Advances in imaging

Imaging of inflammatory activity is of increasing importance, and among available modalities, ultrasonography and magnetic resonance imaging (MRI) seem to be of highest impact. The present review includes recent studies describing several aspects of these modalities as well as short descriptions of other promising imaging methods in rheumatoid arthritis (RA).

High reliability has been shown for evaluation of ultrasonography still images. Recently excellent reliability was found when an atlas was used as reference for scoring dynamic images with ultrasonography. The optimal number of joints to examine by ultrasonography for follow-up during therapeutic interventions needs to be further explored. Use of ultrasonographic guidance for injections has showed improved clinical results when compared with blind injections. Ultrasonographic pathology, especially power Doppler, was found to be of predictive value in patients with arthritis. Cartilage damage is an important aspect of structural joint damage in RA, and a reliable assessment system of joint space narrowing has been developed for use with conventional MRI, and various biochemical MRI techniques are being developed to visualize cartilage quality, of which delayed gadolinium-enhanced magnetic resonance imaging of cartilage seems to be the most promising method in RA.

Novel imaging modalities, especially ultrasonography and MRI, will be of increasing importance to visualize joint inflammation and aid in the diagnosis, treatment and follow-up of patients with RA.