Current, developing and potential indications for MSUS

   Tissue

  Proven indication

     Developing Indication

   Potential Indication

Effusion

Diagnosis of joint, tendon sheath and bursal effusion. Aspiration of effusion. Differentiation of cystic from solid masses, detection of cyst rupture, sinus and fistula. Diagnosis of vascular and nerve compression syndromes by fluid collections

Role of MSUS in improving

efficacy of joint and bursal injection

Differentiation of type of effusion: US microscopy of synovial Fluid

Synovium

Diagnosis of synovial proliferation and synovitis

Diagnosis of lesser degrees of synovitis. Differentiate active from inactive synovitis

US used as standardized outcome measure for synovitis in RA trials. US used to classify joint involvement

(oligoarticular, polyarticular).

Development of tissue specific and

immunospecific contrast agents. US

synovectomy (high-intensity focused US)

Bursa

Diagnosis of superficial and deep bursitis. Bursal aspiration and injection

Differential diagnosis of true effusive bursitis from soft tissue inflammation (greater trochanter bursitis vs. greater trochanter enthesitis without effusion)

Improve understanding of bursa

function and pathology

Bone

Demonstration of joint erosion

Diagnosis of fractures, bone tumors, periosteal disease

US erosion included in diagnostic criteria

for RA.US erosion used as standardized

outcome measure in RA trials.

Differentiate active vascularized erosion

from inactive erosion

Tendon/Ligament

Diagnosis of tendon damage, rupture, tendonitis or tenosynovitis. Diagnosis of ligament injury or enthesitis. Improve assessment of indication for surgery

Monitoring of response to therapy,

surgery. Role of MSUS in improving efficacy of tendon sheath and soft tissue injection

Differentiate active from inactive

enthesitis. Quantitative score of peripheral

enthesitis. Improve understanding of

pathogenesis of mechanical and

inflammatory enthesitis

Skin

Measure skin thickness in scleroderma. Detect subcutaneous oedema. Detect subcutaneous hypertrophy and atrophy, abscess, calcification, foreign body, nodule or tumors

Application of skin thickness as a standard measure of outcome in, scleroderma. Objective monitoring of oedema after therapy. Monitoring of subcutaneous hypertrophy and atrophy, abscess, calcification,

foreign body, nodule or tumor

Diagnosis of scleroderma. Differential

diagnosis of cellulitis, necrotizing fasciitis,

subcutaneous pathology

Cartilage

Imaging of local and generalized cartilage defects and calcification

Monitoring of cartilage thickness homogeneity cartilage disease

Diagnosis of osteoarthritis and other

cartilage disease

Muscle

Diagnosis of muscle trauma, tumor, abscess and calcification

MSUS guidance of muscle biopsy, aspiration

Diagnosis and monitoring of inflammatory muscle disease. Diagnosis and

monitoring of muscle dystrophy

Vasculature

Detection of inflammation with power Doppler. Imaging of location and morphology of vascular structures

Objective and reproducible quantification of inflammation with power Doppler. Correlation of MSUS with histological diagnosis of temporal arteritis and vasculitis

Imaging of ‘normal ’blood flow in joints. Diagnosis of temporal arteritis without recourse to biopsy. Diagnosis of medium and large vessel vasculitis. Diagnosis and monitoring of

Raynaud ’s disease

Nerve

Demonstration of nerve morphology and continuity. Guidance of nerve blocks

Diagnosis of peripheral nerve tumors and pseudotumours. Diagnosis of

nerve injury. Diagnosis of nerve entrapment carpal tunnel syndrome ulnar nerve compression, syndromes. MSUS demonstrates entrapment:, nerve pathology including axonal loss and common peroneal nerve at the fibular neck, posterior tibial nerve at the tarsal tunnel

MSUS as first-line diagnostic modality

for carpal tunnel syndrome and other

entrapment syndromes. MSUS demonstrates

nerve pathology including axonal loss and

demyelination

Salivary glands

Demonstration of salivary gland size and morphology

Correlation of MSUS findings with labial gland histology

Diagnosis of Sjogren’s syndrome