High-resolution Ultrasound in Osteoarthritis – State of the Art

Ingrid Möller, David A Bong
European Musculoskeletal Review, 2012;7(1):33-7
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Abstract

High-resolution musculoskeletal ultrasound (US) is a well-accepted imaging technique that shows the structural and inflammatory pathology of osteoarthritis (OA) and the soft tissues surrounding the involved cartilage, including the synovium, joint capsule, retinacular support structures, tendons, ligaments, muscles, nerves, fibro-cartilaginous structures and adjacent bony cortex. Inflammation of the synovium is a relevant feature in patients with OA. Early osteophytic bone changes in the OA joint are detected by US as an elevation of the bony cortex (‘step-up lesion’) with hyperechoic signal where the joint capsule attaches to the bony margin. Degeneration of the cartilage is one of the most representative structural changes in the OA joint. This abnormality can be demonstrated by US. Central erosion is the hallmark of erosive OA and affects the cartilage and subchondral bone in the central portion of the joint. US as a monitoring tool in OA detects changes after therapeutic intervention. The ability to quantify US images has resulted in many different scoring and grading methods to evaluate OA activity. US continues to evolve from a technical viewpoint.
Keywords
High-resolution ultrasound, osteoarthritis, synovitis, cartilage, osteophyte, monitoring osteoarthritis
Disclosure The authors have no conflicts of interest to declare.
Received: December 02, 2011 Accepted January 19, 2012
Correspondence: David A Bong, Barcelona Sonoanatomy Group, C/ Castanyer 15, 08022 Barcelona, Spain. E: bcnsonoanatomy@gmail.com

Osteoarthritis (OA) is the most common form of arthritis.1 OA is characterised by degeneration of hyaline cartilage, low-grade inflammation of the synovial tissue, alteration of subchondral bone and bony overgrowth in the form of osteophytes. The structural and biomechanical modifications within the osteoarthritic joint impact the structure and function of the periarticular tissues, such as ligaments, muscles, retinacula and tendons and vice versa and, therefore, should be considered as an integral part of the disease. The end result of this pervasive involvement is pain and functional impairment.

The multiple manifestations of this disease coupled with our ignorance of the underlying pathophysiology pose a challenge when attempting to discern which of these features is the most relevant in giving us a reliable and sensitive window through which we can effectively visualise disease onset, monitor disease progression and evaluate response to therapeutic intervention. At this point, there are no validated serum biomarkers, as in rheumatoid arthritis (RA), and we must rely on the subjective interpretation of pain by patients and examiners and insensitive physical and radiographic findings that frequently are a manifestation of advanced disease. These current ‘state-of-the-art’ parameters, along with conventional radiography (CR), which confirms the structural changes, have been used to evaluate patients in clinical trials, with varying effectiveness. This is not surprising, because the most important end organ, the cartilage, is not well seen on CR and lacks pain innervation.

High-resolution musculoskeletal ultrasound (US) is a well-accepted imaging technique that shows the soft tissues that surround the involved joint cartilage, including the synovium, joint capsule, retinacular support structures, tendons, ligaments, muscles, nerves, fibro-cartilaginous structures and adjacent bony cortex (see Figure 1). A thorough understanding of sonoanatomy is essential and provides the basis for evaluation of normal and pathological tissues.2,3 US can be used to show early structural changes and assess disease severity. In addition, Newman et al.,4 as early as 1994, stressed the importance of power Doppler (PD) US to detect soft tissue hyperaemia, one of the cardinal features of synovial inflammation. Soft tissue hyperaemia plays a role in the pathophysiology and assessment of OA disease activity. US is low cost, increasingly available and has a high acceptability among patients. US allows repeated examinations and is therefore an effective tool in monitoring disease activity and provides safe and effective guidance for both diagnostic and therapeutic interventions.

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