Imaging of Juvenile Idiopathic Arthritis: A Multimodality Approach

Abstract

Juvenile idiopathic arthritis (JIA) is a heterogeneous group of diseases characterized by synovial inflammation and is the most common rheumatic complaint in children. To facilitate research and treatment, JIA has been further classified on the basis of the number of joints involved, additional symptoms, family history, and serologic findings. Imaging in patients with JIA has historically relied on radiography, which allows the accurate assessment of chronic changes of JIA, including growth disturbances, periostitis, and joint malalignment. However, radiographic findings of active inflammation are nonspecific, and, in the past, clinical evaluation has taken precedence over imaging of acute disease. Recent advances in disease-modifying therapeutic agents that can help prevent long-term disability in patients with JIA have led to greater emphasis on the detection of early joint-centered inflammation that cannot be accurately assessed radiographically and may not be evident clinically. Both contrast material-enhanced magnetic resonance (MR) imaging and Doppler ultrasonography (US) are well suited for this application and are playing an increasingly important role in diagnosis, risk stratification, treatment monitoring, and problem solving. Contrast-enhanced MR imaging is the most sensitive technique for the detection of synovitis and is the only modality that can help detect bone marrow edema, both of which indicate active inflammation. US is more sensitive than radiography for the detection of synovial proliferation and effusions and is particularly useful in the evaluation of small peripheral joints. The complexity of the temporomandibular and sacroiliac joints limits the usefulness of radiographic or US evaluation, and contrast-enhanced MR imaging is the preferred modality for evaluation of these structures.

Basic radiological assessment of synovial diseases: a pictorial essay

“…In some cases, the meniscus may be smaller in size because of synovial hypertrophy. Also, some additional findings are joint effusion, Baker cyst, lymphadenopathy in the popliteal fossa, extraarticular tenosynovitis, and rice bodies ( Figure 4a) (18).…”

Role of Ultrasonography in Oral and Maxillofacial Surgery: A Review of Literature

“…In fact, the transducer that emits and receives the sound waves is usually located over these structures i.e. on the skin in front of the tragus [31][32][33]. It is a diagnostic procedure that has been shown to be accurate for the diagnosis of articular disc dislocation and joint effusion [34,35] (Figs.…”

Arthritis

“…It is superior to US in depicting early infl ammation and synovitis, as well as in evaluation of the cartilage. MRI readily shows marrow edema, which predicts future erosions [ 14 ]. It also accurately evaluates the late manifestations of the disease, including erosions, joint space loss, and ligamentous involvement (Figs.…”

“…The mandible is subject to erosions, joint space narrowing, and growth disturbance. The temporomandibular joint (TMJ) is affected in up to 87 % of patients with JIA, especially in patients whose initial presentation was before age 4 [ 14 ]. Common fi ndings include shortening of the body and ramus, fl attening of the condyle, widening of the intercondylar joint, narrowing of the joint space, and abnormal concavity of the undersurface of the mandibular body ( antegonial notching , Fig.…”