Limits...
Ultrasound of the small joints of the hands and feet: current status.

McNally EG - Skeletal Radiol. (2007)

Bottom Line: The use of colour flow Doppler studies provides a measure of neovascularisation within the synovial lining of joints and tendons, and within tendons themselves, that is not available with other imaging techniques.Disadvantages compared to MRI include small field of view, poor image presentation, and difficulty in demonstrating cartilage and deep joints in their entirety.Magnetic resonance provides a more uniform and reproducible image for long-term follow-up studies.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Nuffield Orthopaedic Centre, Old Road, Oxford OX3 7LD, UK. eugene.mcnally@ndos.ox.ac.uk

ABSTRACT
The aim of this article was to review the current status of ultrasound imaging of patients with rheumatological disorders of the hands and feet. Ultrasound machines with high-resolution surface probes are readily available in most radiology departments and can be used to address important clinical questions posed by the rheumatologist and sports and rehabilitation physician. There is increasing evidence that ultrasound detects synovitis that is silent to clinical examination. Detection and classification of synovitis and the early detection of bone erosions are important in clinical decision making. Ultrasound has many advantages over other imaging techniques with which it is compared, particularly magnetic resonance. The ability to carry out a rapid assessment of many widely spaced joints, coupled with clinical correlation, the ability to move and stress musculoskeletal structures and the use of ultrasound to guide therapy accurately are principal amongst these. The use of colour flow Doppler studies provides a measure of neovascularisation within the synovial lining of joints and tendons, and within tendons themselves, that is not available with other imaging techniques. Disadvantages compared to MRI include small field of view, poor image presentation, and difficulty in demonstrating cartilage and deep joints in their entirety. Contrast-enhanced magnetic resonance provides a better measure of capillary permeability and extracellular fluid than does ultrasound. The ability to image simultaneously multiple small joints in the hands and feet and their enhancement characteristics cannot be matched with ultrasound, though future developments in 3-D ultrasound may narrow this gap. Magnetic resonance provides a more uniform and reproducible image for long-term follow-up studies.

Show MeSH

Related in: MedlinePlus

Colour flow Doppler image from a patient with synovitis of the third metatarso-phalangeal joint. Flow away from the ultrasound probe is depicted in blue and flow towards the probe is red. MT metatarsal
© Copyright Policy
Related In: Results  -  Collection


getmorefigures.php?uid=PMC2141652&req=5

Fig15: Colour flow Doppler image from a patient with synovitis of the third metatarso-phalangeal joint. Flow away from the ultrasound probe is depicted in blue and flow towards the probe is red. MT metatarsal

Mentions: CFDUS differs from PDUS in that it is dependent on the direction of flow of blood (Fig. 15). The signal acquired carries specific information about the vessel from which it has been obtained in the form of a pressure trace. The precise measurement that is most commonly calculated is the resistive index (RI) (Fig. 16). RI is the difference between systolic and diastolic pressure divided by systolic pressure. Most manufacturers include software within the ultrasound system to calculate the resistive index. A good spectral trace from a vessel within the synovial hypertrophy is acquired. The operator selects one or two pulse cycles from within the trace for analysis. RI is a good marker of high flow resistance: under normal circumstances it is 1 and is reduced by angiogenesis induced by synovitis. In contrast to PDUS, resistive index is a physiological parameter and is, therefore, independent of the equipment used and manufacturer’s software. Despite some of the limitations of power Doppler, particularly with regard to serial studies, it is a sensitive measure, which is easy to obtain and broadly reproducible between different operators on the same machine. It appears to correlate reasonably well with contrast-enhanced MRI and clinical findings and allows a rapid assessment, within days, of improvement following treatment.Fig. 15


Ultrasound of the small joints of the hands and feet: current status.

McNally EG - Skeletal Radiol. (2007)

Colour flow Doppler image from a patient with synovitis of the third metatarso-phalangeal joint. Flow away from the ultrasound probe is depicted in blue and flow towards the probe is red. MT metatarsal
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2141652&req=5

Fig15: Colour flow Doppler image from a patient with synovitis of the third metatarso-phalangeal joint. Flow away from the ultrasound probe is depicted in blue and flow towards the probe is red. MT metatarsal
Mentions: CFDUS differs from PDUS in that it is dependent on the direction of flow of blood (Fig. 15). The signal acquired carries specific information about the vessel from which it has been obtained in the form of a pressure trace. The precise measurement that is most commonly calculated is the resistive index (RI) (Fig. 16). RI is the difference between systolic and diastolic pressure divided by systolic pressure. Most manufacturers include software within the ultrasound system to calculate the resistive index. A good spectral trace from a vessel within the synovial hypertrophy is acquired. The operator selects one or two pulse cycles from within the trace for analysis. RI is a good marker of high flow resistance: under normal circumstances it is 1 and is reduced by angiogenesis induced by synovitis. In contrast to PDUS, resistive index is a physiological parameter and is, therefore, independent of the equipment used and manufacturer’s software. Despite some of the limitations of power Doppler, particularly with regard to serial studies, it is a sensitive measure, which is easy to obtain and broadly reproducible between different operators on the same machine. It appears to correlate reasonably well with contrast-enhanced MRI and clinical findings and allows a rapid assessment, within days, of improvement following treatment.Fig. 15

Bottom Line: The use of colour flow Doppler studies provides a measure of neovascularisation within the synovial lining of joints and tendons, and within tendons themselves, that is not available with other imaging techniques.Disadvantages compared to MRI include small field of view, poor image presentation, and difficulty in demonstrating cartilage and deep joints in their entirety.Magnetic resonance provides a more uniform and reproducible image for long-term follow-up studies.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Nuffield Orthopaedic Centre, Old Road, Oxford OX3 7LD, UK. eugene.mcnally@ndos.ox.ac.uk

ABSTRACT
The aim of this article was to review the current status of ultrasound imaging of patients with rheumatological disorders of the hands and feet. Ultrasound machines with high-resolution surface probes are readily available in most radiology departments and can be used to address important clinical questions posed by the rheumatologist and sports and rehabilitation physician. There is increasing evidence that ultrasound detects synovitis that is silent to clinical examination. Detection and classification of synovitis and the early detection of bone erosions are important in clinical decision making. Ultrasound has many advantages over other imaging techniques with which it is compared, particularly magnetic resonance. The ability to carry out a rapid assessment of many widely spaced joints, coupled with clinical correlation, the ability to move and stress musculoskeletal structures and the use of ultrasound to guide therapy accurately are principal amongst these. The use of colour flow Doppler studies provides a measure of neovascularisation within the synovial lining of joints and tendons, and within tendons themselves, that is not available with other imaging techniques. Disadvantages compared to MRI include small field of view, poor image presentation, and difficulty in demonstrating cartilage and deep joints in their entirety. Contrast-enhanced magnetic resonance provides a better measure of capillary permeability and extracellular fluid than does ultrasound. The ability to image simultaneously multiple small joints in the hands and feet and their enhancement characteristics cannot be matched with ultrasound, though future developments in 3-D ultrasound may narrow this gap. Magnetic resonance provides a more uniform and reproducible image for long-term follow-up studies.

Show MeSH
Related in: MedlinePlus