Imaging in rheumatology
A J Grainger, MRCP, FRCR1 and
D McGonagle, FRCPI, PhD2
1 Department of Musculoskeletal Radiology, B Floor, Clarendon Wing, Leeds General Infirmary, Leeds LS1 3EX and 2 Department of Rheumatology, Leeds University, Leeds, UK
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Figure 1. Lateral knee: patient with septic arthritis showing thickening of the suprapatellar stripe due to synovitis and effusion in the suprapatellar pouch.
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Figure 2. Dorsipalmer middle finger: this patient has chronic tophaceous gout, here seen involving the distal interphalangeal joint of the middle finger. Note the asymmetrical soft tissue swelling and calcification typical of the chronic form of this disease.
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Figure 3. (a) Anteroposterior (AP) and (b) lateral knee radiographs. This patient has calcium pyrophosphate deposition disease. Note the chondrocalcinosis, best seen in the lateral meniscus on the AP film and the synovial calcification seen in the suprapatellar pouch (arrow). Note that joint space loss and subchondral bony changes are most marked at the patellofemoral joint. This is a characteristic distribution for calcium pyrophosphate deposition disease involvement of the knee.
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Figure 4. Anteroposterior shoulder. There is hydroxyapatite deposition in the supraspinatus tendon seen as smooth amorphous calcification.
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Figure 5. Dorsipalmer hand. This patient has systemic sclerosis. Multiple foci of hydroxyapatite crystal deposition can be seen in the soft tissues of the fingers.
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Figure 6. Anteroposterior hip. This shows typical features of osteoarthritis. Note the pattern of joint space loss predominantly involves the superior joint space with preservation of the joint space more medially. This is typical for osteoarthritis and should be contrasted with the appearances of inflammatory arthritis seen in Figure 7 . In addition to subchondral sclerosis a large subchondral cyst is seen in the acetabular roof.
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Figure 7. Anteroposterior hip. This patient suffers from rheumatoid arthritis, note the large erosion on the lateral aspect of the femoral neck (*). Joint space loss is seen to have occurred throughout the joint, typical of an inflammatory arthritis. Contrast with Figure 6.
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Figure 8. Dorsipalmer hand. Multiple joint involvement is seen in this patient with psoriatic arthritis with characteristic erosive arthritis is a predominantly distal distribution. The proximal interphalangeal joint of the little finger is ankylosed.
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Figure 9. Dorsipalmer hand. Appearances of acromegaly. There is widening of the joint spaces, particularly seen at the proximal interphalangeal joints. Other features shown on this film include hypertrophic new bone at the sites of muscle, tendon and ligament insertion and widening of the phalangeal bases. Patients with acromegaly suffer premature osteoarthritis changes.
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Figure 10. Dorsipalmer hand. Appearances of rheumatoid arthritis with multiple marginal erosions seen predominantly affecting the metacarpophalangeal joints. The proximal distribution is characteristically seen in rheumatoid arthritis.
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Figure 11. Dorsipalmer wrist. This enlarged image in a patient with rheumatoid arthritis shows early erosion of the ulnar styloid and ulnar aspect of the triquetrum. These represent early sites for the detection of erosions in rheumatoid arthritis.
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Figure 12. Dorsipalmer hand. In addition to the erosive arthritis seen in this patient with psoriatic arthropathy there is fluffy periosteal new bone formation characteristic of the entheseal disease seen in this condition and seen well along the distal shafts of the proximal phalanges.
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Figure 13. Lateral calcaneum. This patient has psoriatic arthropathy and has entheseal disease at the calcaneal insertion of the plantar fascia. A small erosion is seen (arrowhead) along with a little new bone formation (arrow).
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Figure 14. Dorsipalmer middle finger. This shows the typical appearances of a periarticular gout erosion with overhanging margins and a well defined "punched out" appearance.
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Figure 15. Dorsipalmer fingers. A patient with erosive osteoarthritis. Central erosions at the little finger distal interphalangeal (DIP) joint result in a seagull wing configuration to the joint. Note also a small marginal erosion at the adjacent DIP joints (arrowhead).
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Figure 16. Anteroposterior hip. The hip joint shows severe osteoarthritis change with loss of joint space, subchondral sclerosis and cyst formation. In addition there is periosteal osteophyte formation seen as buttressing along the femoral neck (arrowheads).
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Figure 17. Lateral lumbar spine. Fine syndesmophytes are seen bridging the disk spaces along the anterior aspect of the spine (arrows). Note also calcification in the disks from L1 to S1, another typical feature of ankylosing spondylitis.
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Figure 18. Dorsipalmer hand. Note the joint subluxations seen at the metacarpophalangeal joints in this patient with systemic lupus erythematosis. A characteristic feature is that there is no associated joint destruction.
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Figure 19. Longitudinal ultrasound of metacarpophalangeal joint. This image shows the dorsal aspect of the metacarpal head (M) and proximal phalanx (P) in a patient with rheumatoid arthritis. The joint is distended by thickened synovium (arrowheads). The synovitis fills an erosion seen as a breach in the cortex of the metacarpal head (*).
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Figure 20. Coronal T1 weighted image of the hand. The study shows an erosion (arrowhead) in the head of the middle metacarpal.
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Figure 21. Coronal short tau inversion recovery weighted image of the knee. In a patient with psoriatic arthritis foci of marrow oedema are seen at enthesis sites of the joint capsule and ligaments including the anterior cruciate ligament origin on the lateral aspect of the femoral notch.
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Figure 22. Sagittal T2 weighted water excitation sequences through the (a) lateral and (b) medial compartments of the knee. There are small osteophytes shown in the lateral compartment on the anterior and posterior aspects of the tibia. Note also the articular cartilage which is well shown with this sequence over the femoral and tibial articular surfaces. In the medial compartment there is full thickness cartilage loss over the weight bearing portions of the femur and tibia with the exception of a small area of residual cartilage under the posterior horn of the meniscus (arrowhead). Marrow oedema is seen in the subchondral bone at the sites where it is denuded of cartilage.
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Copyright © 2003 by the British Institute of Radiology.
