Abstract

To investigate the ability of ultrasound (US) compared to radiographs in detecting calcinosis in hands/wrists of systemic sclerosis (SSc) patients, and assess US markers of pathologic perfusion.SSc patients were evaluated for calcinosis in the hands/wrists by X-ray and US. Presence or absence of calcinosis was recorded by patient, hand, and anatomical zone; sensitivity and specificity for calcinosis detection by US versus X-ray was determined. Bilateral US vascular measurements of ulnar artery occlusion (UAO) and finger pulp blood flow (FPBF) were obtained. For each hand, associations between markers of pathologic blood flow (UAO, FPBF, and a composite severity score of UAO and FPBF) and presence of calcinosis were assessed using generalized estimating equations.Of 43 SSc patients (19 diffuse, 24 limited), 39.5% had calcinosis on X-ray compared to 30.2% on US. Sensitivity and specificity for US was 61% and 95% by zone, 78% and 98% by hand, and 76% and 100% by patient, respectively. UAO was seen in 30% and 28% of left and right hands, respectively; FPBF was absent in =1 digit of the left and right hands in 49% and 44%, respectively. UAO was associated with X-ray identified calcinosis by hand (OR 8.08, 95% CI 2.45-26.60, p<0.001), whereas FPBF and the composite severity score were not significant. UAO was associated with calcinosis even in the absence of digital ulcers (OR 33.00, 95% CI 3.39-321.09, p=0.003).US was sensitive and highly specific in detecting calcinosis in SSc. UAO was strongly associated with X-ray identified calcinosis.

View details for DOI 10.1002/acr.24327

View details for PubMedID 32475057