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Journal of Peking University (Health Sciences) ›› 2025, Vol. 57 ›› Issue (6): 1096-1100. doi: 10.19723/j.issn.1671-167X.2025.06.012

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Correlation study of superb microvascular imaging on knee osteoarthritis

Cuiping WANG1, Zhe CHEN2,*(), Yongjing CHENG2   

  1. 1. Department of Sonography, Beijing Hospital; Beijing 100730, China
    2. Department of Rheumatology, Beijing Hospital; National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences; Beijing 100730, China
  • Received:2025-08-13 Online:2025-12-18 Published:2025-10-21
  • Contact: Zhe CHEN
  • Supported by:
    the National High Level Hospital Clinical Research Funding(BJ-2022-134); the National High Level Hospital Clinical Research Funding(BJ-2023-189)

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Abstract:

Objective: To investigate the correlation between superb microvascular imaging (SMI) blood flow grading, ultrasound semi-quantitative scores, and clinical symptom severity in patients with primary knee osteoarthritis (KOA). Methods: A total of 94 knees from 47 patients with primary KOA were evaluated. Ultrasound semi-quantitative scoring and synovial SMI grading were performed for each knee joint. Clinical assessments included the Western Ontario and McMaster Universities osteoarthritis index (WOMAC), visual analog scale (VAS) for pain, and serum biomarkers, such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Correlations between clinical scores and ultrasound parameters were analyzed. Results: SMI demonstrated a significantly higher synovial blood flow detection rate than power Doppler (PD) (14.9% vs. 9.6%, Z=-2.531, P=0.011). WOMAC stiffness scores showed positive correlations with synovitis, articular cartilage damage, and elevated SMI scores (all P < 0.05). WOMAC function scores were positively correlated with osteophyte severity, synovial thickening, and elevated SMI scores (all P < 0.05). The total WOMAC scores were positively associated with synovitis, synovial thickening, articular cartilage damage, and osteophyte severity (all P < 0.05). However, non-parametric Bootstrap analysis (B=2 000 replicates) revealed no independent associations between SMI blood flow grading, age, or body mass index (BMI) and WOMAC pain, stiffness, function, or total scores (all P>0.05, 95%CI contained zero). Conclusion: The SMI technique demonstrates significantly higher sensitivity than PD in detecting intensity grade of synovial microvascular flow. While SMI compensates for the limitations of PD in identifying low-grade inflammation, its high sensitivity to low- velocity blood flow did not correlate with symptom severity or WOMAC pain scores. These findings suggest that SMI serves as a valuable tool for visualizing microvascular activity in subclinical synovitis, but its role as a direct indicator of clinical symptom severity in KOA remains limited. Further studies with larger sample sizes are warranted to validate its clinical utility.

Key words: Superb microvascular imaging, Ultrasound semi-quantitative scoring, Knee osteoarthritis

CLC Number: 

  • R684.3

Table 1

General clinical data of patients with knee osteoarthritis"

Parameter Value
Age/years, $\bar x \pm s$ (range) 62.7±7.1 (47-74)
Height/cm, $\bar x \pm s$ (range) 163.9±7.1 (150-180)
Weight/kg, $\bar x \pm s$ (range) 66.7±10.7 (45-90)
BMI/(kg/m2), $\bar x \pm s$ (range) 41.1±5.8 (27.8-51.2)
Disease duration/years, M (P25, P75) (range) 4.0 (0.5, 7.5) (0.25-20.00)*
WOMAC pain score, $\bar x \pm s$ (range) 10.6±3.3 (6-20)
WOMAC stiffness score, M (P25, P75) (range) 4 (2, 6) (2-10)*
WOMAC fuction score, $\bar x \pm s$ (range) 37.8±12.0 (21-70)
WOMAC total score, $\bar x \pm s$ (range) 52.7±16.6 (29-98)
VAS score, $\bar x \pm s$ (range) 5.4±1.3 (3.9-8.3)
CRP/(mg/L), M (P25, P75) (range) 1.0 (0.5, 3.7) (0.2-57.9)*
ESR/(mm/h), $\bar x \pm s$ (range) 11.9±8.1 (0-34)

Table 2

Comparison of synovial blood flow PD and SMI grades"

Items SMI 0 SMI 1 SMI 2 SMI 3 Total
PD 0 80 5 0 0 85
PD 1 0 6 1 1 8
PD 2 0 0 1 0 1
PD 3 0 0 0 0 0
Total 80 11 2 1 94

Table 3

Correlation analysis of WOMAC scores with ultrasonic semi-quantitative scores and SMI blood flow grades"

Parameter Synovitis Synovial thickening Joint effusion PD
r P r P r P r P
WOMAC pain score 0.091 0.650 0.185 0.355 0.241 0.226 -0.241 0.226
WOMAC stiffness score 0.058 0.001** 0.153 0.448 -0.179 0.371 0.179 0.371
WOMAC function score 0.349 0.074 0.518 0.006** -0.038 0.851 0.038 0.851
WOMAC total score 0.385 0.047* 0.446 0.020* 0.025 0.901 -0.025 0.901
Parameter SMI Articular cartilage Meniscal extrusion Osteophyte
r P r P r P r P
WOMAC pain score -0.016 0.909 0.389 0.023* 0.332 0.091 0.390 0.023*
WOMAC stiffness score 0.375 0.005** 0.430 0.025* 0.101 0.617 0.217 0.277
WOMAC function score 0.331 0.015* 0.340 0.083 0.144 0.472 0.437 0.023*
WOMAC total score 0.267 0.051 0.401 0.038* 0.183 0.361 0.427 0.026*
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