A RECENT systematic review and meta-analysis have highlighted the enhanced diagnostic ability of contrast-enhanced ultrasound (CEUS) over traditional Doppler ultrasound (DUS) for identifying active synovitis in patients with rheumatoid arthritis (RA). The study, which analyzed 23 studies involving 1117 joints from 827 individuals, found that CEUS significantly outperformed DUS in detecting synovitis.
The findings revealed that CEUS was able to detect synovitis in 83.8% of joints, compared to just 49.2% with Doppler ultrasound, representing a relative detection ratio (RDR) of 1.49. This demonstrates a marked improvement in sensitivity, with CEUS providing a more accurate assessment of synovial inflammation, a key feature in RA. The data indicated that the higher detection rate was consistent even when analyzing joints from active RA patients, with CEUS providing more microvascularisation information, which is crucial for diagnosing the condition.
The meta-analysis, based on studies published until February 2024, showed moderate heterogeneity but reinforced CEUS’s potential as a superior tool in the clinical setting. The advantage of CEUS lies in its use of microbubbles to enhance ultrasound imaging, which allows for a more precise visualization of synovial blood flow compared to the Doppler method. This could improve the early detection and monitoring of disease progression in RA.
While CEUS performed effectively in active RA cases, it did not show vascularization in healthy subjects, reinforcing its specificity in identifying abnormal synovial activity. These results suggest that CEUS could become a valuable addition to the diagnostic toolkit for RA, enabling more accurate assessments and better patient management.
As the clinical benefits of CEUS become more evident, its potential to refine RA diagnosis and monitoring is undeniable, particularly in distinguishing active disease from remission. The improved detection of synovitis may lead to more targeted treatments and better patient outcomes in the long term.
Reference:
Polido-Pereira J. How useful is contrast-enhanced ultrasound in rheumatoid arthritis? A systematic review with meta-analysis on the comparison between contrast-enhanced ultrasound and colour or power Doppler ultrasound. Radiol Med. 2025. doi: 10.1007/s11547-025-02055-2.
