Detection of soft-tissue hyperemia: value of power Doppler sonography

Power Doppler sonography is a new technique that offers extended dynamic range over that provided by conventional color Doppler imaging, thereby facilitating measurement of tissue perfusion. We evaluated the efficacy of power Doppler sonography in depicting soft-tissue hyperemia in musculoskeletal inflammatory conditions.

Twenty-three patients with predominantly unifocal musculoskeletal symptoms were evaluated with conventional gray-scale imaging and power Doppler sonography. The shoulder was evaluated in 14 patients, the elbow in three, and various other sites in six. For comparison purposes, the contralateral asymptomatic joint or site was examined in 17 cases. Fluid collections were aspirated in seven patients.

Soft-tissue hyperemia was seen on power Doppler sonograms at the symptomatic site(s) in 22 of 23 cases studied, with an appearance ranging from frank tissue blush to large, isolated peritendinous/peribursal vessels. Findings associated with hyperemia included rotator cuff tendinitis and/or tear, bursitis, and symptomatic wrist ganglia. Findings on power Doppler sonograms were normal in one patient who had a small, sterile hip joint effusion, and findings on subsequent scintigrams, pelvic radiographs, and CT scans were normal.

Power Doppler sonography consistently shows hyperperfusion associated with musculoskeletal inflammatory disease. As such, it represents a useful adjunct to gray-scale sonography in these settings, particularly as findings on conventional sonograms in inflammatory conditions can be nonspecific.