Ultrasonography and the rheumatologist.
OBJECTIVE
An update of the latest developments in ultrasonography in rheumatology. Indications, technical aspects and representative examples of the potential of ultrasonography are illustrated. Finally, education and training issues are briefly discussed.


RESULTS
Ultrasonography can be used in rheumatology for a wide spectrum of indications including inflammatory arthritis, tendon pathology, bursitis, disease activity monitoring, disease progression monitoring, guided aspiration and guided injections. Latest-generation ultrasonography systems provide a very sensitive assessment of both grayscale and Doppler findings. The quality of results in ultrasonography is conditioned by a series of elements that include the characteristics of the equipment, knowledge of relevant anatomy and pathology, experience of the sonographer, techniques used and patient positioning.


CONCLUSIONS
Ultrasonography is challenging the standards of rheumatological clinical practice. It is more sensitive than clinical examination in the detection of synovitis and more sensitive than conventional radiography in the detection of bone erosions. Ultrasonography-guided injections may improve therapy effectiveness if compared with the traditional blind approach. Three-dimensional ultrasonography with a volumetric probe and the power Doppler mode may represent a very useful tool for therapy monitoring in patients with chronic arthritis.
Grassi
Walter
W
Cattedra di Reumatologia, Università Politecnica delle Marche, Ancona, Italy. walter.grassi@univpm.it
Filippucci
Emilio
E
D006801:Humans; D021621:Imaging, Three-Dimensional; D007249:Inflammation / Q000000981:diagnostic imaging; D012219:Rheumatology / Q000193:education / Q000639:trends*; D013585:Synovitis / Q000000981:diagnostic imaging; D014463:Ultrasonography / Q000592:standards / Q000639:trends*; D018608:Ultrasonography, Doppler