Color Doppler Ultrasonography of Hand and Finger Arteries to Differentiate Primary from Secondary Forms of Raynaud's Phenomenon

WOLFGANG A. SCHMIDT, ANDREAS KRAUSE, BERND SCHICKE, AND DIRK WERNICKE

ABSTRACT.

Objective. Modern ultrasound (US) equipment allows rheumatologists to directly visualize hand and finger arteries. How does US aid in diagnosis of Raynaud's phenomenon (RP)?

Methods. Color Doppler US of the proper and common palmar digital, radial, and ulnar arteries and the superficial palmar arch of both hands was performed in 135 consecutive patients who presented with suspected RP.

Results. US was pathologic in 63% of patients with secondary RP, in 6% with primary RP, and in none with pseudo-RP (p < 0.0001). We found 3 types of vascular pathology: Type 1 showed narrowing or chronic occlusion of some proper digital arteries; Type 2 was characterized by the same finding in all proper digital arteries; and Type 3 involved acute occlusions. Type 1 was found in 3 of 53 patients with primary RP and in 19 patients with secondary RP including 5 of 9 patients with anti-centromere positive systemic sclerosis (SSc); Type 2 occurred in 16 patients with SSc, MCTD, and dermatomyositis; and Type 3 was found in 8 patients with antiphospholipid antibody syndrome, thromboangiitis obliterans, vibration trauma, or vasculitis. The ulnar arteries were more commonly affected than the radial arteries. The 2nd radial, 3rd radial, 4th ulnar, and 5th ulnar proper palmar digital arteries were most commonly involved.

Conclusion. Aiding in differentiating primary versus secondary RP, severe versus less severe disease, and acute versus chronic vascular occlusion, digital artery US depicts the same anatomical structures as angiography, but it is cheaper, faster, and noninvasive. (First Release July 15 2008; J Rheumatol 2008;35:1591–8)

Key Indexing Terms:

ULTRASONOGRAPHY
COLOR DOPPLER ULTRASONOGRAPHY
RAYNAUD'S DISEASE
SYSTEMIC SCLEROSIS
CONNECTIVE TISSUE DISEASE
PERIPHERAL ARTERIAL DISEASE

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From the Medical Center for Rheumatology Berlin-Buch; and Department of Statistics, Tumor Centrum Berlin, Berlin, Germany.

W.A. Schmidt, MD, Rheumatologist, Deputy Director; A. Krause, MD, Rheumatologist, Director, Medical Center for Rheumatology Berlin-Buch; B. Schicke, Statistician, Tumor Centrum Berlin; D. Wernicke, MD, Rheumatologist, Medical Center for Rheumatology Berlin-Buch.

Address reprint requests to Dr. W.A. Schmidt, Medical Center for Rheumatology Berlin-Buch, Karower Str. 11, 13125 Berlin, Germany. E-mail w.schmidt@immanuel.de

Accepted for publication March 19, 2008.

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