There have been a number of significant advances in musculoskeletal ultrasound since its early use in the evaluation MRI has revolutionized cross-sectional imaging of the musculoskeletal system and has become the most widely used technique for a wide variety of pathologic conditions. The comprehensive depiction of osseous, articular, and soft-tissue pathology provided by MRI is unparalleled. As a result, physicians and surgeons rely heavily on the information provided by MRI to make diagnostic and treatment decisions.

However, while MRI was gaining its ascendancy, another musculoskeletal imaging technique was quietly on the rise—namely, sonography. Rapid improvements in technology have made sonography an important complementary tool for musculoskeletal imaging, and there is now a large body of literature documenting the effectiveness of musculoskeletal sonography.

This was hospital based observational study of 1000 patients done in the department of radiodiagnosis, GMERS medical collage and bhavsinhji general hospital, Porbandar with use of ultrasound machine (Esaote, MY LAB X8 EXP, 8200657).

The purpose of this article is to show the advantages of musculoskeletal sonography for the diagnosis and treatment of musculoskeletal conditions. There are some scenarios in which sonography is the imaging test of choice over MRI, illustrated by specific examples from our practice. Although there are numerous situations in which MRI is superior to sonography,

MRI is already well established and does not need more advocates. Rather, our goal is to convince the reader that patientdeserve to be offered musculoskeletal sonography as an imaging option.

So, in no particular order, here are the top 10 reasons that musculoskeletal sonography is an important complementary tool to MRI.

1. Every Patient Can Undergo Sonography
2. Sonography Can Resolve Finer Details than MRI
3. Sonography Allows Real-Time Dynamic Examination of the Patient 4: The Ultrasound Probe Can Be Placed Exactly Where It Hurts
4. Sonography Can Effectively Image
5. Doppler Sonography Gives Important Physiologic Information
6. Sonography Is Better for Differentiating Fluid from Solid Material 8: Sonography Is Better for Guiding Therapeutic Interventions
7. Sonography Facilitates Bilateral Comparison
8. Sonography Has a More Flexible Field of View

TABLE 1. Ultrasound appearance of tissue

TABLE 2. Shoulder

TABLE 3. Elbow

TABLE 4. Wrist

TABLE 5. Hip

TABLE 6. Knee

TABLE 7. Ankle

Although MRI remains the imaging reference standard for a wide range of musculoskeletal disorders, musculoskeletal sonography is an important complementary, and in some cases alternative, technique to MRI.(1,2,3) In many instances sonography should be the test of choice on the basis of the advantages that I have discussed here. Radiologists need to embrace musculoskeletal sonography so that their patients can reap the benefits. The musculoskeletal sonography, with greater training in the performance and interpretation of musculoskeletal sonography in radiology residency and fellowship programs.(4,5,6,7) Not only will the patients benefit, but the radiologist will also gain the immense satisfaction that results from directly interacting with a patient, making a diagnosis that has heretofore been elusive, and, in some cases, performing a therapeutic intervention that alleviates the pain. Musculoskeletal sonography is indeed a uniquely rewarding field.(8,9,10)

Musculoskeletal sonography is an important complementary tool to MRI and is essential for radiologists who want to provide patients with state-of-the-art musculoskeletal imaging. The use of musculoskeletal ultrasound continues to grow and there are a number of factors that impact MRI. The development of less expensive portable ultrasound machines has opened the market to non radiologists, and applications for musculoskeletal ultrasound have broadened. Selective substitution of musculoskeletal ultrasound for MRI can result in significant cost saving to the health care system.

Although this change could decrease the use of MRI, issues related to accuracy, variability, education, and competence must be addressed.

1. Nazarian LN. The top 10 reasons musculoskeletal sonography is an important complementary or alternative technique to MRI. AJR Am J Roentgenol.2008;190(6):1621-1626.
2. Jamadar DA, Jacobson JA, Caoili EM, et al. Musculoskeletal sonography technique: focused versus comprehensive evaluation. AJR Am J Roentgenol.2008;190(1):5-9.
3. Connell D, Burke F, Coombes P, et al. Sonographic examination of lateral epicondylitis. AJR Am J Roentgenol. 2001;176(3):777-782.
4. Martinoli C, Bianchi S, Dahmane M, et al. Ultrasound of tendons and nerves. Eur Radiol. 2002;12(1):44-55.
5. Breidahl WH, Stafford Johnson DB, Newman JS, Adler RS. Power Doppler sonography in tenosynovitis: significance of the peritendinous hypoechoic rim. J Ultrasound Med. 1998;17(2):103- 107.
6. Naqvi GA, Jadaan M, Harrington P. Accuracy of ultrasonography and MRI for detection of full thickness rotator cuff tear.
7. Jacobson JA. Musculoskeletal ultrasound: focused impact on MRI. AJR Am J Roentgenol. 2009;193(3):619-627.
8. Tagliafico A, Ameri P, Michaud J, Derchi LE, Sconfienza LM. Wrist and hand sonography: diagnostic value in daily clinical practice. J Ultrasound Med. 2012;31(4):577-587.
9. Klauser AS, Peetrons P. Developments in musculoskeletal ultrasound and clinical applications. Skeletal Radiol. 2010;39(11):1061-1071.
10. Zaidman CM, Al-Lozi M, Pestronk A. Peripheral nerve injury, repair, and outcome: ultrasound assessment. Muscle Nerve. 2009;40(4):540-550.