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   Clinical indications for MSUS


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

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 andimmunospecific contrast agents. USsynovectomy (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 bursafunction and pathology
Bone Demonstration of joint erosion Diagnosis of fractures, bone tumors, periosteal disease US erosion included in diagnostic criteriafor RA.US erosion used as standardizedoutcome measure in RA trials.Differentiate active vascularized erosionfrom 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 inactiveenthesitis. Quantitative score of peripheralenthesitis. Improve understanding ofpathogenesis of mechanical andinflammatory 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. Differentialdiagnosis 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 othercartilage disease
Muscle Diagnosis of muscle trauma, tumor, abscess and calcification MSUS guidance of muscle biopsy, aspiration Diagnosis and monitoring of inflammatory muscle disease. Diagnosis andmonitoring 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 modalityfor carpal tunnel syndrome and otherentrapment syndromes. MSUS demonstratesnerve pathology including axonal loss anddemyelination
Salivary glands Demonstration of salivary gland size and morphology Correlation of MSUS findings with labial gland histology Diagnosis of Sjogren’s syndrome