9Imaging of the musculoskeletal system: magnetic resonance imaging, ultrasonography and computed tomography
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.
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