Musculoskeletal ultrasound--a state of the art review in rheumatology. Part 2: Clinical indications for musculoskeletal ultrasound in rheumatology

Abstract

Rheumatologists remain divided on whether they should introduce musculoskeletal ultrasound (MSUS) into their clinical practice. A central issue in the application of MSUS in clinical rheumatology is the need for proof of clinical relevance and improved patient care. There is now accumulating evidence that MSUS improves clinical diagnosis and intervention skills. High-resolution ultrasound is superior to clinical examination in the diagnosis and localization of joint and bursal effusion and synovitis. MSUS is the imaging modality of choice for the diagnosis of tendon pathology. MSUS is seven times more sensitive than plain radiography in the detection of rheumatoid erosions, allowing earlier diagnosis of progressive rheumatoid arthritis. Ligament, muscle, peripheral nerve and cartilage pathology can also be readily demonstrated by MSUS. There is exciting evidence that MSUS may potentially be used by rheumatologists to non-invasively diagnose and monitor not just joint and muscle disease but also nerve compression syndromes, scleroderma, vasculitis and Sjögren's syndrome. Joint aspiration and injection accuracy can be improved by MSUS, with initial evidence confirming improved efficacy. As the number of rheumatologists performing MSUS increases and the technical capabilities of MSUS improve, there is likely to be a growing number of proven clinical indications for the application of MSUS in rheumatology practice. This paper reviews the evidence for the application of MSUS in rheumatology.

Imaging the joint in osteoarthritis: a place for ultrasound?

“…The assessment of synovial fluid is possible by performing multi-planar and dynamic scans and comparing findings with the contralateral side [1- 3,5]. This useful scanning protocol, which should always be applied, facilitates a correct evaluation of the joint and avoids errors or misinterpretations due to the fact that minimal amounts of fluid are commonly present in the joints of healthy individuals.…”

“…Sonographic equipment are widely available in most hospitals and outpatient units and this can facilitate the use of US in the rheumatologic clinical activity, thus avoiding requests for examinations to radiology units and thereby reducing waiting lists. US focusses a multiregional evaluation of the musculoskeletal system in the same scanning session and permits an extensive evaluation of most changes appearing in OA with the possibility of monitoring disease progression and performing a follow-up of the response to both local and systemic treatment [3,5]. Various procedures such as fluid aspirations within joint and periarticular tissues, local drug injections and biopsy are executed with safety, precision, reliability and optimal patient tolerance under sonographic guidance [37,60,61].…”

“…This is mainly due to tremendous technical advances and progressive, relevant technological developments of US equipment occurring over the past decade [1][2][3][4][5]. Thank to its capacity to represent different anatomic structures in the finest details with consequent possibility to detect an incredible series of changes in minute particulars, sonography seems to represent one of the most promising imaging techniques in rheumatological clinical practice as well as in research imaging [6,7].…”

A Systematic Literature Review Analysis of Ultrasound Joint Count and Scoring Systems to Assess Synovitis in Rheumatoid Arthritis According to the OMERACT Filter

“…Specifically, ultrasound is capable of evaluating the 2 elementary findings associated with synovitis: synovial hypertrophy (SH) and synovial fluid/effusion (SF) 2 . SF is visualized as an anechoic area within the joint capsule, while SH is visualized as hypoechoic material within and involving the joint capsule.…”

Prediction of Radiographic Damage in Early Arthritis by Sonographic Erosions and Power Doppler Signal: A Longitudinal Observational Study

“…PD signal was graded as follows: 0 ϭ no flow in the synovium, 1 ϭ one-third or less of the synovium area (SA), 2 ϭ two-thirds or less of the SA, and 3 ϭ more than two-thirds of the SA (18). Erosions were graded as follows: 0 ϭ no erosion, 1 ϭ Յ1-mm erosion, 2 ϭ 1-2-mm erosion, 3 ϭ 2-4-mm erosion, and 4 ϭ Ͼ4-mm erosion (19). A limited number of scanned joints was chosen on the basis of previous US studies that identified the most frequently affected joints in RA (7).…”