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Complex appearance of vascularization in the wrist and finger joints in rheumatoid arthritis patients
European Journal of Radiology 81 (2012) 1967
Contents lists available at ScienceDirect
European Journal of Radiology journal homepage: www.elsevier.com/locate/ejrad
Letter to the Editor Complex appearance of vascularization in the wrist and finger joints in rheumatoid arthritis patients Dear Editor, We read with great interest the recent article by Dr.Carotti and colleagues regarding the detection of abnormal vascularization in inflammatory joints of rheumatoid arthritis (RA) patients which appeared in the 2010 issue of European Journal of Radiology [1]. We think that the study provides an interesting issue. The study claimed that “the RI value is useful to differentiate the flow pattern between healthy subjects and RA patients and offers a precise measurement of the intensity of synovial vascularization”. We do, however, be very doubtful about the results. The author evaluated 430 joints in the RA patients, and intraarticular vascularization was revealed in 218 joints (127 of the 155 active joints; 91 of the 275 inactive joints). Also, the calculated resistive index (RI) was obtained in 219 (please note the number of cases is inconsistent, and they should be 218) of the 430 pooled joints of the RA patients. Of course, we agree with the more frequent evidence of flow signals in the joints of RA patients. In clinical practical work, however, in the colour flow signals, not all of them can obtain the calculated RI, because besides arterial flow signals, most of the color flow signals are venous flow. On the other hand, even in arterial flow signals, the RI cannot be obtained if the flow signal shows reversed phase in diastolic phase on Spectral Doppler. In such a case, the pulsatility index (PI) can only be calculated. We are really confused by the research results that the calculated RI could be obtained in all the flow signals. In fact, the RI in Fig. 2 was wrong. Because end-diastolic velocity was zero (please note that 0.386 cm/s as end-diastolic velocity is not true), the RI must be 1 in Fig. 2. Another raised question regards the limitation of the results is that we cannot understand how the authors obtain the calcu-
0720-048X/$ – see front matter © 2010 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ejrad.2010.08.032
lated RI in healthy subjects. There is an inconsistency about the results. The author claimed that none of the healthy subjects had a detectable blood flow by CDUS in the pooled joints. But they also claimed healthy subjects had a quantifiable blood flow in 45 of the 430 joints and mean RI for healthy volunteers was 0.86. We are very confused about the results that the author mentioned. The method of calculation of RI was given a special emphasis, again. If there are no end-diastolic velocities like Fig. 2, or the flow signal shows reversed phase in diastolic phase on Spectral Doppler, the RI cannot be obtained. Conflict of interest We and our institutions have no conflicts of interest. Reference [1] Carotti M, Salaffi F, Morbiducci J, et al. Colour Doppler ultrasonography evaluation of vascularization in the wrist and finger joints in rheumatoid arthritis patients and healthy subjects. Eur J Radiol 2012;81(8):1834–8.
Jiaan Zhu ∗ Jing Fang Department of Ultrasound, Shanghai Jiaotong University Affiliated Sixth People’s Hospital, Shanghai Institute of Ultrasound in Medicine, 600 Yishan Rd, Shanghai 200233, China ∗ Corresponding
author. Tel.: +86 21 64369181 8751; fax: +86 21 54488254. E-mail addresses: [email protected], [email protected] (J. Zhu) 16 August 2010 25 August 2010
Contents lists available at ScienceDirect
European Journal of Radiology journal homepage: www.elsevier.com/locate/ejrad
Letter to the Editor Complex appearance of vascularization in the wrist and finger joints in rheumatoid arthritis patients Dear Editor, We read with great interest the recent article by Dr.Carotti and colleagues regarding the detection of abnormal vascularization in inflammatory joints of rheumatoid arthritis (RA) patients which appeared in the 2010 issue of European Journal of Radiology [1]. We think that the study provides an interesting issue. The study claimed that “the RI value is useful to differentiate the flow pattern between healthy subjects and RA patients and offers a precise measurement of the intensity of synovial vascularization”. We do, however, be very doubtful about the results. The author evaluated 430 joints in the RA patients, and intraarticular vascularization was revealed in 218 joints (127 of the 155 active joints; 91 of the 275 inactive joints). Also, the calculated resistive index (RI) was obtained in 219 (please note the number of cases is inconsistent, and they should be 218) of the 430 pooled joints of the RA patients. Of course, we agree with the more frequent evidence of flow signals in the joints of RA patients. In clinical practical work, however, in the colour flow signals, not all of them can obtain the calculated RI, because besides arterial flow signals, most of the color flow signals are venous flow. On the other hand, even in arterial flow signals, the RI cannot be obtained if the flow signal shows reversed phase in diastolic phase on Spectral Doppler. In such a case, the pulsatility index (PI) can only be calculated. We are really confused by the research results that the calculated RI could be obtained in all the flow signals. In fact, the RI in Fig. 2 was wrong. Because end-diastolic velocity was zero (please note that 0.386 cm/s as end-diastolic velocity is not true), the RI must be 1 in Fig. 2. Another raised question regards the limitation of the results is that we cannot understand how the authors obtain the calcu-
0720-048X/$ – see front matter © 2010 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ejrad.2010.08.032
lated RI in healthy subjects. There is an inconsistency about the results. The author claimed that none of the healthy subjects had a detectable blood flow by CDUS in the pooled joints. But they also claimed healthy subjects had a quantifiable blood flow in 45 of the 430 joints and mean RI for healthy volunteers was 0.86. We are very confused about the results that the author mentioned. The method of calculation of RI was given a special emphasis, again. If there are no end-diastolic velocities like Fig. 2, or the flow signal shows reversed phase in diastolic phase on Spectral Doppler, the RI cannot be obtained. Conflict of interest We and our institutions have no conflicts of interest. Reference [1] Carotti M, Salaffi F, Morbiducci J, et al. Colour Doppler ultrasonography evaluation of vascularization in the wrist and finger joints in rheumatoid arthritis patients and healthy subjects. Eur J Radiol 2012;81(8):1834–8.
Jiaan Zhu ∗ Jing Fang Department of Ultrasound, Shanghai Jiaotong University Affiliated Sixth People’s Hospital, Shanghai Institute of Ultrasound in Medicine, 600 Yishan Rd, Shanghai 200233, China ∗ Corresponding
author. Tel.: +86 21 64369181 8751; fax: +86 21 54488254. E-mail addresses: [email protected], [email protected] (J. Zhu) 16 August 2010 25 August 2010