Bruno Fernandes Barros Brehme de Abreu, Gabriella Simões Scarmagnan, Márcio Luís Duarte, Mayara Oliveira da Silva, Wagner Iared
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引用次数: 0
Abstract
Background: Synovial tissue proliferation in the bare area of the joint is an early indicator of synovitis. Vascularization of the pannus helps differentiate between inactive and inflammatory processes, directly impacting therapeutic management. Synovitis can be diagnosed through clinical assessment, ultrasound, and magnetic resonance imaging (MRI); however, uncertainty remains regarding the optimal imaging modality.
Objective: This study aimed to determine the accuracy of ultrasonography with microbubble contrast and contrast-enhanced MRI in diagnosing synovitis, irrespective of its etiology. In addition, the study aimed to determine the joints that were most accurately assessed for synovitis using microbubble ultrasound.
Methods: Electronic searches were conducted in the Cochrane Library, MEDLINE, EMBASE, LILACS, SCOPUS, CINAHL, and Web of Science up to February 8, 2025, with additional screening of reference lists. Studies assessing diagnostic accuracy or detection rates of contrast-enhanced ultrasound (CEUS) and contrast-enhanced MRI for synovitis were included without restrictions on language or publication status. Two studies were selected after quality assessment using QUADAS-2, and eight studies were assessed using the RTI item bank methodology.
Results: Diagnostic accuracies of contrast-enhanced ultrasonography (87%) and contrast-enhanced MRI (87.7%) were comparable. For knee evaluation, CEUS showed a higher detection rate (93.8%) than MRI (82.9%). Across different joints and underlying diseases, the detection rates were 81.9% and 88.3% for contrast-enhanced MRI. In patients with rheumatoid arthritis, MRI demonstrated a higher detection rate (96.2%) compared with ultrasound (67.2%). These findings indicate a similar overall diagnostic performance, although the limited number of included studies restricted generalizability.
Conclusion: CEUS demonstrated diagnostic accuracy comparable to contrast-enhanced MRI, except in patients with rheumatoid arthritis. Given its low cost, portability, and favorable safety profile, CEUS may serve as a useful screening or follow-up tool for synovitis, pending validation in larger multicenter studies.
背景：关节裸露区滑膜组织增生是滑膜炎的早期指标。输卵管的血管化有助于区分非活动性和炎性过程，直接影响治疗管理。滑膜炎可通过临床评估、超声和磁共振成像（MRI）诊断；然而，关于最佳成像方式的不确定性仍然存在。目的：本研究旨在确定超声微泡造影剂和MRI增强造影剂诊断滑膜炎的准确性，而不考虑其病因。此外，本研究旨在确定使用微泡超声最准确评估滑膜炎的关节。方法：电子检索截至2025年2月8日的Cochrane Library、MEDLINE、EMBASE、LILACS、SCOPUS、CINAHL和Web of Science，并对参考文献列表进行额外筛选。评估对比增强超声（CEUS）和对比增强MRI对滑膜炎的诊断准确性或检出率的研究纳入，不受语言或发表状态的限制。在使用QUADAS-2进行质量评估后，选择了两项研究，使用RTI题库方法评估了八项研究。结果：超声造影（87%）与磁共振造影（87.7%）的诊断正确率相当。对于膝关节评估，超声造影的检出率（93.8%）高于MRI（82.9%）。在不同的关节和基础疾病中，对比增强MRI的检出率分别为81.9%和88.3%。在类风湿关节炎患者中，MRI的检出率（96.2%）高于超声（67.2%）。这些发现表明了类似的总体诊断性能，尽管纳入的研究数量有限，限制了普遍性。结论：除类风湿关节炎患者外，超声造影的诊断准确性与增强MRI相当。鉴于其低成本、便携性和良好的安全性，超声造影可能作为滑膜炎的有用筛查或随访工具，有待于更大规模的多中心研究的验证。
期刊介绍：
Published bimonthly by the Associação Paulista de Medicina, the journal accepts articles in the fields of clinical health science (internal medicine, gynecology and obstetrics, mental health, surgery, pediatrics and public health). Articles will be accepted in the form of original articles (clinical trials, cohort, case-control, prevalence, incidence, accuracy and cost-effectiveness studies and systematic reviews with or without meta-analysis), narrative reviews of the literature, case reports, short communications and letters to the editor. Papers with a commercial objective will not be accepted.
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