Arthritis Images
Rheumatoid Arthritis? by Buy
Despite the improved sensitivity of newer methods, conventional radiography remains the dominant imaging method for RA evaluation. Radiography can provide excellent detail of osseous erosions, joint space narrowing, and periarticular osteopenia, but only after the clinical symptoms have been present for several months or even years. Furthermore, radiography is considered a relatively insensitive means to measure changes of RA. Conventional radiography may appear negative for a period of 6 to 12 months after the onset of disease, and in as many as 25% of RA patients no radiographic erosions are seen for as long as 5 years. The lack of radiologic erosions has unfortunately been used to exclude patients from clinical trials or the initiation of antirheumatic drugs.
Patients suffering from RA would greatly benefit from early detection and treatment of disease. MRI and ultrasonography are being used successfully to detect early RA-related changes in patients and preclinical animal models. MRI allows early detection of osseous and soft tissue changes in RA, including joint effusions, synovitis,
tenosynovitis, tendon/ligament damage, bone marrow signal changes, and cartilage destruction; and it is currently considered the superior method in the evaluation of this disease.4-7 MRI can be applied to the analysis of relatively early changes and chronic periods of the disease. Gadolinium-enhanced MRI allows detection of synovitis with great sensitivity and aids in the differentiation of soft tissue inflammation and a joint effusion.
High-frequency ultrasonography (7.5-10 MHz for conventional studies and 20 MHz for fine detail musculoskeletal work), which can detect synovial thickening, and power Doppler ultrasonography, which indirectly measures hyperemia related to capillary flow, have been used to assess the thickened, hypervascularized synovium of the inflamed small joints of the hands and feet in RA. Ultrasound evaluation is believed to have superior sensitivity to MRI with regard to the detection of effusions and tenosynovial fluid but is inferior to MRI in the assessment of synovitis, tendon/ ligament damage, and bone erosions.8 Ultrasonography is particularly useful during earlier stages of disease and serves as a relatively accessible and inexpensive procedure using nonionizing radiation to assess small joints.
Radionuclide techniques can also be used to detect early changes of RA. By specifically