The use of ultrasound imaging in rheumatology- our experiences to-date

Abstract

Background This presentation is designed to demonstrate the value ultrasound imaging brings to Rheumatology and diagnosis. The development and implementation of rheumatologic ultrasound training in Australia will be discussed. Reporting and identifying bony changes and the articular surface of the bone is essential in ultrasound. Understanding what “synovitis” is and its ultrasound appearance in this presentation will be thoroughly discussed in detail. Ultrasound is used extensively in Europe and is a valuable imaging tool used in diagnosis of rheumatoid changes within the hands, knees, elbows and joints. It is important, as a sonographer, to report the correct information relating to auto immune disease and have an understanding of such diseases. Hopefully, a very informative and new presentation. Key points • Identifying “synovitis” • Why use Power Doppler (PD) – what does that tell us • “bony” changes • Joint capsule changes • Protocol to follow • Imaging of the Dorsal wrist – assess synovium with colour (PD) • Radio-carpal joint • Ulnar styloid • Comment on common extensor tendons and retinaculum • MCPJs • PIPJs • Bony cortex • Joint capsule Inflammatory arthritis - overview • In the RA wrist synovium appears hypo-echoic with a thickened synovial wall. • Wrist “fat “is echogenic in comparison to normal tissue and may give the appearance of “clumped” tissue. • Power Doppler imaging (PD) is used to determine if the disease is “active”. • This presentation is very common and the patient usually presents with NO PAIN. • Patient presents with “stiffening” of the hands in the morning. • One or two joints maybe tender. • OA - joints appear swollen. • RA – joints are destroyed and disfigured. • Decreased ROM. • Bone erosions are identified reliably with ultrasound and demonstrated in both the longitudinal and coronal plane.