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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.

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Related in: MedlinePlus

Moderate synovial thickening (arrowheads) with underlying metacarpal head (MC) erosion (arrow)
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Fig18: Moderate synovial thickening (arrowheads) with underlying metacarpal head (MC) erosion (arrow)

Mentions: The identification of bone erosion is a significant step in the natural history of erosive arthritis. The outcome measurement in rheumatoid arthritis and connective tissue (OMERACT) group has defined bone erosion as an intra-articular discontinuity of the bone surface that is visible in two perpendicular planes. Acute erosions generally have an irregular margin and a poorly defined base, which allows through transmission of sound (Figs. 17 and 18) and are associated with active synovitis. Bone defects that do not have synovitis adjacent to them should be regarded with suspicion, though some may turn out to be true chronic erosions [23]. A common pitfall is the normal depression that is present on the dorsal aspect of the head of the metacarpal. This is smooth, with a clearly defined floor that does not allow through sound transmission and is unassociated with overlying synovitis (Fig. 13).Fig. 17


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

McNally EG - Skeletal Radiol. (2007)

Moderate synovial thickening (arrowheads) with underlying metacarpal head (MC) erosion (arrow)
© Copyright Policy
Related In: Results  -  Collection

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

Fig18: Moderate synovial thickening (arrowheads) with underlying metacarpal head (MC) erosion (arrow)
Mentions: The identification of bone erosion is a significant step in the natural history of erosive arthritis. The outcome measurement in rheumatoid arthritis and connective tissue (OMERACT) group has defined bone erosion as an intra-articular discontinuity of the bone surface that is visible in two perpendicular planes. Acute erosions generally have an irregular margin and a poorly defined base, which allows through transmission of sound (Figs. 17 and 18) and are associated with active synovitis. Bone defects that do not have synovitis adjacent to them should be regarded with suspicion, though some may turn out to be true chronic erosions [23]. A common pitfall is the normal depression that is present on the dorsal aspect of the head of the metacarpal. This is smooth, with a clearly defined floor that does not allow through sound transmission and is unassociated with overlying synovitis (Fig. 13).Fig. 17

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