Speaker: Radiography remains first line of clinical imaging assessment

CHICAGO — Despite advances in imaging technologies, radiography remains a useful, first-choice tool in assessing rheumatic disease, such as rheumatoid arthritis and gout, as well as disease activity and progression, according to a speaker at the American College of Rheumatology State-of-the-Art Clinical Symposium, here.

According to Imran Omar, MD, radiography can successfully reveal disease and usually is inexpensive, making it a good choice for both patient and physician. It is also a procedure that can be performed quickly, which is important for patients with limited capacity to remain still during a scan. Furthermore, areas of erosion in joints and crystal deposits in gout can easily be revealed through radiographic images, according to Omar.

Disadvantages include a lower sensitivity to distinguishing active vs. inactive lesions. Additionally, the images are not cross-sectional, so areas of disease can be missed, Omar said. Other risks are also present, according to Omar.

“In today’s medicine, we are becoming more and more aware of the potential effects of ionizing radiation,” he said. “We are especially aware of the cumulative dose of ionizing radiation in our patients.”

The use of CT, Omar said, poses similar challenges with radiation exposure but has the advantage of revealing more information about soft tissue. Additionally, its cross-sectional nature can show areas that may be hidden in radiographs. Omar said in his practice, CT is often the second choice for further patient evaluation.

Dual-energy CT is helpful in finding calcium or uric acid deposits, and the technology is becoming more common, he said, particularly by employing color-mapping techniques.

MRI provides detailed imaging, but its availability is limited and can be costly. Further, patients may not be able to remain immobile through an entire scan.

“Many of these studies are going to take a long time, and many of our patients - especially those with rheumatoid arthritis who may have pain and deformity - may not be able to tolerate the length of these studies,” Omar said.

Pacemakers, orthopedic hardware and other implants can also limit the use of MRI.

Ultrasound is becoming more commonly used in rheumatology, Omar said. Advantages include speed and lower cost than MRI, and the patient is usually positioned more comfortably. Drawbacks include the need for a great deal of training and experience to appropriately interpret the images, according to Omar. - by Shirley Pulawski

Reference:

Omar I. Session III, speaker #3. Presented at: American College of Rheumatology State-of-the-Art Clinical Symposium. May 2-3, 2015; Chicago.

Disclosure: Omar reports no relevant financial disclosures.