What is the best imaging modality for an inflamed hand and fingers?

From the Guidelines

Ultrasound is the best initial imaging modality for an inflamed hand and fingers, as it detects joint inflammation more frequently than clinical examination, with a mean detection rate for synovitis at the hand and wrist of 2.18-fold 1. When evaluating an inflamed hand and fingers, it is essential to consider the most effective imaging modality to guide diagnosis and treatment.

• The primary goal is to accurately assess joint inflammation, and ultrasound has been shown to be superior to clinical examination in this regard 1.
• MRI is also a valuable tool, detecting joint inflammation more frequently than clinical examination, with a mean detection rate for synovitis at the hand and wrist of 2.20-fold 1.
• However, ultrasound is recommended as the first-line imaging modality due to its excellent visualization of synovitis, tenosynovitis, and early erosions without radiation exposure.
• The choice of imaging modality should be tailored to the suspected underlying condition, and ultrasound should be considered for a more accurate assessment of inflammation, as recommended by the EULAR guidelines 1.
• It is crucial to provide the radiologist with specific clinical information about symptom duration, suspected diagnosis, and previous treatments to guide appropriate protocol selection.
• Other imaging modalities, such as MRI, CT scanning, and nuclear medicine studies, may be useful in specific situations, but ultrasound is the best initial choice for evaluating an inflamed hand and fingers 1.

From the Research

Imaging Modalities for Inflamed Hand and Fingers

The best imaging modality for an inflamed hand and fingers can depend on various factors, including the specific condition being diagnosed and the level of detail required. Some of the imaging modalities that can be used to assess inflammation in the hand and fingers include:

• Computed tomography (CT) 2
• Plain radiography (x-ray) 2, 3
• Positron emission tomography (PET) 2
• Technetium Tc 99m bone scintigraphy 2
• Magnetic resonance imaging (MRI) 2, 3, 4
• Leukocyte scintigraphy 2
• Ultrasonography (US) 3, 5, 6

Comparison of Imaging Modalities

Studies have compared the effectiveness of different imaging modalities in detecting inflammatory and destructive changes in the hand and fingers. For example:

• A study found that US and MRI were more sensitive to inflammatory and destructive changes than x-ray and clinical examination 3
• Another study found that MRI was the best available imaging modality for detecting early osteomyelitis due to its high sensitivity and excellent anatomical detail 4
• A study on ultrahigh frequency ultrasound imaging (UHFUS) found that it was capable of quickly and reliably imaging larger structures such as foreign bodies, soft tissue masses, and the flexor tendons, and diagnosing an array of pathologies within these structures 6

Advantages and Disadvantages of Imaging Modalities

Each imaging modality has its own advantages and disadvantages. For example:

• US is a cost-effective, noninvasive, and expedient imaging modality, but it may have limited depth penetration and operator dependence 5, 6
• MRI is highly sensitive and provides excellent anatomical detail, but it can be expensive and may not be available in all settings 3, 4
• CT and PET can provide additional information, but they may involve radiation exposure and higher costs 2, 4