Differential diagnosis of rheumatic diseases
This article comes fro Der Radiologe and is by G Linng and C Schorn from the central Rontgen institute in bad Kreuznach
QUESTION TO ANSWER: Which imaging modalities are appropriate for the Differential diagnosis of Rheumatic diseases.
METHODS AND RESULTS: MRI has far most the highest sensitivity and is unequaled in its brilliant presentation of Anatomy and Pathology. But it is sometimes forgotten, that this is at least in part the result of carefully selected sequences, dedicated to the exspected result.In a method totally independent of any result, this should not be the case. In contrary this method should be highly standardised and regardless what will be the findings. This is true for Plain X-ray. It will be shown, that already the outer sihouette of the soft parts with different features of swelling, and differences in density and even more - defects or appositions of the bony silhouette in the majority of cases at least will allow to classify the patient for a group of diseases and in many cases will lead to a definite diagnosis. Differential diagnoses like Rheumatoid Arthritis versus Psoriatic Arthritis or simply but not always simple - inflammatory Arthritis versus degenerative disease - are allowed to be answered definitely, not always so in MRI. The condition of the subchondral bone can give hints, how advanced and how active the disease is at present.
CONCLUSION: Plain X-ray offers high specifity in the differential diagnoses of rheumatic diseases, it is well standardised and it is a device, to use independent from any suspected findings.So it is the method of choice for questions of differential diagnosis. This is even more true, thinking of the possibility, to investigate all clinically involved regions with not to much extended efforts, wheras MRI and CT are used normally for only one region.
The full abstract and links to the original german article can be found using pubmed, Identifier number is 16673141 and the issue is from May 2006.
