Comparative Study To Evaluate The Neovascular In Synovium Of Rheumatoid Arthritis By Using SMI And CEUS

Objective:To compare the two methods of detecting synovial neovascularization in patients with RA,the synovial neovascularization of rheumatoid arthritis(RA)patients was semi-quantitatively graded by using superb microvascular imaging(SMI)and contrast enhanced ultrasound(CEUS),in addition to explore the value of SMI in evaluating synovial neovascularization in RA patients.Methods:A total of 96 RA patients were selected from July 2016 to December2017 in our hospital.There were 23 males and 73 females,aged 19-69 years,with an average age of(51.55±11.91)years.The duration of the disease was 1years to 20 years,with an average of(10.42±5.96)years.All the patients signed the informed consent.Bilateral shoulder,elbow,wrist,metacarpophalangeal,interphalangeal,knee,ankle and metatarsophalangeal joints were explored for each patient.Choose the most serious lesion site,measure the thickest synovium,and then observe the blood flow in synovial membrane with power Doppler ultrasonography(PDUS)at this section.Then use SMI to detect the enhancement in the synovial membrane.At last,CEUS was used to detect the thickest enhancement of the synovium.Three imaging techniques were observed and recorded to display the enhancement in the synovial membrane.According to the grading standard,the statistical data were classified.Compare the relationship between SMI and CEUS and PDUS,and analyze the correlation between the results of SMI classification and the laboratory examination indexes.Using SPSS21.0 statistical software,we applied Spearman rank correlation test to SMI and CEUS enhancement grading results,SMI enhancement grading results and laboratory examination indicators(ESR,CRP,RF,ACCP),The rank correlation coefficient r_s value indicates the relevance of the data.Using Kappa test for two-way orderly counting data of SMI and CEUS enhanced grading results.Results:1.The blood flow detectable rate of SMI was 90.6%,PDUS blood flow detectable rate was 78.1%.This two imaging methods showed the comparison of the blood flow signals in the synovium,and the difference was statistically significant(?~2=35.468,P<0.05);The difference between PDUS and SMI in the classification of blood flow signals in the synovium was statistically significant(?~2=109.903,P<0.05).2.There was no significant difference in the classification of blood flow signals in the synovial membrane between SMI and CEUS(?~2=2.200,P>0.05),and have high consistency(Kappa=0.832>0.75).3.Spearman rank correlation analysis was applied to SMI blood flow classification and laboratory parameters(RF,CRP,Anti-CCP,ESR).There was a positive correlation between the SMI blood flow classification and the laboratory examination index(RF,CRP,Anti-CCP,ESR).Conclusion:SMI can sensitively display blood flow signals in the synovial membrane,and increase the detection rate of microvessels in synovial membrane,which is in good agreement with CEUS technology.In addition,there is a good correlation between SMI and laboratory test indicators.It is of high value in the early diagnosis of RA,the evaluation and monitoring of the disease and so on.It can also provide reference for the formulation of clinical treatment plan.