Wilhelm Conrad Roentgen won the first Nobel Prize in Physics for the discovery of radiographs in 1895. The initial use of ultrasound for medical imaging followed five decades later. Computed tomography (CT) came into use in the 1960s, followed by MRI in the early 1970s. Recent years have seen an explosion of sophisticated imaging techniques, including whole body, dGEMERIC, and diffusion MRI, CT angiography, and PET-CT. The use of imaging has enhanced and transformed our understanding of not only disease pathophysiology but also the distribution of affected tissue and bone and disease progression.
Radiographs maintain a pivotal role in the evaluation of osteoarthritis, crystal-related arthritis, and spondyloarthritis. With the advent of imaging techniques like MRI, CT, angiography, and ultrasound, we can now also reliably assess changes within the synovium, cartilage, bone, and vessels. These newer imaging techniques are indispensable in the evaluation of conditions like large-vessel vasculitis, which is often not amenable to confirmatory biopsy. The use of sensitive imaging techniques like compositional MRI assessment for osteoarthritis has the potential to identify early biochemical changes that precede morphological changes, perhaps enabling earlier diagnosis. Furthermore, the development of comprehensive scoring methodology for the entheses and axial spondyloarthritis enables objective measurements of response to therapy, which are invaluable to the study of novel therapies. Over the next few years, I anticipate we will continue to see vast advancements in imaging and applications to the clinical care of both children and adults with rheumatic disease.
This issue of Rheumatic Disease Clinics of North America addresses state-of-the-art imaging techniques for the evaluation of inflammatory peripheral and axial arthritis, enthesitis, crystal arthropathies, connective tissue disease, vasculitis, bone tumors, chronic recurrent osteomyelitis and SAPHO syndrome, joint and bone infection, and available imaging scoring techniques. The contributing authors are a wonderful group of experts well poised to discuss the role of imaging as it fits into clinical evaluation and research endeavors for these conditions.