Update on imaging in rheumatology - recent advances

Imaging plays a vital role in the diagnosis and management of rheumatological disorders. Traditionally, plain film radiography was widely used in arthropathies to assess periarticular bony changes; these often reflect established changes in the late stage of disease and thus have limited value in early diagnosis and disease monitoring. Magnetic resonance imaging (MRI) has become an important imaging modality in rheumatological disorders because it can assess both morphological and functional changes. It plays a substantial role in early diagnosis, monitoring of disease evolution, assessment of treatment responses and prognostication. More recently, advances in hardware and novel imaging sequences have aided the development of new MRI techniques: whole-body MRI, for example, is gaining in popularity and allows an assessment of overall inflammatory status in arthritis. Quantitative MRI shows promise in allowing more objective evaluation and standardization of imaging-based assessment of inflammatory arthritis. This article also discusses other emerging imaging techniques. These include high-resolution peripheral quantitative computed tomography in early detection and monitoring of periarticular bone damage, fluorescence optical imaging in visualizing active inflammation, and molecular imaging in investigating pathogenesis and disease evaluation on a cellular level.