Rheumatology Practice Test

Which imaging modality is most sensitive for detecting enthesitis?

X-ray Ultrasound with Doppler MRI of the brain CT scan of the joint

Correct Answer:

Ultrasound with Doppler

Explanation:

Enthesitis is inflammation at the insertion of tendons or ligaments into bone, so the best imaging to detect it is one that can visualize soft tissue changes at the enthesis and show active blood flow. Ultrasound with Doppler does exactly this: it directly images the enthesis, revealing thickening, hypoechogenicity, calcifications or erosions at the insertion, and, with Doppler, shows increased vascularity that indicates active inflammation. This combination makes it more sensitive for detecting enthesitis than X-ray or CT, which mainly reveal bone changes that appear later, and often more practical and accessible than MRI, which is great for deep or spine enthesitis but not as sensitive for superficial sites or as readily used for routine peripheral enthesitis assessment.

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