DIJAGNOSTIČKI ULTRAZVUK U PODRUČJU MALIH ZGLOBOVA ŠAKA I STOPALA S NAGLASKOM NA PRIMJENU U RANOM ARTRITISU

Porin Perić, Marijana Pervan

The small joints of the hands and feet play a central role in the diagnosis and classification of arthropathy. Ultrasound can be used to assess involvement in areas that are clinically occult. The aim of this article was to review the current status of ultrasound imaging of patients with rheumatological disorders of the hands and feet. There is increasing evidence that ultrasound detects synovitis that is silent to clinical examination. Detection and classifi cation of synovitis and the early detection of bone erosions are important in clinical decision making. Ultrasound has many advantages over other imaging techniques with which it is compared, particularly magnetic resonance. The ability to carry out a rapid assessment of many widely spaced joints, coupled with clinical correlation, the ability to move and stress musculoskeletal structures and the use of ultrasound to guide therapy accurately are principal amongst these. The use of colour flow Doppler studies provides a measure of neovascularisation within the synovial lining of joints and tendons, and within tendons themselves, that is not available with other imaging techniques. Disadvantages compared to MRI include small field of view, poor image presentation, and difficulty in demonstrating cartilage and deep joints in their entirety.

Mali zglobovi šaka i stopala imaju središnje mjesto u dijagnostici i klasifikaciji artropatija. Dijagnostički ultrazvuk (UZV) se primjenjuje u područjima koja klinički mogu biti bez simptoma. Cilj ovog članka jest prikazati sadašnje stanje primjene dijagnostičkog ultrazvuka u bolesnika s upalnim reumatskim bolestima šaka i stopala. Danas znamo da ultrazvuk može otkriti sinovitis u području zglobova koji nisu klinički zahvaćeni. Otkrivanje i klasifikacija sinovitisa i rano otkrivanje erozija ključ su moderne dijagnostike upalnih reumatskih bolesti. Ultrazvuk ima brojne prednosti u odnosu na druge slikovne metode, posebice magnetsku rezonanciju (MR). Mogućnost brzog prikaza većine zglobova, usporedba s kliničkim nalazom, mogućnost pritiska i pokretanja muskuloskeletnih struktura pri samom pregledu te uporaba ultrazvuka u ciljano vođenim punkcijama su neke od važnijih prednosti. Uporaba power Dopplera omogućava mjerenja neovaskualrizacije unutar sinovijalne membrane i tetivnih ovojnica, što nije moguće niti jednom drugom slikovnom metodom. Nedostaci primjene u odnosu na MR uključuju: malo vidno polje, slabiji slikovni prikaz te poteškoće u prikazivanju.