Contrast enhanced gray-scale sonography in assessment of joint vascularity in rheumatoid arthritis: results from the IACUS study group

Eur Radiol. 2005 Dec;15(12):2404-10. doi: 10.1007/s00330-005-2884-9. Epub 2005 Aug 16.


The purpose of this study way to assess the value of contrast enhanced gray-scale ultrasound (CEUS) in detection of vascularity in joints of patients with rheumatoid arthritis (RA) in a multicenter study of the International Arthritis Contrast Ultrasound (IACUS) study group. We assessed 113 joints in 113 patients (44 men, 69 women; mean age 51+/-14 years) with clinical diagnosis of RA. Gray-scale ultrasound (US), power Doppler US (PDUS) and CEUS, using a low mechanical index US technique, was performed. CEUS was done by bolus administration of the contrast agent SonoVue (Bracco, Milan, Italy) with a dosage of 4.8-ml SonoVue flushed with 10 ml saline. Detection of joint vascularity was performed for differentiation of active synovitis from inactive intra-articular thickening (synovitis/effusion). With the use of US and PDUS, active synovitis could be differentiated from inactive intra-articular thickening in 68/113 joints (60.1%), whereas CEUS enabled differentiation in 110/113 (97.3%) joints (p<0.0001). Thickness measurement of active synovitis was significantly improved after contrast administration (p=0.008). In conclusion, CEUS improves the differentiation of active synovitis from inactive intra-articular thickening. Since CEUS has shown an ability to improve assessment of vascularized synovial proliferation in RA affected joints, this technique may have further potential in monitoring therapy.

Publication types

  • Clinical Trial
  • Multicenter Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Arthritis, Rheumatoid / complications
  • Arthritis, Rheumatoid / diagnostic imaging*
  • Contrast Media
  • Diagnosis, Differential
  • Europe
  • Female
  • Humans
  • Image Enhancement / methods*
  • International Cooperation
  • Joints / blood supply*
  • Joints / diagnostic imaging*
  • Male
  • Middle Aged
  • Phospholipids*
  • Reproducibility of Results
  • Sensitivity and Specificity
  • Sulfur Hexafluoride*
  • Synovitis / complications
  • Synovitis / diagnostic imaging*
  • Ultrasonography
  • Vascular Diseases / complications
  • Vascular Diseases / diagnostic imaging*


  • Contrast Media
  • Phospholipids
  • contrast agent BR1
  • Sulfur Hexafluoride