New imaging procedures in rheumatology: from bench to bedside

Modern imaging procedures play an import role in diagnostic and therapy-control in rheumatic diseases. Reasons are the continuous development, the evaluation and the implementation in local / international guidelines and classification criteria. According to new therapeutic goals and the aim of clinical and radiological remission the early diagnosis and sufficient therapy-control is unalterable. The ultrasound is today an inherent tool in the early diagnosis of joint- and vascular diseases and is used comprehensively in rheumatic diseases. Beside the highly sensitive detection of inflammation the MRI might depict bone erosions and bone marrow oedema, which is highly predictive for the development of erosions, clearly earlier than conventional x-rays. Due to its advantages the MRI is used frequently in the early diagnosis of spondyloarthritis (ASAS-guidelines). Moreover the capillary microscopy is - due to the rapid performance, the absence of radiation and the high sensitivity - applied in the early diagnosis and therapy-control of connective tissue diseases (e.g systemic sclerosis). New innovative imaging technics find increasing acceptance in the diagnostic algorithm in rheumatic disease. Hence the DECT can detect monosodium urate (MSU) crystals without the need of a joint puncture. Hybrid imaging technics like PET-CT / PET-MRI combine the high sensitivity of the PET and the accurate solution of the CT / MRI. These advantages lead to increasing importance in diagnostic imaging.