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Introduction: Nowadays it is undeniable the usefulness of the diverse modalities of medical imaging as clinical support both in the generation of diagnoses of a good number of diseases and in the planning of treatments tending to provide an alternative solution to people who, for one reason or another, show some imbalance in their health... Development: The development addresses the background and importance of imageneology, explains the different types of cranial tumors, radiological signs. In addition, it deals with the technological advances and their clinical contribution, arriving at the conclusion with the future lines of research with respect to the subject addressed in the article. Conclusions: After reviewing information obtained in some research as referential bibliography, that through diagnostic imaging can be defined signs, findings and radiological characteristics that clearly denote the existence of some pathology at the cranial level. In this way, the knowledge of the radiological semiology will allow an adequate therapeutic management., Introducción: En la actualidad es innegable la utilidad de las diversas modalidades de imagenología médica como apoyo clínico tanto en la generación de diagnósticos de un buen número de enfermedades como en la planeación de tratamientos tendientes a proporcionar una alternativa de solución a las personas que, por una u otra razón, manifiestan algún desequilibrio en su salud. Desarrollo: El desarrollo aborda los antecedentes e importancia de la imagenología, se explica los diferentes tipos de tumores craneales, los signos radiológicos. Además, se aborda sobre los avances tecnológicos y su contribución clínica Llegando a la conclusión. con las futuras líneas de investigación con respecto a la temática abordada en el artículo. Conclusiones: Después de revisar información obtenida en algunas investigaciones como bibliografía referencial, que mediante la imagenología diagnóstica se puede definir signos, hallazgos y características radiológicas que denotan claramente la existencia de algunas patologías a nivel craneal. De esta forma, el conocimiento de la semiología radiológica permitirá realizar un manejo terapéutico adecuado.

Bakgrund: Konventionell röntgen, datortomografi (DT) och entrepreneurial operating system (EOS) är tre radiologiska undersökningsmetoder som kan användas för bilddiagnostik vid skolios av barn och ungdomar. Undersökningarna kan genomföras i en liggande eller stående positionering vid bedömning av ryggradens deformation. Dock avger dessa tre modaliteter joniserad strålning vid bildtagning. Syfte: Syftet med denna litteraturstudie var att jämföra konventionell röntgen, DT och EOS vid bilddiagnostik av skolios med fokus på barn och ungdomar. Metod: För att besvara syftet gjordes en litteraturstudie med systematisk ansats. Studier söktes databaserna Pubmed och Cinahl. Resultat: Två av tre studier påvisar att cobb-vinklen tenderar att minska från stående konventionella- och EOS-undersökningar till liggande DT-undersökningar. Vidare kan både DT och EOS generera 3D-rekonstruktioner för att underlätta bedömningen av deformationen. Den effektiva stråldosen går att reduceras för samtliga tre modaliteter men det finns en tendens att bildkvalitén försämras vid optimering. Slutsats: Konventionell röntgen, DT och EOS har för- och nackdelar avseende bilddiagnostik och stråldos. Samtliga tre modaliteter kan användas vid bedömning av ryggradens deformation och pre- och postoperativa bedömning, men det finns skillnader avseende stråldosen och bildkvalitén. Således krävs vidare forskning för att undersöka modaliteternas tillgänglighet och utifrån ett patientperspektiv., Background: Conventional radiography, computed tomography (CT) and the entrepreneurial operating system (EOS) are three radiological examination methods that can be used for image diagnostics of scoliosis in children and adolescents. The examinations can be carried out in a lying or standing position when assessing the deformation of the spine. However, these three modalities emit ionizing radiation during imaging. Purpose: The purpose of this literature study was to compare conventional radiography, CT and EOS in imaging diagnostics of scoliosis with a focus on children and adolescents. Method: To answer the purpose, a systematic litteratur study was conducted. Literature were search for using the databases PubMed and Cinahl. Result: Two out of three studies showed that cobb-angle tends to decrsease from standning conventional and EOS examinations to lying CT examinations. Furthermore, both CT and EOS can generate 3D reconstuctions to facilitate the assessment of deformation. The effective radiation dose can be reduced for all three modalities, but there is a tendency for image quality to deteriorate during optimization. Conclusion: Conventional X-ray, CT and EOS have advantages and disadvantages in terms of imaging diagnosis and radiation dose. All three modalities can be applied for assessing spinal deformity and pre- and postoperative evaluations, but there are differences in image quality and radiation dose. Therefore, further research is required to investigate the accessibility of the modalities and their suitability from a patient perspective.

Bakgrund: Konventionell röntgen, datortomografi (DT) och entrepreneurial operating system (EOS) är tre radiologiska undersökningsmetoder som kan användas för bilddiagnostik vid skolios av barn och ungdomar. Undersökningarna kan genomföras i en liggande eller stående positionering vid bedömning av ryggradens deformation. Dock avger dessa tre modaliteter joniserad strålning vid bildtagning. Syfte: Syftet med denna litteraturstudie var att jämföra konventionell röntgen, DT och EOS vid bilddiagnostik av skolios med fokus på barn och ungdomar. Metod: För att besvara syftet gjordes en litteraturstudie med systematisk ansats. Studier söktes databaserna Pubmed och Cinahl. Resultat: Två av tre studier påvisar att cobb-vinklen tenderar att minska från stående konventionella- och EOS-undersökningar till liggande DT-undersökningar. Vidare kan både DT och EOS generera 3D-rekonstruktioner för att underlätta bedömningen av deformationen. Den effektiva stråldosen går att reduceras för samtliga tre modaliteter men det finns en tendens att bildkvalitén försämras vid optimering. Slutsats: Konventionell röntgen, DT och EOS har för- och nackdelar avseende bilddiagnostik och stråldos. Samtliga tre modaliteter kan användas vid bedömning av ryggradens deformation och pre- och postoperativa bedömning, men det finns skillnader avseende stråldosen och bildkvalitén. Således krävs vidare forskning för att undersöka modaliteternas tillgänglighet och utifrån ett patientperspektiv., Background: Conventional radiography, computed tomography (CT) and the entrepreneurial operating system (EOS) are three radiological examination methods that can be used for image diagnostics of scoliosis in children and adolescents. The examinations can be carried out in a lying or standing position when assessing the deformation of the spine. However, these three modalities emit ionizing radiation during imaging. Purpose: The purpose of this literature study was to compare conventional radiography, CT and EOS in imaging diagnostics of scoliosis with a focus on children and adolescents. Method: To answer the purpose, a systematic litteratur study was conducted. Literature were search for using the databases PubMed and Cinahl. Result: Two out of three studies showed that cobb-angle tends to decrsease from standning conventional and EOS examinations to lying CT examinations. Furthermore, both CT and EOS can generate 3D reconstuctions to facilitate the assessment of deformation. The effective radiation dose can be reduced for all three modalities, but there is a tendency for image quality to deteriorate during optimization. Conclusion: Conventional X-ray, CT and EOS have advantages and disadvantages in terms of imaging diagnosis and radiation dose. All three modalities can be applied for assessing spinal deformity and pre- and postoperative evaluations, but there are differences in image quality and radiation dose. Therefore, further research is required to investigate the accessibility of the modalities and their suitability from a patient perspective.

Objectives: To identify the prevalence of calcium pyrophosphate crystal deposition (CPPD) using ultrasound and conventional radiology at peripheral joints in patients with suspected or definite CPPD. Methods: A systematic literature search was performed in PubMed and Embase using pre-defined search strategies from inception to April 2021 to identify studies that evaluated conventional radiology and ultrasound in detecting CPPD at peripheral joints, including definite or suspected CPPD [Research question 1 (RQ1) and Research Question 2 (RQ2), respectively]. For the meta-analysis, the first, second, and third sub-analysis included studies with the knee, and knee or wrist as the index joint for CPPD (without restrictions on the reference standard) and synovial fluid analysis or histology as a reference standard (without restrictions on the index joint), respectively. Results: One-thousand eight hundred and twenty-seven manuscripts were identified, of which 94 articles were finally included. Twenty-two and seventy-two papers were included in RQ1 and RQ2, respectively. The knee had the highest prevalence for RQ1 and RQ2 by both conventional radiology and ultrasound, followed by the wrist with the highest prevalence for RQ1. The hand had the lowest CPPD prevalence. The third sub-analysis showed a higher CPPD prevalence on ultrasound than conventional radiology at the knee (only data available). Conclusion: Among all peripheral joints, the knees and wrists could be regarded as the target joints for CPPD detection by imaging. Furthermore, ultrasound seems to detect a higher number of calcium pyrophosphate deposits than conventional radiology, even when using a more restrictive reference standard.

Objectives: To identify the prevalence of calcium pyrophosphate crystal deposition (CPPD) using ultrasound and conventional radiology at peripheral joints in patients with suspected or definite CPPD. Methods: A systematic literature search was performed in PubMed and Embase using pre-defined search strategies from inception to April 2021 to identify studies that evaluated conventional radiology and ultrasound in detecting CPPD at peripheral joints, including definite or suspected CPPD [Research question 1 (RQ1) and Research Question 2 (RQ2), respectively]. For the meta-analysis, the first, second, and third sub-analysis included studies with the knee, and knee or wrist as the index joint for CPPD (without restrictions on the reference standard) and synovial fluid analysis or histology as a reference standard (without restrictions on the index joint), respectively. Results: One-thousand eight hundred and twenty-seven manuscripts were identified, of which 94 articles were finally included. Twenty-two and seventy-two papers were included in RQ1 and RQ2, respectively. The knee had the highest prevalence for RQ1 and RQ2 by both conventional radiology and ultrasound, followed by the wrist with the highest prevalence for RQ1. The hand had the lowest CPPD prevalence. The third sub-analysis showed a higher CPPD prevalence on ultrasound than conventional radiology at the knee (only data available). Conclusion: Among all peripheral joints, the knees and wrists could be regarded as the target joints for CPPD detection by imaging. Furthermore, ultrasound seems to detect a higher number of calcium pyrophosphate deposits than conventional radiology, even when using a more restrictive reference standard.

Objective. To assess the reliability and diagnostic accuracy of new radiographic imaging definitions developed by an international multidisciplinary working group for identification of calcium pyrophosphate deposition (CPPD).Methods. Patients with knee osteoarthritis scheduled for knee replacement were enrolled. Two radiologists and 2 rheumatologists twice assessed radiographic images for presence or absence of CPPD in menisci, hyaline cartilage, tendons, joint capsule, or synovial membrane, using the new definitions. In case of disagreement, a consensus decision was made and considered for the assessment of diagnostic performance. Histologic examination of postsurgical specimens under compensated polarized light microscopy was the reference standard. Prevalence-adjusted bias-adjusted kappa values were used to assess reliability, and diagnostic performance statistics were calculated.Results. Sixty-seven patients were enrolled for the reliability study. The interobserver reliability was substantial in most of the assessed structures when considering all 4 readers (k range 0.59-0.90), substantial to almost perfect among radiologists (k range 0.70-0.91), and moderate to almost perfect among rheumatologists (k range 0.46-0.88). The intraobserver reliability was substantial to almost perfect for all the observers (k range 0.70-1). Fifty-one patients were included in the accuracy study. Radiography demonstrated an overall specificity of 92% for CPPD, but sensitivity remained low for all sites and for the overall diagnosis (54%).Conclusion. The new radiographic definitions of CPPD are highly specific against the gold standard of histologic diagnosis. When the described radiographic findings are present, these definitions allow for a definitive diagnosis of CPPD, rather than other calcium-containing crystal depositions; however, a negative radiographic finding does not exclude the diagnosis.

Objective. To assess the reliability and diagnostic accuracy of new radiographic imaging definitions developed by an international multidisciplinary working group for identification of calcium pyrophosphate deposition (CPPD).Methods. Patients with knee osteoarthritis scheduled for knee replacement were enrolled. Two radiologists and 2 rheumatologists twice assessed radiographic images for presence or absence of CPPD in menisci, hyaline cartilage, tendons, joint capsule, or synovial membrane, using the new definitions. In case of disagreement, a consensus decision was made and considered for the assessment of diagnostic performance. Histologic examination of postsurgical specimens under compensated polarized light microscopy was the reference standard. Prevalence-adjusted bias-adjusted kappa values were used to assess reliability, and diagnostic performance statistics were calculated.Results. Sixty-seven patients were enrolled for the reliability study. The interobserver reliability was substantial in most of the assessed structures when considering all 4 readers (k range 0.59-0.90), substantial to almost perfect among radiologists (k range 0.70-0.91), and moderate to almost perfect among rheumatologists (k range 0.46-0.88). The intraobserver reliability was substantial to almost perfect for all the observers (k range 0.70-1). Fifty-one patients were included in the accuracy study. Radiography demonstrated an overall specificity of 92% for CPPD, but sensitivity remained low for all sites and for the overall diagnosis (54%).Conclusion. The new radiographic definitions of CPPD are highly specific against the gold standard of histologic diagnosis. When the described radiographic findings are present, these definitions allow for a definitive diagnosis of CPPD, rather than other calcium-containing crystal depositions; however, a negative radiographic finding does not exclude the diagnosis.

Objectives: To identify the prevalence of calcium pyrophosphate crystal deposition (CPPD) using ultrasound and conventional radiology at peripheral joints in patients with suspected or definite CPPD. Methods: A systematic literature search was performed in PubMed and Embase using pre-defined search strategies from inception to April 2021 to identify studies that evaluated conventional radiology and ultrasound in detecting CPPD at peripheral joints, including definite or suspected CPPD [Research question 1 (RQ1) and Research Question 2 (RQ2), respectively]. For the meta-analysis, the first, second, and third sub-analysis included studies with the knee, and knee or wrist as the index joint for CPPD (without restrictions on the reference standard) and synovial fluid analysis or histology as a reference standard (without restrictions on the index joint), respectively. Results: One-thousand eight hundred and twenty-seven manuscripts were identified, of which 94 articles were finally included. Twenty-two and seventy-two papers were included in RQ1 and RQ2, respectively. The knee had the highest prevalence for RQ1 and RQ2 by both conventional radiology and ultrasound, followed by the wrist with the highest prevalence for RQ1. The hand had the lowest CPPD prevalence. The third sub-analysis showed a higher CPPD prevalence on ultrasound than conventional radiology at the knee (only data available). Conclusion: Among all peripheral joints, the knees and wrists could be regarded as the target joints for CPPD detection by imaging. Furthermore, ultrasound seems to detect a higher number of calcium pyrophosphate deposits than conventional radiology, even when using a more restrictive reference standard.

Objectives: To identify the prevalence of calcium pyrophosphate crystal deposition (CPPD) using ultrasound and conventional radiology at peripheral joints in patients with suspected or definite CPPD.Methods: A systematic literature search was performed in PubMed and Embase using pre-defined search strategies from inception to April 2021 to identify studies that evaluated conventional radiology and ultrasound in detecting CPPD at peripheral joints, including definite or suspected CPPD [Research question 1 (RQ1) and Research Question 2 (RQ2), respectively]. For the meta-analysis, the first, second, and third sub-analysis included studies with the knee, and knee or wrist as the index joint for CPPD (without restrictions on the reference standard) and synovial fluid analysis or histology as a reference standard (without restrictions on the index joint), respectively.Results: One-thousand eight hundred and twenty-seven manuscripts were identified, of which 94 articles were finally included. Twenty-two and seventytwo papers were included in RQ1 and RQ2, respectively. The knee had the highest prevalence for RQ1 and RQ2 by both conventional radiology and ultrasound, followed by the wrist with the highest prevalence for RQ1. The hand had the lowest CPPD prevalence. The third sub-analysis showed a higher CPPD prevalence on ultrasound than conventional radiology at the knee (only data available).Conclusion: Among all peripheral joints, the knees and wrists could be regarded as the target joints for CPPD detection by imaging. Furthermore, ultrasound seems to detect a higher number of calcium pyrophosphate deposits than conventional radiology, even when using a more restrictive reference standard.

Purpose: To externally validate an artificial intelligence (AI) tool for radiographic knee osteoarthritis severity classification on a clinical dataset. Method: This retrospective, consecutive patient sample, external validation study used weight-bearing, non-fixed-flexion posterior-anterior knee radiographs from a clinical production PACS. The index test was ordinal Kellgren-Lawrence grading by an AI tool, two musculoskeletal radiology consultants, two reporting technologists, and two resident radiologists. Grading was repeated by all readers after at least four weeks. Reference test was the consensus of the two consultants. The primary outcome was quadratic weighted kappa. Secondary outcomes were ordinal weighted accuracy, multiclass accuracy and F1-score. Results: 50 consecutive patients between September 24, 2019 and October 22, 2019 were retrospectively included (3 excluded) totaling 99 knees (1 excluded). Quadratic weighted kappa for the AI tool and the consultant consensus was 0.88 CI95% (0.82–0.92). Agreement between the consultants was 0.89 CI95% (0.85–0.93). Intra-rater agreements for the consultants were 0.96 CI95% (0.94–0.98) and 0.94 CI95% (0.91–0.96) respectively. For the AI tool it was 1 CI95% (1–1). For the AI tool, ordinal weighted accuracy was 97.8% CI95% (96.9–98.6 %). Average multiclass accuracy and F1-score were 84% (83/99) CI95% (77–91%) and 0.67 CI95% (0.51–0.81). Conclusions: The AI tool achieved the same good-to-excellent agreement with the radiology consultant consensus for radiographic knee osteoarthritis severity classification as the consultants did with each other.

Purpose: To externally validate an artificial intelligence (AI) tool for radiographic knee osteoarthritis severity classification on a clinical dataset. Method: This retrospective, consecutive patient sample, external validation study used weight-bearing, non-fixed-flexion posterior-anterior knee radiographs from a clinical production PACS. The index test was ordinal Kellgren-Lawrence grading by an AI tool, two musculoskeletal radiology consultants, two reporting technologists, and two resident radiologists. Grading was repeated by all readers after at least four weeks. Reference test was the consensus of the two consultants. The primary outcome was quadratic weighted kappa. Secondary outcomes were ordinal weighted accuracy, multiclass accuracy and F1-score. Results: 50 consecutive patients between September 24, 2019 and October 22, 2019 were retrospectively included (3 excluded) totaling 99 knees (1 excluded). Quadratic weighted kappa for the AI tool and the consultant consensus was 0.88 CI95% (0.82–0.92). Agreement between the consultants was 0.89 CI95% (0.85–0.93). Intra-rater agreements for the consultants were 0.96 CI95% (0.94–0.98) and 0.94 CI95% (0.91–0.96) respectively. For the AI tool it was 1 CI95% (1–1). For the AI tool, ordinal weighted accuracy was 97.8% CI95% (96.9–98.6 %). Average multiclass accuracy and F1-score were 84% (83/99) CI95% (77–91%) and 0.67 CI95% (0.51–0.81). Conclusions: The AI tool achieved the same good-to-excellent agreement with the radiology consultant consensus for radiographic knee osteoarthritis severity classification as the consultants did with each other.

Purpose: To evaluate the ability of fine-grained annotations to overcome shortcut learning in deep learning (DL)–based diagnosis using chest radiographs. Materials and Methods: Two DL models were developed using radiograph-level annotations (disease present: yes or no) and fine-grained lesion-level annotations (lesion bounding boxes), respectively named CheXNet and CheXDet. A total of 34 501 chest radiographs obtained from January 2005 to September 2019 were retrospectively collected and annotated regarding cardiomegaly, pleural effusion, mass, nodule, pneumonia, pneumothorax, tuberculosis, fracture, and aortic calcification. The internal classification performance and lesion localization performance of the models were compared on a testing set (n = 2922); external classification performance was compared on National Institutes of Health (NIH) Google (n = 4376) and PadChest (n = 24 536) datasets; and external lesion localization performance was compared on the NIH ChestX-ray14 dataset (n = 880). The models were also compared with radiologist performance on a subset of the internal testing set (n = 496). Performance was evaluated using receiver operating characteristic (ROC) curve analysis. Results: Given sufficient training data, both models performed similarly to radiologists. CheXDet achieved significant improvement for external classification, such as classifying fracture on NIH Google (CheXDet area under the ROC curve [AUC], 0.67; CheXNet AUC, 0.51; P<.001) and PadChest (CheXDet AUC, 0.78; CheXNet AUC, 0.55; P<.001). CheXDet achieved higher lesion detection performance than CheXNet for most abnormalities on all datasets, such as detecting pneumothorax on the internal set (CheXDet jackknife alternative free-response ROC [JAFROC] figure of merit [FOM], 0.87; CheXNet JAFROC FOM, 0.13; P<.001) and NIH ChestX-ray14 (CheXDet JAFROC FOM, 0.55; CheXNet JAFROC FOM, 0.04; P<.001). Conclusion: Fine-grained annotations overcame shortcut learning and enabled DL models to iden

Background: Trabecular bone texture analysis (TBTA) has been identified as an imaging biomarker that provides information on trabecular bone changes due to knee osteoarthritis (KOA). Consequently, it is important to conduct a comprehensive review that would permit a better understanding of this unfamiliar image analysis technique in the area of KOA research. We examined how TBTA, conducted on knee radiographs, is associated to (i) KOA incidence and progression, (ii) total knee arthroplasty, and (iii) KOA treatment responses. The primary aims of this study are twofold: to provide (i) a narrative review of the studies conducted on radiographic KOA using TBTA, and (ii) a viewpoint on future research priorities. Method: Literature searches were performed in the PubMed electronic database. Studies published between June 1991 and March 2020 and related to traditional and fractal image analysis of trabecular bone texture (TBT) on knee radiographs were identified. Results: The search resulted in 219 papers. After title and abstract scanning, 39 studies were found eligible and then classified in accordance to six criteria: cross-sectional evaluation of osteoarthritis and non-osteoarthritis knees, understanding of bone microarchitecture, prediction of KOA progression, KOA incidence, and total knee arthroplasty and association with treatment response. Numerous studies have reported the relevance of TBTA as a potential bioimaging marker in the prediction of KOA incidence and progression. However, only a few studies have focused on the association of TBTA with both OA treatment responses and the prediction of knee joint replacement. Conclusion: Clear evidence of biological plausibility for TBTA in KOA is already established. The review confirms the consistent association between TBT and important KOA endpoints such as KOA radiographic incidence and progression. TBTA could provide markers for enrichment of clinical trials enhancing the screening of KOA progressors. Major

Objective: To examine and compare the accuracy of conventional radiography (CR) and musculoskeletal ultrasonography (US) in the diagnosis of calcium pyrophosphate (CPP) crystals deposition disease (CPPD). DESIGN: A systematic search of electronic databases (PubMed, Embase, and Cochrane), conference abstracts and reference lists was undertaken. Studies which evaluated the accuracy of CR and/or US in the diagnosis of CPPD, using synovial fluid analysis (SFA), histology or classification criteria as reference tests were included. Subgroup analyses by anatomic site and by reference test were performed. Results: Twenty-six studies were included. Using SFA/histology as reference test, CR and US showed an excellent (CR AUC = 0.889, 95%CI = 0.811–0.967) and an outstanding (US AUC = 0.954, 95%CI = 0.907–1.0) diagnostic accuracy (p < 0.01), respectively. Furthermore, US showed a higher sensitivity (0.85, 95%CI = 0.79–0.90 vs 0.47, 95%CI = 0.40–0.55) and only a little lower specificity (0.87, 95%CI = 0.83–0.91 vs 0.95, 95%CI = 0.92–0.97) than CR. A considerable heterogeneity between the studies was found, with adopted reference test being the main source of heterogeneity. In fact, subgroup analysis showed a significant change in the diagnostic accuracy of CR, but not of US, using Ryan and McCarty criteria or SFA/histology as reference test (CR: AUC = 0.956, 95%CI = 0.925–1.0 vs AUC = 0.889, 95%CI = 0.828–0.950, respectively, p < 0.01) (US: AUC = 0.922, 95%CI = 0.842–1.0 vs AUC = 0.957, 95%CI = 0.865–1.0, respectively, p = 0.08) Conclusions: Although US is more sensitive and a little less specific than CR for identifying CPP crystals, both these two techniques showed a great diagnostic accuracy and should be regarded as complementary to each other in the diagnostic work-up of patients with CPPD.

Juvenile idiopathic arthritis (JIA) is the most common paediatric rheumatic disease. It represents a group of heterogenous inflammatory disorders with unknown origin and is a diagnosis of exclusion in which imaging plays an important role. JIA is defined as arthritis of one or more joints that begins before the age of 16 years, persists for more than 6 weeks and is of unknown aetiology and pathophysiology. The clinical goal is early suppression of inflammation to prevent irreversible joint damage which has shifted the emphasis from detecting established joint damage to proactively detecting inflammatory change. This drives the need for imaging techniques that are more sensitive than conventional radiography in the evaluation of inflammatory processes as well as early osteochondral change. Physical examination has limited reliability, even if performed by an experienced clinician, emphasising the importance of imaging to aid in clinical decision-making. On behalf of the European Society of Musculoskeletal Radiology (ESSR) arthritis subcommittee and the European Society of Paediatric Radiology (ESPR) musculoskeletal imaging taskforce, based on literature review and/or expert opinion, we discuss paediatric-specific imaging characteristics of the most commonly involved, in literature best documented and clinically important joints in JIA, namely the temporomandibular joints (TMJs), spine, sacroiliac (SI) joints, wrists, hips and knees, followed by a clinically applicable point to consider for each joint. We will also touch upon controversies in the current literature that remain to be resolved with ongoing research. KEY POINTS: • Juvenile idiopathic arthritis (JIA) is the most common chronic paediatric rheumatic disease and, in JIA imaging, is increasingly important to aid in clinical decision-making. • Conventional radiographs have a lower sensitivity and specificity for detection of disease activity and early destructive change, as compared to MRI or ultrasound. Nonet

Juvenile idiopathic arthritis (JIA) is the most common paediatric rheumatic disease. It represents a group of heterogenous inflammatory disorders with unknown origin and is a diagnosis of exclusion in which imaging plays an important role. JIA is defined as arthritis of one or more joints that begins before the age of 16 years, persists for more than 6 weeks and is of unknown aetiology and pathophysiology. The clinical goal is early suppression of inflammation to prevent irreversible joint damage which has shifted the emphasis from detecting established joint damage to proactively detecting inflammatory change. This drives the need for imaging techniques that are more sensitive than conventional radiography in the evaluation of inflammatory processes as well as early osteochondral change. Physical examination has limited reliability, even if performed by an experienced clinician, emphasising the importance of imaging to aid in clinical decision-making. On behalf of the European Society of Musculoskeletal Radiology (ESSR) arthritis subcommittee and the European Society of Paediatric Radiology (ESPR) musculoskeletal imaging taskforce, based on literature review an

Juvenile idiopathic arthritis (JIA) is the most common paediatric rheumatic disease. It represents a group of heterogenous inflammatory disorders with unknown origin and is a diagnosis of exclusion in which imaging plays an important role. JIA is defined as arthritis of one or more joints that begins before the age of 16 years, persists for more than 6 weeks and is of unknown aetiology and pathophysiology. The clinical goal is early suppression of inflammation to prevent irreversible joint damage which has shifted the emphasis from detecting established joint damage to proactively detecting inflammatory change. This drives the need for imaging techniques that are more sensitive than conventional radiography in the evaluation of inflammatory processes as well as early osteochondral change. Physical examination has limited reliability, even if performed by an experienced clinician, emphasising the importance of imaging to aid in clinical decision-making. On behalf of the European Society of Musculoskeletal Radiology (ESSR) arthritis subcommittee and the European Society of Paediatric Radiology (ESPR) musculoskeletal imaging taskforce, based on literature review an

Juvenile idiopathic arthritis (JIA) is the most common paediatric rheumatic disease. It represents a group of heterogenous inflammatory disorders with unknown origin and is a diagnosis of exclusion in which imaging plays an important role. JIA is defined as arthritis of one or more joints that begins before the age of 16 years, persists for more than 6 weeks and is of unknown aetiology and pathophysiology. The clinical goal is early suppression of inflammation to prevent irreversible joint damage which has shifted the emphasis from detecting established joint damage to proactively detecting inflammatory change. This drives the need for imaging techniques that are more sensitive than conventional radiography in the evaluation of inflammatory processes as well as early osteochondral change. Physical examination has limited reliability, even if performed by an experienced clinician, emphasising the importance of imaging to aid in clinical decision-making. On behalf of the European Society of Musculoskeletal Radiology (ESSR) arthritis subcommittee and the European Society of Paediatric Radiology (ESPR) musculoskeletal imaging taskforce, based on literature review and/or expert opinion, we discuss paediatric-specific imaging characteristics of the most commonly involved, in literature best documented and clinically important joints in JIA, namely the temporomandibular joints (TMJs), spine, sacroiliac (SI) joints, wrists, hips and knees, followed by a clinically applicable point to consider for each joint. We will also touch upon controversies in the current literature that remain to be resolved with ongoing research. KEY POINTS: • Juvenile idiopathic arthritis (JIA) is the most common chronic paediatric rheumatic disease and, in JIA imaging, is increasingly important to aid in clinical decision-making. • Conventional radiographs have a lower sensitivity and specificity for detection of disease activity and early destructive change, as compared to MRI or ultrasound. Nonet

Juvenile idiopathic arthritis (JIA) is the most common paediatric rheumatic disease. It represents a group of heterogenous inflammatory disorders with unknown origin and is a diagnosis of exclusion in which imaging plays an important role. JIA is defined as arthritis of one or more joints that begins before the age of 16 years, persists for more than 6 weeks and is of unknown aetiology and pathophysiology. The clinical goal is early suppression of inflammation to prevent irreversible joint damage which has shifted the emphasis from detecting established joint damage to proactively detecting inflammatory change. This drives the need for imaging techniques that are more sensitive than conventional radiography in the evaluation of inflammatory processes as well as early osteochondral change. Physical examination has limited reliability, even if performed by an experienced clinician, emphasising the importance of imaging to aid in clinical decision-making. On behalf of the European Society of Musculoskeletal Radiology (ESSR) arthritis subcommittee and the European Society of Paediatric Radiology (ESPR) musculoskeletal imaging taskforce, based on literature review and/or expert opinion, we discuss paediatric-specific imaging characteristics of the most commonly involved, in literature best documented and clinically important joints in JIA, namely the temporomandibular joints (TMJs), spine, sacroiliac (SI) joints, wrists, hips and knees, followed by a clinically applicable point to consider for each joint. We will also touch upon controversies in the current literature that remain to be resolved with ongoing research. KEY POINTS: • Juvenile idiopathic arthritis (JIA) is the most common chronic paediatric rheumatic disease and, in JIA imaging, is increasingly important to aid in clinical decision-making. • Conventional radiographs have a lower sensitivity and specificity for detection of disease activity and early destructive change, as compared to MRI or ultrasound. Nonet

Juvenile idiopathic arthritis (JIA) is the most common paediatric rheumatic disease. It represents a group of heterogenous inflammatory disorders with unknown origin and is a diagnosis of exclusion in which imaging plays an important role. JIA is defined as arthritis of one or more joints that begins before the age of 16 years, persists for more than 6 weeks and is of unknown aetiology and pathophysiology. The clinical goal is early suppression of inflammation to prevent irreversible joint damage which has shifted the emphasis from detecting established joint damage to proactively detecting inflammatory change. This drives the need for imaging techniques that are more sensitive than conventional radiography in the evaluation of inflammatory processes as well as early osteochondral change. Physical examination has limited reliability, even if performed by an experienced clinician, emphasising the importance of imaging to aid in clinical decision-making. On behalf of the European Society of Musculoskeletal Radiology (ESSR) arthritis subcommittee and the European Society of Paediatric Radiology (ESPR) musculoskeletal imaging taskforce, based on literature review and/or expert opinion, we discuss paediatric-specific imaging characteristics of the most commonly involved, in literature best documented and clinically important joints in JIA, namely the temporomandibular joints (TMJs), spine, sacroiliac (SI) joints, wrists, hips and knees, followed by a clinically applicable point to consider for each joint. We will also touch upon controversies in the current literature that remain to be resolved with ongoing research. KEY POINTS: • Juvenile idiopathic arthritis (JIA) is the most common chronic paediatric rheumatic disease and, in JIA imaging, is increasingly important to aid in clinical decision-making. • Conventional radiographs have a lower sensitivity and specificity for detection of disease activity and early destructive change, as compared to MRI or ultrasound. Nonet

Juvenile idiopathic arthritis (JIA) is the most common paediatric rheumatic disease. It represents a group of heterogenous inflammatory disorders with unknown origin and is a diagnosis of exclusion in which imaging plays an important role. JIA is defined as arthritis of one or more joints that begins before the age of 16 years, persists for more than 6 weeks and is of unknown aetiology and pathophysiology. The clinical goal is early suppression of inflammation to prevent irreversible joint damage which has shifted the emphasis from detecting established joint damage to proactively detecting inflammatory change. This drives the need for imaging techniques that are more sensitive than conventional radiography in the evaluation of inflammatory processes as well as early osteochondral change. Physical examination has limited reliability, even if performed by an experienced clinician, emphasising the importance of imaging to aid in clinical decision-making. On behalf of the European Society of Musculoskeletal Radiology (ESSR) arthritis subcommittee and the European Society of Paediatric Radiology (ESPR) musculoskeletal imaging taskforce, based on literature review and/or expert opinion, we discuss paediatric-specific imaging characteristics of the most commonly involved, in literature best documented and clinically important joints in JIA, namely the temporomandibular joints (TMJs), spine, sacroiliac (SI) joints, wrists, hips and knees, followed by a clinically applicable point to consider for each joint. We will also touch upon controversies in the current literature that remain to be resolved with ongoing research. KEY POINTS: • Juvenile idiopathic arthritis (JIA) is the most common chronic paediatric rheumatic disease and, in JIA imaging, is increasingly important to aid in clinical decision-making. • Conventional radiographs have a lower sensitivity and specificity for detection of disease activity and early destructive change, as compared to MRI or ultrasound. Nonet

Juvenile idiopathic arthritis (JIA) is the most common paediatric rheumatic disease. It represents a group of heterogenous inflammatory disorders with unknown origin and is a diagnosis of exclusion in which imaging plays an important role. JIA is defined as arthritis of one or more joints that begins before the age of 16 years, persists for more than 6 weeks and is of unknown aetiology and pathophysiology. The clinical goal is early suppression of inflammation to prevent irreversible joint damage which has shifted the emphasis from detecting established joint damage to proactively detecting inflammatory change. This drives the need for imaging techniques that are more sensitive than conventional radiography in the evaluation of inflammatory processes as well as early osteochondral change. Physical examination has limited reliability, even if performed by an experienced clinician, emphasising the importance of imaging to aid in clinical decision-making. On behalf of the European Society of Musculoskeletal Radiology (ESSR) arthritis subcommittee and the European Society of Paediatric Radiology (ESPR) musculoskeletal imaging taskforce, based on literature review and/or expert opinion, we discuss paediatric-specific imaging characteristics of the most commonly involved, in literature best documented and clinically important joints in JIA, namely the temporomandibular joints (TMJs), spine, sacroiliac (SI) joints, wrists, hips and knees, followed by a clinically applicable point to consider for each joint. We will also touch upon controversies in the current literature that remain to be resolved with ongoing research. Key Points: • Juvenile idiopathic arthritis (JIA) is the most common chronic paediatric rheumatic disease and, in JIA imaging, is increasingly important to aid in clinical decision-making. • Conventional radiographs have a lower sensitivity and specificity for detection of disease activity and early destructive change, as compared to MRI or ultraso, SCOPUS: re.j, info:eu-repo/semantics/published

Background: To evaluate radiographic progression of patients with new-onset juvenile idiopathic arthritis (JIA) in response to an early, tightly-controlled, treatment-to-target. Methods: Patients with JIA participating in the BeSt-for-Kids-study, randomized to 3 treatment strategy arms, were eligible if at least 1 conventional wrist-radiograph was available. Bone damage as reflected by carpal length was assessed using the Poznanski-score. The BoneXpert-method was used to determine the Bone Age (BA, > 5 years) and bone mineral density (BMD) of the wrist. These scores were evaluated over time and compared between the treatment arms and mean JADAS10-score using linear mixed models corrected for age and symptom duration. Results: In 60 patients, 252 radiographs were analysed. Baseline age and symptom duration were different between the arms. No difference in comparison to the healthy reference population was found at baseline for the Poznanskiscore (IQR varying from − 0,82; 0.68), nor for BA (varying from − 0.88 to 0.74). Baseline BMD was statistically significantly lower in arm 3 (initial treatment with etanercept and methotrexate) (− 1.48; − 0.68) compared to

Imaging plays an important role in diagnosis and monitoring of rheumatic diseases of the upper limb. Many rheumatic diseases present with similar clinical pictures, especially in the early stages. Imaging findings in inflammatory and degenerative joint diseases often are nonspecific, especially in the early stages. Imaging findings should be interpreted in light of the clinical context—clinical and paraclinical findings. Good referrals with short clinical history, main clinical findings, disease-involved joint(s), pain distribution, and relevant blood tests increase the likelihood of a correct diagnosis.

Imaging plays an important role in diagnosis and monitoring of rheumatic diseases of the upper limb. Many rheumatic diseases present with similar clinical pictures, especially in the early stages. Imaging findings in inflammatory and degenerative joint diseases often are nonspecific, especially in the early stages. Imaging findings should be interpreted in light of the clinical context—clinical and paraclinical findings. Good referrals with short clinical history, main clinical findings, disease-involved joint(s), pain distribution, and relevant blood tests increase the likelihood of a correct diagnosis.

Structural damage progression in patients with established rheumatoid arthritis (RA) has traditionally been assessed by conventional radiography (CR), which has proven its value in clinical practice and clinical trials over the past decades. The most prominent abnormalities visualized by CR in RA patients are erosions as a consequence of bone destruction and joint space narrowing (JSN) as a consequence of cartilage damage. Several validated scoring systems to quantify the structural joint damage and progression herein are available. Computed tomography and magnetic resonance imaging are newer, more sensitive methods for detection and monitoring of structural joint damage. A validated scoring system for magnetic resonance imaging of the hands and wrists exists, while no consensus has been reached on a scoring system for computed tomography. Structural damage identified by either CR or magnetic resonance imaging predicts a poorer disease course in patients with both early and established rheumatoid arthritis.

Bakgrund: Forskning visar att barn är känsligare för joniserande strålning än vuxna. Röntgenundersökningar får inte utföras i onödan och nyttan med undersökningen skall överstiga dess risker. Det är viktigt att optimera röntgenundersökningar och så långt som möjligt minimera stråldoser utan att påverka det diagnostiska resultatet, då forskning visar att även låga stråldoser kan ge upphov till DNA-skador och i förlängningen orsaka cancer. Syfte: Att beskriva metoder som optimerar röntgenundersökningar och minskar stråldosen till barn vid konventionell röntgen. Metod: Litteraturstudie vars resultat är baserat på 14 vetenskapliga artiklar funna i databaserna PubMed och CINAHL samt via manuell sökning. Resultat: Det fanns ett flertal metoder och tillvägagångssätt som optimerar röntgenundersökningar och minskar stråldosen till barn vid konventionell röntgen. Metoderna berörde åtgärder i undersökningsrummet, parametrar, filtrering och ny teknik. Konklusion: Röntgensjuksköterskor med kunskap om optimering har goda möjligheter att sänka stråldoser till barn vid konventionell röntgen., Background: Research shows that children are more sensitive to ionizing radiation than adults. X-ray imaging may not be performed unnecessarily and its necessity must exceed the risks. It is important to optimize the imaging and as far as possible minimize the radiation dose without affecting the diagnostic performance negatively. Research shows that even low doses of radiation can cause DNA damage and ultimately induce cancer. Objective: The aim of this paper was to describe methods that optimize the x-ray examination and reduce radiation doses to children in conventional radiography. Method: A literature study whose results are based on 14 scientific articles found in the databases PubMed and CINAHL and manual searches. Results: There were several methods that optimize the x-ray examination and reduce the radiation doses to children in conventional radiography. These methods concern approaches in the examination room, parameters, filtering and new technology. Conclusion: Radiographers’ with knowledge of optimization have good opportunities to lower radiation doses in x-ray examinations of children in conventional radiography.

Bakgrund: Forskning visar att barn är känsligare för joniserande strålning än vuxna. Röntgenundersökningar får inte utföras i onödan och nyttan med undersökningen skall överstiga dess risker. Det är viktigt att optimera röntgenundersökningar och så långt som möjligt minimera stråldoser utan att påverka det diagnostiska resultatet, då forskning visar att även låga stråldoser kan ge upphov till DNA-skador och i förlängningen orsaka cancer. Syfte: Att beskriva metoder som optimerar röntgenundersökningar och minskar stråldosen till barn vid konventionell röntgen. Metod: Litteraturstudie vars resultat är baserat på 14 vetenskapliga artiklar funna i databaserna PubMed och CINAHL samt via manuell sökning. Resultat: Det fanns ett flertal metoder och tillvägagångssätt som optimerar röntgenundersökningar och minskar stråldosen till barn vid konventionell röntgen. Metoderna berörde åtgärder i undersökningsrummet, parametrar, filtrering och ny teknik. Konklusion: Röntgensjuksköterskor med kunskap om optimering har goda möjligheter att sänka stråldoser till barn vid konventionell röntgen., Background: Research shows that children are more sensitive to ionizing radiation than adults. X-ray imaging may not be performed unnecessarily and its necessity must exceed the risks. It is important to optimize the imaging and as far as possible minimize the radiation dose without affecting the diagnostic performance negatively. Research shows that even low doses of radiation can cause DNA damage and ultimately induce cancer. Objective: The aim of this paper was to describe methods that optimize the x-ray examination and reduce radiation doses to children in conventional radiography. Method: A literature study whose results are based on 14 scientific articles found in the databases PubMed and CINAHL and manual searches. Results: There were several methods that optimize the x-ray examination and reduce the radiation doses to children in conventional radiography. These methods concern approaches in the examination room, parameters, filtering and new technology. Conclusion: Radiographers’ with knowledge of optimization have good opportunities to lower radiation doses in x-ray examinations of children in conventional radiography.

Background: Lumbar spine radiography has limited diagnostic value but low radiation dose compared with computed tomography (CT). The average effective radiation dose from lumbar spine radiography is about 1.1 mSv. Low-dose lumbar spine CT may be an alternative to increase the diagnostic value at low radiation dose, around 1 mSv. Purpose: To determine the optimal settings for low-dose lumbar spine CT simultaneously aiming for the highest diagnostic image quality possible. Material and Methods: An ovine lower thoracic and lumbar spine phantom, with all soft tissues around the vertebrae preserved except the skin, was placed in a 20 L plastic container filled with water. The phantom was scanned repeatedly with various technical settings; different tube potential, reference mAs, and with different convolution filters. Five radiologists evaluated the image quality according to a modification of the European guidelines for multislice computed tomography (MSCT) quality criteria for lumbar spine CT 2004. In a visual comparison the different scans were also ranked subjectively according to perceived image quality. Image noise and contrast were measured. Results: A tube potential of 120 kV with reference mAs 30 and medium or medium smooth convolution filter gave the best image quality at a sub-millisievert dose level, i.e. with an effective dose comparable to that from lumbar spine radiography. Conclusion: Low-dose lumbar spine CT thus opens a possibility to substitute lumbar spine radiography with CT without obvious increase in radiation dose.

Vascular calcifications (VC) are a major contributor to the massively increased mortality in hemodialysis (HD) patients. The present study aimed to detect arterial media and intima calcifications in HD patients and to evaluate potential risk factors. 214 patients aged 59.0 +/- 11.0 years on HD for 6.39 +/- 4.59 years were studied. VC were scored based on to plain radiographs. Potential risk factors were assessed. Out of the 214 patients studied, only 14% did not display any detectable VC. Using plain radiographs calcifications could be detected in 136 (63.6%) patients. Calcified plaques on carotid arteries were detected in 168 (78.4%) patients. There was the highest frequency of patients with the most pronounced calcifications. Calcifications of heart valves were detected in 89 (44.1%) patients. Univariante analysis indicate that risk to develop VC is present in older patients, patients with longer dialysis vintage, thicker intima media, higher lumen diameter and mitral valve calcifications. Multivariate multinomial logistic regression analysis revealed these factors as independent predictors of VC in dialysis patients. Our data confirm a high prevalence of VC in HD patients, their association with older ages, longer dialysis vintage, and presence of valvular calcifications and early markers of atherosclerosis.

Bei der vorgelegten Habilitationsschrift handelt es sich um eine kumulative Arbeit. In den einzelnen Originalarbeiten werden die Probleme der bildgebenden Verfahren bei der Diagnostik einer Früharthritis sowie Empfehlungen zur Technik und Evaluierung des Stellenwertes der Arthrosonographie in der Diagnostik rheumatischer Krankheitsbilder, beispielhaft an unterschiedlichen Gelenken dargestellt. In einer prospektiven bildgebenden Verlaufsstudie werden vier bildgebende Verfahren (konventionelle Röntgendiagnostik, Drei-Phasen-Skelett-Szintigraphie, Arthrosonographie, dynamische MR-Tomographie) neben dem klinischen Untersuchungsbefund hinsichtlich des Nachweises des frühentzündlichen Weichteil- und Knochenprozesses initial von 60 Patienten und im Verlauf von 49 Patienten mit arthritischen Erkrankungen der Fingergelenke untersucht. Im Ergebnis konnte gezeigt werden, dass die MR-Tomographie, die Arthrosonographie und die Drei-Phasen-Skelett-Szintigraphie sensitiver im Nachweis eines entzündlichen Gelenkprozesses sind als die konventionelle Röntgendiagnostik. Die Sonographie erlaubt dabei einen sensitiven Nachweis der entzündlichen Weichteilläsionen in Form einer sich entwickelnden Synovitis und Tenosynovitis, ist jedoch im Vergleich zur MR-Tomographie nicht optimal im Nachweis der Knochenerosionen. Oberflächlich liegende Knochenläsionen werden mittels Sonographie besser erfasst als tiefer liegende Knochenläsionen. Der Einsatz der Szintigraphie ist weniger geeignet als die Sonographie und MR-Tomographie im Nachweis des frühentzündlichen Gelenkprozesses wegen ihrer unzureichenden Spezifität. Die MR-Tomographie zeigte sich ebenso sensitiver als die konventionelle Röntgendiagnostik im Nachweis der entzündlichen Weichteilläsionen als auch im Nachweis von Erosionen. Die konventionelle Röntgendiagnostik ist nicht sensitiv genug im Nachweis einer Früharthritis mit frühen Knorpel- und Knochenläsionen. Die Sonographie erlaubt eine gute Differenzierung zwischen Erguss, Synovialis, Pr, This work represents a cumulative collection of several original papers addressing problems of imaging techniques in early arthritis. Guidelines of technique and evaluation of musculoskeletal sonography in the diagnosis of rheumatic diseases are shown on example of different joints. A prospective imaging study was performed to compare conventional radiography, three-phase-bone-scintigraphy, ultrasonography (US), 3D magnetic resonance imaging (MRI) and clinical course in 60 patients initially and 49 patients at follow-up of patients with arthritis of finger joints at two years. We could show that MRI, US and scintigraphy were more sensitive in detection of early arthritic changes than conventional radiography. The sonography was able to detect early inflammatory soft tissue changes such e.g. synovitis and tenosynovitis and demonstrate erosions very sensitively and earlier than conventional radiography. Superficially located bone lesions were detected better than deeper lesions by sonography. Scintigraphy was not suitable for the detection of early erosion because of its low specificity. Moreover, MRI was a sensitive method for the detecting of both soft tissue lesions and early erosions in arthritis. The conventional radiography was unsufficient sensitive in detection of early arthritis with early cartilage and bone lesions. The sonography allows a good differentiation between effusion, synovitis proliferation and tenosynovitis. Bone lesions were detected earlier by sonography than conventional radiography though not to the same extent as 3D MRI. Musculoskeletal sonography is most valuable in a clinical setting because of its good handling, low costs and patient convinience, whereas MRI appears to be the most sensitive detection method of early joint lesions. Overall, sonography and MRI are helpful diagnostic tools in arthritis patients with negative radiographic findings.

Bei der vorgelegten Habilitationsschrift handelt es sich um eine kumulative Arbeit. In den einzelnen Originalarbeiten werden die Probleme der bildgebenden Verfahren bei der Diagnostik einer Früharthritis sowie Empfehlungen zur Technik und Evaluierung des Stellenwertes der Arthrosonographie in der Diagnostik rheumatischer Krankheitsbilder, beispielhaft an unterschiedlichen Gelenken dargestellt. In einer prospektiven bildgebenden Verlaufsstudie werden vier bildgebende Verfahren (konventionelle Röntgendiagnostik, Drei-Phasen-Skelett-Szintigraphie, Arthrosonographie, dynamische MR-Tomographie) neben dem klinischen Untersuchungsbefund hinsichtlich des Nachweises des frühentzündlichen Weichteil- und Knochenprozesses initial von 60 Patienten und im Verlauf von 49 Patienten mit arthritischen Erkrankungen der Fingergelenke untersucht. Im Ergebnis konnte gezeigt werden, dass die MR-Tomographie, die Arthrosonographie und die Drei-Phasen-Skelett-Szintigraphie sensitiver im Nachweis eines entzündlichen Gelenkprozesses sind als die konventionelle Röntgendiagnostik. Die Sonographie erlaubt dabei einen sensitiven Nachweis der entzündlichen Weichteilläsionen in Form einer sich entwickelnden Synovitis und Tenosynovitis, ist jedoch im Vergleich zur MR-Tomographie nicht optimal im Nachweis der Knochenerosionen. Oberflächlich liegende Knochenläsionen werden mittels Sonographie besser erfasst als tiefer liegende Knochenläsionen. Der Einsatz der Szintigraphie ist weniger geeignet als die Sonographie und MR-Tomographie im Nachweis des frühentzündlichen Gelenkprozesses wegen ihrer unzureichenden Spezifität. Die MR-Tomographie zeigte sich ebenso sensitiver als die konventionelle Röntgendiagnostik im Nachweis der entzündlichen Weichteilläsionen als auch im Nachweis von Erosionen. Die konventionelle Röntgendiagnostik ist nicht sensitiv genug im Nachweis einer Früharthritis mit frühen Knorpel- und Knochenläsionen. Die Sonographie erlaubt eine gute Differenzierung zwischen Erguss, Synovialis, Pr, This work represents a cumulative collection of several original papers addressing problems of imaging techniques in early arthritis. Guidelines of technique and evaluation of musculoskeletal sonography in the diagnosis of rheumatic diseases are shown on example of different joints. A prospective imaging study was performed to compare conventional radiography, three-phase-bone-scintigraphy, ultrasonography (US), 3D magnetic resonance imaging (MRI) and clinical course in 60 patients initially and 49 patients at follow-up of patients with arthritis of finger joints at two years. We could show that MRI, US and scintigraphy were more sensitive in detection of early arthritic changes than conventional radiography. The sonography was able to detect early inflammatory soft tissue changes such e.g. synovitis and tenosynovitis and demonstrate erosions very sensitively and earlier than conventional radiography. Superficially located bone lesions were detected better than deeper lesions by sonography. Scintigraphy was not suitable for the detection of early erosion because of its low specificity. Moreover, MRI was a sensitive method for the detecting of both soft tissue lesions and early erosions in arthritis. The conventional radiography was unsufficient sensitive in detection of early arthritis with early cartilage and bone lesions. The sonography allows a good differentiation between effusion, synovitis proliferation and tenosynovitis. Bone lesions were detected earlier by sonography than conventional radiography though not to the same extent as 3D MRI. Musculoskeletal sonography is most valuable in a clinical setting because of its good handling, low costs and patient convinience, whereas MRI appears to be the most sensitive detection method of early joint lesions. Overall, sonography and MRI are helpful diagnostic tools in arthritis patients with negative radiographic findings.