Detection of vascularity in wrist tenosynovitis: power doppler ultrasound compared with contrast-enhanced grey-scale ultrasound

Abstract

Introduction: We sought to assess vascularity in wrist tenosynovitis by using power Doppler ultrasound (PDUS) and to compare detection of intra- and peritendinous vascularity with that of contrast-enhanced grey-scale ultrasound (CEUS).

Methods: Twenty-six tendons of 24 patients (nine men, 15 women; mean age ± SD, 54.4 ± 11.8 years) with a clinical diagnosis of tenosynovitis were examined with B-mode ultrasonography, PDUS, and CEUS by using a second-generation contrast agent, SonoVue (Bracco Diagnostics, Milan, Italy) and a low-mechanical-index ultrasound technique. Thickness of synovitis, extent of vascularized pannus, intensity of peritendinous vascularisation, and detection of intratendinous vessels was incorporated in a 3-score grading system (grade 0 to 2). Interobserver variability was calculated.

Results: With CEUS, a significantly greater extent of vascularity could be detected than by using PDUS (P < 0.001). In terms of peri- and intratendinous vessels, CEUS was significantly more sensitive in the detection of vascularization compared with PDUS (P < 0.001). No significant correlation between synovial thickening and extent of vascularity could be found (P = 0.089 to 0.097). Interobserver reliability was calculated to be excellent when evaluating the grading score (κ = 0.811 to 1.00).

Conclusions: CEUS is a promising tool to detect tendon vascularity with higher sensitivity than PDUS by improved detection of intra- and peritendinous vascularity.

Figure 1

Transverse plane at the wrist through extensor carpi ulnaris tendon. (a) CEUS examination with hypoechoic peritendinous space before contrast medium washin. (b) Hyperechoic peritendinous space and intratendinous enhancement after contrast medium washin. (c) PDUS examination. Grade 2 in every scoring system. Arrows, border of tendon sheath; cross, synovial thickening; ECU, extensor carpi ulnaris tendon.

Figure 2

Transverse plane at the wrist through flexor carpi radialis tendon. (a) CEUS examination with hypoechoic peritendinous space before contrast medium washin. (b) Hyperechoic peritendinous space, tendon after contrast medium washin (grade 2). (c) With PDUS, intratendinous vessels are not displayed (grade 1). Arrows, Border of tendon sheath; cross, synovial thickening; star, radial artery; FCR, flexor carpi radialis tendon.