Imaging in rheumatology has evolved dramatically, from simple radiography (the mainstay of structural assessment) through to the latest advances in musculoskeletal MRI and ultrasonography. Noninvasive diagnosis of a wide range of rheumatic diseases (including rheumatoid arthritis, osteoarthritis and gout) relies on imaging, and this approach is often crucial to the early detection of rheumatic disease. Furthermore, imaging has emerged as an important tool to monitor disease activity, especially in the assessment of the efficacy of therapeutic approaches. This Collection of articles covers key aspects and developments in imaging in rheumatology for both rheumatologists and radiologists as a resource for those interested in improving the noninvasive diagnosis and assessment of rheumatic diseases.
Image courtesy of Michiel Peters, Joop van den Bergh, Astrid van Tubergen and Piet Geusens, Maastric University Medical Centre, Maastrict, Netherlands, and Bert van Rietbergen, Technische Universiteit Eindhoven, Netherlands. 3D reconstruction from micro-CT images of proximal interphalangeal joint of a cadaveric index finger, with segmentation of the cortical (purple) and trabecular (red) bone, and cortical discontinuities (green).
REVIEWS
High-resolution in vivo imaging of bone and joints: a window to microarchitecture
Piet Geusens, Roland Chapurlat, Georg Schett, Ali Ghasem-Zadeh, Ego Seeman, Joost de Jong & Joop van den Bergh
doi:10.1038/nrrheum.2014.23
Nature Reviews Rheumatology 10, 304-313 (2014)
High-resolution peripheral quantitative CT (HR pQCT) has emerged as a unique way to evaluate bone and joints, by producing high-resolution, 3D images of cortical and trabecular bone in vivo. In this Review, the authors describe how HR pQCT is used in the evaluation of bone and joint diseases, together with an evaluation of its technical features, advantages, limitations, and potential in basic research, clinical trials and clinical practice.
Musculoskeletal ultrasonography in patients with rheumatoid arthritis
Sarah Ohrndorf & Marina Backhaus
doi:10.1038/nrrheum.2013.73
Nature Reviews Rheumatology 9, 433-437 (2013)
Musculoskeletal ultrasonography is widely used for evaluating patients with RA and these imaging techniques can also allow the comparison of therapeutic agents, as well as monitoring patient response to treatment. Here, Ohrndorf and Backhaus describe the ultrasonographic features that can be used as predictive markers, and the ultrasonographic scores that can be used to reflect overall RA disease activity.
MRI-based semiquantitative scoring of joint pathology in osteoarthritis
Ali Guermazi, Frank W. Roemer, Ida K. Haugen, Michel D. Crema & Daichi Hayashi
doi:10.1038/nrrheum.2012.223
Nature Reviews Rheumatology 9, 236-251 (2013)
Semiquantitative MRI-based scoring of joint pathology is a powerful tool in osteoarthritis (OA) research, which provides valuable information on the natural history of the disease and can be used in outcome measures. Herein, the authors discuss approaches to semiquantitative MRI-based scoring of OA features and review the scoring systems currently available for whole-joint and feature-specific assessment of knee, hand, hip, spine and shoulder OA.
Emerging optical and nuclear medicine imaging methods in rheumatoid arthritis
James M. Mountz, Abass Alavi & John D. Mountz
doi:10.1038/nrrheum.2012.148
Nature Reviews Rheumatology 8, 719-728 (2012)
Noninvasive biomolecular imaging techniques, such as thermography, near-infrared imaging, PET and single photon emission CT (SPECT), can be used to detect the earliest biological and physiological changes that are associated with rheumatoid arthritis (RA). The authors describe these new imaging approaches, which could enable targeted intervention in early RA before the occurrence of irreversible joint damage.
Meniscus pathology, osteoarthritis and the treatment controversy
Martin Englund, Frank W. Roemer, Daichi Hayashi, Michel D. Crema & Ali Guermazi
doi:10.1038/nrrheum.2012.69
Nature Reviews Rheumatology 8, 412-419 (2012)
Loss of meniscal function is one of the strongest identified risk factors for knee osteoarthritis (OA). However, the best therapeutic strategy for patients with meniscus damage remains controversial. The authors explain the role of meniscus pathology in OA and discuss the current options for treatment of degenerative and traumatic meniscal tears.
Advances and challenges in imaging in juvenile idiopathic arthritis
Silvia Magni-Manzoni, Clara Malattia, Stefano Lanni & Angelo Ravelli
doi:10.1038/nrrheum.2012.30
Nature Reviews Rheumatology 8, 329-336 (2012)
Imaging modalities are vital for the accurate assessment of joint disease. In this Review, the authors focus on imaging in paediatric rheumatic disease, which presents unique challenges. They discuss the utility and limitations of various imaging techniques—including MRI, ultrasonography and conventional radiography—in the assessment and treatment of children with juvenile idiopathic arthritis.
Diagnosis and classification in spondyloarthritis: identifying a chameleon
Astrid van Tubergen & Ulrich Weber
doi:10.1038/nrrheum.2012.33
Nature Reviews Rheumatology 8, 253-261 (2012)
The heterogeneity and interrelatedness of the conditions comprising spondyloarthritis (SpA) complicate diagnosis and patient classification; however, a number of criteria sets have been developed to aid these processes. Here, the authors critically review the currently available SpA classification criteria and highlight the important part that MRI will play in facilitating early diagnosis of this disease.
Imaging modalities for the diagnosis of pulmonary hypertension in systemic sclerosis
Theodoros Dimitroulas, Sophie Mavrogeni & George D. Kitas
doi:10.1038/nrrheum.2012.2
Nature Reviews Rheumatology 8, 203-213 (2012)
Patients with systemic sclerosis (SSc) are at considerable risk of developing pulmonary arterial hypertension, which has a dramatic impact on the natural history of the disease and overall survival of the patient. Modern imaging modalities, such as novel echocardiographic techniques and cardiac MRI, are highly sensitive, quantitative and reproducible methods that allow noninvasive assessment of regional and global myocardial performance without relying on geometric assumptions. In this Review, the authors describe the standard clinical tests and evolving technologies, which can provide comprehensive and quantitative data on myocardial status that are useful in the clinical management and evaluation of patients with SSc.
Validated methods for assessment of subclinical atherosclerosis in rheumatology
György Kerekes, Pál Soltész, Michael T. Nurmohamed, Miguel A. Gonzalez-Gay, Maurizio Turiel, Edit Végh, Yehuda Shoenfeld, Iain McInnes & Zoltán Szekanecz
doi:10.1038/nrrheum.2012.16
Nature Reviews Rheumatology 8, 224-234 (2012)
Rheumatoid diseases such as rheumatoid arthritis are associated with accelerated atherosclerosis, increased cardiovascular morbidity and mortality. The early signs of cardiovascular disease therefore need to be recognized in these patients so that effective cardiovascular protection can be introduced. In this Review the authors discuss validated techniques that are currently available to determine subclinical atherosclerosis in patients with rheumatic conditions.
Mechanisms of joint damage in gout: evidence from cellular and imaging studies
Fiona M. McQueen, Ashika Chhana & Nicola Dalbeth
doi:10.1038/nrrheum.2011.207
Nature Reviews Rheumatology 8, 173-181 (2012)
Advances in the fields of cell biology and imaging have allowed researchers to dig deeper into the underlying mechanisms of joint damage in patients with tophaceous gout. This Review describes some of the recent advances in our understanding of bone erosion and cartilage damage in this disease.
PERSPECTIVES
Timeline: Progress in imaging in rheumatology
Emilio Filippucci, Luca Di Geso & Walter Grassi
doi:10.1038/nrrheum.2014.145
Nature Reviews Rheumatology, advance online publication, Published online: 9 September 2014
Diagnostic imaging in rheumatology has become an important feature of the management of a variety of rheumatic diseases. This Timeline Perspectives charts the progress in the field of imaging in rheumatology over the past few decades, with particular emphasis on developments in radiography, MRI and ultrasonography.
Opinion: Perspectives on imaging in axial spondyloarthritis
Xenofon Baraliakos & Jürgen Braun
doi:10.1038/nrrheum.2013.83
Nature Reviews Rheumatology 9, 498-502 (2013)
Imaging is central for the classification and diagnosis of axial spondyloarthritis, as well as for monitoring disease progression and predicting response to treatment. Xenofon Baraliakos and Jürgen Braun provide an overview of the role of imaging for patients with axial spondyloarthritis and discuss how imaging techniques might influence research and clinical practice in the future.
Recent advances in osteoarthritis imaging—the Osteoarthritis Initiative
Felix Eckstein, Wolfgang Wirth & Michael C. Nevitt
doi:10.1038/nrrheum.2012.113
Nature Reviews Rheumatology 8, 622-630 (2012)
Research in osteoarthritis (OA) is among the most collaborative in rheumatology, and the Osteoarthritis Initiative is championing efforts to pool expertise and data in imaging studies in OA. The rationale for, undertaking of, and emerging results from this project are outlined in this Perspectives article, with an emphasis on how they will advance the understanding and treatment of OA.
What is the clinical relevance of erosions and joint space narrowing in RA?
Siri Lillegraven, Désirée van der Heijde, Till Uhlig, Tore K. Kvien & Espen A. Haavardsholm
doi:10.1038/nrrheum.2011.202
Nature Reviews Rheumatology 8, 117-120 (2012)
Radiographic joint damage is strongly associated with disability in patients with rheumatoid arthritis, but the relative importance of the two major measures of radiographic damage—bone erosions and joint space narrowing—is not clearly understood. In this article, the authors discuss this issue, and describe how imaging modalities that allow detailed visualization of cartilage might lead to improved understanding.
NEWS & VIEWS
Imaging: Diagnostic value of ultrasonography in Sjögren's syndrome
Andreas V. Goules & Athanasios G. Tzioufas
doi:10.1038/nrrheum.2014.86
Nature Reviews Rheumatology 10, 450-452 (2014)
Rheumatoid arthritis: Is imaging needed to define remission in rheumatoid arthritis?
Mikkel Østergaard & Signe Møller-Bisgaard
doi:10.1038/nrrheum.2014.63
Nature Reviews Rheumatology 10, 326-328 (2014)
Imaging: Whole-body MRI in RA: do we still need the rheumatologist?
Wolfgang A. Schmidt
doi:10.1038/nrrheum.2014.7
Nature Reviews Rheumatology 10, 130-132 (2014)
Imaging: Ultrasonography to detect hand and wrist involvement in SSc
Jelena Blagojevic & Marco Matucci-Cerinic
doi:10.1038/nrrheum.2013.179
Nature Reviews Rheumatology 9, 700-701 (2013)
Imaging: Bone erosions in rheumatoid arthritis: better to see more?
Piet P. M. Geusens & Stephanie Finzel
doi:10.1038/nrrheum.2013.89
Nature Reviews Rheumatology 9, 385-386 (2013)
Rheumatoid arthritis: Diagnosis of RA—we have a dream
Walter Grassi & Emilio Filippucci
doi:10.1038/nrrheum.2013.39
Nature Reviews Rheumatology 9, 202-204 (2013)
YEAR IN REVIEW
Imaging in rheumatology in 2013: From images to data to theory
Felix Eckstein & C. Kent Kwoh
doi:10.1038/nrrheum.2013.198
Nature Reviews Rheumatology 10, 69-70 (2014)
Gout in 2013: Imaging, genetics and therapy: gout research continues apace
Fiona M. McQueen
doi:10.1038/nrrheum.2013.164
Nature Reviews Rheumatology 10, 67-69 (2014)
Spondyloarthritis in 2012: Advances in pathogenesis through animal models and imaging
Walter P. Maksymowych
doi:10.1038/nrrheum.2012.233
Nature Reviews Rheumatology 9, 72-74 (2013)
RESEARCH HIGHLIGHTS
Crystal arthritis: Tendon damage in gout—a role for MSU crystals?
Katrina Ray
doi:10.1038/nrrheum.2014.65
Nature Reviews Rheumatology 10, 321 (2014)
Diagnosis: Dual-energy CT and ultrasound compared for gouty arthritis
doi:10.1038/nrrheum.2013.172
Nature Reviews Rheumatology 9, 696 (2013)
Rheumatoid arthritis: Assessment of CVD in patients with RA by strain imaging
Emma Leah
doi:10.1038/nrrheum.2013.117
Nature Reviews Rheumatology 9, 506 (2013)
Rheumatoid arthritis: MRI points to inflammation as source of cartilage damage
Emma Leah
doi:10.1038/nrrheum.2013.76
Nature Reviews Rheumatology 9, 319 (2013)
Imaging: Colour Doppler ultrasonography in inflammatory disease
doi:10.1038/nrrheum.2013.65
Nature Reviews Rheumatology 9, 320 (2013)
Imaging: MRI for monitoring cartilage loss in patients with RA
doi:10.1038/nrrheum.2013.50
Nature Reviews Rheumatology 9, 259 (2013)
Imaging: MRI cannot detect favourable outcome in sciatica
doi:10.1038/nrrheum.2013.52
Nature Reviews Rheumatology 9, 259 (2013)
Connective tissues diseases: Imaging technology acts as a 'virtual skin biopsy' in SSc
Jenny Buckland
doi:10.1038/nrrheum.2013.37
Nature Reviews Rheumatology 9, 196 (2013)
Spondyloarthropathies: No advantage of gadolinium in spondyloarthritis detection
doi:10.1038/nrrheum.2013.32
Nature Reviews Rheumatology 9, 196 (2013)
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