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    Advantages of Volume Ultrasound in Diagnosing Rheumatic Disorders.

    by Emilio Filippucci, MD and Walter Grassi,
    MD, both at the Cattedra di Reumatologia,
    UniversitÓ Politecnica delle Marche Hospital in Italy,
    and Gary Meenagh, MD, of the Rheumatology Department,
    Musgrave Park Hospital, in Belfast, Northern Ireland.

    Over the last decade, many studies have highlighted the value of ultrasound technology in rheumatology. Ultrasound is a non-invasive, inexpensive and non-ionizing radiation imaging technique providing quick and useful information, and with a proven role in the management of rheumatic diseases. This has generated the desire amongst many rheumatologists to learn more about this imaging technique.

    Ultrasound vs. Volume Ultrasound

    In rheumatology, ultrasound is used in the evaluation of patients with regional pain syndromes and chronic arthritis, short-term therapy monitoring and guidance for invasive procedures such as joint aspiration, intra-articular injection therapy, synovial biopsy etc. Ultrasound is a sensitive imaging tool enabling rheumatologists to examine early undifferentiated arthritic conditions, by revealing sub-clinical synovitis and bone erosions undetected by radiography. Current research focuses on the role of ultrasound in short term therapy monitoring and in predicting radiological progression in patients with early rheumatoid arthritis.

    However, ultrasound is regarded as the most operator dependent imaging modality. Despite its many advantages, several issues still need to be adequately addressed, including the standardization of ultrasound examinations and guidelines for ultrasound training in rheumatology.

    But ultrasound is a continuously evolving technique. Volume Ultrasound heralds an ultrasound revolution in rheumatology. Not only do volumetric images provide a spectacular and in depth view of small joints, but they are easier to understand and clearly illustrate several anatomical details that are undetectable using conventional ultrasound. The main clinical indications for Volume Ultrasound in rheumatology could include the early detection of bone erosions in small joints and a more careful assessment of tendon pathology.

    It seems reasonable to predict that as technical advances continue to improve image quality, the use of Volume Ultrasound in the diagnosis of musculo-skeletal disorders will grow quickly. A single volumetric image can provide information of the extent of the lesions spatially. Other benefits include the coronal view, reduced image acquisition time, and the relatively non operator dependant nature of the image acquisition process.

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