Influence of temperature on sonographic images of the median nerve for the diagnosis of carpal tunnel syndrome: a case control study

Background In addition to nerve conduction studies (NCSs), ultrasonography has been widely used as an alternative tool for diagnosing carpal tunnel syndrome (CTS). Although the results of NCSs are influenced by local skin temperature, few studies have explored the effects of skin temperature on ultrasonography of the median nerve. Since swelling and intraneural blood flow of the median nerve might be influenced by local temperature changes, the aim of this study was to evaluate the cross-sectional area (CSA) and intraneural blood flow of the median nerve under three skin temperatures (30 °C, 32 °C, 34 °C). Methods Fifty patients with CTS and 50 healthy volunteers were consecutively recruited from a community hospital. Each participant received physical examinations and NCSs and underwent ultrasonography, including power Doppler, to evaluate intraneural vascularity. Results The CSA of the median nerve in the CTS patients was significantly larger than that in the healthy controls at all three temperatures. However, significant differences in the power Doppler signals of the median nerve between the two studied groups were observed only at 30 and 32 °C, not at 34 °C. Conclusion The significant difference in the intraneural vascularity of the median nerve between the patients with CTS and the healthy subjects was lost at higher temperatures (34 °C). Therefore, the results of power Doppler ultrasonography in diagnosing CTS should be cautiously interpreted in patients with a high skin temperature or those who reside in warm environments.

Ultrasonographic Tissue Perfusion in Peri-implant Health and Disease

Color flow ultrasonography has played a crucial role in medicine for its ability to assess dynamic tissue perfusion and blood flow variations as an indicator of a pathologic condition. While this feature of ultrasound is routinely employed in various medical fields, its intraoral application for the assessment of tissue perfusion at diseased versus healthy dental implants has never been explored. We tested the hypothesis that quantified tissue perfusion of power Doppler ultrasonography correlates with the clinically assessed inflammation of dental implants. Specifically, we designed a discordant-matched case-control study in which patients with nonadjacent dental implants with different clinical diagnoses (healthy, peri-implant mucositis, or peri-implantitis) were scanned and analyzed with real-time ultrasonography. Forty-two posterior implants in 21 patients were included. Ultrasound scans were obtained at the implant regions of midbuccal, mesial/distal (averaged as interproximal), and transverse to compute the velocity- and power-weighted color pixel density from color velocity (CV) and color power (CP), respectively. Linear mixed effect models were then used to assess the relationship between the clinical diagnoses and ultrasound CV and CP. Overall, the results strongly suggested that ultrasound’s quantified CV and CP directly correlate with the clinical diagnosis of dental implants at health, peri-implant mucositis, and peri-implantitis. This study showed for the first time that ultrasound color flow can be applicable in the diagnosis of peri-implant disease and can act as a valuable tool for evaluating the degree of clinical inflammation at implant sites.

Sonographic Advancements in Characterization of Benign and Malignant Ovarian Masses

Background: Characterization of ovarian masses is essentially required and inevitable for optimization of clinical decision making, patient care and management. The diagnosis of ovarian masses is a frequent dilemma in clinical work. Ultrasonography remains the modality of choice in the early investigation of suspected adnexal masses because of its availability and being a safe modality. Aim: To review the current literature on different patterns of manifestation of ovarian masses on ultrasound and its various modes, helping in differential diagnosis on the basis of morphologic, vascular and other characteristics as seen on ultrasound. Methods: Electronic database was searched (PubMed, Google Scholar, Science direct) with data ranging from year 2000 to 2021. Most relevant studies, relating to sonographic appearances of ovarian masses were selected. Results: Twenty five most relevant articles were found: 8 articles were regarding gray-scale ultrasound, 3 articles regarding three dimensional ultrasonography, 2 articles regarding contrast enhanced ultrasonography, 2 regarding elastography and rest were regarding combined use of gray-scale and Doppler ultrasound including color and power Doppler ultrasonography for the assessment of ovarian masses. Our results show that conventional 2D sonography, in conjunction with latest advancements helps improving the diagnosis based on typical sonographic appearances of masses. Screening for ovarian cancer also proves to be helpful for early diagnosis and improvement in survival rate. Conclusion: Ultrasonoraphy and its different modalities such as 3DUS, CEUS, elastography along with conventional 2D and Doppler studies accurately identifies morphologic, structural and vascular featuresof the adnexal masses and differential diagnosis by escapingunnecessary surgeries and improving the survival rate. Keywords: Ultrasonography, Ovarian masses, malignant ovarian masses, contrast enhanced ultrasound,

AB0450 PERIPHERAL MACROVASCULAR INVOLVEMENT IN SYSTEMIC SCLEROSIS AS COMPARED WITH HEALTHY CONTROLS: A SMALL COHORT STUDY BY COLOR AND SPECTRAL DOPPLER ULTRASONOGRAPHY

Background:Together with autoimmune-inflammation and fibrosis, microvasculopathy is a hallmark of SSc. However, also macrovascular changes may occur including peripheral proliferative vasculopathy. Whether this changes may represent a specific SSc marker with a predictive value remains a matter of debate.[1,2,3]Objectives:To study peripheral macrovascular involvement by color doppler ultrasound (CDUS) with spectral wave analysis (SWA) in a cohort of 40 SSc patients as compared to healthy controls. To further analyze any differences among the SSc population.Methods:Forty SSc patients and 36 healthy controls were examined by CDUS with SWA of both hands. Macrovascular involvement was assessed by measuring the resistivity index (RI) of distal ulnar and radial arteries. Examinations were performed with an Esaote MyLab Twice machine equipped with a linear 10-22 MHz probe. Ultrasound examination was carried out by two independent rheumatologists blinded to clinical conditions of the patients. Statistical analysis was performed by using MaxStat software.Results:The RI index resulted increased in the SSc cohort as compared with healthy controls (left ulnar RI 0.977 vs 0.715; right ulnar RI 0.996 vs 0.699; left radial RI 0.988 vs 0.706; right radial RI 0.999 vs 0.688; p<0.001). SSc patients with an increased RI in one artery were more probable to have an increased RI in the other vessels too (r 2 = 0.35; p<0.01). In addition, 8 out of 40 SSc patients presented left ulnar artery occlusion (UAO) and 7 out of 40 SSc patients presented right UAO, of which 6 presented bilateral UAO. Awaiting to enlarge the cohort for further analysis, descriptive data regarding increased RI at CDUS/SWA and clinical features, including years from onset of the disease, subtype of SSc, mRSS, history of digital ulcers, interstitial lung disease and PAH are described in Table 1.Conclusion:Peripheral macrovascular involvement was observed in SSc patients as compared with healthy controls. Further studies will determine whether this feature may have specificity for diagnosis/prognosis in SSc.References:[1]Lescoat A, Yelnik CM, Coiffier G et al. Ulnar Artery Occlusion and Severity Markers of Vasculopathy in Systemic Sclerosis: A Multicenter Cross-Sectional Study. Arthritis Rheumatol. 2019;71:983-990.[2]Lescoat A, Coiffier G, Rouil A et al. Vascular Evaluation of the Hand by Power Doppler Ultrasonography and New Predictive Markers of Ischemic Digital Ulcers in Systemic Sclerosis: Results of a Prospective Pilot Study. Arthritis Care Res (Hoboken). 2017;69:543-551.[3]Schioppo T, Orenti A, Boracchi P, De Lucia O, Murgo A, Ingegnoli F. Evidence of macro- and micro-angiopathy in scleroderma: An integrated approach combining 22-MHz power Doppler ultrasonography and video-capillaroscopy. Microvasc Res. 2019;122:125-130.Table 1.Main clinical features of the SSc cohort (n=40) studied by CDUS for macrovascular involvement.SSc cohort (n = 40)Years from onsetrange (35 y – 0 y)mean = 10.5 yAutoantibodiesACA 13/40Anti-TopoI 14/40Other 13/40mRSSrange (0 -30)mean = 3ILD17/40PAH7/40Capillaroscopy patternEarly 10/40Active 11/40Late 6/40History of digital ulcers16/40Left ulnar IR0.977Left radial IR0.988Right ulnar IR0.996Right radial IR0.999Disclosure of Interests:None declared.

P187 Secukinumab significantly decreased joint synovitis measured by Power Doppler ultrasonography in biologic-naive patients with active psoriatic arthritis: primary (12week) results from a randomised, placebo-controlled Phase 3 study

Background/Aims Power Doppler (PD) ultrasonography (PDUS) is a sensitive, non-invasive imaging technology used to assess joint synovitis and enthesitis in psoriatic arthritis (PsA). The European Alliance of Associations for Rheumatology (EULAR) and the Outcome Measures in Rheumatology (EULAR-OMERACT) developed a standardised ultrasonography composite scoring system that is sensitive to change (the global EULAR-OMERACT synovitis score [GLOESS]) to detect and score joint synovitis. We report primary (12-week) efficacy and safety data from ULTIMATE (NCT02662985), the first large, randomised, double-blind, placebo-controlled Phase 3 study to assess the time course of response to subcutaneous secukinumab on joint synovitis with PDUS in PsA. Methods This 52-week study has a 12-week double-blind treatment period followed by 12week open-label and 6-month open-label extensions. The study recruited biologic-naive patients with active PsA and inadequate response to conventional disease-modifying antirheumatic drug(s), with joint synovitis on PDUS (≥1 joint [of 48] with both total synovitis PDUS score and PD signal ≥2; or ≥ 2 joints with PDUS score ≥2 and PD signal ≥1) at screening and baseline and ≥1 clinical enthesitis site at baseline. Patients received secukinumab (300 or 150 mg) or placebo weekly followed by 4-weekly dosing (from Week 4). The primary endpoint was the difference in mean change in GLOESS from baseline to Week 12 between secukinumab and placebo, determined by mixed-effects model repeated measures analysis. Safety analyses included all patients who received ≥1 dose of study treatment. Results Of 166 patients enrolled, 96% (160/166) completed 12 weeks of treatment (secukinumab: 99% [82/83]; placebo: 94% [78/83]). Baseline demographics, clinical and ultrasound characteristics were similar across treatment groups. The primary endpoint was met; adjusted mean change in GLOESS was significantly higher with secukinumab than placebo (-9.0 vs -5.8; P = 0.004) at Week 12 (Table 1), with statistical significance seen as early as Week 1. All key secondary endpoints were met. No new or unexpected safety signals were reported. P187 Table 1:Efficacy of secukinumab at Week 12EndpointsSecukinumab (300 mg + 150 mg)a (N = 83)Placebo (N = 83)Difference/OR (95% CI)P valuePrimaryPDUS GLOESS, LS mean change (SE)b,c-9.0 (0.9)-5.8 (0.9)Difference: -3.2d (-5.5; -0.8)0.004SecondaryACR20, % responders6834OR: 4.1e (2.1; 8.0)&lt;0.0001ACR50, % responders469OR: 8.9e (3.6; 22.0)&lt;0.0001SPARCC enthesitis index, LS mean change (SE)c-2.35 (0.28)-1.65 (0.28)Difference: -0.69d (-1.39; -0.002)0.02Data presented as non-responder imputation for binary variables and MMRM for continuous variables.Prespecified primary and secondary endpoints were analysed according to a statistical hierarchy. Endpoints are shown in the order of testing.aPatients with psoriasis &gt;10% of body surface area received 300 mg; remainder received 150 mg;bGLOESS using PDUS composite score of 24 paired joints; the range for the GLOESS is 0-144;cAdjusted means and mean change values are from MMRM including treatment, centre and analysis visit as factors, baseline score and weight as continuous covariates and treatment by analysis visit as an interaction term;dDifference in adjusted mean change;eOR. ACR, American College of Rheumatology; CI, confidence interval; EULAR-OMERACT, European League Against Rheumatism and the Outcome Measures in Rheumatology; GLOESS, global EULAR-OMERACT synovitis score; LS, least squares; MMRM, mixed-effects model repeated measures; N, total number of randomised patients; OR, odds ratio; PDUS, Power Doppler ultrasonography; SE, standard error; SPARCC, Spondyloarthritis Research Consortium of Canada Enthesitis Index. Conclusion Secukinumab demonstrated a rapid and significant decrease in synovitis over 12 weeks (per GLOESS), and superior efficacy on ACR20/50 responses and SPARCC enthesitis vs placebo at Week 12 in biologic-naive patients with PsA. The safety profile of secukinumab was consistent with previous reports. Disclosure M. D'Agostino: Honoraria; M-A.D has received speaker/consultancy fees from Sanofi, Novartis, BMS, Celgene, Roche, AbbVie, UCB and Eli Lilly. G. Schett: Honoraria; G.S. has received honoraria from AbbVie, BMS, Celgene, Janssen, Lilly, Novartis, Roche and UCB. A. López Rodríguez: Corporate appointments; A.L.R. is a clinical trial researcher, speaker and consultant for Roche, Eli Lilly, Novartis, BMS and Neovacs. L. Šenolt: Honoraria; L.S. has received speaker's honoraria from AbbVie, Amgen, BMS, Celgene, Eli Lilly, MSD, Novartis, Pfizer, Roche and UCB., L.S. has received expenses for attendance at advisory board meetings from AbbVie, BMS, Celgene, MSD, Novartis, Pfizer, Roche and UCB., L.S. has received honoraria for clinical trials from AbbVie, Amgen, BMS, Celgene, Novartis, Pfizer, Takeda and UCB. Grants/research support; L.S. has received research grants from AbbVie. J. Maldonado-Cocco: Consultancies; J.M-C. is a speaker/consultant for Pfizer, Merck Sharp & Dohme, Sanofi-Aventis, Novartis, BMS, Roche, Boehringer Ingelheim, Schering-Plough, Abbott, UCB, Eli Lilly and Gilead. Other; J.M-C. is a clinical researcher as PI in clinical trials for Pfizer, Merck Sharp & Dohme, Sanofi-Aventis, Novartis, BMS, Roche, Boehringer Ingelheim, Schering-Plough, Abbott, UCB, Eli Lilly and Gilead. R. Burgos-Vargas: None. E. Naredo: Honoraria; E.N. has received speaker fees from AbbVie, Roche, BMS, Pfizer, UCB, Lilly, Novartis, Janssen and Celgene GmbH, and honoraria for clinical trials from AbbVie, Novartis and BMS. Grants/research support; E.N. has received research grants from Lilly. P. Carron: Consultancies; P.C. is a speaker/consultant for Pfizer, Merck Sharp & Dohme, Novartis, BMS, AbbVie, UCB, Eli Lilly, Gilead and Celgene Corporation. Grants/research support; P.C. has received research grants from UCB, Merck Sharp & Dohme and Pfizer. M. Boers: Consultancies; M.B. is a consultant for BMS, Novartis, Pfizer, GSK and Mylan. A. Duggan: Other; A-M.D. is an employee of Novartis. P. Goyanka: Other; P.G. is an employee of Novartis. C. Gaillez: Shareholder/stock ownership; C.G. is a shareholder of NVS and BMS. Other; C.G. is an employee of Novartis.

Laterality of Ovulation and Presence of the Embryo Do Not Affect Uterine Horn Blood Flow During the First Month of Gestation in Llamas

We determined if laterality of ovulation and intrauterine embryo location differentially induces changes in the mesometrial/endometrial vascularization area (MEVA) between uterine horns, during and after embryo migration, elongation and implantation in llamas. Adult, non-pregnant and non-lactating llamas (n = 30) were subjected to daily B-mode ultrasound scanning of their ovaries. Llamas with a growing follicle ≥8 mm in diameter in the left (n = 15) or right (n = 15) ovary were assigned to a single mating with an adult fertile or vasectomized male. Power-doppler ultrasonography was used to determine the MEVA in a cross section of the middle segment of both uterine horns. MEVA was determined by off-line measurements using the ImageJ software. MEVA measurements were performed before mating (day 0) and on days 5, 10, 15, 20, 25, and 30 after mating in pregnant [llamas with left- (n = 6) or right-sided (n = 6) ovulations] and non-pregnant [llamas with left- (n = 6) or right-sided (n = 6) ovulations] females. Ovulation was confirmed by the disappearance of a follicle (≥8 mm) detected previously. Pregnancy was confirmed by the presence of the embryo proper. MEVA was analyzed by one-way ANOVA for repeated measures using the MIXED Procedure in SAS. If significant (P ≤ 0.05) main effects or interactions were detected, Tukey's post-hoc test for multiple comparisons was used. Ovulation rate did not differ (P = 0.4) between females mated to an intact or vasectomized male and between right- or left-sided ovulations. Three females mated to the intact and 3 to the vasectomized male did not ovulate and were excluded of the study. First observation of fluid inside the gestational sac and of embryo proper, were made exclusively in the left uterine horn, on day 15.8 ± 3.8 and 22 ± 2.7, and 16.7± 2.6 and 27.5 ± 2.8 for pregnant llamas ovulating in the right and left ovary, respectively. Although the MEVA of both uterine horns was affected by time (P &lt; 0.05), it was not affected by physiological status (pregnant vs. non-pregnant; P = 0.9) or laterality of ovulation (P = 0.4). Contrary to expectations, regardless of the laterality of ovulation, in pregnant llamas the left horn did not display a greater MEVA before or after embryo arrival, a trend that was observed during the first 30 days of gestation.