Ultrasensitive Doppler Ultrasound for Evaluation of Rheumatoid Arthritis

项目总结 类风湿关节炎(RA)是一种影响130万美国人的关节自身免疫性疾病，患有 在美国，估计每年的护理费用为416亿美元。类风湿关节炎的临床治疗需要定期评估 以指导治疗。RA的临床评分、放射学检查和增强MRI为 分别受到低灵敏度、辐射安全性和成本的限制。多普勒超声在临床上的应用 滑膜炎评估，但对微血管检测的敏感性较低(这可能导致漏诊)和 依赖于运算符。因此，迫切需要更先进的超声多普勒技术 安全、经济、准确的RA评估。 在这里，我们提出了一种新的3D高灵敏度超声微血管成像(HUMI)技术 准确、全面地评估滑膜炎，减少对操作员的依赖。高频(14-39 MHz)平面波成像与先进的处理算法相结合，检测出高密度的微血管 敏感度。通过一维线阵换能器在其垂直方向上的自动平移来实现三维成像 使用紧凑型步进电机进行定向。初步的活体研究表明，胡米比 最先进的商用多普勒，可以3D清晰地检测滑膜微血管。 目的1：研制和优化用于关节成像的Humi。我们将进一步开发和优化3D-Humi On 使用体模和患者研究的活体关节成像的几个换能器。采集参数，如 超声频率、脉冲重复频率(PRF)、多普勒包大小和步进电机运动 3D成像方案将得到优化，以最大限度地提高微血管成像的灵敏度和穿透性。 将使用包括局部奇异值分解和相干奇异值分解在内的先进信号处理算法来改进 微血管成像对比度和抑制噪声和伪影。 3.3目的2：患者研究。将使用AIM 1中优化的HUMI对40例RA患者进行成像，以研究其 滑膜炎疗效评价。手部关节将由两名超声医生用3D-Humi进行扫描，以研究其 再现性。相同的关节将使用多普勒和微血管成像模式在 GE Logiq E10用于基准测试。对比度增强的MRI将作为参考标准。普普通通 RA的临床评分将作为二次验证。各关节滑膜炎评分为0(正常)， MRI和超声图像1例(轻度)，2例(中度)，3例(重度)。组内相关系数(ICC) 将用于评估超声诊断员之间的重复性和每个超声之间的一致性 方法采用MRI检查。皮尔逊相关性也将被用来评估超声评分的关联性。 RA临床评分。将进行类似的分析来评估定量超声的相关性。 参数(如微血管总面积和血管密度)与MRI和临床评分的关系。

PROJECT SUMMARY Rheumatoid arthritis (RA) is an autoimmune disorder of the joint affecting 1.3 million Americans, with an estimated annual care cost of 41.6 billion in the USA. Clinical management of RA requires regular assessment of synovial inflammation to guide therapy. Clinical scores of RA, radiography, and contrast-enhanced MRI are limited by low sensitivity, radiation safety, and cost, respectively. Doppler ultrasound is used clinically for synovitis evaluation, but has low sensitivity for microvessel detection (which may lead to underdiagnosis) and is operator dependent. Therefore, more advanced ultrasound Doppler technologies are critically needed for safe, cost-effective, and accurate evaluation of RA. Here we propose a novel 3D High-sensitivity Ultrasound Microvessel Imaging (HUMI) technology for more accurate and comprehensive evaluation of synovitis with less operator dependency. High frequency (14-39 MHz) plane wave imaging is combined with advanced processing algorithms to detect microvessels with high sensitivity. 3D imaging is achieved by automatic translation of the 1D linear array transducer in its elevational direction using a compact step motor. Preliminary in vivo studies show that HUMI is much more sensitive than state-of-the-art commercial Doppler and can clearly detect synovial microvessels in 3D. Aim 1: Develop and optimize HUMI for joint imaging. We will further develop and optimize 3D-HUMI on several transducers for in vivo joint imaging using phantom and patient studies. Acquisition parameters such as ultrasound frequency, pulse repetition frequency (PRF), Doppler packet size, and step motor movement scheme for 3D imaging will be optimized to maximize microvessel imaging sensitivity and penetration. Advanced signal processing algorithms including local SVD and coherent SVD will be used to improves microvessel imaging contrast and suppress noise and artifacts. 3.3 Aim 2: Patient study. The HUMI optimized in Aim 1 will be used to image 40 RA patients to study its efficacy for synovitis evaluation. Hand joints will be scanned with 3D-HUMI by two sonographers to study its reproducibility. The same joints will be imaged using both Doppler and Micro Vascular Imaging mode on the GE Logiq E10 for benchmarking. Contrast-enhanced MRI will be used as the reference standard. Common clinical scores of RA will be used as secondary validations. Synovitis of each joint will be scored as 0 (normal), 1 (mild), 2 (moderate), and 3 (severe) for MRI and ultrasound images. Intraclass correlation coefficients (ICC) will be used to evaluate inter-sonographer reproducibility and the agreement between each of the ultrasound methods with MRI. Pearson correlation will also be performed to assess the association of ultrasound scores with RA clinical scores. Similar analyses will be performed to assess the association of quantitative ultrasound parameters (such as total area of microvessels and vessel density) with MRI and clinical scores.