Table 2.
Comparison of radiographic imaging, magnetic resonance imaging and musculoskeletal ultrasound techniques in imaging the joint manifestations of rheumatoid arthritis and systemic lupus erythematosus
| Joint manifestations of RA and SLE | Radiographic imaging | Magnetic resonance imaging | Musculoskeletal ultrasound |
|---|---|---|---|
| Synovitis visualization | No | Yes | Yes |
| Tenosynovitis visualization | No | Yes | Yes |
| Bursitis visualization | No | Yes | Yes |
| Joint effusion visualization | Yes | Yes | Yes |
| Bone erosion visualization | Yes, but not in early disease | Yes | Yes |
| Bone marrow edema (BME) | No | Yes | No |
| Joint space narrowing | Yes | Yes | Yes |
| Advantages |
- Gold standard for the detection of radiographical progression in RA - Reproducible - Detects bone erosion and joint space narrowing in advanced disease |
- More sensitive than radiographic imaging - Does not use ionizing radiation - Useful for detecting changes in early disease - MRI measures are sensitive to changes in synovitis, tenosynovitis and BME scores - Can detect bone marrow abnormalities |
- Low cost - Non-invasive - Does not use ionizing radiation - More sensitive than radiographic imaging for detecting erosions (especially in early RA and SLE) - Allows detection of joint inflammation in pre- or early RA and SLE - Can assess multiple locations in one examination |
| Disadvantages |
- Low sensitivity for early inflammatory changes - Cannot detect soft tissue inflammation - Use of ionizing radiation |
- Low-grade abnormalities seen by MRI can be observed in healthy individuals - Generally, MRI assessment is restricted to one location - High cost |
- Low-grade synovitis can be detected in healthy individuals - Cannot visualize bone erosions as well as MRI due to restrictions of the position of the probe and access to all cartilage surfaces - Cannot detect BME - Reproducibility is operator dependent |
The joint manifestations that can be detected by radiographic imaging, MRI and MSUS and the advantages and disadvantages of each imaging technique are summarized. Data from [6, 49, 50, 66, 102–104]
BME Bone marrow edema, MRI magnetic resonance imaging, MSUS musculoskeletal ultrasound, RA rheumatoid arthritis, SLE systemic lupus erythematosus