Can spectral doppler high specificity and gray scale nail assessment suggest inflammation in psoriatic arthritis patients and control groups?

Introduction: The use of high resolution ultrasonography (US) has become a very important tool in nail assessment. This study evaluated nails clinical and ultrasound measurements in psoriatic arthritis (PsA) patients. Methods: A cross sectional study was performed with a total of 60 patients, PSA patients, 10 healthy individuals and 6 hand osteoarthritis patients (OA). Only PsA patients meeting the CASPAR criteria were included in the study. Results: Spectral Doppler (sD) was used to analyze 208 nail beds. Nail plates on the gray scale (GS) showed loss of the normal three-layered pattern in 89 nails (45.9%). Power Doppler (PD) signal was detected in 189 nail beds (92.2%), showing inflammatory activity in most of the patients and nails assessed. Resistance index (RI) was significantly lower in PsA patients as compared to control groups in both the longitudinal and transverse planes (p<0.001).Nail enthesitis was observed when RI values were below 0.4, characterizing 100% sensitivity and 96% specificity (p<0.01). Conclusions: Nail US scanning presented statistical significance in PsA patients. Future studies could show many inflammatory situations, requiring treatment assessment.

Liquefied Thrombus Mimicking an Endoleak on Duplex Ultrasound

Conventional duplex ultrasound is a well-established imaging modality for the surveillance of endovascular aortic repair. A unique case of liquefied thrombus mimicking an endoleak on color and spectral Doppler ultrasound is presented. Contrast computed tomography and contrast-enhanced ultrasound were used to further assess the patient and exclude an endoleak.

Spectral Doppler Tracing of Locomotor Brachii sign in Severe Aortic Insufficiency

A 37-year-old gentleman with no significant past medical history presented to the emergency department with a two-week history of progressively worsening shortness of breath. Vital signs were stable on arrival and initial physical exam was remarkable for a high pitched early diastolic decrescendo murmur at the left lower sternal border. Further physical examination revealed bounding carotid pulses (consistent with Corrigan’s sign), and a systolic contraction and diastolic dilation of pupil (consistent with Landolfi’s sign). Brachial artery was noted to be tortuous and prominently pulsatile with a bruit audible on auscultation, consistent with locomotor brachii (panel A). Upon further evaluation using point of care ultrasound, diastolic flow reversal and double bruit (both systolic and diastolic) on compression, were noted on spectral Doppler tracing (panel B). Transthoracic echocardiography showed bicuspid aortic valve with flail leaflet and severe eccentric aortic insufficiency; thereby confirming the diagnosis of aortic regurgitation. The patient eventually underwent a surgical aortic valve replacement with mechanical valve.

Study of Ventricular Interdependence in Hemodialysis Patients

Background and objectivesStudy of respiratory variations in mitral valve (MV) Doppler flow in hemodialysis (HD) patients has not been investigated and normal adult referenced echocardiographic value is used as an echocardiographic reference to HD patients who have unique hemodynamic. This work aimed to study the respiratory variation in MV Doppler flow in HD patients to determine if it has a unique pattern in these patients, and to study any relation between this variation and volume-related parameters.MethodsWe conducted a prospective cohort study, carried out on 118 patients who underwent regular HD. A standard echocardiography was performed on the patients before and within 6 hs after dialysis. During quiet breathing, the transmitral spectral Doppler E wave was measured during inspiratory and expiratory phases using plethysmography breath-cycle chest-adhesive electrodes. The mathematic differences and the percent changes (ventricular interdependent; VI) in E wave were calculated pre-and post-dialysis. Post dialysis difference in the percent changes (∆ E wave % changes) was calculated as follows: pre-dialysis percent changes of E wave – post dialysis percent changes of E wave/pre dialysis percent changes E wave x 100. ResultsThe means of the mathematic differences between the MV inspiratory and expiratory E pre-and post-dialysis were 0.07 ± 0.18 m/s and 0.08 ± 0.22 m/s respectively with an insignificant difference between both phases; p = 0.337. Meanwhile, the means of the percent variation in the MV inspiratory and expiratory E pre-and post-dialysis were 56 ± 7 % and 44 ± 1.1 % respectively, with a significant reduction after dialysis; P = 0.000. Spearman correlation showed a significant positive correlation between post- dialysis ∆ E wave % change and post-dialysis % change of weight (r = 0.318; P = 0.000). Moreover, post- dialysis % change of weight and post- dialysis % changes of most other volume-related variable were independent predictors of post- dialysis ∆ E wave % in HD patients. ConclusionThe pre- and post- dialysis respiratory changes in the MV E wave in HD patients were higher than the normal adult referenced values. This marked variation could be explained by the unique overloading condition and could explain the LV diastolic dysfunction and the unexplained pulmonary hypertension in HD patients.

B-mode and Doppler Ultrasonography of Accessory Genital Glands and Testes in Male Goats During the Breeding Season

The aims of the present study were to scan the echogenicity of reproductive organs of bucks during the breeding season. The influence of testosterone on haemodynamic Doppler indices of accessory genital glands of breeding bucks was also examined. Ten clinically healthy, sexually mature, Egyptian Baladi male goats were examined and the testes, tail of epididymis and accessory sex glands imaged using greyscale B-mode, colour Doppler ultrasonography. The spectral Doppler indices (pulsatility index and resistive index) were measured. Blood samples were collected and serum concentrations of testosterone, FSH and LH were determined. The results revealed that the echogenicity of testes, tail of epididymis and accessory genital glands was changed by breeding season. Pulsatility index values of supra-testicular artery, marginal artery, tail of the epididymis, ampulla, vesicular gland, pars disseminata of the prostate and bulbourethral gland were 0.85±0.04, 0.54±0.03, 0.4±0.03, 0.37±0.04, 0.51±0.03, 0.39±0.02 and 0.41±0.04, respectively. The resistive index of the above criteria were 0.51±0.04, 0.37±0.02, 0.3±0.03, 0.27±0.02, 0.31±0.03, 0.32±0.03 and 0.32±0.03, respectively. Serum testosterone concentration was 4.78±0.46 ng/mL. Furthermore, FSH and LH were 3.71±0.43 and 1.8±0.17 mIU/mL, respectively. Interestingly, testosterone clearly deceased the values of the both the pulsatility and resistive indices of the accessory genital glands of breeding bucks. Season modified the echogenicity of testes, epididymis and accessory genital glands. Testosterone regulated the reproductive indices of blood flow of the accessory genital glands of breeding bucks. Thus, this study could serve as a baseline of reference values of Egyptian Baladi male goats during the breeding season to improve reproductive efficiency.

Role of Transabdominal Ultrasound in Characterization of the Ovarian Mass

The use of grey-scale ultrasound morphology to characterize a pelvic mass may also be called ‘pattern recognition’. The grey-scale ultrasound image provides as much information as that obtained by the surgeon or pathologist when they cut a surgical specimen to see what it looks like inside. Aim of our study is to characterize the ovarian mass by ultrasound. The study was conducted in Department of Radiology and Imaging, College of Medical Sciences, Bharatpur. Patients with suspected ovarian mass in Gynecology OPD were included in our study. A prospective cross-sectional study was conducted on 60 patients in college of medical science, Bharatpur, over the period of one year (from November 2019 to October 2020). Present study showed benign ovarian (90.0%) pathology are the most commonly encountered ovarian mass. Ovarian mass is most common in adult female of age 15-30 years and malignant ovarian mass was most common among the age group of 30-60 years. Among benign pathology of ovary simple follicular cysts are most common (39.0%), followed by hemorrhagic cyst (31.0%), dermoid cyst (17.0%), chocolate cyst (9.0%) and ectopic pregnancy (4.0%). Among the malignant ovarian mass serous cystadenocarcinoma and mucinous cystadenocarcinoma showed similar frequency (33.0% each) and followed by immature teratoma and krukenberg tumor (17.0% each). Ultrasound parameters like size, septal thickness, solid component and spectral doppler (RI ans PI) are very helpful for determination of malignant pathology. In this study the sensitivity and specificity of size parameter is least (40.3% and 60.2%) and highest in solid component and spectral Doppler parameter (PI) being (82.0% and 92.0%). Combined study of grey scaleand spectral Doppler study plays crucial role in characterization of ovarian mass to differentiate between benign and malignant pathology.

POS0963 POWER AND SPECTRAL DOPPLER ULTRASOUND AS A SCREENING TOOL IN THE DIAGNOSTIC COURSE OF SUSPECTED AXIAL SPONDYLOARTHRITIS: PRELIMINARY DATA FROM A LARGE MONOCENTRIC COHORT

Background:Sacroiliac joints (SIJs) involvement is a characteristic feature of Spondylarthritis (SpA). Magnetic resonance imaging (MRI) has been included in the new Assessment of SpA International Society (ASAS) criteria for the classification of non-radiographic axial SpA. Power Doppler ultrasound (PDUS) and spectral Doppler US have been used in few works, also from our group, to evaluate the inflammatory activity of the SIJs, in comparison with MRI, with different results.Objectives:We aimed to evaluate the value of PDUS with spectral wave analysis (SWA) in the assessment of suspected active sacroiliitis (SI). PDUS of SIJs was used as a screening tool alongside the routine PDUS assessment of peripheral joints.Methods:143 patients (114 females and 29 males, mean age 46,2 years, mean BMI 25.9) with new onset of inflammatory back pain (IBP), were included. Peripheral symptoms were allowed. Every patient underwent a PDUS examination of SIJs as previously reported. The sonographer was blinded to the clinical data. An Esaote Twice US machine, with convex 1-8 MHz and linear 6-18 MHz probes, was used, with standardized parameters. PD signals detected in the SIJs, were scored with a 3-points scale: 0= absence of signals, 1= isolate vessels, 2= more than one vessel. The signals were also classified as intra-articular (vascularity from deep joint and inter-osseous ligament) or peri-articular (vascularity along posterior sacroiliac ligament). SWA was applied to the same vessels calculating the Resistive Index (RI) (Figure 1). A PDUS diagnosis of active SI was made with a grade 1 of vascularity and RI<0,60, or grade 2 of vascularity and RI<0,70. PDUS multi-site examination of peripheral joints and entheses was also performed; entheseal involvement was scored with Belgrade Ultrasound Enthesitis Score (BUSES) and as global enthesitic charge (GEC). Every patient underwent MRI of SIJs within 2 weeks, and before to start pharmacologic treatment. The non-parametric Spearman rank test and univariate linear regression analysis was applied using InStat GraphPad statistical package.Results:A time of 5-8 minutes was sufficient to set and to complete PDUS/SWA examination on both SJJs. All patients considered this examination quick, not painful and substantially comfortable. PD signals were detected in 124 patients (mean RI 0,56). Bone marrow edema (BME) lesions (active SI on MRI) were detected in 94 patients. A final diagnosis of SpA was made in 103 patients (81 females, 22 males). Among SpA patients 24 had psoriasis, 3 inflammatory bowel disease, 3 uveitis, 5 were B27+, and they had mean BUSES of 4,1 and GEC of 1,2. The mean SIJs PDUS score was 1,3 in SpA and 0,52 in not-SpA patients. The mean SIJs RI was 0,53 in SpA and 0,68 in not-SpA patients. A significant correlation was demonstrated between MRI and PDUS diagnosis of SI (r=0,6486, p<0,0001), between MRI diagnosis and PD grading (r=0,4937, p<0,0001). The split analysis of peculiar parameters of imaging between the two methods also showed significant correlation: periarticular vascularity showed correlation with post-contrast MRI evidence of posterior capsulitis and enthesitis (p=0,001), as SIJs BME correlated with intra-articular PD signals (p<0,001). RI from SWA analysis was inversely correlated with MRI diagnosis of active SI (p<0.0001). SIJs PD demonstrated a significant correlation with SIJs pain (p<0,001), but not with inflammatory reactants, GEC, peripheral synovitis, and a weak correlation with BUSES (p=0,038).Conclusion:SIJs PDUS/SWA may be an optional method for preliminary screening of active SI, as a feasible, cheap and an accurate diagnostic tool, compared with MRI as a gold standard for nr-Axial SpA. PD US in SI. Right SI joint with a PD signal within inter-osseous ligament (curved arrow), where spectral PD analysis shows a RI of 0,62. Normal vessels (with high RI, unshowed) can be observed into the first sacral foramen (arrowhead). The first sacral apophysis (arrow) protrudes from the sacrum profile.Disclosure of Interests:None declared.