Kane D, Grassi W, Sturrock R, Balint P V
School of Clinical and Medical Sciences (Rheumatology), Cookson Building, Framlington Place, University of Newcastle-upon-Tyne, Newcastle-upon-Tyne NE2 4HH, UK.
Rheumatology (Oxford). 2004 Jul;43(7):829-38. doi: 10.1093/rheumatology/keh215. Epub 2004 May 25.
Rheumatologists remain divided on whether they should introduce musculoskeletal ultrasound (MSUS) into their clinical practice. A central issue in the application of MSUS in clinical rheumatology is the need for proof of clinical relevance and improved patient care. There is now accumulating evidence that MSUS improves clinical diagnosis and intervention skills. High-resolution ultrasound is superior to clinical examination in the diagnosis and localization of joint and bursal effusion and synovitis. MSUS is the imaging modality of choice for the diagnosis of tendon pathology. MSUS is seven times more sensitive than plain radiography in the detection of rheumatoid erosions, allowing earlier diagnosis of progressive rheumatoid arthritis. Ligament, muscle, peripheral nerve and cartilage pathology can also be readily demonstrated by MSUS. There is exciting evidence that MSUS may potentially be used by rheumatologists to non-invasively diagnose and monitor not just joint and muscle disease but also nerve compression syndromes, scleroderma, vasculitis and Sjögren's syndrome. Joint aspiration and injection accuracy can be improved by MSUS, with initial evidence confirming improved efficacy. As the number of rheumatologists performing MSUS increases and the technical capabilities of MSUS improve, there is likely to be a growing number of proven clinical indications for the application of MSUS in rheumatology practice. This paper reviews the evidence for the application of MSUS in rheumatology.
风湿病学家对于是否应将肌肉骨骼超声（MSUS）引入临床实践仍存在分歧。MSUS在临床风湿病学应用中的一个核心问题是需要证明其临床相关性及改善患者护理。目前有越来越多的证据表明MSUS可提高临床诊断和干预技能。高分辨率超声在关节和滑囊积液及滑膜炎的诊断和定位方面优于临床检查。MSUS是诊断肌腱病变的首选成像方式。在检测类风湿性侵蚀方面，MSUS的敏感性比普通X线摄影高7倍，可更早诊断进行性类风湿性关节炎。韧带、肌肉、周围神经和软骨病变也可通过MSUS轻松显示。有令人兴奋的证据表明，风湿病学家可能不仅可以使用MSUS对关节和肌肉疾病进行无创诊断和监测，还可用于诊断和监测神经压迫综合征、硬皮病、血管炎和干燥综合征。MSUS可提高关节穿刺和注射的准确性，初步证据证实其疗效有所改善。随着进行MSUS检查的风湿病学家数量增加以及MSUS技术能力的提高，MSUS在风湿病学实践中的应用可能会有越来越多已被证实的临床适应症。本文综述了MSUS在风湿病学中应用的证据。
