SP0149 How to implement technical improvements in existing imaging modalities in clinical practice: Ultrasonography
Authors: E. Filippucci
Journal: Annals of the Rheumatic Diseases (2013)

The value of ultrasound in rheumatology is supported by a consistent body of evidence. The number of studies has progressively increased documenting the interest for this imaging tool especially in the assessment of patients with chronic inflammatory arthritis (1,2). More than ten years have passed since ultrasonography was described as an evolving technique, and at present ultrasound equipment keeps on evolving. Probes with very high frequency (up to 22 MHz in greyscale and 14.3 MHz of Doppler frequency), volumetric probes with high-resolution linear transducers, fusion imaging, and dedicated software for automatic assessment of specific findings (such as intima media thickness at common carotids) are only the most representative technological developments which have already found an application in rheumatology described in recent publications (3-11). New applications for research and clinical practice include the detection of submillimetric abnormalities at both joint and tendon levels in patients with early arthritis, the identification of very superficial tissues involvement due to changes of morphology, echostructure, elasticity, and perfusional status at dermal level in patients with psoriatic arthritis and systemic sclerosis, and the visualization of normal intra-articular blood flow in healthy subjects. While hardware and software advances have been developed with the aim to improve ultrasound diagnostic abilities, the delay of the standardization process of musculoskeletal ultrasound in rheumatology was the main side effect. In the near future, the high quality imaging of the current top systems will be available in portable machines, the quality-cost of the US equipment will keep on improving, and the connectivity between US machines and other systems will be enhanced and real-time streaming of ultrasound imaging will become of common use (12). 1. Grassi W, Cervini C. Ultrasonography in rheumatology: an evolving technique. Ann Rheum Dis 1998;57:268-71. 2. Meenagh G, et al. Ultrasonography in rheumatology: developing its potential in clinical practice and research. Rheumatology 2007;46:3-5. 3. Gutierrez M, et al. Differential diagnosis between rheumatoid arthritis and psoriatic arthritis: the value of ultrasound findings at metacarpophalangeal joints level. Ann Rheum Dis 2011;70:1111-4. 4. Gutierrez M, et al. Development of a preliminary US power Doppler composite score for monitoring treatment in PsA. Rheumatology 2012 (in press). 5. Gutierrez M, et al. High-frequency sonography in the evaluation of psoriasis: nail and skin involvement. J Ultrasound Med 2009;28:1569-74. 6. Filippucci E, et al. Interobserver reliability of ultrasonography in the assessment of cartilage damage in rheumatoid arthritis. Ann Rheum Dis 2010;69:1845-8. 7. Filippucci E, et al. Ultrasound imaging for the rheumatologist. XIII. New trends. Three-dimensional ultrasonography. Clin Exp Rheumatol 2008;26:1-4. 8. Di Geso L, et al. Comparison between conventional and automated software-guided ultrasound assessment of bilateral common carotids intima-media thickness in patients with rheumatic diseases. Clin Rheumatol 2012 (in press). 9. Naredo E, et al. Multi-examiner reliability of automated radio frequency-based ultrasound measurements of common carotid intima-media thickness in rheumatoid arthritis. Rheumatology 2011;50:1860-4. 10. Iagnocco A, et al. Magnetic resonance and ultrasonography real-time fusion imaging of the hand and wrist in osteoarthritis and rheumatoid arthritis. Rheumatology 2011;50:1409-13. 11. Di Geso L, et al. Reliability of ultrasound measurements of dermal thickness at digits in systemic sclerosis: role of elastosonography. Clin Exp Rheumatol 2011;29:926-32. 12. Liteplo AS, et al. Real-time video streaming of sonographic clips using domestic internet networks and free videoconferencing software. J Ultrasound Med 2011;30:1459-66. Disclosure of Interest None Declared