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Imaging of the musculoskeletal system: magnetic resonance imaging, ultrasonography and computed tomography

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Abstract

In the last decade, musculoskeletal imaging has rapidly expanded largely due to the imaging capabilities of magnetic resonance imaging and ultrasound. These modalities have increased the clinical understanding and mechanisms of arthritis and are assuming increasing importance in the diagnosis of arthritis; more recently, they have been used to monitor therapy. This chapter reviews recent imaging studies relevant to rheumatic diseases.

Section snippets

Magnetic resonance imaging

MRI has multiplanar imaging capabilities suited for showing inflammation in soft tissues and bone. It allows accurate delineation of structural and inflammatory lesions of all joint structures including tendons and tendon sheaths, ligaments, synovial membrane, cartilage and bone. There has been an explosion of publications relating to the use of MRI in rheumatology in the last 5 years. Better access to scanners, improved resolution of scanners and rapid developments in the sequences used for

Ultrasonography

Ultrasonography has been used for the assessment of musculoskeletal disorders since the 1970s.53 It is without doubt a promising investigative tool in rheumatology and has the advantages of being inexpensive and easily available; moreover, it does not involve ionizing radiation, does not limit the number of joints examined and is well tolerated by patients. It can therefore be used as a screening tool in the setting of rheumatology clinics. Perhaps the most exciting aspect of US is the fact

Computed tomography

Like MRI, CT permits multislice imaging but suffers from the limitation of exposure to ionizing radiation. Multislice CT offers better scan resolution, shorter imaging time and hence lower radiation dose compared with conventional CT.87 CT is useful in diagnosing traumatic injuries in musculoskeletal disorders such as fractures. Unlike MRI, it is not suited to depicting sites of bone inflammation or spreading infection with regard to the spine.89

Recently CT has been used to investigate bone

The future

There is an increasing awareness, based largely on imaging studies, that joint damage is a feature of most arthropathies at clinical presentation, and that prompt early diagnosis facilitates the initiation of appropriate therapy. Improvements and innovations in the imaging field are therefore towards a more sensitive technique which has to be cost-effective, reliable, easily available and well tolerated by both the patients and the operators. A more open MRI unit has been developed which allows

Summary

The systematic application of both MRI and US to imaging the musculoskeletal system is changing our understanding of the pathogenesis of rheumatic diseases. It is also slowly influencing clinical practice, with both of these modalities being increasingly used as diagnostic aids and in the differential diagnosis of clinically undiagnosed arthropathies. There is emerging evidence that these modalities will form an essential component of outcome measures for therapies in the rheumatic diseases.

References (101)

  • H.H Schild

    MRI Made Easy

    (1990)
  • O Hauger et al.

    Water excitation as an alternative to fat saturation in MR imaging: preliminary results in musculoskeletal imaging

    Radiology

    (2002)
  • E Kanal et al.

    American College of Radiology White Paper on MR Safety

    American Journal of Roentgenology

    (2002)
  • K Gaffney et al.

    Quantitative assessment of the rheumatoid synovial microvascular bed by gadolinium-DTPA enhanced magnetic resonance imaging

    Annals of the Rheumatic Diseases

    (1998)
  • B Ostendorf et al.

    Magnetic resonance imaging and miniarthroscopy of metacarpophalangeal joints: sensitive detection of morphologic changes in rheumatoid arthritis

    Arthritis & Rheumatism

    (2001)
  • D.J Veale et al.

    Intra-articular primatised anti-CD4: efficacy in resistant rheumatoid knees. A study of combined arthroscopy, magnetic resonance imaging, and histology

    Annals of the Rheumatic Diseases

    (1999)
  • R.J Reece et al.

    Comparative assessment of leflunomide and methotrexate for the treatment of rheumatoid arthritis, by dynamic enhanced magnetic resonance imaging

    Arthritis & Rheumatism

    (2002)
  • M Østergaard et al.

    Changes in synovial membrane and joint effusion volumes after intraarticular methylprednisolone. Quantitative assessment of inflammatory and destructive changes in arthritis by MRI

    Journal of Rheumatology

    (1996)
  • D Mulherin et al.

    Clinical improvement and radiological deterioration in rheumatoid arthritis: evidence that the pathogenesis of synovial inflammation and articular erosion may differ

    British Journal of Rheumatology

    (1996)
  • D McGonagle et al.

    The relationship between synovitis and bone changes in early untreated rheumatoid arthritis: a controlled magnetic resonance imaging study

    Arthritis & Rheumatism

    (1999)
  • P.G Conaghan et al.

    Elucidation of the relationship between synovitis and bone damage: a randomised MRI study of individual joints in patients with early RA

    Arthritis & Rheumatism

    (2003)
  • F.M McQueen et al.

    What is the fate of erosions in early rheumatoid arthritis? Tracking individual lesions using X rays and magnetic resonance imaging over the first two years of disease

    Annals of the Rheumatic Diseases

    (2001)
  • M Østergaard et al.

    Magnetic resonance imaging-determined synovial membrane volume as a marker of disease activity and a predictor of progressive joint destruction in the wrists of patients with rheumatoid arthritis

    Arthritis & Rheumatism

    (1999)
  • A.L Tan et al.

    Role of metacarpophalangeal joint anatomic factors in the distribution of synovitis and bone erosion in early rheumatoid arthritis

    Arthritis & Rheumatism

    (2003)
  • H Sugimoto et al.

    Early-stage rheumatoid arthritis: diagnostic accuracy of MR imaging

    Radiology

    (1996)
  • P Goupille et al.

    Magnetic resonance imaging: a valuable method for the detection of synovial inflammation in rheumatoid arthritis

    Journal of Rheumatology

    (2001)
  • P.G Conaghan et al.

    New approaches to imaging of early rheumatoid arthritis

    Clinical and Experimental Rheumatology

    (1999)
  • M Klarlund et al.

    Magnetic resonance imaging, radiography, and scintigraphy of the finger joints: one year follow up of patients with early arthritis. The TIRA Group

    Annals of the Rheumatic Diseases

    (2000)
  • F.M McQueen

    Magnetic resonance imaging in early inflammatory arthritis: what is its role?

    Rheumatology

    (2000)
  • C.G Peterfy

    Magnetic resonance imaging in rheumatoid arthritis: current status and future directions

    Journal of Rheumatology

    (2001)
  • M Østergaard et al.

    Interreader agreement in the assessment of magnetic resonance images of rheumatoid arthritis wrist and finger joints—an international multicenter study

    Journal of Rheumatology

    (2001)
  • P Conaghan et al.

    Magnetic resonance imaging in rheumatoid arthritis: summary of OMERACT activities, current status, and plans

    Journal of Rheumatology

    (2001)
  • A Mundinger et al.

    MRI of knee arthritis in rheumatoid arthritis and spondylarthropathies

    Rheumatology International

    (1991)
  • D McGonagle et al.

    Characteristic magnetic resonance imaging entheseal changes of knee synovitis in spondylarthropathy

    Arthritis & Rheumatism

    (1998)
  • B Ostendorf et al.

    Jaccoud's arthropathy in systemic lupus erythematosus

    Arthritis & Rheumatism

    (2003)
  • B Amor et al.

    Criteria of the classification of spondylarthropathies

    Revue du Rhumatisme et des Maladies Osteo-Articulaires

    (1990)
  • M Dougados et al.

    The European Spondylarthropathy Study Group preliminary criteria for the classification of spondylarthropathy

    Arthritis & Rheumatism

    (1991)
  • H Marzo-Ortega et al.

    Efficacy of etanercept in the treatment of the entheseal pathology in resistant spondylarthropathy: a clinical and magnetic resonance imaging study

    Arthritis & Rheumatism

    (2001)
  • V Jevtic

    Magnetic resonance imaging appearances of different discovertebral lesions

    European Radiology

    (2001)
  • J Braun et al.

    Magnetic resonance imaging examinations of the spine in patients with ankylosing spondylitis, before and after successful theraphy with infliximab: Evaluation of a new scoring system

    Arthritis & Rheumatism

    (2003)
  • U Blum et al.

    Magnetic resonance imaging (MRI) for detection of active sacroiliitis—a prospective study comparing conventional radiography, scintigraphy, and contrast enhanced MRI

    Journal of Rheumatology

    (1996)
  • J Oostveen et al.

    Early detection of sacroiliitis on magnetic resonance imaging and subsequent development of sacroiliitis on plain radiography. A prospective, longitudinal study

    Journal of Rheumatology

    (1999)
  • M Bollow et al.

    Quantitative analyses of sacroiliac biopsies in spondyloarthropathies: T cells and macrophages predominate in early and active sacroiliitis-cellularity correlates with the degree of enhancement detected by magnetic resonance imaging

    Annals of the Rheumatic Diseases

    (2000)
  • H Ahlstrom et al.

    Magnetic resonance imaging of sacroiliac joint inflammation

    Arthritis & Rheumatism

    (1990)
  • D.T Felson et al.

    The association of bone marrow lesions with pain in knee osteoarthritis

    Annals of Internal Medicine

    (2001)
  • C.L Hill et al.

    Knee effusions, popliteal cysts, and synovial thickening: association with knee pain in osteoarthritis

    Journal of Rheumatology

    (2001)
  • N Boutry et al.

    Rapidly destructive osteoarthritis of the hip: MR imaging findings

    AJR. American Journal of Roentgenology

    (2002)
  • A.S Greenstein et al.

    Magnetic resonance imaging as a predictor of progressive joint destruction in neuropathic joint disease

    Arthritis & Rheumatism

    (2002)
  • J Hohe et al.

    Surface size, curvature analysis, and assessment of knee joint incongruity with MRI in vivo

    Magnetic Resonance in Medicine

    (2002)
  • A.E Wluka et al.

    The determinants of change in tibial cartilage volume in osteoarthritic knees

    Arthritis & Rheumatism

    (2002)
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