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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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A synovial mass (arrowheads) undergoing biopsy. Ultrasound allows accurate placement of a small biopsy needle within the synovial tissue
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Fig21: A synovial mass (arrowheads) undergoing biopsy. Ultrasound allows accurate placement of a small biopsy needle within the synovial tissue

Mentions: The current literature suggests that ultrasound is superior to MRI at detecting small quantities of fluid within the joint. There may be improved detection of erosions at the proximal interphalangeal joints and in the wrist and, although ultrasound struggles with some areas of MCP joints, particularly the radial and ulnar aspects of the fourth finger, overall erosion detection by US at the MCPJs is comparable to that by MRI [38]. US demonstrates angioneogenesis in active synovitis directly (Fig. 19), whereas MRI requires injection of contrast medium. US is a dynamic technique; the examination can be tailored to include further involved joints following an up-to-date history with the patient present There are fewer problems with asymptomatic abnormalities, as these can be clinically correlated during the examination. Unlike MR, US is readily suited to guiding intervention, such as small joint injection or synovial biopsy (Figs. 20, 21). There is also increasing evidence that patients prefer ultrasound to MRI [48]. This may be related to claustrophobia but equally to the human interaction that occurs during an ultrasound examination.Fig. 19


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

McNally EG - Skeletal Radiol. (2007)

A synovial mass (arrowheads) undergoing biopsy. Ultrasound allows accurate placement of a small biopsy needle within the synovial tissue
© Copyright Policy
Related In: Results  -  Collection

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

Fig21: A synovial mass (arrowheads) undergoing biopsy. Ultrasound allows accurate placement of a small biopsy needle within the synovial tissue
Mentions: The current literature suggests that ultrasound is superior to MRI at detecting small quantities of fluid within the joint. There may be improved detection of erosions at the proximal interphalangeal joints and in the wrist and, although ultrasound struggles with some areas of MCP joints, particularly the radial and ulnar aspects of the fourth finger, overall erosion detection by US at the MCPJs is comparable to that by MRI [38]. US demonstrates angioneogenesis in active synovitis directly (Fig. 19), whereas MRI requires injection of contrast medium. US is a dynamic technique; the examination can be tailored to include further involved joints following an up-to-date history with the patient present There are fewer problems with asymptomatic abnormalities, as these can be clinically correlated during the examination. Unlike MR, US is readily suited to guiding intervention, such as small joint injection or synovial biopsy (Figs. 20, 21). There is also increasing evidence that patients prefer ultrasound to MRI [48]. This may be related to claustrophobia but equally to the human interaction that occurs during an ultrasound examination.Fig. 19

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