Resumen de Imaging in rheumatology – recent advances

Kanimozhi Vendhan, Margaret A. Hall Craggs

• Magnetic resonance imaging (MRI) and ultrasound scanning are being used increasingly for the early diagnosis of arthropathies. Substantial advances in hardware and software in both MRI and ultrasound have led to increased image spatial resolution. Novel MR techniques such as dGEMRIC and sodium MRI are used for the physiologic imaging of articular cartilage. These offer the potential for the diagnosis of early osteoarthritis and for assessment following treatment. Sequences such as MAVRIC and SEMAC facilitate imaging around metallic implants. Whole-body MRI is useful in the assessment of multifocal and systemic rheumatic diseases.

  Conventionally, morphological MRI has been used to assess inflammatory joint disease. In rheumatoid arthritis, the diseased joints show proliferative synovitis on MRI. In axial and peripheral spondyloarthropathies, sacroiliitis is a common feature. MR findings in acute sacroiliitis include subchondral bone marrow oedema, synovitis, capsulitis and enthesitis.

  Ultrasound scanning has the advantage of being low cost and provides dynamic imaging. On an ultrasound scan, proliferative synovitis is seen as distension of the joint capsule by hypoechoic tissue with increased blood flow on Doppler imaging. Ultrasound scanning is excellent for the detection of peripheral enthesitis, a feature of seronegative arthropathies.