J Korean Med Sci.  2013 Apr;28(4):497-507. 10.3346/jkms.2013.28.4.497.

Value of Ultrasound in Rheumatologic Diseases

• Kang T
• Horton L
• Emery P
• Wakefield

• KMID: 1786955
• DOI: http://doi.org/10.3346/jkms.2013.28.4.497

Abstract

The use of musculoskeletal ultrasound in rheumatology clinical practice has rapidly increased over the past decade. Ultrasound has enabled rheumatologists to diagnose, prognosticate and monitor disease outcome. Although international standardization remains a concern still, the use of ultrasound in rheumatology is expected to grow further as costs fall and the opportunity to train in the technique improves. We present a review of value of ultrasound, focusing on major applications of ultrasound in rheumatologic diseases.

Keyword

Rheumatology Ultrasound; Musculoskeletal Ultrasound; Doppler; Arthritis

MeSH Terms

Humans
Magnetic Resonance Imaging
Musculoskeletal System/ultrasonography
Osteoarthritis/ultrasonography
Rheumatic Diseases/*ultrasonography
Sjogren's Syndrome/ultrasonography
Spondylarthropathies/ultrasonography
Synovitis/ultrasonography
Tendinopathy/ultrasonography
Vasculitis/ultrasonography

Figure

• 

  Fig. 1 Ultrasound images of joints and peri-articular tissue showing typical signs of common rheumatologic diseases. (A) Longitudinal dorsal scan of the tibiotalar joint. A large ankle joint effusion with synovial proliferation (arrows) is seen. (B) Transverse and longitudinal scan of 3rd extensor tendon at dorsum of metacarpophalangeal joint showing tendinopathy represented as swelling of tendon sheath (arrow) in both plane. (C) In the transverse anterior scan of shoulder at 90° internal rotation, bony erosion (arrow) is seen. (D) MSD crystals are deposited within tendon sheath, causing tenosynovitis of extensor tendons. The high sparkling reflectivity of MSD crystals can make it easier to be detected and can be differentiated from synovial proliferation. (E) The sonographic double contour sign (arrow) is seen by the deposition of MSD crystals in the cartilage surface layers of knee joint. It is also characterized by angle independency (not demonstrated). (F) Achilles tendon near calcaneal insertion shows focal increased thickness and loss of fibrillar structures (arrow).

• 

  Fig. 2 Assessment of inflammatory activity can be achieved with power Doppler. (A, B) These are two longitudinal dorsal views through the wrist joint. Both show moderate levels of gray scale and power Doppler abnormalities consistent with active joint disease.

• 

  Fig. 3 Osteophyte usually appears as elevated small bony prominence (arrow) at the end of normal bone contour, close to joint space (A). It usually does not show Doppler signal (B).

• 

  Fig. 4 Ultrasound guided intra-articular injection of 3rd proximal interphalageal joint of hand. (A) The tip and shaft of metallic needle (arrows) can be easily identified. (B) The crystalline steroid suspension can be observed on the screen as fine hyperechoic clouds or spots (arrow), which can increase the accuracy of injection.

• 

  Fig. 5 Transverse view of the parotid gland in a patient with primary Sjögren syndrome. Affected glands can show parenchymal inhomogenecity with multiple oval shaped small hypoechoic changes (courtesy of Sandrine Jousse-Joulin).

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  Fig. 6 Elastography of wrist joint. In the left image, longitudinal gray scale image over the ulnocarpal area in rheumatoid arthritis patient shows loss of fibrillar pattern and peritendinous synovial proliferation (arrows). In the right elastography image, tissue elasticity was displayed using colours. The hard tissue areas are seen as blue and soft tissue areas are seen as red colour. Swollen tendon regions in the gray scale are seen as red in the elastography (arrow), representing the decreased elasticity (hardness) of this region due to tendinopathies affected by rheumatoid arthritis.

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