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Imaging in Rheumatology / Radiology

  • MRI and ultrasonography are highly sensitive modalities and their use can improve diagnostic criteria for e.g. rheumatoid arthritis.

  • As evidence on the predictive validity of early US/MRI findings for radiographic progression and functional outcomes accumulates, US/MRI are employed in outcome assessment in rheumatoid arthritis therapy trials.

  • Reduced ultrasonography joint scores are being developed and validated to improve feasibility of both diagnosis and monitoring in routine clinical care.

Further reading:

Mathew AJ, Danda D, Conaghan PG. "MRI and ultrasound in rheumatoid arthritis," Curr Opin Rheumatol. 2016 Feb 26. [Epub ahead of print] PMID: 26927442

Esperanza Naredo, Lara Valor, Inmaculada De la Torre, et. al. "Predictive Value of Doppler Ultrasound-Detected Synovitis in Relation to Successful Tapering of Biology Therapy in Patients with Rheumatoid Arthritis," Rheumatology (Oxford, England) (Impact Factor: 4.48). 03/2015; 73(Suppl 2). DOI: 10.1093/rheumatology/kev006

Haavardsholm EA, Aga AB, Olsen IC, Hammer HB, Uhlig T, et. al. "Aiming for Remission in Rheumatoid Arthritis: Clinical and Radiographic Outcomes from a Randomized Controlled Strategy Trial Investigating the Added Value of Ultrasonography in a Treat-to-Target Regimen," Arthritis Rheumatol. 2015; 67 (suppl 10).

  • Radiography is an imaging technique that uses x-rays to create images of a region of interest in the body. Ultrasonography (US) is an imaging technique that uses high-frequency ultrasound waves to create images in real time. Computed tomography (CT) is an imaging technique that uses x-rays to create tomographic images. Magnetic resonance imaging (MRI) is an imaging technique that uses magnetism and radiofrequency waves to create tomographic images. Planar scintigraphy, single photon emission computed tomography (SPECT), and positron emission tomography (PET) are the nuclear medicine molecular imaging techniques available. They are used to image the distribution and accumulation of an administered radiotracer in organs/tissues of the body; the spatial distribution and amount of accumulation depend on the properties of the radiotracer and the disease states present in the involved organs.

  • Density, echogenicity, attenuation, and signal intensity are the descriptors of how bright or dark tissues are on radiography, US, CT, and MR images, respectively. Standardized uptake value (SUV) is a quantitative measure of PET radiotracer uptake in a tissue of interest.

  • If fluid has very high signal intensity on an MR image, then the image is likely T2-weighted. If fluid has low signal intensity on an MR image, then the image is likely T1-weighted. An easy reference organ is the signal intensity of cerebrospinal fluid on MR images; if it is bright, then the image is likely a T2-weighted image.


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