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Veena K. Ranganath - Ultrasound Scoring of Joint Synovitis : Objective Quantification of Articular Inflammation

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Veena K. Ranganath Ultrasound Scoring of Joint Synovitis : Objective Quantification of Articular Inflammation

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Veena K. Ranganath - Ultrasound Scoring of Joint Synovitis : Objective Quantification of Articular Inflammation
Ultrasound Scoring of Joint Synovitis : Objective Quantification of Articular Inflammation
Veena K. Ranganath
Ultrasound Scoring of Joint Synovitis : Objective Quantification of Articular Inflammation

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Book cover of Ultrasound Scoring of Joint Synovitis Ami Ben-Artzi Gurjit - photo 1
Book cover of Ultrasound Scoring of Joint Synovitis
Ami Ben-Artzi , Gurjit S. Kaeley and Veena K. Ranganath
Ultrasound Scoring of Joint Synovitis
Objective Quantification of Articular Inflammation
1st ed. 2021
Logo of the publisher Ami Ben-Artzi Cedars-Sinai Medical Center Beverly - photo 2
Logo of the publisher
Ami Ben-Artzi
Cedars-Sinai Medical Center, Beverly Hills, CA, USA
Gurjit S. Kaeley
College of Medicine, University of Florida, Jacksonville, FL, USA
Veena K. Ranganath
Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
ISBN 978-3-030-43271-3 e-ISBN 978-3-030-43272-0
https://doi.org/10.1007/978-3-030-43272-0
Springer Nature Switzerland AG 2021
This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use.
The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This Springer imprint is published by the registered company Springer Nature Switzerland AG

The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland

Synovitis Atlas

Dear Atlas User,

We began work on this atlas in 2014, describing the LAJAX US-34 (pronounced Lay-Jax, based on Los Angeles - Jacksonville) scoring methodology. While contemporary synovitis atlases are impressive, and continue to make valuable contributions to musculoskeletal ultrasound applications in rheumatology, we found they have some limitations, especially when applied to clinical trials.

We introduce this atlas, to complement the existing body of synovitis atlases, and address some specific challenges presented when they are applied to a multi-center clinical trial using ultrasound findings as an outcome measure. We began with the widely accepted semiquantitative scale of scoring for grayscale synovitis (03) and Doppler signal (03), but then defined the grades using more objective terms than our contemporaries. Recent publications have found that Doppler signal has much more profound clinical implications than grayscale synovitis. For this reason, the proposed atlas has a novel approach to the grading of synovitis: grayscale synovitis is not seen as an important variable on its own, it only serves to define the region where Doppler signal can be interpreted. This atlas is unique in its focus on the Doppler signal interpretation. The new grade definitions aim to accomplish three goals:

  1. Reduce intra-observer variability in Doppler signal interpretation

  2. Reduce inter-observer variability in Doppler signal interpretation

  3. Increase sensitivity to change in Doppler signal over time

To achieve these aims, this atlas compromises on two fronts:

  1. The proposed grading of grayscale synovitis is not always clinically relevant or accurate. But, it serves to outline the region where Doppler signal is interpreted.

  2. To attain a more reproducible, objective grading system, in certain situations, the atlas will compromise on the clinical relevance of the Doppler signal grading.

While the proposed grading system can be applied to clinical practice, it is designed to perform in multi-center clinical trials that seek to detect change in intra-articular Doppler signal over time. This contribution can complement the synovitis atlas publications currently available.

Contents
Springer Nature Switzerland AG 2021
A. Ben-Artzi et al. Ultrasound Scoring of Joint Synovitis https://doi.org/10.1007/978-3-030-43272-0_1
1. Introduction
Ami Ben-Artzi
(1)
Cedars-Sinai Medical Center, Beverly Hills, CA, USA
(2)
College of Medicine, University of Florida, Jacksonville, FL, USA
(3)
Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
Ami Ben-Artzi (Corresponding author)
Email:
Veena K. Ranganath
Email:
Scoring Grayscale Synovitis

Grayscale synovitis is graded on a semiquantitative 03 scale.

The purpose of grayscale synovitis grading is to obtain consensus on the area where Doppler signal is to be assessed. The purpose is not to quantify the amount of synovial tissue hypertrophy. For this reason, the term grayscale synovitis refers to any hypoechoic or anechoic signal within the joint capsule. No distinction is made between effusion and histologic synovial hypertrophy.

Grayscale synovitis grading is defined for each joint using the following:

  • Assessment of the position of joint capsule margin, as it relates to nearby anatomic structures such as bony landmarks and adjacent tendons.

  • Assessment of joint capsule morphology, such as distention and shape. Objective definition of capsule distention is provided to assist in difficult cases. Assessment of joint capsule shape, while defined, introduces a subjective quality which could not be avoided.

  • Objective measurements.

The objective criteria introduced for grayscale scoring allow for more consistent grading in situations where other atlases lack clarity.

Scoring Grayscale Synovitis
Defining Capsule Distention

The term capsule distention is often used to describe the shape of the joint capsule (A).

Capsule distention may be assessed systematically by evaluating the angle (E) formed between the superficial border of the joint capsule (C) and the deep border of the joint capsule (D) near the capsules visible origin (F). The origin is defined as the joint line or the deepest visible point of articulation between two bones.

Definition of capsule distention Example of synovitis without capsule - photo 3

Definition ofcapsule distention

Example of synovitis without capsule distention When no capsule distention is - photo 4

Example of synovitis,

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