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The value of contrast-enhanced ultrasound in synovial pathotypes of rheumatoid arthritis: an exploratory study
Ting Wang1,2,3,4, Zhen Wang1,2,3,4, Yakun Yu5
1Ultrasound Medical Center, The Second Hospital of Lanzhou University, Cuiyingmen No.82, Chengguan District, Lanzhou, China.
Objective:
To analyze the differences in contrast-enhanced ultrasound (CEUS) patterns among synovial pathotypes in rheumatoid arthritis (RA), aiming to provide a non-invasive basis for differentiating RA subtypes.
Materials And Methods:
A total of 151 patients with RA (involving 151 joints) were included and underwent gray-scale ultrasound, Power Doppler ultrasound (PDUS), CEUS, and ultrasound-guided synovial biopsy sequentially. The synovial tissues were classified into three pathological types by immunohistochemistry, including lympho-myeloid, diffuse-myeloid, and pauci-immune. This study analyzed the differences in ultrasound features among different synovial pathotypes and proposed five distinct synovial vascular enhancement patterns. Variables with correlations > 0.3 were selected to construct three classification models, namely Model 1 (Clinical variables), Model 2 (Clinical-PDUS), and Model 3 (Clinical-PDUS-CEUS).
Results:
CEUS synovial vascular enhancement patterns: the pauci-immune predominantly exhibited pattern II (35.7%), the diffuse-myeloid predominantly exhibited pattern IV (42.5%), and the lympho-myeloid predominantly exhibited pattern V (72.0%). Qualitative parameters (enhancement pattern, degree, and range) and quantitative parameters (peak intensity [PI], maximum gradient [MGrad], and wash-out area under the curve [WoAUC]) of CEUS were significantly associated with pathological types (r = 0.426-0.602, all p < 0.001). In differentiating pathological subtypes, Model 3 achieved an AUC of 0.902, which was significantly higher than Model 1 (AUC = 0.728) and Model 2 (AUC = 0.751). However, the diagnostic efficacy for the diffuse-myeloid still needs optimization (AUC = 0.818).
Conclusions:
CEUS features of synovium can help differentiate RA synovial pathotypes and may provide important guidance for the early diagnosis and treatment selection of RA.
Key Points:
Question Are there differences between RA synovial pathotype and their corresponding contrast-enhanced (CEUS) findings? Findings Five patterns of synovial vascular enhancement corresponding to pathology types were identified, and a model was constructed. Clinical relevance CEUS synovial qualitative analysis and quantitative parameters can help differentiate RA synovial pathotypes.
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