Ultrasonography In Rheumatology Research Articles

Ultrasonography in rheumatology: Beyond the joints and the vessels!

Ultrasonography in rheumatology: Beyond the joints and the vessels!

New developments in ultrasound in rheumatology: innovative tools and promising applications

In the setting of rheumatology, the assessment of the involvement of joints and peri-articular structures was the first application of ultrasonography in the management of rheumatic diseases. In this field, the main novelties are related to the development of new technical tools to help overcome some of the limitations of conventional ultrasonographic assessment. In the meantime, there has been a growing interest in the application of ultrasound to extra-articular sites, relying on the definition of new indications. The present review aims to provide a critical analysis of the technical developments and new fields of application of ultrasonography in rheumatology.

Comments on: Use and scope of ultrasonography in rheumatology in India

Comments on: Use and scope of ultrasonography in rheumatology in India

Use and scope of ultrasonography in rheumatology in India

Musculoskeletal ultrasound (MSUS), once a sole territory of radiologists, has over the past decade been increasingly exploited by rheumatologists in clinical practice and as a research tool. Technical expansion in the field of ultrasonography has made MSUS a powerful tool in the early identification of inflammatory and noninflammatory rheumatic disease, monitoring disease, predicting therapeutic responses and guidance for procedures such as diagnostic fluid aspiration and peri- or intra-lesional therapeutic injections. US can be performed readily in the clinic, with an assessment of multiple joints at the same appointment, providing a “one-stop” answer to many MS problems. MSUS is widely accepted as an adjunct to clinical examination among rheumatologists in Europe and is rapidly gaining acceptance in the United States. In India, US is under the purview of the preconception and prenatal diagnostics techniques Act, which does not acknowledge the multiple role of point-of-care ultrasonography. There are some other critical issues of equipment costs, training and certification and the relationship of rheumatologists and radiologists in advancing the field of MSUS in India.

Detection of bone erosions in early rheumatoid arthritis: 3D ultrasonography versus computed tomography.

Three-dimensional (3D) volumetric ultrasonography (US) is an interesting tool that could improve the traditional approach to musculoskeletal US in rheumatology, due to its virtual operator independence and reduced examination time. The aim of this study was to investigate the performance of 3DUS in the detection of bone erosions in hand and wrist joints of early rheumatoid arthritis (ERA) patients, with computed tomography (CT) as the reference method. Twenty ERA patients without erosions on standard radiography of hands and wrists underwent 3DUS and CT evaluation of eleven joints: radiocarpal, intercarpal, ulnocarpal, second to fifth metacarpo-phalangeal (MCP), and second to fifth proximal interphalangeal (PIP) joints of dominant hand. Eleven (55.0%) patients were erosive with CT and ten of them were erosive also at 3DUS evaluation. In five patients, 3DUS identified cortical breaks that were not erosions at CT evaluation. Considering CT as the gold standard to identify erosive patients, the 3DUS sensitivity, specificity, PPV, and NPV were 0.9, 0.55, 0.71, and 0.83, respectively. A total of 32 erosions were detected with CT, 15 of them were also observed at the same sites with 3DUS, whereas 17 were not seen on 3DUS evaluation. The majority of these 3DUS false-negative erosions were in the wrist joints. Furthermore, 18 erosions recorded by 3DUS were false positive. The majority of these 3DUS false-positive erosions were located at PIP joints. This study underlines the limits of 3DUS in detecting individual bone erosion, mostly at the wrist, despite the good sensitivity in identifying erosive patients.

The Italian MSUS Study Group recommendations for the format and content of the report and documentation in musculoskeletal ultrasonography in rheumatology

The objective of this study was to draw up a set of recommendations for the format and content of the musculoskeletal ultrasonography (MSUS) report in rheumatology. A panel of rheumatologists, members of the MSUS Study Group of the Italian Society of Rheumatology, met in order to identify the main discrepancies in the MSUS report. A set of 15 recommendations was then defined, aimed at resolving the main discrepancies. They consisted of information about the motivations for the MSUS examination, the equipment, the US modalities and scanning technique, a list of the examined structures and findings, the scoring/grading systems, the number of images and main findings to include and conclusions. Subsequently a Delphi-based procedure was started in order to obtain agreement on a core set of recommendations. Consensus for each recommendation was considered achieved when the percentage of agreement was >75%. Three complete rounds were performed. The response rate was 85.2% for the first round, 78.3% for the second and 88.9% for the third. Finally, consensus was obtained for 14 of 15 statements. These 14 statements represent the recommendations of the group for the format and content of the report and documentation in MSUS in rheumatology. To the best of our knowledge, our group has produced the first recommendations for the format and content of the report and documentation in MSUS in rheumatology. The report is an integral part of the MSUS examination and its use in a homogeneous form can help in the correct interpretation of the findings.

SP0149 How to implement technical improvements in existing imaging modalities in clinical practice: Ultrasonography

The value of ultrasound in rheumatology is supported by a consistent body of evidence. The number of studies has progressively increased documenting the interest for this imaging tool especially in...

Technology Insight: the role of color and power Doppler ultrasonography in rheumatology

An increasing number of rheumatologists have access to ultrasound equipment that provide both color and power Doppler modes, which can be used to investigate musculoskeletal and vascular pathologies. Musculoskeletal Doppler ultrasonography can be used to estimate levels of inflammation, to document the anti-inflammatory effect of agents such as corticosteroids and tumor necrosis factor inhibitors, to differentiate between inflammatory and degenerative disease, and to distinguish between normal and inflamed joints in cases of minor synovial swelling. Vascular Doppler ultrasonography can be used to determine organ involvement in small-vessel vasculitides, to delineate aneurysms in vasculitides of medium-sized arteries, and to assess the characteristic findings in large-vessel vasculitis. Numerous studies, including a meta-analysis, have been published on the use of temporal-artery ultrasonography for the diagnosis of giant cell arteritis. Duplex ultrasonography is a sensitive approach for detecting characteristic edematous wall swellings in active temporal arteritis and for assessing vasculitis of the axillary arteries (large-vessel giant cell arteritis) in patients with suspected temporal arteritis, polymyalgia rheumatica, or fever of unknown origin. Duplex ultrasonography can also be used to assess vasculitis of subclavian and carotid arteries in younger patients with Takayasu's arteritis and acute finger artery occlusions in patients with small-vessel vasculitides.

Ultrasonography and the rheumatologist

An update of the latest developments in ultrasonography in rheumatology. Indications, technical aspects and representative examples of the potential of ultrasonography are illustrated. Finally, education and training issues are briefly discussed. Ultrasonography can be used in rheumatology for a wide spectrum of indications including inflammatory arthritis, tendon pathology, bursitis, disease activity monitoring, disease progression monitoring, guided aspiration and guided injections. Latest-generation ultrasonography systems provide a very sensitive assessment of both grayscale and Doppler findings. The quality of results in ultrasonography is conditioned by a series of elements that include the characteristics of the equipment, knowledge of relevant anatomy and pathology, experience of the sonographer, techniques used and patient positioning. Ultrasonography is challenging the standards of rheumatological clinical practice. It is more sensitive than clinical examination in the detection of synovitis and more sensitive than conventional radiography in the detection of bone erosions. Ultrasonography-guided injections may improve therapy effectiveness if compared with the traditional blind approach. Three-dimensional ultrasonography with a volumetric probe and the power Doppler mode may represent a very useful tool for therapy monitoring in patients with chronic arthritis.

Ultrasonography in rheumatology: developing its potential in clinical practice and research

Ultrasonography in rheumatology: developing its potential in clinical practice and research

Échographie en rhumatologie

The importance of ultrasonography in rheumatology has increased dramatically. Its use is likely to significantly modify rheumatology practice. Rheumatologists may perform this examination themselves, provided they have been correctly trained for it (about 2 years). Technical advances (high- and multi-frequency transducers) allow accurate ultrasonographic analysis of tendon, muscle and joint structures. Ultrasonography constitutes a direct prolongation of the clinical examination, which provides further arguments to the rheumatologist's diagnosis and helps for more accuracy in the therapeutic management. The numerous potential applications of ultrasonography for musculoskeletal diseases are currently under evaluation by clinical research teams. The clinical knowledge of the rheumatologist enhances the potentialities of ultrasound examinations. The actual less expensive cost of ultrasound devices allow rheumatologists to use this technique in their daily practice, both in the hospital context or in a private practice.

Ultrasound in rheumatology

Over the last decade, several studies have highlighted the value of ultrasonography for both clinical and research purposes in rheumatology. Ultrasonography is a non-invasive, inexpensive and free-of-radiation-hazards imaging technique providing quick and useful information for the management of rheumatic diseases. Considerable evidence supporting the role of ultrasonography in rheumatological clinical practice has led many rheumatologists to want to become experienced with this imaging technique. The main indications of ultrasonography in rheumatology include the evaluation of patients with regional pain syndromes and chronic arthritis, short-term therapy monitoring and guidance for invasive procedures. Ultrasonography's long learning curve is the main obstacle that hinders its widespread use in rheumatology. Many technical aspects may affect the scanning process and a correct interpretation of sonographic images depends on several elements such as a deep knowledge of ultrasonography anatomy and pathology.

Doppler sonography in rheumatology

The importance of ultrasonography in rheumatology has increased dramatically within the last few years both with regard to clinical practice and to research. High-resolution colour Doppler ultrasound equipment is, to date, widely available. Colour and power Doppler studies of intra-articular and peritendinous blood flow allow an estimation of the inflammatory activity and aid in distinguishing anatomical structures. Contrast agent increases the ability of ultrasonography to detect even minor perfusion. These findings have a practical clinical impact on the management of inflammatory rheumatic diseases. The resolution of ultrasonography is superior to that of magnetic resonance imaging (MRI) and computed tomography (CT) with regard to superficial anatomical structures. Furthermore, ultrasonography can depict the artery wall in contrast to angiography. In temporal arteritis and Takayasu's arteritis, ultrasonography depicts characteristic, homogenous wall thickening, stenoses and acute occlusions. These pathologies resolve quickly with treatment in the temporal arteries and much more slowly in larger arteries.

The role of ultrasonography in rheumatology

The role of ultrasonography in rheumatology