Imaging the joint in osteoarthritis: a place for ultrasound?

Abstract

Ultrasound (US) is a valuable tool for imaging musculoskeletal changes in osteoarthritis. It shows early and late findings related to inflammation and structural damage. Sonography is a safe tool, which has recently registered an increasing and widespread use, it being considered as a bedside procedure in the clinical assessment of rheumatic patients. Its applications in osteoarthritis are related to easy accessibility of equipment, low cost, short duration of single examinations and the possibility of performing a multiregional joint evaluation in the same scanning session. Permitting an extensive evaluation of most joint changes present in osteoarthritis, it gives the opportunity to monitor disease progression and perform a follow-up of the response to different local and systemic treatments. US-guided procedures are commonly performed with safety, reliability and optimal patient tolerance. Development in technology and technique with improvement of new research studies will further amplify the diagnostic role of ultrasound in osteoarthritis in the near future. (C) 2009 Elsevier Ltd. All rights reserved

The Application of Imaging in Osteoarthritis

“…Ultrasound has the advantage over MRI and bone scintigraphy in that it is more readily available and non-invasive. However its main disadvantage is that it is operator dependent with a long learning curve (Iagnocco 2010). It is portable and therefore allows repeated assessment of subtle progression of joint pathology in both static and dynamic modes (Moller, Bong et al 2008).…”

“…Whilst CR changes such as JSN, subchondral sclerosis, marginal osteophytes and cysts are used to assess OA progression, in the hand these may be late findings. Thus US may provide a useful adjunct to the early assessment of subclinical manifestations of OA (Iagnocco 2010). The recent development of high resolution high frequency transducers, multi-frequency probes, matrix probes and volumetric probes has expanded the application of US in the assessment of cartilage thickness, menisci, tendons, ligaments, joint capsule, synovial membrane, synovial fluid and bursae as well as to a lesser extent subchondral bone.…”

“…The anatomical site and type of tissue under investigation will determine the US technique used (Moller, Bong et al 2008). Scanning protocols are tailored to specific joints with established guidelines ensuring standardization of images in two planes (Keen, Wakefield et al 2009;Iagnocco 2010). For example, in the small joints of the hand, longitudinal and transverse scans in flexion for the dorsal aspects and in neutral to visualize the volar aspects are performed with a high frequency (more than 12 MHz) probe (Moller, Bong et al 2008;Iagnocco 2010;Mancarella, Magnani et al 2010;Wittoek, Carron et al 2010).…”

“…Scanning protocols are tailored to specific joints with established guidelines ensuring standardization of images in two planes (Keen, Wakefield et al 2009;Iagnocco 2010). For example, in the small joints of the hand, longitudinal and transverse scans in flexion for the dorsal aspects and in neutral to visualize the volar aspects are performed with a high frequency (more than 12 MHz) probe (Moller, Bong et al 2008;Iagnocco 2010;Mancarella, Magnani et al 2010;Wittoek, Carron et al 2010). In order to visualize the weight bearing surfaces of the femoral condyles in the knee, the scan is performed with the knee flexed in the supine position (Moller, Bong et al 2008;Yoon, Kim et al 2008).…”

“…In order to visualize the weight bearing surfaces of the femoral condyles in the knee, the scan is performed with the knee flexed in the supine position (Moller, Bong et al 2008;Yoon, Kim et al 2008). In the hip the leg is extended and externally rotated to allow visualization of the anterior surface of the femoral head using a lower frequency (8-12 MHz) probe (Backhaus, Burmester et al 2001;Moller, Bong et al 2008;Iagnocco 2010). Studies in the literature vary as to how the joint is positioned and which planes are scanned (Naredo, Acebes et al 2008).…”