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Vascular perfusion kinetics by contrast-enhanced ultrasound are related to synovial microvascularity in the joints of psoriatic arthritis

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Abstract

The purpose of the study was to assess the relationship of the continuous mode contrast-enhanced harmonic ultrasound (CEUS) imaging with the histopathological and immunohistochemical (IHC) quantitative estimation of microvascular proliferation on synovial samples of patients affected by sustained psoriatic arthritis (PsA). A dedicated linear transducer was used in conjunction with a specific continuous mode contrast enhanced harmonic imaging technology with a second-generation sulfur hexafluoride-filled microbubbles C-agent. The examination was carried out within 1 week before arthroscopic biopsies in 32 active joints. Perfusional parameters were analyzed including regional blood flow (RBF); peak (PEAK) of the C-signal intensity, proportional to the regional blood volume (RBV); beta (β) perfusion frequency; slope (S), representing the inclination of the tangent in the origin; and the refilling time (RT), the reverse of beta. Arthroscopic synovial biopsies were targeted in the hypervascularity areas, as in the same knee recesses assessed by CEUS; the synovial cell infiltrate and vascularity (vessel density) was evaluated by IHC staining of CD45 (mononuclear cell) and CD31, CD105 (endothelial cell) markers, measured by computer-assisted morphometric analysis. In the CEUS area examined, the corresponding time-intensity curves demonstrated a slow rise time. Synovial histology showed slight increased layer lining thickness, perivascular lymphomonocyte cell infiltration, and microvascular remodeling, with marked vessel wall thickening with reduction of the vascular lumen. A significant correlation was found between RT and CD31+ as PEAK and CD105+ vessel density; RT was inversely correlated to RBF, PEAK, S, and β. The study demonstrated the association of the CEUS perfusion kinetics with the histopathological quantitative and morphologic estimation of synovial microvascular proliferation, suggesting that a CEUS imaging represents a reliable tool for the estimate of the synovial hypervascularity in PsA.

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Authors and Affiliations

  1. Rheumatology Unit, Department of Medicine DIMED, University of Padova, Via Giustiniani, 2, 35128, Padova, Italy

    Ugo Fiocco, Francesco Caso, Luisa Costa, Francesca Oliviero, Anna Scanu, Daniele Boso, Maristella Vezzù, Luisella Cozzi, Leonardo Punzi & Andrea Doria

  2. Section of Radiology, Department of Medicine, University of Padova, Via Giustiniani, 2, 35128, Padova, Italy

    Roberto Stramare, Alessandro Coran, Elena Scagliori, Valeria Beltrame & Leopoldo Rubaltelli

  3. Department of Information Engineering, University of Padova, Via Giustiniani, 2, 35128, Padova, Italy

    Enrico Grisan

  4. Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II, via S. Pansini 5, 80131, Naples, Italy

    Luisa Costa & Raffaele Scarpa

  5. Surgical Pathology, University of Padova, Via Giustiniani, 2, 35128, Padova, Italy

    Francesca Lunardi & Fiorella Calabrese

  6. Respiratory Pathophysiology Division, University of Padova, Via Giustiniani, 2, 35128, Padova, Italy

    Fulvia Chieco Bianchi

  7. Haematology and Clinical Immunology Branch, University of Padova, Via Giustiniani, 2, 35128, Padua, Italy

    Veronica Martini

  8. Department of Clinical and Experimental Medicine, Clinica Medica 5, University of Padova, Via Giustiniani, 2, 35128, Padua, Italy

    David Sacerdoti

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  1. Ugo Fiocco
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  2. Roberto Stramare
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  3. Alessandro Coran
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Correspondence to Ugo Fiocco.

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Fiocco, U., Stramare, R., Coran, A. et al. Vascular perfusion kinetics by contrast-enhanced ultrasound are related to synovial microvascularity in the joints of psoriatic arthritis. Clin Rheumatol 34, 1903–1912 (2015). https://doi.org/10.1007/s10067-015-2894-1

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