Contrast-enhanced ultrasonography is more sensitive than grayscale and power Doppler ultrasonography compared to MRI in therapy monitoring of rheumatoid arthritis patients

Ultraschall Med. 2011 Dec;32 Suppl 2:E38-44. doi: 10.1055/s-0031-1281770. Epub 2011 Nov 3.


Purpose: To evaluate wrist and finger joints in patients with rheumatoid arthritis (RA) by grayscale, power Doppler (PD) and contrast-enhanced musculoskeletal ultrasonography (US) and to compare these findings with MRI, clinical (DAS28) and laboratory (ESR; CRP) data.

Materials and methods: US was performed at baseline (t0) and after three, six and twelve (t12) months before and after a change of medical treatment. MRI was carried out at t0 and t12 and used as the reference method. Contrast-enhanced US was used to assess one clinically most affected joint region. Different semiquantitative synovitis scores were calculated by grayscale and PD US.

Results: Contrast-enhanced US results evaluated by enhancement, slope and semi-quantitative assessment significantly correlated to each other, to grayscale US, CRP, as well as to MRI with the highest correlation coefficients for the used contrast-enhanced US modes (r = 0.56, r = 0.55, r = 0.57; each p < 0.05). Sum scores evaluated by grayscale US showed that synovial inflammation in finger joints was detected significantly more frequently in the palmar aspect than on the dorsal side (p = 0.001). Using power Doppler US, the wrists were significantly more inflamed from dorsal than on the palmar side (p = 0.0004). Significant longitudinal correlations between grayscale and power Doppler US scores were detected.

Conclusion: Grayscale, power Doppler and contrast-enhanced US are accurate tools for the detection and follow-up of synovitis in RA wrist and finger joints, with contrast-enhanced US being most sensitive compared to MRI. All imaging methods reflected a good response to TNFα blocking therapy.

Publication types

  • Comparative Study

MeSH terms

  • Adalimumab
  • Adult
  • Aged
  • Antibodies, Monoclonal, Humanized / therapeutic use*
  • Antirheumatic Agents / therapeutic use*
  • Arthritis, Rheumatoid / diagnostic imaging*
  • Arthritis, Rheumatoid / drug therapy*
  • Contrast Media / administration & dosage*
  • Drug Therapy, Combination
  • Female
  • Finger Joint / diagnostic imaging
  • Finger Joint / drug effects
  • Follow-Up Studies
  • Humans
  • Image Enhancement / methods*
  • Image Interpretation, Computer-Assisted / methods*
  • Magnetic Resonance Imaging*
  • Male
  • Middle Aged
  • Sensitivity and Specificity
  • Statistics as Topic
  • Synovitis / diagnostic imaging
  • Synovitis / drug therapy
  • Ultrasonography, Doppler / methods*
  • Wrist Joint / diagnostic imaging
  • Wrist Joint / drug effects


  • Antibodies, Monoclonal, Humanized
  • Antirheumatic Agents
  • Contrast Media
  • Adalimumab