Numerous diagnostic imaging techniques may be used to supplement history, physical examination, and laboratory tests in the evaluation of bone and joint disease. The choice of the imaging techniques to use and in what sequence depends on the sensitivity and specificity of the technique for a particular problem, on the availability, cost, and risk, and experience in its use.
The goal is to answer the question raised by the clinician in the shortest time at the least cost and risk to the patient. Prior consultation with the radiologist and providing clinical information when ordering an imaging examination will help the radiologist and technologist to tailor the examination to the problem under investigation.
Oblique radiographs of the right and left hands and wrists in a woman with rheumatoid arthritis show narrowing of the radiocarpal, midcarpal, carpometacarpal, second metacarpophalangeal, and radioulnar joints, with periarticular osteoporosis and erosions.
FIG. 7-2 In a patient who had pain and swelling of the metatarsophalangeal joint of the great toe with normal radiographs, the proton density (a) and STIR (b) showed osteoarthrosis with articular cartilage narrowing, bone marrow edema pattern, collapse of the subchondral bone, synovitis, and thickening of the medial ligaments (see arrows). Using C-arm fluoroscopy the tube was tilted to make the joint tangential to the x-ray, allowing a needle to be inserted into the joint for aspiration and injection of local anesthetic and corticosteroids (c). Contrast was injected confirming the intra-articular position of the needle.
There is abnormal increased uptake of In-111 white blood cells in the right femur (arrow) and thigh, not matched by a similar area on the Tc-99m bone marrow scan indicating active infection in this patient.
Reformatted coronal and sagittal reformatted images show large areas of osteolysis (arrows) around the acetabular component of a total hip prosthesis.
FIG. 7-5 The lateral radiograph (a) of the wrist in a patient who had swelling and pain, without trauma shows a calcific deposit in the dorsal soft tissues (arrow) representing calcific tendinitis of the extensor tendons. With ultrasound guidance (b) a needle (arrow) was inserted into the calcific deposit, which was aspirated and injected with corticosteroids, which resulted in relief of symptoms in less than twenty four hours.