先進的超音波技術應用於類風濕性關節炎:早期檢測、臨床疾病活動度相關性和治療效果

Abstract

傳統能量都卜勒在檢測早期類風濕性關節炎(RA)時對於微弱與緩慢血流的靈敏度有限，可能導致誤診。超快能量都卜勒(Ultrafast power Doppler, ufPD)是一種新穎影像技術，具備更高的血流檢測靈敏度，可作為RA診斷與疾病活動度監測的重要工具。本論文整合三項研究。第一項研究納入33名RA患者(含19名確診與14名早期)及15名健康者，比較ufPD與傳統能量都卜勒於腕關節掃描的表現。ufPD檢測到較大的滑膜血流面積，其風濕病學結果測量評分的敏感度達0.985、準確度為0.719，明顯優於傳統能量都卜勒(敏感度0.424、準確度0.604)。ufPD顯示更高的滑膜血流性、擴張的血管和更亮的都卜勒訊號，其峰值滑膜都卜勒亮度的接收者操作特徵曲線下面積為0.802(敏感度0.909、準確度0.813)，為最具診斷價值的變數。尤其在早期RA，ufPD大幅提升診斷敏感度與準確度(各增加0.561和0.209)。第二項研究評估ufPD灌流影像參數與疾病活動度指標的關聯性。ufPD影像參數與臨床指標呈現弱至中度相關（r = 0.221–0.374, p < 0.05），其中滑膜都卜勒亮度相關性最高。達到深度臨床緩解的患者中，此相關性更為顯著（r = 0.578–0.641, p < 0.001），顯示ufPD可作為疾病活動評估工具。第三項研究評估超音波(US)介導微氣泡(MB)敷料合併匹洛西卡凝膠於手部關節炎的治療效果。30名患者的症狀性關節分配到MB/US組、US組與對照組。結果顯示MB/US組在疼痛緩解、滑膜肥大與血管性改善方面均優於其他組，整體治療反應率達66.7%，且無不良反應，顯示此技術有助於增強藥物傳輸與治療效果。未來計畫將結合自適應解調技術進一步提升ufPD影像品質，並透過磁振造影作為黃金標準，評估其對RA與早期乾癬性關節炎的診斷能力。

Conventional power Doppler (cPD) has a limited sensitivity in detection of slow blood flow in early-stage rheumatoid arthritis (RA), potentially leading to misdiagnosis. Ultrafast power Doppler (ufPD) is an innovative imaging technique with enhanced sensitivity for slow-flow detection, making it a valuable tool for RA diagnosis and disease activity monitoring. This dissertation integrates findings from three studies. The first study included 33 RA patients (19 established and 14 early-stage) and 15 healthy controls to compare ufPD with cPD in wrist joint scanning. ufPD detected significantly larger synovial blood flow areas. Using the OMERACT scoring system, ufPD yielded a sensitivity of 0.985 and an accuracy of 0.719, outperforming cPD (sensitivity 0.424, accuracy 0.604). Among the ufPD image features, peak synovial PD brightness showed the highest diagnostic value (Area Under ROC Curve 0.802, sensitivity 0.909, accuracy 0.813). Notably, ufPD significantly improved diagnostic sensitivity and accuracy in early RA (an increment of 0.561 and 0.209 respectively). The second study explored the correlation between ufPD perfusion imaging variables and clinical disease activity indices. ufPD variables showed weak-to-moderate correlations with clinical indices (r = 0.221–0.374, p <0.05), with synovial PD brightness being the most strongly correlated. Among patients in deep clinical remission, these correlations strengthened (r = 0.578–0.641, p <0.001), supporting the utility of ufPD in disease activity assessment. The third study assessed the therapeutic efficacy of ultrasound (US)-mediated microbubbles (MB) dressing combined with piroxicam gel in hand arthritis. The symptomatic joints of 30 patients were assigned to MB/US, US, or control groups. The MB/US group showed superior pain relief and greater improvement in synovial hypertrophy (76.7%) and vascularity (66.7%), with an overall treatment response rate of 66.7%, and no side effects reported. Future studies aim to enhance ufPD perfusion imaging using adaptive demodulation of tissue signals and to validate its diagnostic performance against MRI as a gold standard, with potential application in early psoriatic arthritis detection.