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Interligator S, Le Bozec A, Cluzel G, Devilder M, Ghaouche J, Guenoun D, Fleury A, Petit Lemaire F, Carlier RY, Valente C, Creze M. Infectious sacroiliitis: MRI- and CT-based assessment of disease extent, complications, and anatomic correlation. Skeletal Radiol 2023:10.1007/s00256-023-04535-w. [PMID: 38110777 DOI: 10.1007/s00256-023-04535-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 11/25/2023] [Accepted: 11/27/2023] [Indexed: 12/20/2023]
Abstract
OBJECTIVE To describe the frequency of MR and CT features of infectious sacroiliitis (ISI) and assess its extent and complications MATERIALS AND METHODS: This retrospective study included patients with ISI who were evaluated between 2008 and 2021 in a single center. Two radiologists reviewed MRI and CT images to determine the anatomical distribution (unilateral/bilateral, iliac/sacral bone, proximal/middle/distal), severity (bone marrow edema [BME]/periostitis/erosions), concurrent infection (vertebral/nonvertebral), and complications (abscess/probable adjacent osteomyelitis/cavitation/devitalized areas/sequestrum/pelvic venous thrombosis) of ISI. Interobserver reproducibility was assessed. Correlation analysis evaluated the effect of the causative microorganism on severity. Two human bodies were dissected to outline possible ways that ISI can spread. RESULTS Forty patients with ISI (40 years ± 22; 26 women) were evaluated. Ten patients had bilateral ISI. Concurrent vertebral infection was associated in 15% of cases. Reproducibility of sacral BME, periostitis, and reactive locoregional abnormalities was perfect (κ = 1). Reproducibility was low for erosion count (κ = 0.52[0.52-0.82]) and periarticular osteopenia (κ = 0.50[0.18-0.82]). Inflammatory changes were BME (42/42 joints), muscle edema (38/42), and severe periostitis along the ilium (33/37). Destructive structural changes occurred with confluent erosions (iliac, 20/48; sacral, 13/48), sequestrum (20/48), and cavitation (12/48). Complications occurred in 75% of cases, including periarticular abscesses (n = 30/47), probable adjacent osteomyelitis (n = 16/37), and pelvic thrombophlebitis (n = 3). Tuberculous ISI (6/40) correlated with sclerosis (rs = 0.45[0.16; 0.67]; p < 10-2) and bone devitalization (rs = 0.38[0.16; 0.67]; p = .02). The anatomical study highlighted the shared venous vascularization of sacroiliac joints, pelvic organs, and mobile spine. CONCLUSION Complications of ISI are frequent, including abscesses, adjacent osteomyelitis, and periostitis. ISI had bilateral involvement nonrarely and is commonly associated with another spinal infection.
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Affiliation(s)
- Sarah Interligator
- Department of Radiology, Hôpital Bicêtre, Assistance-Publique des Hôpitaux de Paris, 78 rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, Paris, France
| | - Antoine Le Bozec
- Department of Pharmacy, Hôpital Bicêtre, Assistance-Publique des Hôpitaux de Paris, 78 rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, Paris, France
| | - Guillaume Cluzel
- Department of Radiology, Hôpital Bicêtre, Assistance-Publique des Hôpitaux de Paris, 78 rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, Paris, France
| | - Matthieu Devilder
- Department of Radiology, Hôpital Bicêtre, Assistance-Publique des Hôpitaux de Paris, 78 rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, Paris, France
| | - Jessica Ghaouche
- Department of Radiology, Hôpital Bicêtre, Assistance-Publique des Hôpitaux de Paris, 78 rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, Paris, France
| | - Daphne Guenoun
- Department of Radiology, Hôpital Sainte-Marguerite, 270, Boulevard Sainte-Marguerite, 13009, Marseille, France
| | - Albane Fleury
- Department of Radiology, Hôpital Bicêtre, Assistance-Publique des Hôpitaux de Paris, 78 rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, Paris, France
| | - Florian Petit Lemaire
- Department of Radiology, Hôpital Bicêtre, Assistance-Publique des Hôpitaux de Paris, 78 rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, Paris, France
| | - Robert-Yves Carlier
- Department of Radiology, Hôpital Raymond Poincaré, Assistance-Publique des Hôpitaux de Paris, 104 Boulevard Raymond Poincaré, 92380 Garches, Paris, France
| | - Catarina Valente
- Department of Radiology, Hôpital Bicêtre, Assistance-Publique des Hôpitaux de Paris, 78 rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, Paris, France
| | - Maud Creze
- Department of Radiology, Hôpital Bicêtre, Assistance-Publique des Hôpitaux de Paris, 78 rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, Paris, France.
- Laboratoire d'Imagerie Biomedicale Multimodale Paris-Saclay, BioMaps, Paris-Saclay University, 4 place du Général Leclerc, 91401 Orsay, Paris, France.
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Riczo DB. What You Need to Know About Sacroiliac Dysfunction. Orthop Nurs 2023; 42:33-45. [PMID: 36702094 DOI: 10.1097/nor.0000000000000915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Low back pain is the leading cause of disability worldwide, and sacroiliac dysfunction is estimated to occur in 15%-30% of those with nonspecific low back pain. Nurses are in the unique position to support and provide education to patients who may be experiencing sacroiliac dysfunction or possibly apply this knowledge to themselves, as low back pain is a significant problem experienced by nurses. A patient's clinical presentation, including pain patterns and characteristics, functional limitations, common etiologies and musculoskeletal system involvement, current diagnostic tools, and realm of treatments, are discussed along with their respective efficacy. Distinction is made between specific diagnosis and treatment of joint involvement and that of sacroiliac regional pain, as well as other factors that play a role in diagnosis and treatment for the reader's consideration.
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Affiliation(s)
- Deborah B Riczo
- Deborah B. Riczo, DPT, MEd, PT, Guest Faculty, Cleveland State University Doctor of Physical Therapy Program, and Founder, Riczo Health Education, Seven Hills, OH
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Hecquet S, Lustig JP, Verhoeven F, Chouk M, Aubry S, Wendling D, Prati C. Frequency and anatomic distribution of magnetic resonance imaging lesions in the sacroiliac joints of spondyloarthritis and non-spondyloarthritis patients. Ther Adv Musculoskelet Dis 2022; 14:1759720X221119245. [PMID: 36081745 PMCID: PMC9445526 DOI: 10.1177/1759720x221119245] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 07/22/2022] [Indexed: 11/16/2022] Open
Abstract
Background Lesions detected by magnetic resonance imaging (MRI) of the sacroiliac joints are critical to the diagnosis of non-radiographic axial spondyloarthritis. However, inflammatory and structural lesions may be encountered in other conditions. Objectives The objective of this study was to evaluate and compare the frequency and localization of inflammatory and structural lesions on MRIs of the sacroiliac joint of spondyloarthritis (SpA) and non-spondyloarthritis (non-SpA) patients. Design This is a retrospective study including 200 patients, each having undergone an MRI of the sacroiliac joints. Methods Two experienced readers evaluated the whole set of images to detect erosions, subchondral sclerosis, fatty lesions, bone marrow edema (BME) and ankylosis according to the definitions established by the ASAS MRI working group. We divided sacroiliac joints into five segments: upper, antero-middle, intermediate-middle, postero-middle and lower. Results A total of 96 subjects with SpA (mean age 37.4 ± 11.8 years) and 104 without SpA (mean age 39.9 ± 11.6 years) were included. Of the 96 SpA patients, 65% had inflammatory buttock pain compared with 25% in the non-SpA group. BME was seen in 65% of SpA patients, mainly in the intermediate-middle segment, and in 20% of non-SpA patients, predominantly in the antero-middle segment. Subchondral sclerosis occurred in 44% of non-SpA patients, mostly in the antero-middle segment, and in 36% of SpA patients. Fatty lesions were present in 34% of SpA and in 21% of non-SpA patients. Erosions were seen in 25% of non-SpA and in 60% of SpA patients. BME and structural lesions were minimally observed in the postero-middle segment in non-SpA patients. Conclusion Inflammatory and structural lesions were observed in all segments of the joint in SpA, mainly in the middle segments, while lesions predominantly affected the antero-middle segment in non-SpA, and were uncommon in the postero-middle segment.
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Affiliation(s)
- Sophie Hecquet
- Department of Rheumatology, CHU, 3 Boulevard Alexandre Fleming, 25000 Besançon, France
| | | | - Frank Verhoeven
- Department of Rheumatology, CHU, Besançon, France.,PEPITE EA4267, FHU INCREASE, Bourgogne Franche-Comté University, UFR Santé, Besançon, France
| | | | - Sébastien Aubry
- Department of Radiology, CHU, Besançon, France.,EA4662 Nanomedecine Laboratory, Bourgogne Franche-Comté University, UFR Santé, Besançon, France
| | - Daniel Wendling
- Department of Rheumatology, CHU, Besançon, France.,EPILAB EA 4266, Bourgogne Franche-Comté University, UFR Santé, Besançon, France
| | - Clément Prati
- Department of Rheumatology, CHU, Besançon, France.,PEPITE EA4267, FHU INCREASE, Bourgogne Franche-Comté University, UFR Santé, Besançon, France
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Badr S, Jacques T, Lefebvre G, Boulil Y, Abou Diwan R, Cotten A. Main Diagnostic Pitfalls in Reading the Sacroiliac Joints on MRI. Diagnostics (Basel) 2021; 11:diagnostics11112001. [PMID: 34829349 PMCID: PMC8624408 DOI: 10.3390/diagnostics11112001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/21/2021] [Accepted: 10/25/2021] [Indexed: 12/11/2022] Open
Abstract
Magnetic resonance imaging of the sacroiliac joints is now frequently performed to help identify patients with early axial spondyloarthritis. However, differential diagnoses exist and should be recognized. The aim of this article is to review the most frequent differential diagnoses that may mimic inflammatory sacroiliitis in clinical practice.
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Affiliation(s)
- Sammy Badr
- Department of Musculoskeletal Radiology, Lille University Hospital, 59000 Lille, France; (S.B.); (T.J.); (G.L.); (Y.B.); (R.A.D.)
- MABLab-Marrow Adiposity and Bone Lab ULR4490, University of Lille, 59000 Lille, France
| | - Thibaut Jacques
- Department of Musculoskeletal Radiology, Lille University Hospital, 59000 Lille, France; (S.B.); (T.J.); (G.L.); (Y.B.); (R.A.D.)
- Lille University School of Medicine, 59000 Lille, France
| | - Guillaume Lefebvre
- Department of Musculoskeletal Radiology, Lille University Hospital, 59000 Lille, France; (S.B.); (T.J.); (G.L.); (Y.B.); (R.A.D.)
| | - Youssef Boulil
- Department of Musculoskeletal Radiology, Lille University Hospital, 59000 Lille, France; (S.B.); (T.J.); (G.L.); (Y.B.); (R.A.D.)
| | - Ralph Abou Diwan
- Department of Musculoskeletal Radiology, Lille University Hospital, 59000 Lille, France; (S.B.); (T.J.); (G.L.); (Y.B.); (R.A.D.)
| | - Anne Cotten
- Department of Musculoskeletal Radiology, Lille University Hospital, 59000 Lille, France; (S.B.); (T.J.); (G.L.); (Y.B.); (R.A.D.)
- Lille University School of Medicine, 59000 Lille, France
- Correspondence:
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