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Annals of the Rheumatic Diseases logoLink to Annals of the Rheumatic Diseases
. 2005 Jun;64(6):824–827. doi: 10.1136/ard.2004.028548

Doppler ultrasound findings in healthy wrists and finger joints before and after use of two different contrast agents

L Terslev 1, S Torp-Pedersen 1, N Bang 1, M Koenig 1, M Nielsen 1, H Bliddal 1
PMCID: PMC1755519  PMID: 15897304

Abstract

Objective: To examine the effect of contrast agents on Doppler ultrasound findings in the synovial membrane in the wrist and fingers of healthy volunteers.

Material and methods: Eleven healthy subjects were included in the study (5 women and 6 men, mean age 38 years, range (20–60)). They had no clinical signs of inflammatory or degenerative joint diseases. A total of 66 joints were examined—6 joints for each subject: wrist and metacarpophalangeal (MCP) joints 1–5—before contrast injection and after Levovist and SonoVue injection with a 30 minute interval.

Results: Colour Doppler activity was detected in 10/55 (18%) MCP joints before contrast injection and in 29/55 (53%) and 28/55 (51%) joints after Levovist (p<0.0001) and SonoVue injection (p = 0.0001), respectively. A significant increase in Doppler activity in the radial (p<0.05) and ulnar (p = 0.01) parts of the wrist joint was detected only after SonoVue injections. With spectral Doppler no difference was found in the resistive index (RI) in the vessels measured before as compared with those only detected after contrast injection.

Conclusion: The number of joints with colour Doppler activity in healthy volunteers was increased by the use of contrast agents. No changes in RI were detected. The value of contrast agents remains to be demonstrated in inflammatory diagnostics.

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Figure 1.

Figure 1

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 Colour Doppler in the wrist before and after SonoVue injection. The images are longitudinal through the extensor digitorum longus tendon (EDL). The surface of the radius (R) and carpal bones (C) are seen as bright reflectors. The synovium of the radiocarpal joint(s) is seen as a anechoic/hypoechoic mass with extensions that are synovial duplications. (A) Before contrast injection. A single Doppler focus is visible inside the synovium. (B) After contrast injection. A larger Doppler focus is visible.

Figure 2.

Figure 2

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 Hypothetical model for the interaction between Doppler ultrasound and amount of synovial flow. (A) The synovial vessels are ranked on the x axis with increasing ability to be detected by Doppler to the right. An overlap between vessels of the normal synovium and inflamed synovium is expected. Thresholds for detection of flow for low, medium, and high sensitivity Doppler are shown with dashed lines. In this model only high sensitivity Doppler will detect flow in a normal synovium and then will detect only a few vessels. (B) After contrast injection, all vessels have an increased ability to be detected by Doppler. The bars have increased in height and some vessels have crossed the Doppler thresholds. According to the model no Doppler activity will be found in normal joints before or after contrast injection if a medium sensitivity Doppler is used. Also, if a contrast study on patients with rheumatoid arthritis does not include mildly inflamed joints, then contrast injection will not result in additional joints becoming Doppler positive.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

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