Aktuelle Rheumatologie 2017; 42(05): 377-384
DOI: 10.1055/s-0042-108722
Übersichtsarbeit
Georg Thieme Verlag KG Stuttgart · New York

Ultraschall peripherer Gelenke und des Achsenskeletts

Ultrasound of Peripheral Joints and the Spine
D. Scheicht
1   Rheumatologie, Krankenhaus Porz am Rhein, Köln
,
J. Strunk
1   Rheumatologie, Krankenhaus Porz am Rhein, Köln
,
W. Hartung
2   Rheumatologie und Klinische Immunologie, Asklepios Klinik, Bad Abbach
› Author Affiliations
Further Information

Publication History

Publication Date:
18 September 2017 (online)

Zusammenfassung

Die Sonografie von Gelenken und periartikulären Strukturen ist heute zu einem festen Bestandteil der rheumatologischen Diagnostik geworden. Besonders in der Diagnostik der frühen Arthritis und der Differenzialdiagnostik bei unklaren klinischen Befunden besteht aufgrund der hohen Sensitivität hinsichtlich entzündlicher Veränderungen an Knochen und Weichteilen eine wichtige Bedeutung. Weiterhin hat die Gelenkultraschalluntersuchung einen festen Stellenwert im Therapiemonitoring und der Prognoseabschätzung.

Abstract

Musculoskeletal ultrasound of the peripheral joints and the periarticular structures is an important diagnostic tool in rheumatology today. This method exhibits high sensitivity for the detection of inflammatory changes of the bone and soft tissue. Therefore, it plays an important role in the diagnosis of early arthritis and in differential diagnosis in ambivalent clinical findings. Furthermore, it has significant value in therapy monitoring and estimation of prognosis.

 
  • Literatur

  • 1 Karim Z, Wakefield RJ, Conaghan PG. et al. The impact of ultrasonography on diagnosis and management of patients with musculoskeletal conditions. Arthritis Rheum 2001; 44: 2932-2933
  • 2 Feleppa EJ, Alam SK, Deng CX. Emerging ultrasound technologies for early markers of disease. Dis Markers 2002; 18: 249-268
  • 3 Strunk J, Backhaus M, Schmidt W. et al. Farbdopplersonographie bei der Untersuchung peripherer Gelenke und Sehnen. Z Rheumatol 2010; 69: 164-170
  • 4 Hartung W, Backhaus M, Ohrndorf S. Joint sonography in rheumatology. Z Rheumatol 2013; 72: 791-801 quiz 802–803
  • 5 Backhaus M, Burmester GR, Gerber T. et al. Guidelines for musculoskeletal ultrasound in rheumatology. Ann Rheum Dis 2001; 60: 641-649
  • 6 Grassi W, Filippucci E. Ultrasonography and the rheumatologist. Curr Opin Rheumatol 2007; 19: 55-60
  • 7 Naredo E, Cabero F, Beneyto PCA. A randomized comparative study of short term response to blind injection versus sonographic-guided injection of local corticosteroids in patients with painful shoulder. J Rheumatol 2004; 31: 308-314
  • 8 D’Agostino M-A, Ayral X, Baron G. et al. Impact of ultrasound imaging on local corticosteroid injections of symptomatic ankle, hind-, and mid-foot in chronic inflammatory diseases. Arthritis Care Res 2005; 53: 284-292
  • 9 Schmidt WA, Schmidt H, Schicke B. et al. Standard reference values for musculoskeletal ultrasonography. Ann Rheum Dis 2004; 63: 988-994
  • 10 Guillén Astete CA, Boteanu A, Mendoza AZ. Comparison of Prevalence of Synovitis by Ultrasound Assessment in Subjects Exposed or Not to Self-Reported Physical Overexertion: The Monday’s Synovitis. Scientific Wold Journal. 2014; 563981
  • 11 Witt M, Mueller F, Nigg A. et al. Relevance of Grade 1 Gray-Scale Ultrasound Findings in Wrists and Small Joints to the Assessment of Subclinical Synovitis in Rheumatoid Arthritis. Arthritis Rheum 2013; 65: 1694-1701
  • 12 Sattler H, Schmidt KL. Status of arthrosonography in rheumatologic diagnosis: examination technic, findings and their interpretation. I. The elbow joint. Z Rheumatol 1986; 45: 1-6
  • 13 Wakefield RJ, Balint PV, Szkudlarek M. et al. Musculoskeletal Ultrasound Including Definitions for Ultrasonographic Pathology. J Rheumatol 2005; 32: 10-13
  • 14 Schmidt WA. Ultrasound in Rheumatology. Int J Rheum Dis 2014; 17: 711-715
  • 15 Peace KAL, Lee JC, Healy J. Imaging the infrapatellar tendon in the elite athlete. Clin Radiol 2006; 61: 570-578
  • 16 Scheel AK, Hermann KGa, Kahler E. et al. A novel ultrasonographic synovitis scoring system suitable for analyzing finger joint inflammation in rheumatoid arthritis. Arthritis Rheum 2005; 52: 733-743
  • 17 Szkudlarek M, Court-Payen M, Jacobsen S. et al. Interobserver agreement in ultrasonography of the finger and toe joints in rheumatoid arthritis. Arthritis Rheum 2003; 48: 955-962
  • 18 Bruyn GaW, Hanova P, Iagnocco A. et al. Ultrasound definition of tendon damage in patients with rheumatoid arthritis. Results of a OMERACT consensus-based ultrasound score focussing on the diagnostic reliability. Ann Rheum Dis 2014; 1929-1934
  • 19 Døhn UM, Ejbjerg BJ, Court-Payen M. et al. Are bone erosions detected by magnetic resonance imaging and ultrasonography true erosions? A comparison with computed tomography in rheumatoid arthritis metacarpophalangeal joints. Arthritis Res Ther 2006; 8: R110
  • 20 Baillet A, Gaujoux-Viala C, Mouterde G. et al. Comparison of the efficacy of sonography, magnetic resonance imaging and conventional radiography for the detection of bone erosions in rheumatoid arthritis patients: a systematic review and meta-analysis. Rheumatology 2011; 50: 1137-1147
  • 21 Schmidt WA, Volker L, Zacher J. et al. Colour doppler ultrasonography to detect pannus in knee joint synovitis. Clin Exp Rheumatol 2000; 18: 439-444
  • 22 Walther M, Harms H, Krenn V. et al. Correlation of power Doppler sonography with vascularity of the synovial tissue of the knee joint in patients with osteoarthritis and rheumatoid arthritis. Arthritis Rheum 2001; 44: 331-338
  • 23 Terslev L, Torp-Pedersen S, Savnik A. et al. Doppler ultrasound and magnetic resonance imaging of synovial inflammation of the hand in rheumatoid arthritis: a comparative study. Arthritis Rheum 2003; 48: 2434-2441
  • 24 Terslev L, von der Recke P, Torp-Pedersen S. et al. Diagnostic sensitivity and specificity of Doppler ultrasound in rheumatoid arthritis. J Rheumatol 2008; 35: 49-53
  • 25 Scheel AK, Schmidt WA, Hermann K-GA. et al. Interobserver reliability of rheumatologists performing musculoskeletal ultrasonography: results from a EULAR “Train the trainers” course. Ann Rheum Dis 2005; 64: 1043-1049
  • 26 Salaffi F, Filippucci E, Carotti M. et al. Inter-observer agreement of standard joint counts in early rheumatoid arthritis: A comparison with grey scale ultrasonography – A preliminary study. Rheumatology 2008; 47: 54-58
  • 27 Wakefield RJ, Gibbon WW, Conaghan PG. et al. The value of sonography in the detection of bone erosions in patients with rheumatoid arthritis: a comparison with conventional radiography. Arthritis Rheum 2000; 43: 2762-2770
  • 28 Ottaviani S, Richette P, Allard A. et al. Ultrasonography in gout: a case-control study. Clin Exp Rheumatol 2012; 30: 499-504
  • 29 Thiele RG, Schlesinger N. Diagnosis of gout by ultrasound. Rheumatology 2007; 46: 1116-1121
  • 30 Keen HI, Wakefield RJ, Grainger AJ et al. An Ultrasonographic Study of Osteoarthritis of the Hand: Synovitis and Its Relationship to Structural Pathology and Symptoms.
  • 31 Colebatch AN, Edwards CJ, Østergaard M. et al. EULAR recommendations for the use of imaging of the joints in the clinical management of rheumatoid arthritis. Ann Rheum Dis 2013; 72: 804-814
  • 32 Nam J, Hensor E, Hunt L et al. Anti-CCP Positive Patients without Clinical Synovitis Progress If Ultrasound Positive. Arthritis Rheumatol. 2015 67 (Suppl 10): [abstract]
  • 33 Backhaus M, Kamradt T, Sandrock D. et al. Arthritis of the finger joints: a comprehensive approach comparing conventional radiography, scintigraphy, ultrasound, and contrast-enhanced magnetic resonance imaging. Arthritis Rheum 1999; 42: 1232-1245
  • 34 Backhaus M, Burmester GR, Sandrock D. et al. Prospective two year follow up study comparing novel and conventional imaging procedures in patients with arthritic finger joints. Ann Rheum Dis 2002; 61: 895-904
  • 35 Scheel aK, Hermann K-Ga, Ohrndorf S. et al. Prospective 7 year follow up imaging study comparing radiography, ultrasonography, and magnetic resonance imaging in rheumatoid arthritis finger joints. Ann Rheum Dis 2006; 65: 595-600
  • 36 Sommier J, Michel-Batot C, Sauliere N. et al. Structural Lesions in RA: Proposition for a New Semiquantitative Score (ScUSSe: Scoring by UltraSound Structural erosion). Arthritis Rheum 2006; 54 Suppl 209 [abstract]
  • 37 Balint PV, Kane D, Wilson H. et al. Ultrasonography of entheseal insertions in the lower limb in spondyloarthropathy. Ann Rheum Dis 2002; 61: 905-910
  • 38 Rezaei H, Torp-Pedersen S, af Klint E. et al. Diagnostic utility of musculoskeletal ultrasound in patients with suspected arthritis – a probabilistic approach. Arthritis Res Ther 2014; 16: 448
  • 39 Nakagomi D, Ikeda K, Okubo A. et al. Ultrasound can improve the accuracy of the 2010 American College of Rheumatology/European League against rheumatism classification criteria for rheumatoid arthritis to predict the requirement for methotrexate treatment. Arthritis Rheum. 2013; 65: 890-898
  • 40 Bresnihan B, Kane D. Sonography and subclinical synovitis. Ann Rheum Dis 2004; 63: 333-334
  • 41 Strunk J. Brauchen wir im Jahr 2011 bildgebende Verfahren für die Diagnose einer rheumatoiden Arthritis?. Z Rheumatol 2011; 70: 183-184
  • 42 Lillegraven S, Boyesen P, Hammer HB. et al. Tenosynovitis of the extensor carpi ulnaris tendon predicts erosive progression in early rheumatoid arthritis. Ann Rheum Dis 2011; 70: 2049-2050
  • 43 Macchioni P, Magnani M, Mule R. et al. Ultrasonographic predictors for the development of joint damage in rheumatoid arthritis patients: a single joint prospective study. Clin Exp Rheumatol 2013; 31: 8-17
  • 44 Hammer HB, Haavardsholm EA, Bøyesen P. et al. Bone erosions at the distal ulna detected by ultrasonography are associated with structural damage assessed by conventional radiography and MRI: a study of patients with recent onset rheumatoid arthritis. Rheumatology 2009; 48: 1530-1532
  • 45 Backhaus M, Ohrndorf S, Kellner H et al. Evaluation of a Novel 7-Joint Ultrasound Score in Daily Rheumatologic Practice: A Pilot Project.
  • 46 Taylor PC, Steuer A, Gruber J. et al. Comparison of ultrasonographic assessment of synovitis and joint vascularity with radiographic evaluation in a randomized, placebo-controlled study of infliximab therapy in early rheumatoid arthritis. Arthritis Rheum 2004; 50: 1107-1116
  • 47 Filippucci E, Iagnocco A, Salaffi F. et al. Power Doppler sonography monitoring of synovial perfusion at the wrist joints in patients with rheumatoid arthritis treated with adalimumab. Ann Rheum Dis 2006; 65: 1433-1437
  • 48 Naredo E, Rodríguez M, Campos C. et al. Validity, reproducibility, and responsiveness of a twelve-joint simplified power Doppler ultrasonographic assessment of joint inflammation in rheumatoid arthritis. Arthritis Care Res 2008; 59: 515-522
  • 49 Iagnocco A, Finucci A, Ceccarelli F. et al. Power Doppler ultrasound monitoring of response to anti-tumour necrosis factor alpha treatment in patients with rheumatoid arthritis. Rheumatology 2015; 54: 1890-1896
  • 50 Dale J, Purves D, Mcconnachie A et al. Tightening Up? Impact of Musculoskeletal Ultrasound Disease Activity Assessment on Early Rheumatoid Arthritis Patients Treated Using a Treat to Target Strategy
  • 51 Foltz V, Gandjbakhch F, Etchepare F. et al. Power Doppler Ultrasound, but Not Low-Field Magnetic Resonance Imaging, Predicts Relapse and Radiographic Disease Progression in Rheumatoid Arthritis Patients With Low Levels of Disease Activity. Arthritis Rheum 2012; 64: 67-76
  • 52 Nguyen H, Ruyssen-Witrand A, Gandjbakhch F. et al. Prevalence of ultrasound-detected residual synovitis and risk of relapse and structural progression in rheumatoid arthritis patients in clinical remission: a systematic review and meta-analysis. Rheumatology 2014; 53: 2110-2118
  • 53 Kawashiri S-Y, Suzuki T, Nakashima Y et al. Ultrasonographic examination of rheumatoid arthritis patients who are free of physical synovitis: power Doppler subclinical synovitis is associated with bone erosion.
  • 54 Peluso G, Michelutti A, Bosello S. et al. Clinical and ultrasonographic remission determines different chances of relapse in early and long standing rheumatoid arthritis. Ann Rheum Dis 2011; 70: 172-175
  • 55 Iwamoto T, Ikeda K, Hosokawa J. et al. Prediction of relapse after discontinuation of biologic agents by ultrasonographic assessment in patients with rheumatoid arthritis in clinical remission: high predictive values of total gray-scale and power Doppler scores that represent residual synovial. Arthritis Care Res (Hoboken) 2014; 66: 1576-1581
  • 56 Narouze SN, Provenzano DA. Sonographically guided cervical facet nerve and joint injections: why sonography?. J Ultrasound Med 2013; 32: 1885-1896
  • 57 Pekkafahli MZ, Kiralp MZ, Basekim CC. et al. Sacroiliac joint injections performed with sonographic guidance. J Ultrasound Med 2003; 22: 553-559
  • 58 Klauser A, De Zordo T, Feuchtner G. et al. Feasibility of ultrasound-guided sacroiliac joint injection considering sonoanatomic landmarks at two different levels in cadavers and patients. Arthritis Rheum 2008; 59: 1618-1624
  • 59 Hartung W, Ross CJ, Straub R. et al. Ultrasound-guided sacroiliac joint injection in patients with established sacroiliitis: precise IA injection verified by MRI scanning does not predict clinical outcome. Rheumatology (Oxford) 2009; DOI: kep424 [pii] 10.1093/rheumatology/kep424.
  • 60 Hu Y, Zhu J, Xue Q. et al. Scanning of the sacroiliac joint and entheses by color Doppler ultrasonography in patients with ankylosing spondylitis. J Rheumatol 2011; 38: 1651-1655
  • 61 Zhu J, Fang J. Complex appearance of vascularization in the wrist and finger joints in rheumatoid arthritis patients. Eur J Radiol 2012; 81: 1967
  • 62 Klauser AS, De Zordo T, Bellmann-Weiler R. et al. Feasibility of second-generation ultrasound contrast media in the detection of active sacroiliitis. Arthritis Rheum 2009; 61: 909-916
  • 63 Kowalska B. Assessment of the utility of ultrasonography with high-frequency transducers in the diagnosis of entrapment neuropathies. J Ultrason 2014; 14: 371-392
  • 64 Dejaco C, Stradner M, Zauner D. et al. Ultrasound for diagnosis of carpal tunnel syndrome: comparison of different methods to determine median nerve volume and value of power Doppler sonography. Ann Rheum Dis 2013; 72: 1934-1939
  • 65 Krolak C, Wirth S, Hoepfner S. et al. Systematic characterization of sonomorphological changes in the early stage of rheumatoid arthritis. Ultraschall Med 2003; 24: 101-106
  • 66 Ghanei ME, Karami M, Zarezadeh A. et al. Usefulness of combination of grey-scale and color Doppler ultrasound findings in the diagnosis of ulnar nerve entrapment syndrome. J Res Med Sci 2015; 20: 342-345
  • 67 Kim JH, Won SJ, Rhee WI. et al. Diagnostic cutoff value for ultrasonography in the ulnar neuropathy at the elbow. Ann Rehabil Med 2015; 39: 170-175
  • 68 Fantino O. Role of ultrasound in posteromedial tarsal tunnel syndrome: 81 cases. Journal of ultrasound 2014; 17: 99-112
  • 69 De Zordo T, Chhem R, Smekal V. et al. Real-Time Sonoelastography: Findings in Patients with Symptomatic Achilles Tendons and Comparison to Healthy Volunteers. Ultraschall Med 2009; DOI: 10.1055/s-0028-1109809.
  • 70 Turan A, Tufan A, Mercan R. et al. Real-time sonoelastography of Achilles tendon in patients with ankylosing spondylitis. Skeletal Radiol 2013; 42: 1113-1118
  • 71 Yamamoto Y, Yamaguchi S, Sasho T. et al. Quantitative Ultrasound Elastography With an Acoustic Coupler for Achilles Tendon Elasticity: Measurement Repeatability and Normative Values. J Ultrasound Med 2016; 35: 159-166
  • 72 Strunk J, Lange U. Three-dimensional power Doppler sonographic visualization of synovial angiogenesis in rheumatoid arthritis. J Rheumatol 2004; 31: 1004-1006
  • 73 Klauser A, Frauscher F, Schirmer M. et al. The value of contrast-enhanced color Doppler ultrasound in the detection of vascularization of finger joints in patients with rheumatoid arthritis. Arthritis Rheum 2002; 46: 647-653
  • 74 Fiocco U, Stramare R, Coran A. et al. Vascular perfusion kinetics by contrast-enhanced ultrasound are related to synovial microvascularity in the joints of psoriatic arthritis. Clin Rheumatol 2015; 34: 1903-1912
  • 75 Tamas MM, Bondor CI, Rednic N. et al. The evolution of time-intensity curves of contrast enhanced ultrasonography in early arthritis patients with wrist involvement. Med Ultrason 2015; 17: 345-351
  • 76 Geis S, Gehmert S, Lamby P. et al. Contrast enhanced ultrasound (CEUS) and time intensity curve (TIC) analysis in compartment syndrome: first results. Clin Hemorheol Microcirc 2012; 50: 1-11
  • 77 Sellei RM, Waehling A, Weber CD. et al. Contrast enhanced ultrasound (CEUS) reliably detects critical perfusion changes in compartmental muscle: a model in healthy volunteers. Eur J Trauma Emerg Surg 2014; 40: 535-539