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Basra M, Patel H, Sobczak A, Ditchek J, Biglione A, Kesselman MM, Posey A. Use of Multimodality Imaging in the Evaluation of Patients With Spondyloarthropathies and Sacroiliitis. Cureus 2024; 16:e57185. [PMID: 38681346 PMCID: PMC11056229 DOI: 10.7759/cureus.57185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 03/29/2024] [Indexed: 05/01/2024] Open
Abstract
Spondyloarthropathy (SpA) is one of the most common causes of low back pain. It is caused by inflammatory arthritis in the spine, manifesting in various forms such as psoriatic arthritis (PsA), ankylosing spondylitis (AS), and sacroiliitis. A comprehensive systematic literature search was done to evaluate and compare MRI, CT, single-photon emission CT, PET, ultrasound (US) imaging, low-dose CT, and diffusion-weighted imaging (DWI) techniques in assessing SpAs. The search strategy was constructed by an analysis of key terms from relevant articles in MEDLINE ProQuest, Embase, and PubMed. The key terms used to search for these articles were "SpA," "sacroiliitis," "spondylitis," "psoriatic arthritis," "MRI," "CT scan," "x-ray," "magnetic resonance imaging," "computed tomography," "bone density," and "ultrasound." A total of 1,131 articles published in English between January 1, 2003, and October 15, 2023 were identified and screened for eligibility by members of the research team, which resulted in 69 total articles selected for the final review. US has played an important role in visualizing joint inflammation and enthesitis (inflammation of the enthesis), which are common features of PsA. Although MRI and CT are considered more reliable modalities for diagnosing active sacroiliitis, US imaging with Doppler flow can also be useful in conjunction with CT images to visualize abnormal blood flow in the sacroiliac joints, as well as other joints affected by inflammatory arthritis. MRI provides increased diagnostic confidence in the diagnosis of sacroiliitis in active AS patients when compared to CT. CT is more sensitive than plain radiographs. The PET activity score showed a good correlation in diagnosing inflammatory sacroiliitis but lacked in identifying structural lesions. CT has high diagnostic accuracy, but it exposes patients to a high radiation dose. MRI visualizes joint and tissue inflammation, bone, and bone marrow change and can identify peripheral inflammation in soft tissue and joints in patients diagnosed with PsA. MRI can also visualize bone marrow changes and subchondral edema, which can aid in the early diagnosis of ankylosing SpA and gauge disease severity. DWI and short-tau inversion recovery imaging are both MRI techniques used in detecting sacroiliitis. MRI and CT are shown to be reliable imaging modalities for the diagnosis of sacroiliitis; however, it was found that Doppler US played an accurate role in the diagnosis as well. MRI visualizes joints and tissue with the most precision, making it useful in evaluating patients with PsA, while PET CT is useful in the diagnosis of inflammatory sacroiliitis patients. There is limited literature available comparing the multiple modalities of imaging available for each SpA. The review's objective is to analyze imaging findings in patients diagnosed with sacroiliitis and SpAs. The findings in this literature review are valuable for properly assessing and diagnosing patients suffering from SpAs.
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Affiliation(s)
- Mahi Basra
- Osteopathic Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Clearwater, USA
| | - Hemangi Patel
- Sports Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| | - Alexandria Sobczak
- Osteopathic Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| | - Jordan Ditchek
- Radiology, Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Davie, USA
| | | | - Marc M Kesselman
- Rheumatology, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Davie, USA
| | - Alessandra Posey
- Sports Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Davie, USA
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Horner NS, Rice MW, Sivasundaram L, Ephron CG, Nho SJ. Effect of Sacroiliac Joint Pain on Outcomes in Patients Undergoing Hip Arthroscopy for the Treatment of Femoroacetabular Impingement Syndrome: A Matched Comparative Cohort Analysis at Minimum 2-Year Follow-up. Am J Sports Med 2022; 50:2606-2612. [PMID: 35862645 DOI: 10.1177/03635465221108975] [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] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patients with femoroacetabular impingement syndrome (FAIS) may frequently have co-existing sacroiliac joint (SIJ) pain. It is known that patients with lower back pain undergoing total hip arthroplasty (THA) have inferior outcomes; however, it is unclear what the effect of SIJ pain is on outcomes after hip arthroscopy. PURPOSE To determine whether patients undergoing hip arthroscopy with SIJ pain either subjectively or on physical examination achieve similar postoperative improvement in patient-reported outcomes (PROs) compared with patients without SIJ pain at 2-year follow-up. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Patients with a minimum 2-year follow-up who underwent primary hip arthroscopy for FAIS with SIJ pain were matched in a 1:2 ratio to controls without SIJ pain. Baseline demographics, as well as postoperative PROs and rates of achievement of the minimal clinically important difference (MCID) or Patient Acceptable Symptom State (PASS) at 2-year follow-up were compared between the 2 groups. RESULTS A total of 73 patients (75 hips) with SIJ pain were matched to 150 control patients (150 hips) without SIJ pain. Both groups demonstrated statistically significant improvement in all PROs at 2 years (P < .05 for all). Patients with SIJ pain had significantly lower postoperative PRO scores for the Hip Outcome Score-Activities of Daily Living (HOS-ADL) (SIJ pain: 80.4 ± 22.4 vs no SIJ pain: 88.0 ± 15.1; P = .006), modified Harris Hip Score (mHHS) (SIJ pain: 73.2 ± 22.8 vs no SIJ pain: 80.0 ± 17.3; P < .001), and International Hip Outcome Tool-12 questionnaire (iHOT-12) (SIJ pain: 61.7 ± 25.9 vs no SIJ pain: 73.7 ± 23.7; P = .008). There were no statistically significant differences in improvement (delta) in PRO scores between the 2 groups (P > .05 for all). The SIJ pain group had significantly lower achievement of MCID for the HOS-ADL (SIJ pain: 65.2% vs no SIJ pain: 80.5%; P = .044) but not HOS-SS, mHHS, or iHOT-12 (P > .05 for all). The SIJ pain group had significantly lower achievement of PASS for the mHHS (SIJ pain: 27.5% vs no SIJ pain: 45.3%; P = .030) and iHOT-12 (SIJ pain: 31.0% vs no SIJ pain: 56.0%; P = .010) but not the HOS-ADL and HOS-SS (P > .05 for both). Only 4.1% of patients with SIJ pain and 2.4% of controls required revision surgery or converted to THA at the time of final follow-up (P = .69). CONCLUSION Patients with FAIS and SIJ pain on history or physical examination experience significant improvement in PROs at 2 years after hip arthroscopy. However, they may be less likely to achieve the MCID or PASS and have significantly lower postoperative PROs compared with a matched cohort of patients without SIJ pain. Overall rates of revision and conversion to THA were similarly low in both groups.
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Affiliation(s)
- Nolan S Horner
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, USA
| | - Morgan W Rice
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, USA
| | - Lakshmanan Sivasundaram
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, USA
| | - Christopher G Ephron
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, USA
| | - Shane J Nho
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, USA
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Gorelik N, Tamizuddin F, Rodrigues TC, Beltran L, Malik F, Reddy S, Koo J, Subhas N, Gyftopoulos S. Comparison between radiography and magnetic resonance imaging for the detection of sacroiliitis in the initial diagnosis of axial spondyloarthritis: a cost-effectiveness study. Skeletal Radiol 2020; 49:1581-1588. [PMID: 32382977 DOI: 10.1007/s00256-020-03444-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 03/03/2020] [Accepted: 04/05/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The purpose of our study was to determine the cost-effectiveness of radiography and MRI-based imaging strategies for the initial diagnosis of sacroiliitis in a hypothetical population with suspected axial spondyloarthritis. MATERIALS AND METHODS A decision analytic model from the health care system perspective for patients with inflammatory back pain suggestive of axial spondyloarthritis was used to evaluate the incremental cost-effectiveness of 3 imaging strategies for the sacroiliac joints over a 3-year horizon: radiography, MRI, and radiography followed by MRI. Comprehensive literature search and expert opinion provided input data on cost, probability, and utility estimates. The primary effectiveness outcome was quality-adjusted life-years (QALYs), with a willingness-to-pay threshold set to $100,000/QALY gained (2018 American dollars). RESULTS Radiography was the least costly strategy ($46,220). Radiography followed by MRI was the most effective strategy over a 3-year course (2.64 QALYs). Radiography was the most cost-effective strategy. MRI-based and radiography followed by MRI-based strategies were not found to be cost-effective imaging options for this patient population. Radiography remained the most cost-effective strategy over all willingness-to-pay thresholds up to $100,000. CONCLUSION Radiography is the most cost-effective imaging strategy for the initial diagnosis of sacroiliitis in patients with inflammatory back pain suspicious for axial spondyloarthritis.
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Affiliation(s)
- Natalia Gorelik
- Department of Radiology, McGill University Health Center, 1001 Decarie Blvd, Montreal, QC, H4A 3J1, Canada.
| | - Farah Tamizuddin
- New York University School of Medicine, 550 1st Avenue, New York, NY, 10016, USA
| | - Tatiane Cantarelli Rodrigues
- Department of Radiology, Hospital do Coração (HCor) and Teleimagem, Rua Desembargador Eliseu Guilherme 53 - 7th floor, São Paulo, SP, 04004-030, Brazil
| | - Luis Beltran
- Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Fardina Malik
- Department of Rheumatology, NYU School of Medicine, 333 East 38th Street, 4th Floor, New York, NY, 10016, USA
| | - Soumya Reddy
- Department of Rheumatology, NYU School of Medicine, 333 East 38th Street, 4th Floor, New York, NY, 10016, USA
| | - James Koo
- Rusk Rehabilitation, NYU Langone Health, 333 East 38th Street, 5th Floor, New York, NY, 10016, USA
| | - Naveen Subhas
- Department of Radiology, Cleveland Clinic, 9500 Euclid Ave # A21, Cleveland, OH, 44195, USA
| | - Soterios Gyftopoulos
- Department of Radiology, NYU Langone Medical Center, 333 E 38th St, 6th Floor, New York, NY, 10016, USA
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Putilina MV, Ivanova MP, Petrikeeva AE, Berns SA. [Difficulties in diagnosing sacroiliitis in young patients]. Zh Nevrol Psikhiatr Im S S Korsakova 2020; 120:117-126. [PMID: 32929934 DOI: 10.17116/jnevro2020120081117] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
In real clinical practice, back pain in young patients is associated with neurological manifestations of degenerative changes in the lumbosacral spine. However, such complaints may be a manifestation of a lesion of the sacroiliac joint-sacroiliitis, and degenerative changes in the spine may accompany it, but not cause pain. Sacroiliitis is an inflammatory lesion of the sacroiliac joint, which can develop as an independent disease or as a symptom of another nosology. The causes of this pathology are diverse: injuries, long-term overloading of the joint, congenital abnormalities of the joints, infectious or systemic diseases, and tumors. In neurological practice, sacroiliitis is similar to myofascial syndromes and can disguise as degenerative diseases of the spine, so early diagnosis and proper therapy are of particular importance. Awareness of doctors about the features of examination of young patients, the use of neuroimaging techniques (CT, MRI), laboratory diagnostics, will help to improve the results of therapy. Prescription of NSAIDs with a pronounced anti-inflammatory potential will slow down the progression of the inflammatory process.
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Affiliation(s)
- M V Putilina
- Pirogov Russian National Research Medical University of the Ministry of Health of Russia, Moscow, Russia
| | - M P Ivanova
- Zhadkevich City Clinical Hospital of the Moscow Healthcare Department, Moscow, Russia
| | - A E Petrikeeva
- Zhadkevich City Clinical Hospital of the Moscow Healthcare Department, Moscow, Russia
| | - S A Berns
- Evdokimov Moscow State University of Medicine and Dentistry of the Ministry of Health of Russia, Moscow, Russia
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Aslam F, Chivers FS, Doshi KB, Chang‐Miller A. Positive HLA‐B27 and sacroiliitis is not always spondyloarthritis. Int J Rheum Dis 2019; 22:2213-2217. [DOI: 10.1111/1756-185x.13738] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 09/26/2019] [Accepted: 10/06/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Fawad Aslam
- Division of Rheumatology Department of Internal Medicine Mayo Clinic Scottsdale AZ USA
| | | | - Krupa B. Doshi
- Division of Endocrinology Department of Internal Medicine Mayo Clinic Scottsdale AZ USA
| | - April Chang‐Miller
- Division of Rheumatology Department of Internal Medicine Mayo Clinic Scottsdale AZ USA
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Is There a Role for MRI to Establish Treatment Indications and Effectively Monitor Response in Patients with Axial Spondyloarthritis? Rheum Dis Clin North Am 2019; 45:341-358. [DOI: 10.1016/j.rdc.2019.04.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Abstract
The triggers and pathogenesis of axial spondyloarthritis (axSpA) are not yet completely understood. However, therapeutic agents targeting tumor necrosis factor-α and interleukin-17 inflammatory pathways have proven successful in suppressing many of the clinical symptoms and signs of axSpA, giving us an indication of which pathways are responsible for initiating and maintaining the inflammation. The mechanisms that eventuate in syndesmophytes and ankyloses are less clear. This review addresses these two critical pathways of inflammation, discussing their nature and these factors that may activate or enhance the pathways in patients with axSpA. In addition, genetic and other markers important to the inflammatory pathways implicated in axSpA are explored, and prognostic biomarkers are discussed. Treatment options available for the management of axSpA and their associated targets are highlighted.
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Affiliation(s)
- Daniel E Furst
- Department of Medicine, Division of Rheumatology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
| | - James S Louie
- Department of Medicine, Division of Rheumatology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
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Slater R, Zur Linden A, James F. Diagnostic imaging characteristics of canine infectious sacroiliitis. THE CANADIAN VETERINARY JOURNAL = LA REVUE VETERINAIRE CANADIENNE 2019; 60:630-636. [PMID: 31156264 PMCID: PMC6515814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Infectious sacroiliitis has not been described in dogs. This retrospective case series describes the presentation, diagnostic imaging characteristics, and outcomes of 2 canine patients with infectious sacroiliitis. Selection criteria included presentation with back pain from 2010 to 2017, diagnostic imaging of the sacroiliac joints, and short- and long-term response to antibiotic therapy. Medical records, and magnetic resonance imaging (MRI) were reviewed by a Board-certified veterinary radiologist, a neurologist, and a small animal intern. Two dogs met the inclusion criteria. Magnetic resonance imaging revealed unilaterally wide and irregular sacroiliac joint spaces, with juxta-articular soft tissue contrast enhancement and bone marrow edema. One patient had a communicating abscess of the psoas muscle, which cultured positive for Pasteurella canis. Following treatment with pain relief medications and antibiotics, both patients made a complete clinical recovery, with no signs of lameness 2 to 4 weeks after cessation of treatment, and no lameness reported by the owner afterwards. Infectious sacroiliitis should be considered when dogs are presented with lumbosacral pain.
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Affiliation(s)
- Robert Slater
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario
| | - Alex Zur Linden
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario
| | - Fiona James
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario
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Association between inflammatory back pain features, acute and structural sacroiliitis on MRI, and the diagnosis of spondyloarthritis. Clin Rheumatol 2019; 38:1579-1585. [PMID: 30628016 DOI: 10.1007/s10067-019-04432-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 12/27/2018] [Accepted: 01/02/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To evaluate the association between inflammatory back pain (IBP) features, acute and structural MRI findings suggestive of sacroiliitis, and diagnosis of spondyloarthritis (SpA). METHODS Data from 224 patients who underwent MRI for suspected sacroiliitis (2005-2015) was retrospectively reviewed by an expert rheumatologist for the presence of IBP features and for clinical standard of reference diagnosis. A telephone questionnaire was performed in cases of missing data. Acute and structural MRI parameters were scored by an experienced radiologist for the presence of sacroiliitis using the Assessment of Spondyloarthritis International Society (ASAS) criteria, Berlin score, and observer's global impression (GI) scores. Association between IBP features and MRI scores, and odds ratio for SpA diagnosis, were calculated. RESULTS One hundred ninety-three subjects were included (119 F:74 M, mean age 39.7 ± 15.6, mean follow-up 49 ± 18 months). Fifty-two (26.9%) subjects were diagnosed with SpA. IBP scores were significantly higher in SpA patients (p < 0.001). IBP, ASAS, and GI MRI scores were significantly associated with the SpA diagnosis (p < 0.001 for all). The presence of night pain and morning stiffness was significantly associated with sacroiliac-joints' bone marrow edema (BME, p < 0.05). Sensitivity for diagnosis of SpA was high for IBP (96%) and low for the MRI parameters (26.9-57.4%), and specificity was low for IBP (32%) and high for the MRI parameters (88.3-94.3%). CONCLUSIONS The presence of IBP features is highly associated with diagnosis of SpA and correlates with MRI BME, all probably reflect inflammation. The combination of IBP and MRI should be the cornerstone in the clinician's final diagnosis of SpA.
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Wang F, Chu C, Zhu L, Zhao C, Wei Y, Chen W, He J, Sun L, Zhou Z. Whole-lesion ADC histogram analysis and the spondyloarthritis research consortium of canada (SPARCC) MRI index in evaluating the disease activity of ankylosing spondylitis. J Magn Reson Imaging 2018; 50:114-126. [PMID: 30556229 DOI: 10.1002/jmri.26568] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 10/18/2018] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Conventional MRI is limited in quantitative evaluation of ankylosing spondylitis (AS) activity states. A comparison of the effectiveness of the whole-lesion apparent diffusion coefficient (ADC) histogram analysis with the Spondyloarthritis Research Consortium of Canada (SPARCC) MRI index in evaluating the disease activity of AS might aid in this assessment. PURPOSE To compare the effectiveness of the whole-lesion ADC histogram analysis with the SPARCC MRI index in evaluating the disease activity states of AS. STUDY TYPE Prospective. POPULATION A total of 57 AS patients and 27 healthy matched volunteers were included. FIELD STRENGTH/SEQUENCE 3.0T MR including a diffusion-weighted imaging (DWI) sequence (b = 0, 1000 s/mm2 ). STATISTICAL TESTS One-way analysis of variance (ANOVA) and Scheffe's post-hoc was used to compare the parameters among different groups. A receiver operating characteristic (ROC) analysis and the Spearman rank correlation were performed to test the diagnostic performance of all parameters in distinguishing different disease activity states and determining the correlations between them. ASSESSMENT AS disease activity states was evaluated according to the Ankylosing Spondylitis Disease Activity Score (ASDAS). Initial DWI images and corresponding ADC maps were imported into our in-house software. Regions of interest (ROIs) were drawn in all slices and the relevant parameters were derived simultaneously. The SPARCC MRI index scores were counted artificially based on T2 -PDW-SPAIR images. RESULTS The ADCmean , ADC percentiles, and SPARCC MRI index of the active group were significantly higher than the inactive and control groups (all P < 0.001). The 90th percentile could differentiate the inactive from the control group and the low disease activity group from the inactive group (P = 0.011 and 0.006, respectively). The 50th percentile of the high disease activity group was significantly higher than the low group (P = 0.004), while the SPARCC MRI index of the very high disease activity group was higher than the high group (P < 0.001). DATA CONCLUSION The whole-volume ADC histogram analysis was superior to the SPARCC MRI index in assessing AS activity states. LEVEL OF EVIDENCE 1 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;50:114-126.
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Affiliation(s)
- Fengxian Wang
- Department of Radiology, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, Nanjing, P.R. China
| | - Chen Chu
- Department of Radiology, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, Nanjing, P.R. China
| | - Li Zhu
- Department of Radiology, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, Nanjing, P.R. China
| | - Cheng Zhao
- Department of Rheumatology, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, Nanjing, P.R. China
| | - Yu Wei
- Department of Rheumatology, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, Nanjing, P.R. China
| | - Weibo Chen
- Philips Healthcare, Shanghai, P.R. China
| | - Jian He
- Department of Radiology, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, Nanjing, P.R. China
| | - Lingyun Sun
- Department of Rheumatology, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, Nanjing, P.R. China
| | - Zhengyang Zhou
- Department of Radiology, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, Nanjing, P.R. China
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Wang F, Chu C, Zhao C, Wei Y, Zhang Q, Feng Q, Chen W, He J, Sun L, Zhou Z. Diffusion kurtosis imaging in sacroiliitis to evaluate the activity of ankylosing spondylitis. J Magn Reson Imaging 2018; 49:101-108. [PMID: 30102434 DOI: 10.1002/jmri.26194] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 04/26/2018] [Indexed: 12/19/2022] Open
Affiliation(s)
- Fengxian Wang
- Department of Radiology; Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School; Nanjing China
| | - Chen Chu
- Department of Radiology; Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School; Nanjing China
| | - Cheng Zhao
- Department of Rheumatology; Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School; Nanjing China
| | - Yu Wei
- Department of Rheumatology; Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School; Nanjing China
| | - Qinglei Zhang
- Department of Radiology; Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School; Nanjing China
| | - Qianqian Feng
- Department of Radiology; Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School; Nanjing China
| | | | - Jian He
- Department of Radiology; Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School; Nanjing China
| | - Lingyun Sun
- Department of Rheumatology; Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School; Nanjing China
| | - Zhengyang Zhou
- Department of Radiology; Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School; Nanjing China
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What's in a name? That which we call sacroiliitis by any other name would look the same…. Reumatologia 2018; 56:129-130. [PMID: 30042599 PMCID: PMC6052373 DOI: 10.5114/reum.2018.76899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 05/09/2018] [Indexed: 11/18/2022] Open
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Abstract
Spondyloarthritis (SpA) is a group of chronic inflammatory conditions which severely impact quality of life. Several criteria have been developed in the past to aid the diagnosis of SpA based on symptoms and radiographic changes during the course of the disease. However, it takes several years before structural changes manifest on conventional radiographs, leading to a diagnostic delay of 6 to 10 years. The use of MRI and its incorporation into the Assessment of Spondyloarthritis (ASAS) criteria, has radically changed the diagnosis of SpA in the last decade by allowing visualisation of both active and chronic inflammatory changes and enabling clinicians to recognise SpA during it’s early stage and initiate treatment. An understanding of the various terminology used in the divisions of disease presentations and their relevant imaging findings are key, along with the use of clear definitions of structural and inflammatory changes on MRI, in ensuring accurate diagnosis and classification of SpA.
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Mahmood F, Helliwell P. Ankylosing Spondylitis: A Review. EUROPEAN MEDICAL JOURNAL 2017. [DOI: 10.33590/emj/10314487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Ankylosing spondylitis is a chronic autoimmune inflammatory condition belonging to the spondyloarthropathy category of rheumatic diseases. It typically affects the axial skeleton but may also present with peripheral arthritis and extra-articular features. Ankylosing spondylitis tends to occur in patients under the age of 45 years, has a higher incidence in males, and can lead to disability and reduced quality of life if not adequately treated. Management consists of a multidisciplinary team approach. Although traditional disease modifying anti-rheumatic drugs are less effective for the axial component of this disease, biologic therapies do seem effective. In severe cases, surgery may be warranted.
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Sudoł-Szopińska I, Znajdek M, Gietka P, Vasilevska-Nikodinovska V, Patrovic L, Salapura V. Imaging of juvenile spondyloarthritis. Part II: Ultrasonography and magnetic resonance imaging. J Ultrason 2017; 17:176-181. [PMID: 29075522 PMCID: PMC5647612 DOI: 10.15557/jou.2017.0026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Revised: 06/13/2017] [Accepted: 06/18/2017] [Indexed: 12/26/2022] Open
Abstract
Juvenile spondyloarthropathies are mainly manifested by symptoms of peripheral arthritis and enthesitis. Early involvement of sacroiliac joints and spine is exceptionally rare in children; this usually happens in adulthood. Conventional radiographs visualize late inflammatory lesions. Early diagnosis is possible with the use of ultrasonography and magnetic resonance imaging. The first part of the article presented classifications and radiographic presentation of juvenile spondyloarthropathies. This part discusses changes seen on ultrasonography and magnetic resonance imaging. In patients with juvenile spondyloarthropathies, these examinations are conducted to diagnose inflammatory lesions in peripheral joints, tendon sheaths, tendons and bursae. Moreover, magnetic resonance also shows subchondral bone marrow edema, which is considered an early sign of inflammation. Ultrasonography and magnetic resonance imaging do not show specific lesions for any rheumatic disease. Nevertheless, they are conducted for early diagnosis, treatment monitoring and identifying complications. This article presents a spectrum of inflammatory changes and discusses the diagnostic value of ultrasonography and magnetic resonance imaging.
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Affiliation(s)
- Iwona Sudoł-Szopińska
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
- Department of Medical Imaging, Second Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Michał Znajdek
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Piotr Gietka
- Clinic of Pediatrics, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | | | - Lukas Patrovic
- MRI Department, Jessenius, Diagnostic Center, Špitálska 6, Nitra, Slovakia
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Selected issues in diagnostic imaging of spondyloarthritides: psoriatic arthritis and juvenile spondyloarthritis. Reumatologia 2017; 54:310-317. [PMID: 28115782 PMCID: PMC5241368 DOI: 10.5114/reum.2016.64908] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 12/14/2016] [Indexed: 02/07/2023] Open
Abstract
Spondyloarthritides (also known as spondyloarthropathies) are a group of rheumatic diseases that consists of diversified entities, i.e. ankylosing spondylitis, reactive arthritis, psoriatic arthritis, arthritis in the course of Crohn's disease and ulcerative colitis, and juvenile spondyloarthropathies. In the diagnostics of spondyloarthritides, plain radiography has played a crucial role for years due to its undisputed ability to show distinctive bony changes. Yet as those diseases often manifest themselves by soft tissue pathology and bone marrow inflammation, ultrasonography and magnetic resonance imaging are currently a subject of numerous studies in the quest for setting up diagnostic criteria, especially at early stages of inflammatory processes. In our review, we present an up-to-date insight into classifications, etiopathogenesis and imaging of psoriatic arthritis and juvenile spondyloarthritis.
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Sudoł-Szopińska I, Włodkowska-Korytkowska M, Kwiatkowska B. Spectrum of Inflammatory Changes in the SIJs on Radiographs and MR Images in Patients with Suspected Axial Spondyloarthritis. Pol J Radiol 2016; 81:125-33. [PMID: 27081416 PMCID: PMC4809388 DOI: 10.12659/pjr.895867] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 09/20/2015] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The aim of the paper was to compare radiographs and MRI in assessment of active and chronic inflammatory changes in the sacroiliac joints in patients with chronic back pain and suspected axial spondyloarthritis. Moreover, the aim was to determine which of the two methods is more accurate in diagnosing individual inflammatory changes in the sacroiliac joints and whether there is a correlation between radiographs and MRI in their identification. MATERIAL/METHODS The analysis was conducted in a group of 101 patients, including 61 women and 40 men, referred to radiographs and MR examinations by rheumatologists due to chronic back pain. AP images of the lumbar region of the spine were performed in each patient in the supine position. The images included the sacroiliac joints. Changes in the SIJs were assessed based on the New York criteria of 1966. In MR examination, the SIJs were assessed in terms of the presence of active and chronic inflammatory changes described by the ASAS. The statistical analysis of the variables tested was conducted in the Excel and Statistica systems. RESULTS In relation to the final clinical diagnosis of axSpA, MRI had higher sensitivity and specificity than radiography in diagnosing sacroiliitis (sensitivity: 71% vs. 22%, specificity: 90% vs. 94% on radiographs according to New York criteria. In relation to MRI, radiographs resulted in 40% of incorrect sacroiliitis diagnoses (both false positive and false negative results). In as many as 50% of cases (7/14), MRI failed to confirm the presence of inflammatory changes in the sacroiliac joints observed in radiography according to the modNY criteria (false positive results on radiographs). Both examinations are characterised by very low agreement, which is near to random, in assessing individual features of sacroiliitis, such as sclerosis, change in the joint space width, erosions and ankylosis. CONCLUSIONS 1. Radiographs do not allow early inflammatory lesions indicating sacroiliitis to be diagnosed, which leads to diagnostic delay. MRI is the method of choice in diagnosing early sacroiliitis and detecting structural lesions, in particular sclerosis and erosions. 2. Radiographs and MRI are characterised by low, near to random, agreement in the detectability of the individual inflammatory changes in the sacroiliac joints.
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Affiliation(s)
- Iwona Sudoł-Szopińska
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland; Department of Diagnostic Imaging, Second Faculty, Warsaw Medical University, Warsaw, Poland
| | | | - Brygida Kwiatkowska
- Early Arthritis Clinic, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
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18
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Owlia MB, Danesh-Ardakani M. Frequency of sacroiliitis among patients with low back pain. Electron Physician 2016; 8:2094-100. [PMID: 27123217 PMCID: PMC4844474 DOI: 10.19082/2094] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 01/24/2016] [Indexed: 01/27/2023] Open
Abstract
Introduction Sacroiliitis is one of the important symptoms in patients attending infectious diseases and rheumatology clinics. Some patients with sacroiliitis are asymptomatic, and some have unspecific symptoms. The aim of this study was to determine the frequency of sacroiliitis causes among patients attending Shahid Sadoughi’s infectious disease and rheumatology clinics. Methods In this study, we evaluated patients attending Shahid Sadoughi rheumatology and infectious diseases clinic in 2014. Patients who had positive findings in favor of sacroiliitis were evaluated by history, physical exam, laboratory tests, and imaging. The patients were divided into infectious, inflammatory non-infectious, and degenerative causes. The data were analyzed by IBM SPSS version 20 using the independent samples t-test, ANOVA, the chi-squared test, and the Fisher’s exact test. Results We studied 136 patients. Among them 64 (47.1%) were male, and 72 (52.9%) were female. The mean age of the participants was 34.28 ± 10.36 years. Among the patients, 12 (8.8%) had infectious causes, 120 (88.2%) had inflammatory non-infectious causes, and four (2.9%) had degenerative causes. Conclusion Based on our results, inflammatory non-infectious causes are at the top of the list of sacroiliitis causes, but we should always consider infectious causes, including brucellosis.
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Affiliation(s)
- Mohammad Bagher Owlia
- M.D., Full Professor of rheumatology, Department of Rheumatology, Faculty of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mitra Danesh-Ardakani
- M.D., Infectious Diseases Specialist, Department of Infectious Diseases, Faculty of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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