Scientific Retreats 2007

August 5, 2007 (historical)

Soft Tissue Imaging

The fields of imaging musculoskeletal (MSK) soft tissues have expanded tremendously in the past 10 years. New modalities have been developed and existing ones improved to provide massive amounts of clinical information through non-invasive means. There is wide variation in the clinical use and utility of these methods due to both cost of procedures, and uncertainty of benefit to be gained from the added information. Techniques such as computed tomography (both quantitative and three dimensional), digital luminescence radiography, high-resolution ultrasonography (including Doppler), fluorodeoxy-D-glucose enhanced positron emission tomography, contrast enhanced microcomputed tomography, and magnetic resonance imaging offer great promise for application to imaging of soft tissues. In addition, the area of functional imaging, with particular emphasis on muscle and connective tissues, is developing at a rapid pace. Many of these technologies hold great promise for diagnosing injury and disease, and for monitoring therapy and healing, and repair and regeneration, of soft tissues. They could become integral parts of routine diagnosis and management in orthopaedic and rheumatologic practices. Most show substantial advantage over standard clinical assessments and enable more accurate diagnosis and management of disease and injury to the MSK soft tissues.

Some of the key questions are:

  • Do the current "state-of-the-science" imaging technologies meet most of the needs with regard to diagnosis of injury and disease in MSK soft tissues? If not, can we identify the most pressing research and clinical gaps? Are there emerging methods for MSK soft tissue imaging that show great promise to meet these needs?
  • Are these imaging modalities being validated and widely used in both research and clinical settings? If not, what are the obstacles that prevent broader use of these methods?
  • How can imaging modalities better aid in early detection, screening, diagnosis and treatment of diseases and injuries? What are examples of areas where such technologies could be readily applied with significant benefit? Can the various technologies be combined to obtain more and better information? What are the technical and practical challenges to such approaches?
  • What are the "near" and "far" term opportunities in the area of MSK soft tissue imaging?
  • How can NIAMS advance investigations of the use of imaging with regard to early diagnosis of disease and the understanding of MSK soft tissue function? With regard to the integration of static and dynamic imaging with the field of musculoskeletal modeling?

Background Materials:

  • Jacobson JA. Musculoskeletal Ultrasound and MRI: Which do I choose?, Seminars in Musculoskeletal Radiology. 8:135-149, 2005.
  • Grassi W, Filippucci E, Carotti M, Salaffi F. Imaging Modalities for Identifying the Origin of Regional Musculoskeletal Pain. Best Practice and Research Clinical Rheumatology. 17:17-23, 2003.
  • Blemker SS, Asakawa DS, Gold GE, Delp SL. Image-Based Musculoskeletal Modeling: Applications, Advances, and Future Opportunities. Journal of Magnetic Resonance Imaging. 25:441-451, 2007.