenation status (mean PDUS grade: hyperoxia, 2.7 ± 0.6 [SD]; intermediate, 1.3 ± 0.7; hypoxia, 1.1 ± 0.8; P < .001). Participants with intermediate status synovium had a lower clinical disease activity index than those with hypoxia (intermediate, 11.0 [IQR, 5.0-21.5] vs hypoxia, 26.0 [IQR, 18.0-39.0]; P = .001). Conclusion Photoacoustic imaging-detected hypoxia in thickened synovium correlated with less vascularization and higher disease activity in participants with rheumatoid arthritis. Clinical trial registration no. NCT04297475 © RSNA, 2022 Online supplemental material is available for this article.

Ultralow-loss Optical Waveguides through Balancing Deep-Blue TADF and Orange Room Temperature Phosphorescence in Hybrid Antimony Halide Microstructures.

Harnessing the potential of thermally activated delayed fluorescence (TADF) and room temperature phosphorescence (RTP) is crucial for developing light-emitting diodes (LEDs), lasers, sensors, and many others. However, effective strategies in this domain are still relatively scarce. This study presents a new approach to achieving highly efficient deep-blue TADF (with a PLQY of 25 %) and low-energy orange RTP (with a PLQY of 90 %) through the fabrication of lead-free hybrid halides. This new class of monomeric and dimeric 0D antimony halides can be facilely synthesized using a bottom-up solution process, requiring only a few seconds to minutes, which offer exceptional stability and nontoxicity. By leveraging the highly adaptable molecular arrangement and crystal packing modes, the hybrid antimony halides demonstrate the ability to self-assemble into regular 1D microrod and 2D microplate morphologies. This self-assembly is facilitated by multiple non-covalent interactions between the inorganic cores and organic shells. Notably, these microstructures exhibit outstanding polarized luminescence and function as low-dimensional optical waveguides with remarkably low optical-loss coefficients. Therefore, this work not only presents a pioneering demonstration of deep-blue TADF in hybrid antimony halides, but also introduces 1D and 2D micro/nanostructures that hold promising potential for applications in white LEDs and low-dimensional photonic systems.

Metal-Halide Coordination Polymers with Excitation Wavelength- and Time-Dependent Ultralong Room-Temperature Phosphorescence.

Metal-organic hybrids with ultralong room-temperature phosphorescence (RTP) have potential applications in many fields, including optical communications, anticounterfeiting, encryption, bioimaging, and so on. Herein, we report two isostructural one-dimensional zinc-organic halides as coordination polymers ZnX2(bpp) (X = Cl, 1; Br, 2; bpp = 1,3-di(4-pyridyl)propane) with excitation wavelength- and time-dependent ultralong RTP properties. The dynamic multicolor afterglow can be assigned to the emission of the pristine ligand bpp and its interactions with halogen atoms. Experiments and theoretical calculations both suggest that ZnX2 is crucial for ultralong RTP: (a) the metal coordination and X...π bonds in coordination polymers fix the bpp molecules and suppress the nonradiative transitions; (b) the spin-orbital coupling of coordination polymers is largely enhanced relative to the bpp because of the heavy atom effect; and (c) the charge transfer exists between halogens and bpp ligand. Therefore, this work not only presents metal-halide coordination polymers with excitation wavelength- and time-dependent RTP properties, but also provides a facile method for the new types of dynamic multicolor afterglow materials.

Highly Efficient and Direct Ultralong All-Phosphorescence from Metal-Organic Framework Photonic Glasses.

Realizing efficient and ultralong room-temperature phosphorescence (RTP) is highly desirable but remains a challenge due to the inherent competition between excited state lifetime and photoluminescence quantum yield (PLQY). Herein, we report the bottom-up self-assembly of transparent metal-organic framework (MOF) bulk glasses exhibiting direct ultralong all-phosphorescence (lifetime: 630.15 ms) with a PLQY of up to 75 % at ambient conditions. These macroscopic MOF glasses have high Young's modulus and hardness, which provide a rigid environment to reduce non-radiative transitions and boost triplet excitons. Spectral technologies and theoretical calculations demonstrate the photoluminescence of MOF glasses is directly derived from the different triplet excited states, indicating the great capability for color-tunable afterglow emission. We further developed information storage and light-emitting devices based on the efficient and pure RTP of the fabricated MOF photonic glasses.

Multimodal photoacoustic/ultrasonic imaging system: a promising imaging method for the evaluation of disease activity in rheumatoid arthritis.

OBJECTIVES: We aimed to assess the clinical value of multimodal photoacoustic/ultrasound (PA/US) articular imaging scores, a novel imaging method which can reflect the micro-vessels and oxygenation level of inflamed joints of rheumatoid arthritis (RA). METHODS: Seven small joints were examined by the PA/US imaging system. A 0-3 scoring system was used to semi-quantify the PA and power-Doppler (PD) signals, and the sums of PA and PD scores (PA-sum and PD-sum scores) of the seven joints were calculated. The relative oxygen saturation (SO2) values of the inflamed joints were measured and classified into 3 PA+SO2 patterns. The correlations between the PA/US imaging scores and the disease activity scores were assessed. RESULTS: Thirty-one patients of RA and a total of 217 joints were examined using the PA/US system. The PA-sum had high positive correlations with the standard clinical scores of RA (DAS28 [ESR] ρ = 0.754, DAS28 [CRP] ρ = 0.796, SDAI ρ = 0.836, CDAI ρ = 0.837, p < 0.001), which were superior to the PD-sum (DAS28 [ESR] ρ = 0.651, DAS28 [CRP] ρ = 0.676, SDAI ρ = 0.716, CDAI ρ = 0.709, p < 0.001). For the patients with high PA-sum scores, significant differences between hypoxia and hyperoxia were identified in pain visual analog score (p = 0.020) and patient's global assessment (p = 0.026). The PA+SO2 patterns presented moderate and high correlation with PGA (ρ = 0.477, p = 0.0077) and VAS pain score (ρ = 0.717, p < 0.001). CONCLUSION: The PA scores have significant correlations with standard clinical scores for RA, and the PA+SO2 patterns are also related with clinical scores that reflect pain severity. PA may have clinical potential in evaluating RA. KEY POINTS: • Multimodal photoacoustic/ultrasound imaging is a novel method to assess micro-vessels and oxygenation of local lesions. • Significant correlations between multimodal imaging parameters and clinical scores of RA patients were verified. • The multimodal PA/US system can provide objective imaging parameters, including PA scores of micro-vessels and relative SO2 value, as a supplementary to disease activity evaluation.

New Consideration of Herlyn-Werner-Wunderlich Syndrome Diagnosed by Ultrasound.

OBJECTIVES: As a rare malformation of the female reproductive system, Herlyn-Werner-Wunderlich syndrome (HWWS) was categorized into 3 classifications. It was recommended recently that, on the basis of the past classification, cervicovaginal atresia without communicating uteri should be newly added as classification 4. The surgical intervention will differ by type. To better optimize patient counseling as well as the preoperative evaluation and planning, our objective was to describe the ultrasound characteristics of each type of HWWS, including the new type. METHODS: From January 1995 to November 2015, 37 cases of HWWS in with complete ultrasound information confirmed by surgery in the Peking Union Medical College Hospital were reviewed. We analyzed their ultrasound features, including hematometra, hematocervix, hematocolpos, and an ovarian chocolate cyst. RESULTS: All of the ultrasound images of the 37 patients showed uterus didelphys with ipsilateral renal agenesis. Compared with the other 3 types, classification 4 showed distinctive ultrasound characteristics. Most cases of classification 4 showed hematometra (5 of 7 [71.4%]) and an ipsilateral ovarian chocolate cyst (6 of 7 [85.7%]), which was significantly higher than in the other 3. A rudimentary uterine horn was also a distinctive characteristic in this type. Meanwhile none of the classification 4 cases showed hematocervix or hydrocolpos, which were common signs of the other 3. CONCLUSIONS: According to this new classification criteria for HWWS, ultrasound characteristics of the new classification 4 differ from the others. As classification 4 was suggested to have a different surgical option, we should pay attention to its ultrasound characteristics, which might help in providing more information about the treatment and prognosis to the gynecologist.

[Ultrasonographic Features of Pseudomyxoma Peritonei and TheirComparison with Computed Tomographic Findings].

OBJECTIVE: To investigate the value of ultrasound in the diagnosis of pseudomyxoma peritonei (PMP) and summarize the ultrasonographic features of PMP by comparing with computed tomography (CT) findings. METHOD: Ultrasound and CT scan results of 25 patients with PMP confirmed by pathology after surgery were analyzed retrospectively. RESULTS: Among these 25 PMP patients,three were diagnosed by ultrasound and six by CT(P=0.579). The specific ultrasonographic features of PMP were as follows:the dense punctuate echoes or floccules were detected in hydrops abdominis,which seldom or never move with the change of body position. Honeycomb-like lesions were typical. Notches were formed on the surface of liver or spleen due to the mucinous material and/or the mucinous lesions. CONCLUSIONS: Both ultrasound and CT scan have poor detection rate in the diagnosis of PMP. PMP has specific ultrasonographic features,which may make it possible to diagnose most PMP lesions by ultrasound before surgery

Machine learning to predict the occurrence of thyroid nodules: towards a quantitative approach for judicious utilization of thyroid ultrasonography.

Introduction: Ultrasound is instrumental in the early detection of thyroid nodules, which is crucial for appropriate management and favorable outcomes. However, there is a lack of clinical guidelines for the judicious use of thyroid ultrasonography in routine screening. Machine learning (ML) has been increasingly used on big data to predict clinical outcomes. This study aims to leverage the ML approach in assessing the risk of thyroid nodules based on common clinical features. Methods: Data were sourced from a Chinese cohort undergoing routine physical examinations including thyroid ultrasonography between 2013 and 2023. Models were established to predict the 3-year risk of thyroid nodules based on patients' baseline characteristics and laboratory tests. Four ML algorithms, including logistic regression, random forest, extreme gradient boosting, and light gradient boosting machine, were trained and tested using fivefold cross-validation. The importance of each feature was measured by the permutation score. A nomogram was established to facilitate risk assessment in the clinical settings. Results: The final dataset comprised 4,386 eligible subjects. Thyroid nodules were detected in 54.8% (n=2,404) individuals within the 3-year observation period. All ML models significantly outperformed the baseline regression model, successfully predicting the occurrence of thyroid nodules in approximately two-thirds of individuals. Age, high-density lipoprotein, fasting blood glucose and creatinine levels exhibited the highest impact on the outcome in these models. The nomogram showed consistency and validity, providing greater net benefits for clinical decision-making than other strategies. Conclusion: This study demonstrates the viability of an ML-based approach in predicting the occurrence of thyroid nodules. The findings highlight the potential of ML models in identifying high-risk individuals for personalized screening, thereby guiding the judicious use of ultrasound in this context.

A flexible ligand and halogen engineering enable one phosphor-based full-color persistent luminescence in hybrid perovskitoids.

Color-tunable room temperature phosphorescent (RTP) materials have raised wide interest due to their potential application in the fields of encryption and anti-counterfeiting. Herein, a series of CdX2-organic hybrid perovskitoids, (H-apim)CdX3 and (apim)CdX2 (denoted as CdX-apim1 and CdX-apim2, apim = 1-(3-aminopropyl)imidazole, X = Cl, Br), were synthesized using apim with both rigid and flexible groups as ligands, which exhibit naked-eye detectable RTP with different durations and colors (from cyan to red) by virtue of different halogen atoms, coordination modes and the coplanar configuration of flexible groups. Interestingly, CdCl-apim1 and CdX-apim2 both exhibit excitation wavelength-dependent RTP properties, which can be attributed to the multiple excitation of imidazole/apim, the diverse interactions with halogen atoms, and aggregated state of imidazoles. Structural analysis and theoretical calculations confirm that the aminopropyl groups in CdCl-apim1 do not participate in luminescence, while those in CdCl-apim2 are involved in luminescence including both metal/halogen to ligand charge transfer and twisted intramolecular charge transfer. Furthermore, we demonstrate that these perovskitoids can be applied in multi-step anti-counterfeiting, information encryption and smart ink fields. This work not only develops a new type of perovskitoid with full-color persistent luminescence, but also provides new insight into the effect of flexible ligands and halogen engineering on the wide-range modulation of RTP properties.

[Sonographic features of lymphoma in the abdominal lymph nodes].

OBJECTIVE: To summarize the sonographic features of the lymphoma in the abdominal lymph nodes. METHOD: The clinical data and sonographic findings of 41 lymphoma patients with original appearance of abdominal mass or lymphadenectasis were retrospectively analyzed. RESULTS: Among these 41 cases, the retroperitoneal and mesenteric lymph nodes were most commonly involved.These patients were divided into two types according to sonographic appearances:solitary mass(n=14) and multiple nodules(n=27) .Solitary hypoechoic mass in abdomen was found in the former type, mostly with irregular or lobular shape, and the inner echo was often heterogenous.The typical appearances of the latter type were multiple enlarged lymph nodes, mostly round or oval, with homogeneous inner echo and clear margins.Some other sonographic characteristics were also helpful for the diagnosis of lymphoma, such as cobblestone sign, intranodular reticulation, vessels-embedded sign, and hilar vascularity. CONCLUSION: Ultrasonography can provide useful information in the diagnosis of the lymphoma in the abdominal lymph nodes.

How Neighbors Influence Rice-Crayfish Integrated System Adoption: Evidence from 980 Farmers in the Lower and Middle Reaches of the Yangtze River.

Rice-aquatic animal integrated systems can alleviate food and environmental insecurity. Understanding how this practice is adopted by farmers is significant for promoting the development of the agricultural industry. Given the information inadequacy and information frictions in agricultural society in China, farmers are susceptible to the behaviors of their neighbors through social interaction. This paper defines neighboring groups that are both spatially and socially connected to identify whether neighbors influence farmers' adoption of rice-crayfish integrated systems using a sample in the lower and middle reaches of the Yangtze River in China. The findings reveal that for every one-unit increase in neighbors' adoption behavior, the probability of farmers' adoption increases by 0.367 units. Therefore, our results may have great value for policymakers seeking to take advantage of the neighborhood effect to complement formal extension systems and promote the developments of China's ecological agriculture.

Protection of toll-like receptor 9 against lipopolysaccharide-induced inflammation and oxidative stress of pulmonary epithelial cells via MyD88-mediated pathways.

Acute lung injury (ALI) caused by lipopolysaccharide (LPS) is a common, severe clinical syndrome. Injury caused by inflammation and oxidative stress in vascular endothelial and alveolar epithelial cells is a vital process in the pathogenesis of ALI. Toll-like receptor 9 (TLR9) is highly expressed in LPS-induced ALI rats. In this study, Beas-2B human pulmonary epithelial cells and A549 alveolar epithelial cells were stimulated by LPS, resulting in the upregulation of TLR9 in a concentrationdependent manner. Furthermore, TLR9 overexpression and interference vectors were transfected before LPS administration to explore the role of TLR9 in LPS-induced ALI in vitro. The findings revealed that inhibition of TLR9 reduced inflammation and oxidative stress while suppressing apoptosis of LPS-induced Beas-2B and A549 cells, whereas TLR9 overexpression aggravated these conditions. Moreover, TLR9 inhibition resulted in downregulated protein expression of myeloid differentiation protein 88 (MyD88) and activator activator protein 1 (AP-1), as well as phosphorylation of nuclear factor-?B (NF-kappaB), c-Jun N-terminal kinase (JNK), and p38 mitogen-activated protein kinase (MAPK). The phosphorylation of extracellular-regulated protein kinases 1/2 was upregulated compared to that of cells subjected to only LPS administration, and this was reversed by TLR9 overexpression. These results indicate that inhibition of TLR9 plays a protective role against LPS-induced inflammation and oxidative stress in Beas-2B and A549 cells, possibly via the MyD88/NF-kappaB and MyD88/MAPKs/AP-1 pathways.

RATING: Medical knowledge-guided rheumatoid arthritis assessment from multimodal ultrasound images via deep learning.

Multimodal ultrasound has demonstrated its power in the clinical assessment of rheumatoid arthritis (RA). However, for radiologists, it requires strong experience. In this paper, we propose a rheumatoid arthritis knowledge guided (RATING) system that automatically scores the RA activity and generates interpretable features to assist radiologists' decision-making based on deep learning. RATING leverages the complementary advantages of multimodal ultrasound images and solves the limited training data problem with self-supervised pretraining. RATING outperforms all of the existing methods, achieving an accuracy of 86.1% on a prospective test dataset and 85.0% on an external test dataset. A reader study demonstrates that the RATING system improves the average accuracy of 10 radiologists from 41.4% to 64.0%. As an assistive tool, not only can RATING indicate the possible lesions and enhance the diagnostic performance with multimodal ultrasound but it can also enlighten the road to human-machine collaboration in healthcare.

A case report of membranous occlusion of the subclavian vein: a rare cause of McCleery syndrome.

Patients presenting with periodic swelling of the upper extremity without thrombosis are diagnosed with McCleery syndrome. There have been sporadic cases reported over the past decades. Due to the rarity of this disease, no standard consensus on diagnosis and treatment of McCleery syndrome was established. Subclavius tendon and anterior scalene muscle compression were proposed as the primary cause of McCleery syndrome. Partial resecting muscle, tendon or ligament was recommended as therapies. We report one rare case of membranous occlusion of the subclavian vein (SCV) that leads to periodic swelling of upper extremity and diagnosis of McCleery syndrome was made. This 21-year-old man complained of swelling and pain in the right upper extremity after strenuous exercise lasting for 3 months. Physical examination, spinal X-ray and magnetic resonance imaging showed no signs related to classic venous thoracic outlet syndrome (VTOS). Duplex ultrasonography demonstrated membranous occlusion without thrombosis at the proximal end of the right SCV. The lesion was confirmed by venography. Treated by balloon dilation alone, the patient recovered uneventfully during 18 months of follow-up. Repeated duplex ultrasonography revealed patency of the SCV. To our best knowledge, our case provides the first reported membranous occlusion of the SCV. Excluding the presence of thrombosis in SCV, he was diagnosed with McCleery syndrome and was cured by balloon dilation alone. We can learn from this rare case that membranous occlusion of veins can be a rare cause of McCleery syndrome and is worthy of careful consideration and differentiation of VOTS.

Functional photoacoustic/ultrasound imaging for the assessment of breast intraductal lesions: preliminary clinical findings.

This study aimed to identify features of breast intraductal lesions in photoacoustic/ultrasound (PA/US) imaging and compare PA/US with color Doppler flow/ultrasound (CDFI/US) in the evaluation of breast intraductal lesions. In the nine patients with 10 breast intraductal lesions and 8 patients with 8 benign lesions, total vessel scores evaluated from PA/US are significantly greater than those from CDFI/US (p=0.005). PA internal vessel scores and oxygen saturation (SO2) score are significantly increased in breast intraductal lesions than in benign lesions (p=0.016, p=0.006). With a cutoff PA score (sum of PA internal vessel score and SO2 score) of 2.5, we obtained a sensitivity of 90% and a specificity of 87.5% in differentiation of two groups. PA/US upgraded 40% of breast intraductal lesions, and downgraded 50% of benign lesions from the Breast Imaging Reporting and Data System grading results based on CDFI/US. PA/US functional imaging has the potential in differentiating breast intraductal lesions.

Ultra-microangiography in evaluating the disease activity of rheumatoid arthritis and enhancing the efficacy of ultrasonography: A preliminary study.

OBJECTIVE: Ultra-microangiography (UMA) is a novel Doppler technique that has high sensitivity for low-velocity blood flows. In this study, a distinctive imaging feature, penetrating blood vessels on the surface of eroded bones within the inflamed joints, was observed on UMA. We aimed to investigate the feasibility of UMA in assessing disease activity and identify the clinical value of the UMA feature for evaluating rheumatoid arthritis (RA). METHODS AND MATERIALS: Power-Doppler ultrasound (PDUS) and UMA were performed on small joints of RA patients. The semiquantitative scores of PDUS and UMA of the joints were assessed and compared. The UMA imaging feature of penetrating vessels on the surface of eroded bones was evaluated, and the patients were divided into three groups based on imaging features. (Group 1: no inflammatory signs; Group 2: inflammatory US features but no UMA features; and Group 3: detected UMA features). The correlations between the groups and clinical parameters were assessed. RESULTS: A total of 52 patients with RA were recruited, with 364 joints (MCP, PIP, MTP and wrist) scanned. Synovial blood vessel signals were detected for 68 by PDUS and for 93 by UMA (display rate of blood vessel signals: 18.68 % VS 25.55 %). UMA presented better display capability of blood vessels within the inflamed regions than that of PDUS in overall. Significant differences were detected in clinical scores (P < 0.0001 for DAS28 [ESR], DAS28 [CRP], SDAI, CDAI, CRP P = 0.0303, SJC P = 0.0059, and TJC P = 0.0423) between Group 2 and 3. Significant correlations between the groups and clinical parameters were also observed (DAS28 [ESR] ρ=0.750; DAS28 [CRP] ρ=0.762; SDAI ρ=0.778; CDAI ρ=0.773; CRP ρ= 0.524; SJC ρ=0.742; TJC ρ=0.693, P < 0.0001), indicating that the UMA feature was related to high disease activity. CONCLUSIONS: UMA can help enhance the detection rate of micro-vascularization. The UMA feature of the penetrating vessels on the surface of eroded bones is likely to be associated with severe disease activity.