Role of Ultrasound in the Assessment of Small-Joint Synovitis

EMBASE and MEDLINE databases were searched using PUBMED and OVID software with the search terms ‘‘ultrasound small joints,’’ ‘‘ultrasound arthritis,’’ and ‘‘ultrasound synovitis.’’ We limited the search to articles within the past 10 years. Szkudlarek et al [1] studied 200 metatarsalphalangeal (MTP) joints of 40 patients with rheumatoid arthritis (RA) and 100 MTP joints of 20 healthy controls by clinical examination B-mode US, conventional radiography, and enhanced magnetic resonance imaging (MRI), with MRI used as the gold standard. Ultrasound was blinded to MRI or clinical results and synovial assessment was semiquantitative on a 0 to 4 scale. There was good correlation between US and contrast-enhanced MRI for detection and semiquantitative grading of synovitis. US had a higher frequency for the detection of synovium, the authors of the study suggested that this related to the ability of US to detect fibrotic synovial tissue that may not enhance on MRI. US was significantly more sensitive than clinical examination (0.87 vs 0.43) when compared with MRI.