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Goitein Inbar T, Lidar M, Eshed I. The value of a repeat MRI examination of the sacroiliac joints following an inconclusive initial examination. Skeletal Radiol 2024; 53:1183-1190. [PMID: 38196026 DOI: 10.1007/s00256-024-04561-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 12/30/2023] [Accepted: 01/02/2024] [Indexed: 01/11/2024]
Abstract
OBJECTIVE Assess the diagnostic utility of repeat sacroiliac joint (SIJ) magnetic resonance imaging (MRI) examinations following an inconclusive initial examination performed for suspected sacroiliitis. METHOD Subjects with > 1 SIJ MRI examinations, an inconclusive first scan and at least 6 months interval between scans, were included. All scans were evaluated for the presence of structural/active SIJ lesions as well as any other pathology. Clinical data was extracted from the patients' clinical files, and any missing data was obtained by a telephone interview. Diagnosis and active/structural scores were compared between first and follow-up examinations (t test). RESULTS Seventy-one subjects were included in the study, 77.4% females, mean age 41.0 ± 15 years, mean time interval between exams 30.4 ± 25.24 months. Twelve subjects performed > 2 scans. In only two subjects (2.81%), both females, MRI diagnosis changed from inconclusive to definite sacroiliitis. None of the subjects with > 2 scans had evidence of sacroiliitis in any of the following MRI examinations. Significant differences were observed between the scores of active SIJ lesion of the first and follow-up MRI (1.51/1.62, p = 0.02) but not for scores of structural lesions (1.22/1.68, p = 0.2). CONCLUSIONS Repeat SIJ MRI when the first MRI is inconclusive for sacroiliitis is more valuable in ruling out than in securing diagnosis of sacroiliitis. We suggest that when MRI findings are inconclusive, decision-making should be based on clinical data.
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Affiliation(s)
- Tamar Goitein Inbar
- The Goldman School of Medicine, Ben Gurion University of the Negev Affiliated With the Soroka Medical Center, Beersheba, Israel
| | - Merav Lidar
- Rheumatology Unit, Sheba Medical Center Affiliated with the School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Iris Eshed
- Department of Diagnostic Imaging, Sheba Medical Center affiliated with the, School of Medicine, Tel Aviv University, Tel Hashomer, 5265601, Tel Aviv, Israel.
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Marques ML, Ramiro S, van Lunteren M, Stal RA, Landewé RB, van de Sande M, Fagerli KM, Berg IJ, van Oosterhout M, Exarchou S, Ramonda R, van der Heijde D, van Gaalen FA. Can rheumatologists unequivocally diagnose axial spondyloarthritis in patients with chronic back pain of less than 2 years duration? Primary outcome of the 2-year SPondyloArthritis Caught Early (SPACE) cohort. Ann Rheum Dis 2024; 83:589-598. [PMID: 38233104 DOI: 10.1136/ard-2023-224959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 12/29/2023] [Indexed: 01/19/2024]
Abstract
OBJECTIVES To investigate the prevalence of axial spondyloarthritis (axSpA) in patients with chronic back pain (CBP) of less than 2 years (2y) duration referred to the rheumatologist, the development of diagnosis over time, and patient characteristics of those developing definite (d-)axSpA over 2y. METHODS We analysed the 2y data from SPondyloArthritis Caught Early, a European cohort of patients (<45 years) with CBP (≥3 months, ≤2y) of unknown origin. The diagnostic workup comprised evaluation of clinical SpA features, acute phase reactants, HLA-B27, radiographs and MRI (sacroiliac joints and spine), with repeated assessments. At each visit (baseline, 3 months, 1y and 2y), rheumatologists reported a diagnosis of axSpA or non-axSpA with level of confidence (LoC; 0-not confident at all to 10-very confident). MAIN OUTCOME axSpA diagnosis with LoC≥7 (d-axSpA) at 2y. RESULTS In 552 patients with CBP, d-axSpA was diagnosed in 175 (32%) at baseline and 165 (30%) at 2y. Baseline diagnosis remained rather stable: at 2y, baseline d-axSpA was revised in 5% of patients, while 8% 'gained' d-axSpA. Diagnostic uncertainty persisted in 30%. HLA-B27+ and baseline sacroiliitis imaging discriminated best 2y-d-axSpA versus 2y-d-non-axSpA patients. Good response to non-steroidal anti-inflammatory drugs and MRI-sacroiliitis most frequently developed over follow-up in patients with a new d-axSpA diagnosis. Of the patients who developed MRI-sacroiliitis, 7/8 were HLA-B27+ and 5/8 male. CONCLUSION A diagnosis of d-axSpA can be reliably made in nearly one-third of patients with CBP referred to the rheumatologist, but diagnostic uncertainty may persist in 5%-30% after 2y. Repeated assessments yield is modest, but repeating MRI may be worthwhile in male HLA-B27+ patients.
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Affiliation(s)
- Mary Lucy Marques
- Rheumatology, Leiden University Medical Center, Leiden, Zuid-Holland, Netherlands
- Rheumatology, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
| | - Sofia Ramiro
- Rheumatology, Leiden University Medical Center, Leiden, Zuid-Holland, Netherlands
- Rheumatology, Zuyderland Medical Centre Heerlen, Heerlen, Limburg, Netherlands
| | - Miranda van Lunteren
- Rheumatology, Leiden University Medical Center, Leiden, Zuid-Holland, Netherlands
| | - Rosalinde Anne Stal
- Rheumatology, Leiden University Medical Center, Leiden, Zuid-Holland, Netherlands
| | - Robert Bm Landewé
- Rheumatology, Zuyderland Medical Centre Heerlen, Heerlen, Limburg, Netherlands
- Department of Rheumatology, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Marleen van de Sande
- Department of Rheumatology, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Karen Minde Fagerli
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Inger Jorid Berg
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | | | - Sofia Exarchou
- Department of Clinical Sciences Malmö, Rheumatology, Lund University, Lund, Sweden
| | - Roberta Ramonda
- Rheumatology Unit, Padua University Hospital, Padova, Veneto, Italy
| | | | - Floris A van Gaalen
- Rheumatology, Leiden University Medical Center, Leiden, Zuid-Holland, Netherlands
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3
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van der Heijde D, Molto A, Ramiro S, Braun J, Dougados M, van Gaalen FA, Gensler LS, Inman RD, Landewé RBM, Marzo-Ortega H, Navarro-Compán V, Phoka A, Poddubnyy D, Protopopov M, Reveille J, Rudwaleit M, Sampaio-Barros P, Sepriano A, Sieper J, Van den Bosch FE, van der Horst-Bruinsma I, Machado PM, Baraliakos X. Goodbye to the term 'ankylosing spondylitis', hello 'axial spondyloarthritis': time to embrace the ASAS-defined nomenclature. Ann Rheum Dis 2024; 83:547-549. [PMID: 38071514 DOI: 10.1136/ard-2023-225185] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 11/21/2023] [Indexed: 12/22/2023]
Abstract
Ankylosing spondylitis (AS) is the historic term used for decades for the HLA-B27-associated inflammatory disease affecting mainly the sacroiliac joints (SIJ) and spine. Classification criteria for AS have radiographic sacroiliitis as a dominant characteristic. However, with the availability of MRI of SIJ, it could be demonstrated that the disease starts long before definite SIJ changes become visible on radiographs. The Assessment of SpondyloArthritis international Society, representing a worldwide group of experts reached consensus on changes in the nomenclature pertaining to axial spondyloarthritis (axSpA), such as the terminology of diagnosis and of assessment of disease activity tools. These are important changes in the field, as experts in axSpA are now in agreement that the term axSpA is the overall term for the disease. A further differentiation, of which radiographic versus non-radiographic is only one aspect, may be relevant for research purposes. Another important decision was that the terms AS and radiographic axSpA (r-axSpA) can be used interchangeably, but that the preferred term is r-axSpA. Based on the decision that axSpA is the correct terminology, a proposal was made to officially change the meaning of the ASDAS acronym to 'Axial Spondyloarthritis Disease Activity Score'. In addition, for simplification it was proposed that the term ASDAS (instead of ASDAS-CRP) should be preferred and applied to the ASDAS calculated with C reactive protein (CRP). It is hoped that these changes will be used consequently for education, in textbooks, manuscripts and presentations.
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Affiliation(s)
| | - Anna Molto
- Rheumatology, Hospital Cochin, Paris, France
- Université Paris-Cité, INSERM U1153, Paris, France
| | - Sofia Ramiro
- Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- Rheumatology, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - Jürgen Braun
- Rheumazentrum Ruhrgebiet, Ruhr University Bochum, Herne, Germany
| | - Maxime Dougados
- Hopital Cochin, Rheumatology, Université Paris Descartes Faculté de Médecine, Paris, France
| | | | - Lianne S Gensler
- Medicine/Rheumatology, University of California, San Francisco, California, USA
| | - Robert D Inman
- Schroeder Arthritis Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Robert B M Landewé
- Rheumatology, Zuyderland Medical Centre, Heerlen, The Netherlands
- Rheumatology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Helena Marzo-Ortega
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | | | | | - Denis Poddubnyy
- Gastroenterology, Infectious Diseases and Rheumatology (including Nutrition Medicine), Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Mikhail Protopopov
- Gastroenterology, Infectious Diseases and Rheumatology (including Nutrition Medicine), Charité Universitätsmedizin Berlin, Berlin, Germany
| | - John Reveille
- Rheumatology, University of Texas McGovern Medical School, Houston, Texas, USA
| | - Martin Rudwaleit
- Internal Medicine and Rheumatology, Klinikum Bielefeld Rosenhöhe, Bielefeld, Germany
| | - Percival Sampaio-Barros
- Rheumatology, Faculdade de Medicina da Universidade de São Paulo e Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Alexandre Sepriano
- Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- Nova Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Joachim Sieper
- Gastroenterology, Infectious Diseases and Rheumatology (including Nutrition Medicine), Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Filip E Van den Bosch
- Rheumatology, Ghent University Hospital, Gent, Belgium
- Internal Medicine and Pediatrics, VIB-UGent Center for Inflammation Research, Ghent University, Gent, Belgium
| | | | - Pedro M Machado
- Rheumatology and Neuromuscular Diseases, University College London, National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre, London, UK
- NHS Foundation Trust, London, UK
- Rheumatology, Norhwick Park Hospital, London North West University Healthcare NHS Trust, London, UK
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Lassoued Ferjani H, Kharrat L, Ben Nessib D, Kaffel D, Maatallah K, Hamdi W. Does sacroiliitis is a mandatory criterion for enthesitis-related arthritis diagnosis? Reumatol Clin (Engl Ed) 2024; 20:187-192. [PMID: 38644029 DOI: 10.1016/j.reumae.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 12/14/2023] [Accepted: 12/16/2023] [Indexed: 04/23/2024]
Abstract
INTRODUCTION AND OBJECTIVES Magnetic resonance imaging (MRI) sensitivity and specificity seem to be less studied in enthesitis-related arthritis (ERA). We aimed to determine the ability of sacroiliac MRI to diagnose ERA patients. MATERIALS AND METHODS We conducted a retrospective study including 44 patients with juvenile idiopathic arthritis (JIA). Each patient had a sacroiliac joint MRI. We divided patients into two groups: G1 patients with ERA and G2 patients with non-ERA subtype. RESULTS ERA was noted in 61% of the cases. Sacroiliac joints were painful in 15 patients (34%). MRI was normal in 25 patients (57%) (G1:11 versus G2:14) and showed bone marrow edema in the sacroiliac joints in 19 patients (34%) (G1=16 versus G2=3, p=0.005). Sacroiliac joints MRI's sensitivity and specificity in the ERA diagnosis were 61.54% and 82.35%, respectively. Positive and negative predictive values were 84.21% and 58.33%, respectively. Furthermore, sacroiliac joint pain in the clinical examination was able to predict sacroiliac bone edema in MRI with an odds ratio of 6.8 (95% CI 1.68-28.09; p=0.006). CONCLUSION Our study showed that sacroiliac joint MRI has good specificity and positive predictive value in the diagnosis of ERA patients among JIA patients. This underlines the usefulness of sacroiliac joint MRI in the early diagnosis of ERA patients.
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Affiliation(s)
- Hanene Lassoued Ferjani
- Rheumatology Department, Kassab Orthopedics Institute, Ksar Saïd, Tunisia; Faculty of Medicine of Tunis, University Tunis el Manar, Tunisia; Research Unit UR17SP04, Ksar Saïd, 2010 Tunis, Tunisia
| | - Lobna Kharrat
- Rheumatology Department, Kassab Orthopedics Institute, Ksar Saïd, Tunisia; Faculty of Medicine of Tunis, University Tunis el Manar, Tunisia.
| | - Dorra Ben Nessib
- Rheumatology Department, Kassab Orthopedics Institute, Ksar Saïd, Tunisia; Faculty of Medicine of Tunis, University Tunis el Manar, Tunisia; Research Unit UR17SP04, Ksar Saïd, 2010 Tunis, Tunisia
| | - Dhia Kaffel
- Rheumatology Department, Kassab Orthopedics Institute, Ksar Saïd, Tunisia; Faculty of Medicine of Tunis, University Tunis el Manar, Tunisia; Research Unit UR17SP04, Ksar Saïd, 2010 Tunis, Tunisia
| | - Kaouther Maatallah
- Rheumatology Department, Kassab Orthopedics Institute, Ksar Saïd, Tunisia; Faculty of Medicine of Tunis, University Tunis el Manar, Tunisia; Research Unit UR17SP04, Ksar Saïd, 2010 Tunis, Tunisia
| | - Wafa Hamdi
- Rheumatology Department, Kassab Orthopedics Institute, Ksar Saïd, Tunisia; Faculty of Medicine of Tunis, University Tunis el Manar, Tunisia; Research Unit UR17SP04, Ksar Saïd, 2010 Tunis, Tunisia
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Sener S, Atalay E, Yildiz AE, Kasap Cuceoglu M, Basaran O, Batu ED, Bilginer Y, Ozen S. Subclinical enthesitis in enthesitis-related arthritis and sacroiliitis associated with familial Mediterranean fever. Mod Rheumatol 2024; 34:607-613. [PMID: 37267199 DOI: 10.1093/mr/road053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 05/08/2023] [Accepted: 05/31/2023] [Indexed: 06/04/2023]
Abstract
OBJECTIVES In our study, we investigated the presence of subclinical enthesitis by ultrasonography (US) in asymptomatic patients with enthesitis-related arthritis (ERA) and sacroiliitis associated with familial Mediterranean fever (FMF). METHODS A total of 50 patients, including 35 patients with ERA and 15 with sacroiliitis associated with FMF, were included in the study. All patients were evaluated with US by a paediatric radiologist. Enthesis of seven tendons (common extensor and flexor tendons, quadriceps tendon, proximal and distal patellar tendon, Achilles tendon, and plantar fascia) was examined on both sides. RESULTS Subclinical enthesitis was detected in 10 ERA (28.5%) and three FMF (20%) patients. Enthesitis was radiologically diagnosed in 16 (2.3%) out of 700 evaluated entheseal sites. The most frequent sites of enthesitis were Achilles (37.5%) and quadriceps (31.3%) tendons. All patients were in clinical remission and had no active complaints, and acute phase reactants were within normal limits. Therefore, the patients were followed up without treatment change. However, disease flare-up was observed in three of these patients (23.1%) during the follow-up, and their treatments were intensified. CONCLUSIONS Our results showed that the US can be particularly helpful in detecting subclinical enthesitis and predicting disease flare-ups.
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Affiliation(s)
- Seher Sener
- Division of Pediatric Rheumatology, Department of Pediatrics, Hacettepe Faculty of Medicine, Ankara, Turkey
| | - Erdal Atalay
- Division of Pediatric Rheumatology, Department of Pediatrics, Sanliurfa Training and Research Hospital, Sanliurfa, Turkey
| | - Adalet Elcin Yildiz
- Department of Radiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Muserref Kasap Cuceoglu
- Division of Pediatric Rheumatology, Department of Pediatrics, Hacettepe Faculty of Medicine, Ankara, Turkey
| | - Ozge Basaran
- Division of Pediatric Rheumatology, Department of Pediatrics, Hacettepe Faculty of Medicine, Ankara, Turkey
| | - Ezgi Deniz Batu
- Division of Pediatric Rheumatology, Department of Pediatrics, Hacettepe Faculty of Medicine, Ankara, Turkey
| | - Yelda Bilginer
- Division of Pediatric Rheumatology, Department of Pediatrics, Hacettepe Faculty of Medicine, Ankara, Turkey
| | - Seza Ozen
- Division of Pediatric Rheumatology, Department of Pediatrics, Hacettepe Faculty of Medicine, Ankara, Turkey
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Zhang K, Liu C, Pan J, Zhu Y, Li X, Zheng J, Zhan Y, Li W, Li S, Luo G, Hong G. Use of MRI-based deep learning radiomics to diagnose sacroiliitis related to axial spondyloarthritis. Eur J Radiol 2024; 172:111347. [PMID: 38325189 DOI: 10.1016/j.ejrad.2024.111347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/13/2024] [Accepted: 01/25/2024] [Indexed: 02/09/2024]
Abstract
OBJECTIVES This study aimed to evaluate the performance of a deep learning radiomics (DLR) model, which integrates multimodal MRI features and clinical information, in diagnosing sacroiliitis related to axial spondyloarthritis (axSpA). MATERIAL & METHODS A total of 485 patients diagnosed with sacroiliitis related to axSpA (n = 288) or non-sacroiliitis (n = 197) by sacroiliac joint (SIJ) MRI between May 2018 and October 2022 were retrospectively included in this study. The patients were randomly divided into training (n = 388) and testing (n = 97) cohorts. Data were collected using three MRI scanners. We applied a convolutional neural network (CNN) called 3D U-Net for automated SIJ segmentation. Additionally, three CNNs (ResNet50, ResNet101, and DenseNet121) were used to diagnose axSpA-related sacroiliitis using a single modality. The prediction results of all the CNN models across different modalities were integrated using a stacking method based on different algorithms to construct ensemble models, and the optimal ensemble model was used as DLR signature. A combined model incorporating DLR signature with clinical factors was developed using multivariable logistic regression. The performance of the models was evaluated using receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA). RESULTS Automated deep learning-based segmentation and manual delineation showed good correlation. ResNet50, as the optimal basic model, achieved an area under the curve (AUC) and accuracy of 0.839 and 0.804, respectively. The combined model yielded the highest performance in diagnosing axSpA-related sacroiliitis (AUC: 0.910; accuracy: 0.856) and outperformed the best ensemble model (AUC: 0.868; accuracy: 0.825) (all P < 0.05). Moreover, the DCA showed good clinical utility in the combined model. CONCLUSION We developed a diagnostic model for axSpA-related sacroiliitis by combining the DLR signature with clinical factors, which resulted in excellent diagnostic performance.
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Affiliation(s)
- Ke Zhang
- Department of Radiology, the Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai 519000, China
| | - Chaoran Liu
- Department of Radiology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, 510280, China
| | - Jielin Pan
- Department of Radiology, Zhuhai People's Hospital, Zhuhai Hospital affiliated with Jinan University, Zhuhai, 519000, China
| | - Yunfei Zhu
- Department of Radiology, the Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai 519000, China
| | - Ximeng Li
- Department of Radiology, the Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai 519000, China
| | - Jing Zheng
- Department of rheumatology, the Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai 519000, China
| | - Yingying Zhan
- Department of Radiology, the Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai 519000, China
| | - Wenjuan Li
- Department of Radiology, the Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai 519000, China
| | - Shaolin Li
- Department of Radiology, the Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai 519000, China.
| | - Guibo Luo
- Shenzhen Graduate School, Peking University, Xili, Nanshan District, Shenzhen 518055, China.
| | - Guobin Hong
- Department of Radiology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, 510280, China.
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Vereecke E, Jans L, Herregods N, Chen M, Jaremko JL, Laloo F, Carron P, Varkas G, de Hooge M, Van den Bosch F, Elewaut D, Morbée L. Association of anatomical variants of the sacroiliac joint with bone marrow edema in patients with axial spondyloarthritis. Skeletal Radiol 2024; 53:507-514. [PMID: 37682337 DOI: 10.1007/s00256-023-04435-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/17/2023] [Accepted: 08/17/2023] [Indexed: 09/09/2023]
Abstract
OBJECTIVE To determine the prevalence of sacroiliac joint variants in patients with axial spondyloarthritis (axSpA) using MRI-based synthetic CT images and to evaluate their relationships with the presence of bone marrow edema, as this may potentially complicate diagnosing active sacroiliitis on MRI in patients with suspected axSpA. METHODS 172 patients were retrospectively included. All patients underwent MRI because of clinical suspicion of sacroiliitis. The diagnosis of axSpA was made by a tertiary hospital rheumatologist. Two readers independently determined the presence of bone marrow edema and the presence of one or more of the nine known sacroiliac joint (SIJ) variants. RESULTS SIJ variants were common in axSpA patients (82.9%) and the non-SpA group (85.4%); there were no significant differences in prevalence. Bone marrow edema was frequently found in axSpA (86.8%) and non-SpA patients (34%). AxSpA patients with SIJ variants (except for accessory joint) demonstrated 4 to 10 times higher odds for bone marrow edema, however not statistically significant. The more variants were present in this group, the higher the chance of bone marrow edema. However, some multicollinearity cannot be excluded, since bone marrow edema is very frequent in the axSpA group by definition. CONCLUSION SIJ variants are common in axSpA and non-SpA patients. SIJ variants were associated with higher prevalence of bone marrow edema in axSpA patients, potentially due to altered biomechanics, except for accessory joint which may act as a stabilizer.
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Affiliation(s)
- Elke Vereecke
- Department of Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | - Lennart Jans
- Department of Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Nele Herregods
- Department of Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Min Chen
- Department of Radiology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Jacob L Jaremko
- Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta Hospital, Edmonton, AB, Canada
| | - Frederiek Laloo
- Department of Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Philippe Carron
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium
- Molecular Immunology and Inflammation Unit, VIB-UGent Center for Inflammation Research, Zwijnaarde, Belgium
| | - Gaëlle Varkas
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium
- Molecular Immunology and Inflammation Unit, VIB-UGent Center for Inflammation Research, Zwijnaarde, Belgium
- Department of Rheumatology, Jan Palfijn Hospital, Ghent, Belgium
| | - Manouk de Hooge
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium
- Molecular Immunology and Inflammation Unit, VIB-UGent Center for Inflammation Research, Zwijnaarde, Belgium
| | - Filip Van den Bosch
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium
- Molecular Immunology and Inflammation Unit, VIB-UGent Center for Inflammation Research, Zwijnaarde, Belgium
| | - Dirk Elewaut
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium
- Molecular Immunology and Inflammation Unit, VIB-UGent Center for Inflammation Research, Zwijnaarde, Belgium
| | - Lieve Morbée
- Department of Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
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8
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Arnbak B, Jensen TS, Hendricks O, Østergaard M, Zejden A, Jurik AG, Manniche C. Prognostic value of the clinical and imaging arm of the ASAS criteria for progression of structural sacroiliac joint lesions. Mod Rheumatol 2024; 34:391-398. [PMID: 36508308 DOI: 10.1093/mr/roac154] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/27/2022] [Accepted: 12/08/2022] [Indexed: 02/17/2024]
Abstract
OBJECTIVE To investigate the prognostic value of the two arms of the Assessment of SpondyloArthritis international Society (ASAS) criteria regarding the progression of structural lesions in the sacroiliac joints (SIJs). METHODS Information on baseline fulfilment of the ASAS criteria and baseline and follow-up magnetic resonance imaging of the SIJ in 603 patients aged 18-40 years referred with low back pain to an outpatient spine were collected. Magnetic resonance imaging positivity was defined as bone marrow oedema (BMO) in two or more consecutive slices or two or more lesions in one slice, as described in the ASAS definition of sacroiliitis. RESULTS Of 71 participants fulfilling the ASAS criteria at baseline, 66 (93%) fulfilled the 'imaging arm' and 14 (20%) fulfilled the 'clinical arm'. The 'clinical arm' predicted the progression of erosions with an odds ratio of 55 (compared with not fulfilling the ASAS criteria), while the 'imaging arm' predicted the progression of erosions with an odds ratio of 8. Moreover, in 24% of the patients in the 'imaging arm', all having BMO at the SIJ at baseline, the BMO disappeared without neither erosions nor ankylosis emerging. CONCLUSION We found that the 'clinical arm' was a strong predictor for the progression of SIJ erosion, while the 'imaging arm' had a more modest prognostic value for structural progression.
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Affiliation(s)
- Bodil Arnbak
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Department of Radiology, Hospital Lillebaelt, Vejle, Denmark
| | - Tue Secher Jensen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Research Department, Chiropractic Knowledge Hub, Odense, Denmark
- Diagnostic Centre - Imaging Section, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Oliver Hendricks
- Danish Hospital for Rheumatic Diseases, Soenderborg, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Anna Zejden
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Anne Grethe Jurik
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Claus Manniche
- Department of Occupational and Environmental Medicine, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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9
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Liu L, Zhang H, Zhang W, Mei W, Huang R. Sacroiliitis diagnosis based on interpretable features and multi-task learning. Phys Med Biol 2024; 69:045034. [PMID: 38237177 DOI: 10.1088/1361-6560/ad2010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 01/18/2024] [Indexed: 02/17/2024]
Abstract
Objective.Sacroiliitis is an early pathological manifestation of ankylosing spondylitis (AS), and a positive sacroiliitis test on imaging may help clinical practitioners diagnose AS early. Deep learning based automatic diagnosis algorithms can deliver grading findings for sacroiliitis, however, it requires a large amount of data with precise labels to train the model and lacks grading features visualization. In this paper, we aimed to propose a radiomics and deep learning based deep feature visualization positive diagnosis algorithm for sacroiliitis on CT scans. Visualization of grading features can enhance clinical interpretability with visual grading features, which assist doctors in diagnosis and treatment more effectively.Approach.The region of interest (ROI) is identified by segmenting the sacroiliac joint (SIJ) 3D CT images using a combination of the U-net model and certain statistical approaches. Then, in addition to extracting spatial and frequency domain features from ROI according to the radiographic manifestations of sacroiliitis, the radiomics features have also been integrated into the proposed encoder module to obtain a powerful encoder and extract features effectively. Finally, a multi-task learning technique and five-class labels are utilized to help with performing positive tests to reduce discrepancies in the evaluation of several radiologists.Main results.On our private dataset, proposed methods have obtained an accuracy rate of 87.3%, which is 9.8% higher than the baseline and consistent with assessments made by qualified medical professionals.Significance.The results of the ablation experiment and interpreting analysis demonstrated that the proposed methods are applied in automatic CT scan sacroiliitis diagnosis due to their excellently interpretable and portable advantages.
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Affiliation(s)
- Lei Liu
- Medical College, Shantou University, Shantou, Guangdong, 515041, People's Republic of China
| | - Haoyu Zhang
- College of Engineering, Shantou University, Shantou, Guangdong, 515063, People's Republic of China
| | - Weifeng Zhang
- College of Engineering, Shantou University, Shantou, Guangdong, 515063, People's Republic of China
| | - Wei Mei
- Department of Radiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, 515041, People's Republic of China
| | - Ruibin Huang
- Department of Radiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, 515041, People's Republic of China
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10
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Yue T, Lai JM, Yang Y, Zhang D, Su GX, Zhu J, Wu FQ. [Clinical and imaging features of infective sacroiliitis in children]. Zhonghua Er Ke Za Zhi 2023; 61:1092-1097. [PMID: 38018046 DOI: 10.3760/cma.j.cn112140-20230825-00131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
Objective: To summarize the clinical, radiological characteristics, and prognosis of infectious sacroiliitis in children. Methods: A case-control study was conducted, including 12 cases of infectious sacroiliitis diagnosed in the Rheumatology and Immunology Department of the Children's Hospital affiliated with the Capital Institute of Pediatrics from June 2018 to June 2023. These cases comprised the case group. Concurrently, 28 cases of pediatric idiopathic arthritis involving the sacroiliac joint in the same department served as the control group. Basic patient information, clinical features, laboratory parameters, and clinical treatment outcomes for both groups were collected and analyzed. Independent sample t-tests and chi-squared tests were used for inter-group comparisons. Results: Among the 12 cases in the case group, there were 5 males and 7 females, with a disease duration of 0.8 (0.5, 1.2) months. Nine patients presented with fever, and 1 patient had limping gait. Human leukocyte antigen (HLA)-B27 positivity was observed in 1 case, and there was no family history of ankylosing spondylitis. In the control group of 28 cases, there were 19 males and 9 females, with a disease duration of 7.0 (3.0, 17.0) months. One patient (4%) had fever, and 14 cases (50%) exhibited limping gait. HLA-B27 positivity was found in 18 cases (64%), and 18 cases (64%) had a family history of ankylosing spondylitis. The case group had higher white blood cell count (WBC), neutrophil ratio, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) levels, as well as a higher proportion of unilateral involvement on magnetic resonance imaging and bone destruction on CT compared to the control group ((11.1±6.2)×109 vs. (7.3±2.3)×109/L, 0.64±0.10 vs. 0.55±0.12, 72 (34, 86) vs. 18 (5, 41) mm/1 h, 24.6 (10.1, 67.3) mg/L vs. 3.6 (0.8, 15.0) mg/L, 11/12 vs. 36% (10/28), 9/12 vs. 11% (3/28), t=2.90, 3.07, Z=-2.94, -3.28, χ2=10.55, 16.53, all P<0.05). Conclusions: Pediatric infectious sacroiliitis often presents as unilateral involvement with a short disease history. Elevated WBC, CRP, and ESR, as well as a high rate of bone destruction, are also common characteristics.
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Affiliation(s)
- T Yue
- Department of Rheumatology and Immunology, Children's Hospital Capital Institute of Pediatrics, Beijing 100020, China
| | - J M Lai
- Department of Rheumatology and Immunology, Children's Hospital Capital Institute of Pediatrics, Beijing 100020, China
| | - Y Yang
- Department of Radiology, Children's Hospital Capital Institute of Pediatrics, Beijing 100020, China
| | - D Zhang
- Department of Rheumatology and Immunology, Children's Hospital Capital Institute of Pediatrics, Beijing 100020, China
| | - G X Su
- Department of Rheumatology and Immunology, Children's Hospital Capital Institute of Pediatrics, Beijing 100020, China
| | - J Zhu
- Department of Rheumatology and Immunology, Children's Hospital Capital Institute of Pediatrics, Beijing 100020, China
| | - F Q Wu
- Department of Rheumatology and Immunology, Children's Hospital Capital Institute of Pediatrics, Beijing 100020, China
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11
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Moon SJ, Lee S, Hwang J, Lee J, Kang S, Cha HS. Performances of machine learning algorithms in discriminating sacroiliitis features on MRI: a systematic review. RMD Open 2023; 9:e003783. [PMID: 37996126 PMCID: PMC10668284 DOI: 10.1136/rmdopen-2023-003783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 11/08/2023] [Indexed: 11/25/2023] Open
Abstract
OBJECTIVES Summarise the evidence of the performance of the machine learning algorithm in discriminating sacroiliitis features on MRI and compare it with the accuracy of human physicians. METHODS MEDLINE, EMBASE, CIHNAL, Web of Science, IEEE, American College of Rheumatology and European Alliance of Associations for Rheumatology abstract archives were searched for studies published between 2008 and 4 June 2023. Two authors independently screened and extracted the variables, and the results are presented using tables and forest plots. RESULTS Ten studies were selected from 2381. Over half of the studies used deep learning models, using Assessment of Spondyloarthritis International Society sacroiliitis criteria as the ground truth, and manually extracted the regions of interest. All studies reported the area under the curve as a performance index, ranging from 0.76 to 0.99. Sensitivity and specificity were the second-most commonly reported indices, with sensitivity ranging from 0.56 to 1.00 and specificity ranging from 0.67 to 1.00; these results are comparable to a radiologist's sensitivity of 0.67-1.00 and specificity of 0.78-1.00 in the same cohort. More than half of the studies showed a high risk of bias in the analysis domain of quality appraisal owing to the small sample size or overfitting issues. CONCLUSION The performance of machine learning algorithms in discriminating sacroiliitis features on MRI varied owing to the high heterogeneity between studies and the small sample sizes, overfitting, and under-reporting issues of individual studies. Further well-designed and transparent studies are required.
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Affiliation(s)
- Sun Jae Moon
- Department of Medicine, Santa Marie 24 Clinic, Seongnam-si, Korea (the Republic of)
| | - Seulkee Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)
| | - Jinseub Hwang
- Department of Data Science, Daegu University, Gyeongsan-si, Korea (the Republic of)
| | - Jaejoon Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)
| | - Seonyoung Kang
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)
| | - Hoon-Suk Cha
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)
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12
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Lee S, Jeon U, Lee JH, Kang S, Kim H, Lee J, Chung MJ, Cha HS. Artificial intelligence for the detection of sacroiliitis on magnetic resonance imaging in patients with axial spondyloarthritis. Front Immunol 2023; 14:1278247. [PMID: 38022576 PMCID: PMC10676202 DOI: 10.3389/fimmu.2023.1278247] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 10/25/2023] [Indexed: 12/01/2023] Open
Abstract
Background Magnetic resonance imaging (MRI) is important for the early detection of axial spondyloarthritis (axSpA). We developed an artificial intelligence (AI) model for detecting sacroiliitis in patients with axSpA using MRI. Methods This study included MRI examinations of patients who underwent semi-coronal MRI scans of the sacroiliac joints owing to chronic back pain with short tau inversion recovery (STIR) sequences between January 2010 and December 2021. Sacroiliitis was defined as a positive MRI finding according to the ASAS classification criteria for axSpA. We developed a two-stage framework. First, the Faster R-CNN network extracted regions of interest (ROIs) to localize the sacroiliac joints. Maximum intensity projection (MIP) of three consecutive slices was used to mimic the reading of two adjacent slices. Second, the VGG-19 network determined the presence of sacroiliitis in localized ROIs. We augmented the positive dataset six-fold. The sacroiliitis classification performance was measured using the sensitivity, specificity, and area under the receiver operating characteristic curve (AUROC). The prediction models were evaluated using three-round three-fold cross-validation. Results A total of 296 participants with 4,746 MRI slices were included in the study. Sacroiliitis was identified in 864 MRI slices of 119 participants. The mean sensitivity, specificity, and AUROC for the detection of sacroiliitis were 0.725 (95% CI, 0.705-0.745), 0.936 (95% CI, 0.924-0.947), and 0.830 (95%CI, 0.792-0.868), respectively, at the image level and 0.947 (95% CI, 0.912-0.982), 0.691 (95% CI, 0.603-0.779), and 0.816 (95% CI, 0.776-0.856), respectively, at the patient level. In the original model, without using MIP and dataset augmentation, the mean sensitivity, specificity, and AUROC were 0.517 (95% CI, 0.493-0.780), 0.944 (95% CI, 0.933-0.955), and 0.731 (95% CI, 0.681-0.780), respectively, at the image level and 0.806 (95% CI, 0.729-0.883), 0.617 (95% CI, 0.523-0.711), and 0.711 (95% CI, 0.660-0.763), respectively, at the patient level. The performance was improved by MIP techniques and data augmentation. Conclusion An AI model was developed for the detection of sacroiliitis using MRI, compatible with the ASAS criteria for axSpA, with the potential to aid MRI application in a wider clinical setting.
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Affiliation(s)
- Seulkee Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Uju Jeon
- Medical AI Research Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Ji Hyun Lee
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seonyoung Kang
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyungjin Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jaejoon Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Myung Jin Chung
- Medical AI Research Center, Samsung Medical Center, Seoul, Republic of Korea
- Department of Data Convergence and Future Medicine, Sungkyunkwan University School of Medicine, Suwon, Republic of Korea
| | - Hoon-Suk Cha
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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13
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Tasso M, Uguccioni V, Bertolini N, Bernasconi A, Mariconda M, Scarpa R, Costa L, Caso F. Role of Patrick-FABER test in detecting sacroiliitis and diagnosing spondyloarthritis in subjects with low back pain. Clin Exp Rheumatol 2023; 41:2298-2300. [PMID: 37650318 DOI: 10.55563/clinexprheumatol/kgje8k] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 05/15/2023] [Indexed: 09/01/2023]
Abstract
OBJECTIVES To evaluate sensitivity, specificity, and predictive value of Patrick-FABER test in assessing magnetic resonance imaging (MRI) sacroiliitis and addressing the diagnosis of spondyloarthritis (SpA) in subjects with low back pain (LBP). METHODS Subjects with LBP were consecutively enrolled. The assessors were blinded to patients' clinical, laboratory, or imaging data. All subjects underwent sacroiliac joint MRI to detect presence of sacroiliac oedema or structural changes. RESULTS One hundred and ten subjects were included in the study [males (61.8%); median age of 45 (21-69) years; LBP duration of 78 (3-240) months]. Patrick-FABER test sign's sensitivity was 76.2% (95% CI: 60.5-87.9%), specificity was 66.2% (95% CI: 53.6-77.2%), positive predictive value (PPV) was 58.1% (95% CI: 44.1-71.3%) and negative predictive value (NPV) was 81.8% (95% CI: 69.1-90.9%) for the diagnosis of sacroiliitis, with an overall diagnostic accuracy of 70%. At the univariate and multivariate analysis, Patrick-FABER test sign was associated with inflammatory lesions of sacroiliitis at MRI and SpA diagnosis. Univariate and multivariate analysis showed an association between smoking status (p=0.01), sacroiliitis, and SpA diagnosis. The odds of having sacroiliitis was 2.7 higher in smokers (OR: 2.7; 95% CI: 1.1-7) as compared to non-smokers and 6.3 higher in those with a positive Patrick-FABER test sign (OR: 6.3; 95%CI: 2.5-15.6) as compared to those with a negative sign. CONCLUSIONS Our study shows that Patrick-FABER test positivity could represent a useful clinical test for addressing the use of sacroiliac joints MRI and SpA diagnosis in subjects with LBP. Further, smoking habit could represent an associate anamnestic element for addressing the use of sacroiliac MRI.
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Affiliation(s)
- Marco Tasso
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Valentina Uguccioni
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Nicoletta Bertolini
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Alessio Bernasconi
- Orthopaedic Surgery Unit, Department of Public Health, University of Naples Federico II, Napoli, Italy
| | - Massimo Mariconda
- Orthopaedic Surgery Unit, Department of Public Health, University of Naples Federico II, Napoli, Italy
| | - Raffaele Scarpa
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy.
| | - Luisa Costa
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Francesco Caso
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
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14
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Abstract
Recently, several inflammatory markers, including the uric acid to HDL cholesterol ratio (UHR), triglyceride/HDL cholesterol ratio (THR), systemic inflammatory index (SII), and C-reactive protein to albumin ratio (CAR), have been reported to be associated with inflammatory conditions. However, their collective role in sacroiliitis has not been extensively studied. This study aims to investigate the general characteristics and inflammatory markers in patients with and without sacroiliitis, and to observe any differences in these parameters in subjects with active and chronic sacroiliitis. Patient with sacroiliitis who showed up in the Radiology Department of Abant Izzet Baysal University Hospital were enrolled. Patients diagnosed with sacroiliitis based on clinical symptoms, physical examination, and conventional radiography or MRI findings were included in the sacroiliitis group. Patients without sacroiliitis who present with back pain or hip pain but have normal radiographic findings were included in the control group. General characteristics, including age, sex, body mass index (BMI), medical history, and disease duration, were collected from all participants. Blood samples were collected to measure inflammatory markers, including UHR, THR, SII, and CAR. The collected data were compared between sacroiliitis and control groups. Subgroup analysis was also performed to compare the inflammatory markers between subjects with active and chronic sacroiliitis. The median UHR of the sacroiliitis and control subjects were 11% (3-20%) and 7% (3-13%), respectively (p<0.001). Serum UHR was significantly and positively correlated with CRP (r: 0.4, p = 0.001) and ferritin (r: 0.17, p = 0.045) levels. In ROC analysis, a UHR level higher than 8% has an 81% sensitivity and 64% specificity in detecting sacroiliitis (AUC: 0.8, p<0.001, 95% CI: 0.72-0.84). In conclusion, we suggest that UHR could provide useful data as an additional diagnostic tool in patients with sacroiliitis.
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Affiliation(s)
- Melike Elif Kalfaoglu
- Department of Radiology, Izzet Baysal Training and Research Hospital, Bolu Abant Izzet Baysal University, Bolu, Turkey
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15
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Sudoł-Szopińska I, Herregods N, Zejden A, Jans L, Giraudo C, Boesen M, Becce F, Bazzocchi A, Simoni P, Aparisi Gómez MP, Jaremko J, Maas M, Teh J, Hermann KG, Menegotto F, Isaac A, Reijnierse M, Shah A, Rennie W, Jurik AG. Current Role of Conventional Radiography of Sacroiliac Joints in Adults and Juveniles with Suspected Axial Spondyloarthritis: Opinion from the ESSR Arthritis and Pediatric Subcommittees. Semin Musculoskelet Radiol 2023; 27:588-595. [PMID: 37816367 DOI: 10.1055/s-0043-1772169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/12/2023]
Abstract
This opinion article by the European Society of Musculoskeletal Radiology Arthritis and Pediatric Subcommittees discusses the current use of conventional radiography (CR) of the sacroiliac joints in adults and juveniles with suspected axial spondyloarthritis (axSpA). The strengths and limitations of CR compared with magnetic resonance imaging (MRI) and computed tomography (CT) are presented.Based on the current literature and expert opinions, the subcommittees recognize the superior sensitivity of MRI to detect early sacroiliitis. In adults, supplementary pelvic radiography, low-dose CT, or synthetic CT may be needed to evaluate differential diagnoses. CR remains the method of choice to detect structural changes in patients with suspected late-stage axSpA or established disease and in patients with suspected concomitant hip or pubic symphysis involvement. In children, MRI is the imaging modality of choice because it can detect active as well as structural changes and is radiation free.
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Affiliation(s)
- Iwona Sudoł-Szopińska
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Nele Herregods
- Department of Radiology and Nuclear Medicine - Division of Pediatric Radiology, Princess Elisabeth Children's Hospital/Ghent University Hospital, Ghent, Belgium
| | - Anna Zejden
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - Lennart Jans
- Department of Radiology, Ghent University Hospital, Ghent, Belgium
| | - Chiara Giraudo
- Department of Medicine - DIMED, University of Padova, Padova, Italy
| | - Mikael Boesen
- Department of Radiology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Fabio Becce
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Alberto Bazzocchi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Paolo Simoni
- Pediatric Imaging Department, Reine Fabiola Children's University Hospital, ULB, Brussels, Belgium
| | - Maria Pilar Aparisi Gómez
- Department of Radiology, Auckland City Hospital, Auckland District Health Board, Grafton, Auckland, New Zealand
- Department of Radiology, IMSKE, Valencia, Spain
| | - Jacob Jaremko
- Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta Hospital, Edmonton, AB, Canada
| | - Mario Maas
- Department of Radiology & Nuclear Medicine, Amsterdam UMC, location AMC - University of Amsterdam, Amsterdam, Netherlands
| | - James Teh
- Radiology Department, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - Kay-Geert Hermann
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Flavia Menegotto
- Bristol Royal Hospital for Children Paediatric Radiology Department, University Hospitals Bristol and Weston NHS Foundation Trust (UHBW), Bristol, United Kingdom
| | - Amanda Isaac
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Monique Reijnierse
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | - Amit Shah
- Department of Radiology, University Hospitals of Leicester NHS Trust, Infirmary Square, Leicester, United Kingdom
| | - Winston Rennie
- Department of Radiology, University Hospitals of Leicester NHS Trust, Loughborough University, Loughborough, United Kingdom
| | - Anne Grethe Jurik
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
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16
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Zhang K, Luo G, Li W, Zhu Y, Pan J, Li X, Liu C, Liang J, Zhan Y, Zheng J, Li S, Cai W, Hong G. Automatic Image Segmentation and Grading Diagnosis of Sacroiliitis Associated with AS Using a Deep Convolutional Neural Network on CT Images. J Digit Imaging 2023; 36:2025-2034. [PMID: 37268841 PMCID: PMC10501961 DOI: 10.1007/s10278-023-00858-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/18/2023] [Accepted: 05/22/2023] [Indexed: 06/04/2023] Open
Abstract
Ankylosing spondylitis (AS) is a chronic inflammatory disease that causes inflammatory low back pain and may even limit activity. The grading diagnosis of sacroiliitis on imaging plays a central role in diagnosing AS. However, the grading diagnosis of sacroiliitis on computed tomography (CT) images is viewer-dependent and may vary between radiologists and medical institutions. In this study, we aimed to develop a fully automatic method to segment sacroiliac joint (SIJ) and further grading diagnose sacroiliitis associated with AS on CT. We studied 435 CT examinations from patients with AS and control at two hospitals. No-new-UNet (nnU-Net) was used to segment the SIJ, and a 3D convolutional neural network (CNN) was used to grade sacroiliitis with a three-class method, using the grading results of three veteran musculoskeletal radiologists as the ground truth. We defined grades 0-I as class 0, grade II as class 1, and grades III-IV as class 2 according to modified New York criteria. nnU-Net segmentation of SIJ achieved Dice, Jaccard, and relative volume difference (RVD) coefficients of 0.915, 0.851, and 0.040 with the validation set, respectively, and 0.889, 0.812, and 0.098 with the test set, respectively. The areas under the curves (AUCs) of classes 0, 1, and 2 using the 3D CNN were 0.91, 0.80, and 0.96 with the validation set, respectively, and 0.94, 0.82, and 0.93 with the test set, respectively. 3D CNN was superior to the junior and senior radiologists in the grading of class 1 for the validation set and inferior to expert for the test set (P < 0.05). The fully automatic method constructed in this study based on a convolutional neural network could be used for SIJ segmentation and then accurately grading and diagnosis of sacroiliitis associated with AS on CT images, especially for class 0 and class 2. The method for class 1 was less effective but still more accurate than that of the senior radiologist.
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Affiliation(s)
- Ke Zhang
- Department of Radiology, the Fifth Affiliated Hospital, Sun Yat-Sen University, Zhuhai, 519000 China
| | - Guibo Luo
- Department of Radiology, Massachusetts General Hospitaland, Harvard Medical School
, 25 New Chardon Street 400C, Boston, MA 02114 USA
- Shenzhen Graduate School, Peking University, Nanshan District, XiliShenzhen, 518055 China
| | - Wenjuan Li
- Department of Radiology, the Fifth Affiliated Hospital, Sun Yat-Sen University, Zhuhai, 519000 China
| | - Yunfei Zhu
- Department of Radiology, the Fifth Affiliated Hospital, Sun Yat-Sen University, Zhuhai, 519000 China
| | - Jielin Pan
- Department of Radiology, Zhuhai People’s Hospital, Zhuhai Hospital Affiliated With Jinan University, Zhuhai, 519000 China
| | - Ximeng Li
- Department of Radiology, the Fifth Affiliated Hospital, Sun Yat-Sen University, Zhuhai, 519000 China
| | - Chaoran Liu
- Department of Radiology, the Fifth Affiliated Hospital, Sun Yat-Sen University, Zhuhai, 519000 China
| | - Jianchao Liang
- Department of Radiology, Zhuhai People’s Hospital, Zhuhai Hospital Affiliated With Jinan University, Zhuhai, 519000 China
| | - Yingying Zhan
- Department of Radiology, the Fifth Affiliated Hospital, Sun Yat-Sen University, Zhuhai, 519000 China
| | - Jing Zheng
- Department of Rheumatology, the Fifth Affiliated Hospital, Sun Yat-Sen University, Zhuhai, 519000 China
| | - Shaolin Li
- Department of Radiology, the Fifth Affiliated Hospital, Sun Yat-Sen University, Zhuhai, 519000 China
| | - Wenli Cai
- Department of Radiology, Massachusetts General Hospitaland, Harvard Medical School
, 25 New Chardon Street 400C, Boston, MA 02114 USA
| | - Guobin Hong
- Department of Radiology, the Fifth Affiliated Hospital, Sun Yat-Sen University, Zhuhai, 519000 China
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17
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Hermann KGA, Diekhoff T. [Computed tomography versus magnetic resonance imaging : Pros and cons in axial spondyloarthritis]. Z Rheumatol 2023; 82:638-645. [PMID: 37815608 DOI: 10.1007/s00393-023-01415-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2023] [Indexed: 10/11/2023]
Abstract
The diagnosis of axial spondyloarthritis depends on direct visualization of the sacroiliitis in addition to clinical assessment and determination of the histocompatibility antigen HLA-B27. While the value of conventional radiographic images has meanwhile been described in many studies as insufficient to diagnose the disease at an early stage, magnetic resonance imaging and also computed tomography now offer the possibility to visualize findings, such as bone marrow edema, erosion, fat metaplasia, backfill and ankylosis. Thus, it is necessary to decide which procedure should be used and when. Furthermore, both cross-sectional imaging techniques are currently undergoing major changes, and technical advancements are making great strides every year. This article provides an overview of which future technologies will be included in the rheumatological diagnostics of the sacroiliac joints. This overview also illustrates which standard methods are established in the diagnostics of axial spondyloarthritis and how they are used.
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Affiliation(s)
- Kay Geert A Hermann
- Klinik für Radiologie, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
| | - Torsten Diekhoff
- Klinik für Radiologie, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
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Fakih O, Balblanc JC, Lohse A. Rare mimicker of sacroiliitis. Ann Rheum Dis 2023; 82:1368. [PMID: 37072153 DOI: 10.1136/ard-2023-224164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 04/06/2023] [Indexed: 04/20/2023]
Affiliation(s)
- Olivier Fakih
- Service de rhumatologie, Hôpital Nord Franche-Comté, Trévenans, France
| | | | - Anne Lohse
- Service de rhumatologie, Hôpital Nord Franche-Comté, Trévenans, France
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19
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Di Dier K, Deppe D, Diekhoff T, Herregods N, Jans L. Clash of the titans: Current CT and CT-like imaging modalities in sacroiliitis in spondyloarthritis. Best Pract Res Clin Rheumatol 2023; 37:101876. [PMID: 37953120 DOI: 10.1016/j.berh.2023.101876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 07/07/2023] [Accepted: 10/16/2023] [Indexed: 11/14/2023]
Abstract
Sacroiliitis is characterised by active and structural changes of the joint. While the Assessment of Spondyloarthritis international Society (ASAS) classification criteria stress the importance of bone marrow inflammation, recent reports suggest that osteitis can occur in various diseases, mechanical conditions and healthy individuals. Thus, structural lesions such as joint surface erosion and ankylosis are important factors for differential diagnosis. Various imaging modalities are available to examine these changes. However, computed tomography (CT) is generally considered the reference standard. Nonetheless, recent advances in magnetic resonance imaging (MRI) allow for direct bone imaging and the reconstruction of CT-like images that can provide similar information. This way, the ability of MRI to detect and measure structural lesions is strengthened. The aim of this review is to provide an overview of the pros and cons of CT and CT-like imaging modalities in sacroiliitis.
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Affiliation(s)
- Kelly Di Dier
- Department of Radiology, Faculty of Medicine, Ghent University Hospital, De Pintelaan 185, 9000, Gent, Belgium.
| | - Dominik Deppe
- Department of Radiology (CCM), Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt - Universität Zu Berlin, Freie Unversität Berlin, Charitéplaz 1, 10117, Berlin, Germany.
| | - Torsten Diekhoff
- Department of Radiology (CCM), Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt - Universität Zu Berlin, Freie Unversität Berlin, Charitéplaz 1, 10117, Berlin, Germany.
| | - Nele Herregods
- Department of Radiology, Faculty of Medicine, Ghent University Hospital, De Pintelaan 185, 9000, Gent, Belgium.
| | - Lennart Jans
- Department of Radiology, Faculty of Medicine, Ghent University Hospital, De Pintelaan 185, 9000, Gent, Belgium.
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Lorenzin M, Cozzi G, Scagnellato L, Ortolan A, Vio S, Striani G, Scapin V, De Conti G, Doria A, Ramonda R. Relationship between sex and clinical and imaging features of early axial spondyloarthritis: results from a 48 month follow-up (Italian arm of the SPondyloArthritis Caught Early (SPACE) study). Scand J Rheumatol 2023; 52:519-529. [PMID: 36847124 DOI: 10.1080/03009742.2023.2169990] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 01/15/2023] [Indexed: 03/01/2023]
Abstract
OBJECTIVES To assess the association between sex and clinical and disease activity indices, and X-rays and magnetic resonance imaging (MRI) features, in early-stage axial spondyloarthritis (axSpA). METHOD Baseline data analysis was conducted on the Italian SPACE cohort, including patients with chronic back pain (duration ≥ 3 months and ≤ 2 years; onset < 45 years). Patients underwent MRI and X-rays of the sacroiliac joints (SIJs) to establish the diagnosis of axSpA, according to Assessment of SpondyloArthritis international Society criteria and physician's judgement. Clinical features, disease activity and functional indices, and images were collected at baseline and yearly during 48 months. Spinal and SIJ X-rays and MRI images were scored by two readers following Spondyloarthritis Research Consortium of Canada (SPARCC), modified Stoke Ankylosing Spondylitis Spinal Score, and modified New York criteria. Characteristics of axSpA patients according to sex (male/female) were compared over time using descriptive statistics. RESULTS Ninety-one patients had axSpA (83.5% non-radiographic; 16.5% radiographic); 47.3% were male. Males were younger, with shorter duration of axial symptoms, and more frequently had HLA-B27 positivity, radiographic sacroiliitis with a bilateral/symmetric pattern, and more signs of spondylitis. Females more frequently showed peripheral/entheseal involvement and the non-radiographic phenotype. Males showed increased pelvic/spinal radiographic progression and more often had active sacroiliitis on MRI. Although the frequency of inflammatory corner lesions did not differ between males and females, localization varied, with more cervical/thoracic MRI-spine lesions in females and more lumbar lesions in males. We observed a significant downward trend of SPARCC SIJ/spine scores in all patients, irrespective of sex. More fat lesions were observed on MRI-spine in females and on MRI-SIJ in males. CONCLUSION Sex was associated with distinct axSpA features: females showed low-grade radiographic sacroiliitis and spinal progression, and a higher prevalence of cervical and thoracic spine MRI signs.
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Affiliation(s)
- M Lorenzin
- Rheumatology Unit, Department of Medicine-DIMED, Padova University Hospital, Padova, Italy
| | - G Cozzi
- Rheumatology Unit, Department of Medicine-DIMED, Padova University Hospital, Padova, Italy
| | - L Scagnellato
- Rheumatology Unit, Department of Medicine-DIMED, Padova University Hospital, Padova, Italy
| | - A Ortolan
- Rheumatology Unit, Department of Medicine-DIMED, Padova University Hospital, Padova, Italy
| | - S Vio
- Radiology Unit, Padova University Hospital, Padova, Italy
| | - G Striani
- Rheumatology Unit, Department of Medicine-DIMED, Padova University Hospital, Padova, Italy
| | - V Scapin
- Radiology Unit, Padova University Hospital, Padova, Italy
| | - G De Conti
- Radiology Unit, Padova University Hospital, Padova, Italy
| | - A Doria
- Rheumatology Unit, Department of Medicine-DIMED, Padova University Hospital, Padova, Italy
| | - R Ramonda
- Rheumatology Unit, Department of Medicine-DIMED, Padova University Hospital, Padova, Italy
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Kiracı M, Bilgin E, Duran E, Farisoğulları B, Bölek EC, Yardımcı GK, Ozsoy Z, Ayan G, Uzun GS, Akbaba TH, Balci-Peynircioglu B, Karadag O, Akdogan A, Bilgen SA, Kiraz S, Ertenli AI, Kalyoncu U, Kılıç L. Comparison of demographic, clinic and radiological features of patients with axial spondyloarthritis accompanying familial Mediterranean fever to patients with each condition alone. Scand J Rheumatol 2023; 52:530-538. [PMID: 36503416 DOI: 10.1080/03009742.2022.2143621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 11/01/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To compare the demographic, clinical, and radiological features of patients with axial spondyloarthritis (axSpA) accompanying familial Mediterranean fever (FMF) to patients with each condition alone. METHOD Hacettepe University Hospital database was screened regarding ICD-10 codes for FMF (E85.0) and axSpA (M45). The diagnosis of FMF was confirmed by Tel-Hashomer criteria, and axSpA by the presence of sacroiliitis according to the modified New York criteria or active sacroiliitis on magnetic resonance imaging. As control groups, 136 gender-matched, consequent FMF patients without axSpA and 102 consequent axSpA patients without FMF previously treated with any biological agents were included in the analysis. RESULTS In patients with FMF + axSpA compared to the axSpA group, age at axSpA symptom onset and age at diagnosis were lower [median with interquartile range (IQR): 21 (17-30) vs 27 (21-37), p < 0.001; 23 (21-38) vs 32 (24-43) years, p = 0.001], moderate to severe hip disease and total hip replacement were more prevalent (23.4% vs 4.7%, p < 0.001; 11.2% vs 2.8%, p = 0.016). In patients with FMF + axSpA compared to the FMF group, age at FMF symptom onset and age at diagnosis were higher [13 (6-30) vs 11 (5-18), p = 0.057; 23 (13-33) vs 18 (10-31) years, p = 0.033] and amyloidosis was more prevalent (6.6% vs 2.2%, p = 0.076). Although the M694V variant (in one or two alleles) was more prevalent in the FMF + axSpA group, the difference was not statistically significant. CONCLUSION In patients with FMF + axSpA, the age of onset of axSpA was significantly earlier, moderate to severe hip involvement and amyloidosis were more common than in patients with each condition alone.
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Affiliation(s)
- M Kiracı
- Department of Internal Medicine, Hacettepe University, Ankara, Turkey
| | - E Bilgin
- Department of Internal Medicine, Division of Rheumatology, Hacettepe University, Ankara, Turkey
| | - E Duran
- Department of Internal Medicine, Division of Rheumatology, Hacettepe University, Ankara, Turkey
| | - B Farisoğulları
- Department of Internal Medicine, Division of Rheumatology, Hacettepe University, Ankara, Turkey
| | - E C Bölek
- Department of Internal Medicine, Division of Rheumatology, Hacettepe University, Ankara, Turkey
| | - G K Yardımcı
- Department of Internal Medicine, Division of Rheumatology, Hacettepe University, Ankara, Turkey
| | - Z Ozsoy
- Department of Internal Medicine, Division of Rheumatology, Hacettepe University, Ankara, Turkey
| | - G Ayan
- Department of Internal Medicine, Division of Rheumatology, Hacettepe University, Ankara, Turkey
| | - G S Uzun
- Department of Internal Medicine, Division of Rheumatology, Hacettepe University, Ankara, Turkey
| | - T H Akbaba
- Department of Medical Biology, Hacettepe University, Ankara, Turkey
| | | | - O Karadag
- Department of Internal Medicine, Division of Rheumatology, Hacettepe University, Ankara, Turkey
| | - A Akdogan
- Department of Internal Medicine, Division of Rheumatology, Hacettepe University, Ankara, Turkey
| | - S A Bilgen
- Department of Internal Medicine, Division of Rheumatology, Hacettepe University, Ankara, Turkey
| | - S Kiraz
- Department of Internal Medicine, Division of Rheumatology, Hacettepe University, Ankara, Turkey
| | - A I Ertenli
- Department of Internal Medicine, Division of Rheumatology, Hacettepe University, Ankara, Turkey
| | - U Kalyoncu
- Department of Internal Medicine, Division of Rheumatology, Hacettepe University, Ankara, Turkey
| | - L Kılıç
- Department of Internal Medicine, Hacettepe University, Ankara, Turkey
- Department of Internal Medicine, Division of Rheumatology, Hacettepe University, Ankara, Turkey
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Arad U, Werren C, White D. Paraneoplastic sacroiliitis. BMJ Case Rep 2023; 16:e252572. [PMID: 37652573 PMCID: PMC10476127 DOI: 10.1136/bcr-2022-252572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023] Open
Abstract
A man in his early 70s presented with stiffness and aching in the shoulder and pelvic girdles. His C reactive protein level was elevated at 116 mg/L, leading to an initial diagnosis of polymyalgia rheumatica. Treatment with prednisone at 20 mg/day provided limited improvement and relapses recurred despite concomitant immunosuppressive agents. Extensive investigations failed to reveal an underlying aetiology.Five years later, gross painless haematuria led to the detection of an invasive papillary urothelial carcinoma. A review of the staging CT scan revealed findings compatible with bilateral erosive sacroiliitis, which had developed since his initial presentation. Radical cystoprostatectomy provided temporary relief but after a further 9 months, symptoms relapsed, and metastatic spread was discovered.Paraneoplastic sacroiliitis is a rare clinical entity; and to the best of our knowledge, this is the first reported case associated with a solid tumour.
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Affiliation(s)
- Uri Arad
- Rheumatology, Waikato Hospital, Hamilton, New Zealand
- Waikato Clinical School, University of Auckland, Hamilton, New Zealand
| | | | - Douglas White
- Rheumatology, Waikato Hospital, Hamilton, New Zealand
- Waikato Clinical School, University of Auckland, Hamilton, New Zealand
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23
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Avar-Aydin PO, Ozcakar ZB, Kaynak Sahap S, Aydin F, Cakar N, Arslanoglu C, Yalcinkaya F, Fitoz S. Childhood-Onset Sacroiliitis: Causes and Correlation Between Clinical Findings and Magnetic Resonance Imaging. J Clin Rheumatol 2023; 29:e71-e77. [PMID: 36881849 DOI: 10.1097/rhu.0000000000001955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
OBJECTIVE The aims of this study were to describe disease associations of magnetic resonance imaging (MRI)-confirmed and clinically symptomatic sacroiliitis in pediatric patients with rheumatic diseases and to examine the relationship between patient characteristics and MRI findings of the sacroiliac joint (SIJ). METHODS Demographic and clinical data were extracted from the electronic medical records of the patients with sacroiliitis followed in the last 5 years. Active inflammatory and structural damage lesions of the SIJ-MRI were examined by the modified Spondyloarthritis Research Consortium of Canada scoring system, and correlation analysis of these results with clinical characteristics was evaluated. RESULTS A total of 46 symptomatic patients were found to have MRI-proven sacroiliitis of 3 different etiologies: juvenile idiopathic arthritis (JIA) (n = 17), familial Mediterranean fever (FMF) (n = 14), and chronic nonbacterial osteomyelitis (CNO) (n = 8). Seven patients, FMF and JIA (n = 6) and FMF and CNO (n = 1), had a co-diagnosis that might cause sacroiliitis. Although inflammation scores and structural damage lesions did not statistically differ between the groups, capsulitis and enthesitis on the MRI were more frequently detected in the CNO group. There was a negative correlation between symptom onset and inflammation scores of bone marrow edema. Disease composite scores and acute phase reactants were correlated with MRI inflammation scores. CONCLUSIONS We demonstrated that JIA, FMF, and CNO were the major rheumatic causes of sacroiliitis in children originating from the Mediterranean region. Quantitative MRI scoring tools can be used to assess the inflammation and damage of the SIJ in rheumatic diseases, show discrepancies between them, and have an important correlation with various clinical and laboratory features.
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Affiliation(s)
| | | | - Seda Kaynak Sahap
- Pediatric Radiology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Fatma Aydin
- From the Departments of Pediatric Rheumatology
| | | | | | | | - Suat Fitoz
- Pediatric Radiology, Ankara University Faculty of Medicine, Ankara, Turkey
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Abstract
PURPOSE OF REVIEW Imaging is used in the diagnosis of peripheral and axial disease in juvenile spondyloarthritis (JSpA). Imaging of the joints and entheses in children and adolescents can be challenging for those unfamiliar with the appearance of the maturing skeleton. These differences are key for rheumatologists and radiologists to be aware of. RECENT FINDINGS In youth, skeletal variation during maturation makes the identification of arthritis, enthesitis, and sacroiliitis difficult. A great effort has been put forward to define imaging characteristics seen in healthy children in order to more accurately identify disease. Additionally, there are novel imaging modalities on the horizon that are promising to further differentiate normal physiologic changes versus disease. SUMMARY This review describes the current state of imaging, limitations, and future imaging modalities in youth, with key attention to differences in imaging interpretation of the peripheral joints, entheses, and sacroiliac joint in youth and adults.
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Affiliation(s)
- Hallie A Carol
- Division of Rheumatology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Pamela F Weiss
- Division of Rheumatology, Department of Pediatrics, Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia and Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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25
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Herregods N, Anisau A, Schiettecatte E, Vereecke E, Morbée L, Laloo F, Jaremko JL, Jans L. MRI in pediatric sacroiliitis, what radiologists should know. Pediatr Radiol 2023; 53:1576-1586. [PMID: 36856758 DOI: 10.1007/s00247-023-05602-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 12/21/2022] [Accepted: 01/11/2023] [Indexed: 03/02/2023]
Abstract
MRI is used for early detection of inflammation of sacroiliac joints as it shows active lesions of sacroiliitis long before radiographs show damage to the sacroiliac joints. Early diagnosis of arthritis allows early treatment of inflammation and can help delay disease progression and prevent irreversible damage. Also, early identification of axial involvement in juvenile spondyloarthropathy is crucial, as treatment options are different than for peripheral juvenile spondyloarthropathy. In general, standard sequences used in adults are also applied to children. However, interpreting MR images of pediatric sacroiliac joints is more challenging than in adults, because of normal physiological changes during skeletal maturation, which can simulate disease on MR images. Furthermore, classical definitions of sacroiliitis used in adults, for both active inflammatory and structural lesions, can be difficult to extrapolate to children. The development of reliable pediatric-specific definitions for sacroiliitis is still in active study. Understanding both normal and pathological signal changes in children is important to distinguish physiologic findings from disease and to make a correct diagnosis. In this review, the main imaging characteristics of sacroiliitis on MRI in children and its frequent pitfalls will be illustrated, while also citing some discussion points regarding the scan protocol.
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Affiliation(s)
- Nele Herregods
- Department of Radiology and Nuclear Medicine, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium.
| | - Aliaksandr Anisau
- Department of Radiology and Nuclear Medicine, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium
| | - Eva Schiettecatte
- Department of Radiology and Nuclear Medicine, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium
| | - Elke Vereecke
- Department of Radiology and Nuclear Medicine, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium
| | - Lieve Morbée
- Department of Radiology and Nuclear Medicine, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium
| | - Frederiek Laloo
- Department of Radiology and Nuclear Medicine, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium
| | - Jacob L Jaremko
- Department of Radiology & Diagnostic Imaging, University of Alberta, 8440-112 Street, EdmontonAlberta, T6G 2B7, Canada
- Medical Imaging Consultants, Edmonton, AB, Canada
| | - Lennart Jans
- Department of Radiology and Nuclear Medicine, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium
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Abstract
PURPOSE OF REVIEW Pelvic radiography in which structural lesions characteristic of sacroiliitis can be detected, is recommended as the first imaging modality when axial spondyloarthritis (axSpA) is suspected clinically. However, cross-sectional modalities like computed tomography (CT) and magnetic resonance imaging (MRI) are superior to radiographs for diagnosing sacroiliitis. Thus, we currently debate the role of radiography as first imaging modality in the diagnostic workup of axSpA. RECENT FINDINGS Diagnosing sacroiliitis on pelvic radiographs is challenging with large interobserver and intraobserver variation. Low-dose CT (ldCT) of the sacroiliac joints (SIJs) was proved to be more sensitive and reliable than radiographs with comparable ionizing radiation exposure. MRI is the preferred modality for detecting early SIJ inflammation, well before structural lesions evolve. New, promising MRI sequences sensitive to cortical bone improve erosion detection, making MRI a one-stop shop for the diagnosis of sacroiliitis. SUMMARY Given the debatable additive value of pelvic radiographs for the detection of sacroiliitis, and the presence of excellent alternatives for imaging the bony cortex of the SIJs such as ldCT and MRI with state-of-the-art sequences sensitive to cortical bone, it is high time to discuss the use of these more accurate modalities instead of radiographs.
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Affiliation(s)
- Iris Eshed
- Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Israel, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Torsten Diekhoff
- Department of Radiology (CCM), Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität Zu Berlin, Freie Universität Berlin, Charitéplatz 1, Berlin, Germany
| | - Kay Geert A Hermann
- Department of Radiology (CCM), Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität Zu Berlin, Freie Universität Berlin, Charitéplatz 1, Berlin, Germany
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Aung TT, Siva C. Osteitis Condensans Ilii: An Important Mimic of Sacroiliitis. J Clin Rheumatol 2023; 29:e14. [PMID: 36727754 DOI: 10.1097/rhu.0000000000001944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
| | - Chokkalingam Siva
- Division of Rheumatology, University of Missouri School of Medicine, Columbia, MO
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Üreten K, Maraş Y, Duran S, Gök K. Deep learning methods in the diagnosis of sacroiliitis from plain pelvic radiographs. Mod Rheumatol 2023; 33:202-206. [PMID: 34888699 DOI: 10.1093/mr/roab124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/14/2021] [Accepted: 12/06/2021] [Indexed: 01/05/2023]
Abstract
OBJECTIVES The aim of this study is to develop a computer-aided diagnosis method to assist physicians in evaluating sacroiliac radiographs. METHODS Convolutional neural networks, a deep learning method, were used in this retrospective study. Transfer learning was implemented with pre-trained VGG-16, ResNet-101 and Inception-v3 networks. Normal pelvic radiographs (n = 290) and pelvic radiographs with sacroiliitis (n = 295) were used for the training of networks. RESULTS The training results were evaluated with the criteria of accuracy, sensitivity, specificity and precision calculated from the confusion matrix and AUC (area under the ROC curve) calculated from ROC (receiver operating characteristic) curve. Pre-trained VGG-16 model revealed accuracy, sensitivity, specificity, precision and AUC figures of 89.9%, 90.9%, 88.9%, 88.9% and 0.96 with test images, respectively. These results were 84.3%, 91.9%, 78.8%, 75.6 and 0.92 with pre-trained ResNet-101, and 82.0%, 79.6%, 85.0%, 86.7% and 0.90 with pre-trained inception-v3, respectively. CONCLUSIONS Successful results were obtained with all three models in this study where transfer learning was applied with pre-trained VGG-16, ResNet-101 and Inception-v3 networks. This method can assist clinicians in the diagnosis of sacroiliitis, provide them with a second objective interpretation and also reduce the need for advanced imaging methods such as magnetic resonance imaging.
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Affiliation(s)
- Kemal Üreten
- Department of Rheumatology, Faculty of Medicine, Kırıkkale University, Ankara, Turkey
- Computer Engineering Department, MSc, Çankaya University, Ankara, Turkey
| | - Yüksel Maraş
- Department of Rheumatology, Ankara City Hospital, Ankara, Turkey
| | - Semra Duran
- Department of Radiology, Ankara City Hospital, Ankara, Turkey
| | - Kevser Gök
- Department of Rheumatology, Ankara City Hospital, Ankara, Turkey
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Nessib DB, Bouaziz MC, Maatallah K, Ladeb MF, Kchir MM, Riahi H, Hamdi W. Early Identification of Sacroiliitis in Patients with Suspected Spondyloarthritis: A Challenging Task. Curr Rheumatol Rev 2023; 19:488-495. [PMID: 37254543 DOI: 10.2174/1573397119666230529105122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 04/13/2023] [Accepted: 04/26/2023] [Indexed: 06/01/2023]
Abstract
OBJECTIVE The purpose of this study was to assess the performance of computed tomography (CT) scan and magnetic resonance imaging (MRI) for detecting sacroiliitis in nonradiographic SpA (nr-SpA). METHODS This cross-sectional monocentric double-blind study included 63 patients consulting for symptoms suggestive of SpA between February 2014 and February 2017. Patients with conventional radiographs showing a confirmed sacroiliitis (grade 3 or 4) were not included. Eligible patients underwent CT and MRI of sacroiliac joints (SIJ). CT and MR images were interpreted by 2 experienced musculoskeletal radiologists blinded to clinical and laboratory data. Two professors in rheumatology blinded to radiologists' conclusions analyzed clinical data, laboratory tests, HLA typing, X-rays, CT and MRI images, and divided the patients into 2 groups: confirmed nr-SpA or no SpA. This classification was considered the gold standard when analyzing the results. RESULTS 46 women and 17 men were included in this study. 47 patients were classified as confirmed nr-SpA (74.6%) and 16 patients as no SpA (25.4%). Sensitivity, specificity, and positive and negative predictive values of CT and MRI for detecting sacroiliitis were, respectively, estimated at 71.7%, 71.4%, 89.2%, 43.5%, and 51.2%, 100%, 100%, and 40%. CT and MRI findings were found to be statistically associated (p<0.001). CONCLUSION SIJ MRI is a highly specific method in the detection of sacroiliitis, but with a moderate sensitivity. SIJ CT scan, usually known as the third option after radiography and MRI, has much greater diagnostic utility than it has been documented previously.
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Affiliation(s)
- Dorra Ben Nessib
- Rheumatology Department, Kassab Orthopedics Institute, Mannouba, 2010, Tunisia
- Faculty of Medicine of Tunis, University Tunis el Manar, Tunis, Tunisia
- Research unit UR17SP04, 2010, Ksar Said 2010, Tunis, Tunisia; Institute, Mannouba 2010, Tunisia
| | - Mouna Chelli Bouaziz
- Faculty of Medicine of Tunis, University Tunis el Manar, Tunis, Tunisia
- Radiology Department, Kassab Orthopedics Institute, Mannouba, 2010, Tunisia
| | - Kaouther Maatallah
- Rheumatology Department, Kassab Orthopedics Institute, Mannouba, 2010, Tunisia
- Faculty of Medicine of Tunis, University Tunis el Manar, Tunis, Tunisia
- Research unit UR17SP04, 2010, Ksar Said 2010, Tunis, Tunisia; Institute, Mannouba 2010, Tunisia
| | - Mohamed Fethi Ladeb
- Faculty of Medicine of Tunis, University Tunis el Manar, Tunis, Tunisia
- Radiology Department, Kassab Orthopedics Institute, Mannouba, 2010, Tunisia
| | - Mohamed Montacer Kchir
- Rheumatology Department, Kassab Orthopedics Institute, Mannouba, 2010, Tunisia
- Faculty of Medicine of Tunis, University Tunis el Manar, Tunis, Tunisia
- Research unit UR17SP04, 2010, Ksar Said 2010, Tunis, Tunisia; Institute, Mannouba 2010, Tunisia
| | - Hend Riahi
- Faculty of Medicine of Tunis, University Tunis el Manar, Tunis, Tunisia
- Radiology Department, Kassab Orthopedics Institute, Mannouba, 2010, Tunisia
| | - Wafa Hamdi
- Rheumatology Department, Kassab Orthopedics Institute, Mannouba, 2010, Tunisia
- Faculty of Medicine of Tunis, University Tunis el Manar, Tunis, Tunisia
- Research unit UR17SP04, 2010, Ksar Said 2010, Tunis, Tunisia; Institute, Mannouba 2010, Tunisia
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Semenetz ZJ, Al-Jaberi L, Brescia AC, Saul D, Holton RS. An Atypical Case of Scurvy in an Adolescent With Sacroiliitis. Clin Pediatr (Phila) 2022; 61:826-829. [PMID: 35746876 DOI: 10.1177/00099228221106426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Zachary J Semenetz
- Nemours Children's Hospital, Wilmington, DE, USA
- Thomas Jefferson University, Philadelphia, PA, USA
| | | | | | - David Saul
- Nemours Children's Hospital, Wilmington, DE, USA
- Thomas Jefferson University, Philadelphia, PA, USA
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Zhang K, Zheng J, Pan J, Jiang Y, Zhan Y, Li W, Zhang H, Hong G. Axial spondyloarthritis: synthetic magnetic resonance imaging in the detection of sacroiliac joint lesions. Chin Med J (Engl) 2022; 135:2625-2627. [PMID: 35170502 PMCID: PMC9944704 DOI: 10.1097/cm9.0000000000001987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Indexed: 01/26/2023] Open
Affiliation(s)
- Ke Zhang
- Department of Radiology, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, Guangdong 519000, China
| | - Jing Zheng
- Department of Rheumatology and Immunology, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, Guangdong 519000, China
| | - Jielin Pan
- Department of Radiology, Zhuhai People's Hospital, Zhuhai Hospital Affiliated with Jinan University, Zhuhai, Guangdong 519000, China
| | - Yunping Jiang
- Department of Radiology, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, Guangdong 519000, China
| | - Yingying Zhan
- Department of Radiology, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, Guangdong 519000, China
| | - Wenjuan Li
- Department of Radiology, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, Guangdong 519000, China
| | - Hua Zhang
- Department of Rheumatology and Immunology, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, Guangdong 519000, China
| | - Guobin Hong
- Department of Radiology, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, Guangdong 519000, China
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Salah R, Bouya A, Bennis A, Zaddoug O, Benchakroun M, Zine A, Tanane M, Bouabid S. Gluteus maximus abscess revealing a tuberculous arthritis: A case report and review of the literature. Indian J Tuberc 2022; 69:710-714. [PMID: 36460414 DOI: 10.1016/j.ijtb.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 10/01/2021] [Indexed: 06/17/2023]
Abstract
Although tuberculosis is a widespread disease in Morocco, musculoskeletal form is relatively rare and even rarer when affects the sacroiliac joint. Tuberculous sacroiliitis remains a challenge for orthopedists owing to its insidious onset and non-specific clinical presentation. Herein, we report the case of a 23-year-old male with a growing mass in his left gluteal area, diagnosed with tuberculous sacroiliitis, based on bacteriological and histological findings. The aim of our work is to draw attention to the importance of continued awareness for early detection and adequate treatment of this very rare entity.
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Affiliation(s)
- Rhita Salah
- Orthopedic Surgery and Traumatology, Department of Orthopedic Surgery and Traumatology, Military Hospital Mohammed V, Morocco.
| | - Ayoub Bouya
- Orthopedic Surgery and Traumatology, Department of Orthopedic Surgery and Traumatology, Military Hospital Mohammed V, Morocco
| | - Azzelarab Bennis
- Orthopedic Surgery and Traumatology, Department of Orthopedic Surgery and Traumatology, Military Hospital Mohammed V, Morocco
| | - Omar Zaddoug
- Orthopedic Surgery and Traumatology, Department of Orthopedic Surgery and Traumatology, Military Hospital Mohammed V, Morocco
| | - Mohamed Benchakroun
- Orthopedic Surgery and Traumatology, Department of Orthopedic Surgery and Traumatology, Military Hospital Mohammed V, Morocco
| | - Ali Zine
- Orthopedic Surgery and Traumatology, Department of Orthopedic Surgery and Traumatology, Military Hospital Mohammed V, Morocco
| | - Mansour Tanane
- Orthopedic Surgery and Traumatology, Department of Orthopedic Surgery and Traumatology, Military Hospital Mohammed V, Morocco
| | - Salim Bouabid
- Orthopedic Surgery and Traumatology, Department of Orthopedic Surgery and Traumatology, Military Hospital Mohammed V, Morocco
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Maksymowych WP, Baraliakos X, Lambert RG, Landewé R, Sandoval D, Carlier H, Lisse J, Li X, Hojnik M, Østergaard M. Effects of ixekizumab treatment on structural changes in the sacroiliac joint: MRI assessments at 16 weeks in patients with non-radiographic axial spondyloarthritis. Lancet Rheumatol 2022; 4:e626-e634. [PMID: 38288892 DOI: 10.1016/s2665-9913(22)00185-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 06/10/2022] [Accepted: 06/13/2022] [Indexed: 02/01/2024]
Abstract
BACKGROUND There is limited understanding regarding the inhibition of structural damage in the sacroiliac joint of patients with non-radiographic axial spondyloarthritis. This study evaluated the effect of the interleukin-17A inhibitor ixekizumab versus placebo on structural lesions in the sacroiliac joints as assessed by MRI at week 16 in patients with non-radiographic axial spondyloarthritis from the COAST-X study. METHODS COAST-X was a 52-week, randomised, double-blind, placebo-controlled, parallel-group study done at 107 sites in 15 countries in Europe, Asia, North America, and South America. Eligible participants were adults (aged ≥18 years) with active axial spondyloarthritis without definite radiographic sacroiliitis (non-radiographic axial spondyloarthritis), objective signs of inflammation (via MRI or C-reactive protein), and an inadequate response or intolerance to non-steroidal anti-inflammatory drugs. Patients were randomly allocated to placebo or double-blind ixekizumab 80 mg every 4 weeks (Q4W) or 2 weeks (Q2W), with an 80 mg or 160 mg starting dose. We report a post-hoc analysis of 266 patients with available MRI scans from baseline and week 16. MRI scans were scored using the Spondyloarthritis Research Consortium of Canada (SPARCC) sacroiliac joint structural score (SSS) method independently by two masked readers. Treatment comparisons used analysis of covariance based on observed cases. Correlations were evaluated among changes in SPARCC SSS for erosion, fat lesions, and backfill, and between changes in SPARCC SSS and sacroiliac joint inflammation scores and clinical measures. COAST-X was registered with ClinicalTrials.gov, NCT02757352. FINDINGS Between Aug 2, 2016, and Jan 29, 2018, 303 patients were enrolled to the COAST-X study. 290 (96%) of 303 participants completed the week 16 visit (95 in the ixekizumab Q4W group, 98 in the ixekizumab Q2W group, and 97 in the placebo group), and MRI scans were available for 266 patients at baseline and week 16 (85 in the ixekizumab Q4W group, 91 in the ixekizumab Q2W group, and 90 in the placebo group). Changes from baseline to week 16 in mean SPARCC SSS for erosion were -0·39 for ixekizumab Q4W (p=0·003 vs placebo), -0·40 for ixekizumab Q2W (p=0·002), and 0·16 for placebo; for fat lesions: 0·16 for ixekizumab Q4W (p=0·013), 0·10 for ixekizumab Q2W (p=0·067), and -0·04 for placebo; and for backfill: 0·21 for ixekizumab Q4W (p=0·011), 0·22 for ixekizumab Q2W (p=0·006), and -0·10 for placebo. Ankylosis did not change. Effects of ixekizumab versus placebo on structural changes were most pronounced in patients with baseline inflammation in the sacroiliac joints. Changes from baseline at week 16 in erosion, fat lesions, and backfill were correlated. INTERPRETATION Although the clinical relevance is not yet clear, patients with non-radiographic axial spondyloarthritis receiving ixekizumab had significant reductions in erosions and increases in fat lesions and backfill in the sacroiliac joints versus placebo at week 16, suggesting an early repair process with ixekizumab treatment. FUNDING Eli Lilly and Company.
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Affiliation(s)
- Walter P Maksymowych
- Department of Medicine, Division of Rheumatology, University of Alberta, Edmonton, AB, Canada; CARE Arthritis, Edmonton, AB, Canada
| | | | - Robert G Lambert
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, AB, Canada; Medical Imaging Consultants, Edmonton, AB, Canada
| | - Robert Landewé
- Department of Clinical Immunology and Rheumatology, University of Amsterdam, Amsterdam, Netherlands
| | | | | | | | - Xiaoqi Li
- Eli Lilly and Company, Indianapolis, IN, USA
| | - Maja Hojnik
- Eli Lilly and Company, Indianapolis, IN, USA
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, and Center of Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
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Morbée L, Jans LBO, Herregods N. Novel imaging techniques for sacroiliac joint assessment. Curr Opin Rheumatol 2022; 34:187-194. [PMID: 35699310 DOI: 10.1097/bor.0000000000000871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW Imaging of the sacroiliac joints is one of the cornerstones in the diagnosis and monitoring of axial spondyloarthritis. We aim to present an overview of the emerging imaging techniques for sacroiliac joint assessment and provide an insight into their relevant benefits and pitfalls. RECENT FINDINGS Evaluation of structural and active inflammatory lesions in sacroiliitis are both important for understanding the disease process. Dual-energy computed tomography (CT) can detect inflammatory bone marrow edema in the sacroiliac joints and provides an alternative for magnetic resonance imaging (MRI). Three-dimensional gradient echo sequences improve the visualization of erosions on MRI. Susceptibility weighted MRI and deep learning-based synthetic CT are innovative MRI techniques that allow for generating 'CT-like' images and better depict osseous structural lesions than routine MRI sequences. SUMMARY New imaging innovations and developments result in significant improvements in the imaging of spondyloarthritis. Advanced MRI techniques enhance its potential for the accurate detection of structural and active inflammatory lesions of sacroiliitis in one single imaging session.
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Affiliation(s)
- Lieve Morbée
- Department of Radiology, Ghent University Hospital, Ghent, Belgium
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Zhang Y, Guo Z, Wang L, Zhan Y, Qu J, Lei X. Baseline Severity of Sacroiliitis and Extensive Fat Metaplasia Predicts the Progression of Backfill at the Sacroiliac Joint in Patients With Axial Spondyloarthritis. Front Immunol 2022; 13:887470. [PMID: 35833133 PMCID: PMC9271670 DOI: 10.3389/fimmu.2022.887470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 05/25/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectivesFat metaplasia in an erosion cavity, also known as backfill, is an essential intermediary in new bone formation in axial spondyloarthritis (axSpA) patients; however, the predictors of backfill progression are unknown. This longitudinal study aimed to assess the predictors of backfill progression in axSpA patients on magnetic resonance imaging (MRI).MethodsClinical and MRI data were collected at baseline and follow-up in 52 axSpA patients. Backfill progression was defined as the new or increased T1 hyperintensity within the SI joint space. Logistic regression analyses were performed to identify the predictors of the backfill progression.ResultsA total of 19 patients had “backfill” at baseline and 30 patients exhibited the backfill progression after follow-up. The mean disease duration and SPARCC scores at baseline were significantly different between patients with and without backfill progression (P<0.001, P=0.003, respectively). Patients with backfill progression had a higher frequency of backfill at baseline, a higher SSS score of fat metaplasia, and a higher SSS score of backfill than those without (P=0.001, P<0.001, and P=0.002, respectively). A higher fat fraction value in the fat metaplasia area at the baseline was more frequent in patients with, than without, backfill progression (P=0.019). In the univariate logistic regression analyses, a higher SPARCC score for inflammation and a higher SSS score for fat metaplasia at baseline were associated with backfill progression.ConclusionsSeverity of sacroiliitis and extensive fat metaplasia at baseline are predictors of the backfill progression in axSpA patients.
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Affiliation(s)
- Yimeng Zhang
- Department of Radiology, First Central Clinical College, Tianjin Medical University, Tianjin, China
- Department of Radiology, Tianjin First Central Hospital, Tianjin Institute of Imaging Medicine, Tianjin, China
| | - Zikang Guo
- Department of Radiology, First Central Clinical College, Tianjin Medical University, Tianjin, China
- Department of Radiology, Tianjin First Central Hospital, Tianjin Institute of Imaging Medicine, Tianjin, China
| | - Lisong Wang
- School of Basic Medical Sciences, Tianjin Medical University, Tianjin, China
| | - Ying Zhan
- Department of Radiology, Tianjin First Central Hospital, Tianjin Institute of Imaging Medicine, Tianjin, China
| | - Jin Qu
- Department of Radiology, Tianjin First Central Hospital, Tianjin Institute of Imaging Medicine, Tianjin, China
| | - Xinwei Lei
- Department of Radiology, Tianjin First Central Hospital, Tianjin Institute of Imaging Medicine, Tianjin, China
- *Correspondence: Xinwei Lei,
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Diekhoff T, Lambert R, Hermann KG. MRI in axial spondyloarthritis: understanding an 'ASAS-positive MRI' and the ASAS classification criteria. Skeletal Radiol 2022; 51:1721-1730. [PMID: 35199195 PMCID: PMC9283193 DOI: 10.1007/s00256-022-04018-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 02/15/2022] [Accepted: 02/15/2022] [Indexed: 02/02/2023]
Abstract
In 2009, the Assessment of SpondyloArthritis international Society (ASAS) published a definition of 'active sacroiliitis on magnetic resonance imaging (MRI) for classification of axial spondyloarthritis'. This new definition of an 'ASAS-positive MRI' was integral to new classification criteria for axial spondyloarthritis that were published in the same year. The ASAS MRI definition had the considerable advantage of simplicity and the definition gained popularity as guidance for interpreting MRI of the sacroiliac joints in clinical practice. However, classification criteria are not designed for use in clinical practice with the consequence that overreliance on the presence of bone marrow edema, which is the principal determinant of an 'ASAS-positive MRI', may result in a tendency to overcall inflammatory sacroiliitis in the clinical setting. This article aims to inform the reader about the rationale behind the ASAS definition of a positive MRI and ASAS classification criteria, their proper use in research and why they should not be used in clinical practice. The article also contains guidance for an updated imaging protocol and interpretation of images including typical imaging findings, differential diagnosis, and common pitfalls.
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Affiliation(s)
- Torsten Diekhoff
- Department of Radiology (CCM), Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität Zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Robert Lambert
- Department of Radiology & Diagnostic Imaging, University of Alberta, 2A2.41MC, 8440 - 112 Street, Edmonton, AB, T6G 2B7, Canada
- Medical Imaging Consultants, 202-11010 - 101 Street, Edmonton, AB, T5H 4B9, Canada
| | - Kay Geert Hermann
- Department of Radiology (CCM), Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität Zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117, Berlin, Germany
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Borlandelli E, Ciaffi J, Festuccia G, Facchini G, Miceli M, Brusi V, Mancarella L, Lisi L, Di Martino A, Faldini C, Meliconi R, Ursini F. Osteitis condensans ilii: prevalence and characteristics of a neglected mimic of sacroiliitis. Clin Rheumatol 2021; 41:483-490. [PMID: 34568992 DOI: 10.1007/s10067-021-05925-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 09/04/2021] [Accepted: 09/16/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Osteitis condensans ilii (OCI) is a benign condition characterised by triangular sclerosis of the iliac bone which may mimic radiographic sacroiliitis. Prevalence is estimated between 0.9 and 2.5%, with female predominance, but the most recent article reporting original epidemiological data in the general population was published in 1971. The aim of our study is to contribute updated figures about prevalence of OCI in Italy. METHOD A retrospective review of pelvic radiographs was conducted. Consecutive patients visiting the emergency department of our Institution between 1st January and 31st December 2020 were enrolled. Individuals with a past diagnosis of axial spondyloarthritis were excluded. Presence of OCI was evaluated by two musculoskeletal radiologists. Clinical and radiologic features such as osteoarthritis and insertional enthesopathy were also assessed. RESULTS We included 1047 individuals (61% female) with a median age of 74 years. OCI was present in 10 cases, accounting for a prevalence in the general population of 1.0% (95% CI 0.5-1.7). All patients with OCI were women and, in the female sample, prevalence was 1.6% (95% CI 0.7-2.8). Clinical characteristics and associated radiographic features were not different between patients with OCI and women without OCI. CONCLUSIONS The prevalence of OCI observed in our study is consistent with previous literature, and we confirm that it is more frequently retrieved in women. Longitudinal research is warranted to elucidate the evolution, while knowledge about the disorder is needed to raise the awareness of rheumatologists and radiologists and to properly identify and report the condition. Key Points • OCI may mimic sacroiliitis and is a major differential diagnosis of radiographic axial spondyloarthritis. • Prevalence of OCI in our sample is 1.0%, in line with previous literature. • OCI predominantly affects women, and our study suggests that the disorder can be incidentally identified even after childbearing age. • Increased awareness of the characteristics of OCI can facilitate identification and reporting of the disorder.
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Affiliation(s)
- Elena Borlandelli
- Diagnostic and Interventional Radiology Unit, IRCCS Istituto Ortopedico Rizzoli (IOR), 40136, Bologna, Italy
| | - Jacopo Ciaffi
- Medicine & Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli (IOR), Ortopedico Rizzoli, via G.C. Pupilli 1, 40136, Bologna, Italy.
| | - Gianluca Festuccia
- Medicine & Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli (IOR), Ortopedico Rizzoli, via G.C. Pupilli 1, 40136, Bologna, Italy
| | - Giancarlo Facchini
- Diagnostic and Interventional Radiology Unit, IRCCS Istituto Ortopedico Rizzoli (IOR), 40136, Bologna, Italy
| | - Marco Miceli
- Diagnostic and Interventional Radiology Unit, IRCCS Istituto Ortopedico Rizzoli (IOR), 40136, Bologna, Italy
| | - Veronica Brusi
- Medicine & Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli (IOR), Ortopedico Rizzoli, via G.C. Pupilli 1, 40136, Bologna, Italy
| | - Luana Mancarella
- Medicine & Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli (IOR), Ortopedico Rizzoli, via G.C. Pupilli 1, 40136, Bologna, Italy
| | - Lucia Lisi
- Medicine & Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli (IOR), Ortopedico Rizzoli, via G.C. Pupilli 1, 40136, Bologna, Italy
| | - Alberto Di Martino
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli (IOR), 40136, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, 40125, Bologna, Italy
| | - Cesare Faldini
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli (IOR), 40136, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, 40125, Bologna, Italy
| | - Riccardo Meliconi
- Medicine & Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli (IOR), Ortopedico Rizzoli, via G.C. Pupilli 1, 40136, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, 40125, Bologna, Italy
| | - Francesco Ursini
- Medicine & Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli (IOR), Ortopedico Rizzoli, via G.C. Pupilli 1, 40136, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, 40125, Bologna, Italy
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Chandwar K, Lathiya H, Gohel A, Shah C. Sacral osteoid osteoma: a rare cause of inflammatory back pain and sacroiliitis in a young man. BMJ Case Rep 2021; 14:e244074. [PMID: 34380684 PMCID: PMC8359513 DOI: 10.1136/bcr-2021-244074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2021] [Indexed: 11/03/2022] Open
Affiliation(s)
- Kunal Chandwar
- Department of Clinical Immunology and Rheumatology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Harsh Lathiya
- Department of Radiology, Zydus Research Center, Ahmedabad, Gujarat, India
| | - Abhishek Gohel
- Department of Neurology, NIMHANS, Bangalore, Karnataka, India
| | - Chandani Shah
- Department of Neurology, Sawai Man Singh Medical College and Hospital, Jaipur, Rajasthan, India
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Ha YJ, Kim HJ, Lee E, Park JH, Park YS, Lee YJ, Kang Y, Yoon H. Subclinical sacroiliitis detected by abdominopelvic computed tomography in Korean patients with Crohn's disease. Korean J Intern Med 2021; 36:868-877. [PMID: 32872747 PMCID: PMC8273833 DOI: 10.3904/kjim.2020.199] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 07/03/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND/AIMS Sacroiliitis is a frequent extraintestinal manifestation of inflammatory bowel diseases (IBDs). This study aimed to assess the prevalence of sacroiliitis using a validated screening tool based on abdominopelvic computed tomography (APCT) in Korean patients with Crohn's disease (CD) and examine potential associations between clinical characteristics and sacroiliitis. METHODS One hundred five patients with CD undergoing APCT for any indication at an IBD clinic were matched 1:1 for age and sex with 105 controls without underlying chronic illnesses. Using a validated APCT screening tool that defines sacroiliitis as either ankylosis or a total erosion score (TES) ≥ 3, all computed tomography scans were assessed by two independent, blinded radiologists. We compared the prevalence of sacroiliitis between CD patients and controls and clinical characteristics between CD patients with and without sacroiliitis. RESULTS The prevalence of sacroiliitis was significantly higher in CD patients than in controls (13.3% vs. 4.8%, p = 0.030). All subjects with sacroiliitis had a TES ≥ 3, but no ankylosis. The assessment of sacroiliitis in APCT showed excellent interreader reliability (Cohen's kappa = 0.933 for presence of sacroiliitis). Sacroiliitis in CD patients was bilateral and asymptomatic. There were no significant associations between sacroiliitis and any demographic data or clinical characteristics in these patients. CONCLUSION The prevalence of APCT-detected sacroiliitis in CD patients was higher than that in controls, but the condition was asymptomatic. The clinical significance of asymptomatic sacroiliitis in Korean CD patients remains unclear.
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Affiliation(s)
- You-Jung Ha
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam,
Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul,
Korea
| | - Hyo Jin Kim
- Department of Radiology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul,
Korea
| | - Eugene Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam,
Korea
| | - Ji Hye Park
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam,
Korea
| | - Young Soo Park
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam,
Korea
| | - Yun Jong Lee
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam,
Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul,
Korea
| | - Yusuhn Kang
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam,
Korea
| | - Hyuk Yoon
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam,
Korea
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40
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Knitza J. [Deep learning for detection of radiographic sacroiliitis]. Z Rheumatol 2021; 80:661-662. [PMID: 34160663 DOI: 10.1007/s00393-021-01029-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Johannes Knitza
- Medizinische Klinik 3 - Rheumatologie und Immunologie, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Ulmenweg 18, 91054, Erlangen, Deutschland.
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Shim E, Ha T, Kim BH, Hong SJ, Kang CH, Jeon S, Cha J. Additive values of pelvic tomosynthesis in comparison to pelvic radiography alone for the diagnosis of sacroiliitis in patients with suspected axial spondyloarthritis. Skeletal Radiol 2021; 50:1197-1207. [PMID: 33188609 DOI: 10.1007/s00256-020-03626-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 09/21/2020] [Accepted: 09/21/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To compare inter-reader agreement and diagnostic confidence in detecting sacroiliitis by the modified New York criteria (mNY) on digital radiography (DR) versus digital pelvic tomosynthesis assisted DR (DR+DPT), and to evaluate changes in the presence of axial spondyloarthritis (axSpA) according to the Assessment of Spondyloarthritis International Society (ASAS) criteria. METHODS One hundred and thirty-eight patients who underwent both DR and DPT with suspicious axSpA in our rheumatologic clinic were included from February 2017 to February 2018. Three radiologists independently graded sacroiliitis and confidence level on DR first and then re-graded them on DPT in a paired manner. Agreement, confidence, and diagnostic accuracy were evaluated for readers. Changes in the presence of disease by mNY and ASAS criteria were assessed between DR alone and DR+DPT. RESULTS On DR alone, 73 patients were assessed with radiographic sacroiliitis, and 85 were classified into axSpA by the ASAS criteria; however, 78 and 85, respectively, were classified on DR+DPT. With the assistance of DPT, 17 and 12 patients changed to the disease positivity according to the mNY and ASAS criteria, respectively; the negative results changed to positive in 11 and six patients, respectively. For all readers, agreement improved with DPT (0.79 to 0.89). DR+DPT achieved higher diagnostic accuracy (AUC, P < 0.05). CONCLUSION The combination of DR and DPT achieved a higher diagnostic performance than that of DR alone, with better agreement. On DR+DPT, the diagnoses of 9.0% of patients with suspicious axSpA (12 of 134) were changed to the status of disease by the ASAS criteria.
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Affiliation(s)
- Euddeum Shim
- Department of Radiology, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi-do, 15355, Republic of Korea
| | - Taeho Ha
- Department of Radiology, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi-do, 15355, Republic of Korea
| | - Baek Hyun Kim
- Department of Radiology, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi-do, 15355, Republic of Korea.
| | - Suk-Joo Hong
- Department of Radiology, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Chang Ho Kang
- Department of Radiology, Korea University Anam Hospital, 126-1 Anam-dong 5-ga, Seongbuk-gu, Seoul, 02856, Republic of Korea
| | - Sookyung Jeon
- Mammogrpahy and Radiography Application Specialist, GE Healthcare Korea, 15F, Seoul Square, 416 Hangang-daero, Jung-gu, Seoul, 04637, Republic of Korea
| | - Jaehyung Cha
- Medical Science Research Center, Korea Unversity Ansan Hospital, 123, Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi-do, 15355, Republic of Korea
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Levine I, Malik F, Castillo G, Jaros B, Alaia E, Ream J, Scher JU, Hudesman D, Axelrad J. Prevalence, Predictors, and Disease Activity of Sacroiliitis Among Patients with Crohn's Disease. Inflamm Bowel Dis 2021; 27:809-815. [PMID: 32793977 DOI: 10.1093/ibd/izaa198] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Sacroiliitis is an inflammatory arthritis of the sacroiliac joints and is associated with inflammatory bowel disease (IBD). Yet, sacroiliitis often goes undiagnosed in IBD, and the clinical association between IBD disease activity and sacroiliitis is not well established. Patients with Crohn's disease (CD) often receive magnetic resonance enterography (MRE) to assess disease activity, affording clinicians the opportunity to evaluate for the presence of sacroiliitis. We aimed to identify the prevalence and disease characteristics associated with sacroiliitis in CD patients undergoing MRE. METHODS All CD patients undergoing MRE for any indication between 2014 and 2018 at an IBD referral center were identified. The MREs were reviewed for the presence of sacroiliitis based on bone marrow edema (BME) and structural lesions. We analyzed demographics, IBD characteristics, clinical and endoscopic disease activity, and management between CD patients with and without sacroiliitis. RESULTS Two hundred fifty-eight patients with CD underwent MRE during the study period. Overall, 17% of patients had MR evidence of sacroiliitis, of whom 73% demonstrated bone marrow edema. Female gender, back pain, and later age of CD diagnosis were associated with sacroiliitis (P = 0.05, P < 0.001, P = 0.04, respectively). Disease location and CD therapy were not associated with sacroiliitis on MRE. Clinical, endoscopic, and radiographic disease activity were not associated with sacroiliitis on MRE. CONCLUSION Sacroiliitis is a common comorbid condition in CD. With limited clinical clues and disease characteristics to suggest sacroiliitis, physicians may utilize MRE to identify sacroiliitis, especially in CD patients with back pain.
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Affiliation(s)
- Irving Levine
- NYU School of Medicine, Department of Medicine, New York, NY, USA
| | - Fardina Malik
- NYU Langone Health, Department of Medicine, Division of Rheumatology, New York, NY, USA
| | - Gabriel Castillo
- NYU School of Medicine, Department of Medicine, New York, NY, USA
| | - Brian Jaros
- NYU School of Medicine, Department of Medicine, New York, NY, USA
| | - Erin Alaia
- NYU Langone Health, Department of Radiology, New York, NY, USA
| | - Justin Ream
- NYU Langone Health, Department of Radiology, New York, NY, USA
| | - Jose U Scher
- NYU Langone Health, Department of Medicine, Division of Rheumatology, New York, NY, USA
| | - David Hudesman
- NYU Langone Health, Department of Medicine, Division of Gastroenterology, New York, NY, USA
| | - Jordan Axelrad
- NYU Langone Health, Department of Medicine, Division of Gastroenterology, New York, NY, USA
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Bressem KK, Vahldiek JL, Adams L, Niehues SM, Haibel H, Rodriguez VR, Torgutalp M, Protopopov M, Proft F, Rademacher J, Sieper J, Rudwaleit M, Hamm B, Makowski MR, Hermann KG, Poddubnyy D. Deep learning for detection of radiographic sacroiliitis: achieving expert-level performance. Arthritis Res Ther 2021; 23:106. [PMID: 33832519 PMCID: PMC8028815 DOI: 10.1186/s13075-021-02484-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 03/22/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Radiographs of the sacroiliac joints are commonly used for the diagnosis and classification of axial spondyloarthritis. The aim of this study was to develop and validate an artificial neural network for the detection of definite radiographic sacroiliitis as a manifestation of axial spondyloarthritis (axSpA). METHODS Conventional radiographs of the sacroiliac joints obtained in two independent studies of patients with axSpA were used. The first cohort comprised 1553 radiographs and was split into training (n = 1324) and validation (n = 229) sets. The second cohort comprised 458 radiographs and was used as an independent test dataset. All radiographs were assessed in a central reading session, and the final decision on the presence or absence of definite radiographic sacroiliitis was used as a reference. The performance of the neural network was evaluated by calculating areas under the receiver operating characteristic curves (AUCs) as well as sensitivity and specificity. Cohen's kappa and the absolute agreement were used to assess the agreement between the neural network and the human readers. RESULTS The neural network achieved an excellent performance in the detection of definite radiographic sacroiliitis with an AUC of 0.97 and 0.94 for the validation and test datasets, respectively. Sensitivity and specificity for the cut-off weighting both measurements equally were 88% and 95% for the validation and 92% and 81% for the test set. The Cohen's kappa between the neural network and the reference judgements were 0.79 and 0.72 for the validation and test sets with an absolute agreement of 90% and 88%, respectively. CONCLUSION Deep artificial neural networks enable the accurate detection of definite radiographic sacroiliitis relevant for the diagnosis and classification of axSpA.
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Affiliation(s)
- Keno K Bressem
- Department of Radiology, Charité - Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
- Berlin Institute of Health, BIH, Berlin, Germany
| | - Janis L Vahldiek
- Department of Radiology, Charité - Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Germany.
| | - Lisa Adams
- Department of Radiology, Charité - Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
- Berlin Institute of Health, BIH, Berlin, Germany
| | - Stefan Markus Niehues
- Department of Radiology, Charité - Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Hildrun Haibel
- Department of Gastroenterology, Infectious Diseases and Rheumatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Valeria Rios Rodriguez
- Department of Gastroenterology, Infectious Diseases and Rheumatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Murat Torgutalp
- Department of Gastroenterology, Infectious Diseases and Rheumatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Mikhail Protopopov
- Department of Gastroenterology, Infectious Diseases and Rheumatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Fabian Proft
- Department of Gastroenterology, Infectious Diseases and Rheumatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Judith Rademacher
- Berlin Institute of Health, BIH, Berlin, Germany
- Department of Gastroenterology, Infectious Diseases and Rheumatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Joachim Sieper
- Department of Gastroenterology, Infectious Diseases and Rheumatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Martin Rudwaleit
- Department of Internal Medicine and Rheumatology, Klinikum Bielefeld Rosenhöhe, Bielefeld, Germany
| | - Bernd Hamm
- Department of Radiology, Charité - Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Marcus R Makowski
- Department of Radiology, Charité - Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
- Department of Diagnostic and Interventional Radiology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Kay-Geert Hermann
- Department of Radiology, Charité - Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Denis Poddubnyy
- Department of Gastroenterology, Infectious Diseases and Rheumatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Department of Epidemiology, German Rheumatism Research Centre, Berlin, Germany
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Affiliation(s)
| | - Vincenzo Venerito
- Rheumatology Unit, Department of Emergency and Organ Transplantations, University of Bari, Bari, Italy
| | - Marco Fornaro
- Rheumatology Unit, Department of Emergency and Organ Transplantations, University of Bari, Bari, Italy
| | - Fabio Cacciapaglia
- Rheumatology Unit, Department of Emergency and Organ Transplantations, University of Bari, Bari, Italy
| | - Giuseppe Lopalco
- Rheumatology Unit, Department of Emergency and Organ Transplantations, University of Bari, Bari, Italy
| | - Florenzo Iannone
- Rheumatology Unit, Department of Emergency and Organ Transplantations, University of Bari, Bari, Italy
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Feld J, Ye JY, Chandran V, Inman RD, Haroon N, Cook R, Gladman DD. Axial Disease in Psoriatic arthritis: The presence and progression of unilateral grade 2 sacroiliitis in a psoriatic arthritis cohort. Semin Arthritis Rheum 2021; 51:464-468. [PMID: 33774593 DOI: 10.1016/j.semarthrit.2021.03.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 03/06/2021] [Accepted: 03/15/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND/PURPOSE A universally accepted definition of axial psoriatic arthritis (axPsA) is lacking. We aimed to 1) assess the presence of axial involvement as defined by "at least unilateral grade 2 sacroiliitis (Uni2SI)" and 2) assess the radiographic progression of Uni2SI and identify risk factors for progression. METHODS PsA patients participating in a prospective observational cohort were classified according to their highest sacroiliitis grade. The baseline features of patients with Uni2SI were compared to patients meeting the radiographic criteria of the modified New York Ankylosing Spondylitis (mNY AS) criteria. Risk factors were examined for progression from Uni2SI in a sub-group of patients with >1 follow-up radiographs. Logistic regression and a survival analysis were carried out and identified risk factors associated with radiographic mNY AS compared to Uni2SI. RESULTS Axial disease defined as ≥Uni2SI was detected in 612/1354 patients (45%). mNY AS sacroiliitis was observed in 477 patients (35%). Radiographic progression of Uni2SI was assessed in 154 patients, 80 (52%) progressed to mNY AS criteria within 5.5 years. At baseline, progressors were diagnosed at a younger age (35.6 vs. 38.9, p = 0.05), had less degenerative disc disease (OR = 0.47, p = 0.02), worse peripheral radiographic damage (OR=1.02, p = 0.03) and worse psoriasis (OR = 1.09, p = 0.01) compared to non-progressors. Patients with an elevated erythrocyte sedimentation rate were more likely to progress (HR = 1.83, p = 0.02), while patients with longer disease duration were less likely to progress (HR = 0.95, p = 0.02). CONCLUSION The radiographic mNY AS criteria appear to be suitable for defining axial PsA according to radiographs. MRI definitions are needed as well for the most appropriate definition of axial PsA.
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Affiliation(s)
- Joy Feld
- Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, ON, Canada; Carmel and Lin Medical Centers, Haifa, Israel
| | - Justine Y Ye
- Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Vinod Chandran
- Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, ON, Canada; Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Robert D Inman
- Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, ON, Canada; Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Department of Immunology, Medical Sciences Building, University of Toronto, Toronto, Ontario, Canada
| | - Nigil Haroon
- Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, ON, Canada; Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Richard Cook
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Ontario, Canada
| | - Dafna D Gladman
- Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, ON, Canada; Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.
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Huang ZX, Deng WM, Zheng SL, Guo X, Zeng SQ, Li TW. Magnetic resonance imaging in ankylosing spondylitis: reduction of active sacroiliitis and hip arthritis during treatment with an adalimumab biosimilar. Clin Rheumatol 2021; 40:2099-2101. [PMID: 33559010 DOI: 10.1007/s10067-021-05628-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 01/11/2021] [Accepted: 01/31/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Zhi-Xiang Huang
- Department of Rheumatology and Immunology, Guangdong Second Provincial General Hospital, No 466 Xingangzhong Road, Guangzhou, 510317, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Wei-Ming Deng
- Department of Rheumatology and Immunology, Guangdong Second Provincial General Hospital, No 466 Xingangzhong Road, Guangzhou, 510317, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Shao-Ling Zheng
- Department of Rheumatology and Immunology, Guangdong Second Provincial General Hospital, No 466 Xingangzhong Road, Guangzhou, 510317, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Xin Guo
- Department of Rheumatology and Immunology, Guangdong Second Provincial General Hospital, No 466 Xingangzhong Road, Guangzhou, 510317, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Shao-Qing Zeng
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Tian-Wang Li
- Department of Rheumatology and Immunology, Guangdong Second Provincial General Hospital, No 466 Xingangzhong Road, Guangzhou, 510317, China.
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.
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Germann C, Kroismayr D, Brunner F, Pfirrmann CWA, Sutter R, Zubler V. Influence of pregnancy/childbirth on long-term bone marrow edema and subchondral sclerosis of sacroiliac joints. Skeletal Radiol 2021; 50:1617-1628. [PMID: 33474587 PMCID: PMC8208931 DOI: 10.1007/s00256-020-03700-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 12/14/2020] [Accepted: 12/14/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate long-term effects of pregnancy/childbirth on bone marrow edema (BME) and subchondral sclerosis of sacroiliac joints (SIJ) in comparison to MRI changes caused by spondyloarthritis (SpA) and assess the influence of birth method and number of children on SIJ-MRI changes. MATERIALS AND METHODS This is a retrospective cohort study with 349 women (mean age 47 ± 14 years) suffering low back pain. Four subgroups were formed based on SpA diagnosis and childbirth (CB) history. Two musculoskeletal radiologists scored the presence of BME and sclerosis on SIJ-MRI using the Berlin method. Further, an 11-point "global assessment score" representing the overall confidence of SpA diagnosis based on MRI was evaluated in addition to the ASAS (Assessment of Spondyloarthritis International Society) criterion of "positive MRI" for sacroiliitis. RESULTS CB did not correlate with BME score (p = 0.38), whereas SpA diagnosis was associated with a higher BME score (r = 0.31, p < 0.001). Both CB (r = 0.21, p < 0.001) and SpA diagnosis (r = 0.33, p < 0.001) were correlated with a higher sclerosis score. CB was not associated with a higher confidence level in diagnosing SpA based on MRI (p = 0.07), whereas SpA diagnosis was associated with a higher score (r = 0.61, p < 0.001). Both CB (phi = 0.13, p = 0.02) and SpA diagnosis (phi = 0.23, p < 0.001) were significantly associated with a positive ASAS criterion for sacroiliitis. In non-SpA patients with CB, number of children (p = 0.001) was an independent predictor of sclerosis score, while birth method yielded no significant effect (p = 0.75). CONCLUSION Pregnancy/CB has no impact on long-term BME on SIJ, however, may cause long-term subchondral sclerosis-similar to SpA-associated sclerosis. Number of children is positively correlated with SIJ sclerosis. Birth method yields no effect on SIJ sclerosis.
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Affiliation(s)
- Christoph Germann
- Radiology, Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH-8008, Zurich, Switzerland.
| | - Daniela Kroismayr
- Radiology, Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH-8008, Zurich, Switzerland
| | - Florian Brunner
- Physical Medicine and Rheumatology, Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH-8008, Zurich, Switzerland
| | - Christian W A Pfirrmann
- Radiology, Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH-8008, Zurich, Switzerland
| | - Reto Sutter
- Radiology, Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH-8008, Zurich, Switzerland
| | - Veronika Zubler
- Radiology, Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH-8008, Zurich, Switzerland
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Younan-Farah T, Zibawi M, Abs L, Fayad F. Atypical Unilateral Sacroiliitis Secondary to Mechanical Stress Injury. J Radiol Case Rep 2020; 14:10-17. [PMID: 33088421 DOI: 10.3941/jrcr.v14i9.3582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We report for the first time a case of atypical unilateral sacroiliitis secondary to mechanical stress injury. Unilateral sacroiliitis can be caused by a variety of etiologies. The first diagnosis to rule out is infection since it requires urgent treatment to avoid its serious consequences. Spondyloarthritis can be manifested by unilateral sacroiliitis in its early stage. Sacral fractures should always be looked for on the imaging modalities performed. In our case, no signs of infection or systemic disease were found. No fracture was seen on the imaging examinations and we had negative cultures on the computed tomography-guided biopsy realized. A history of mechanical stress was the only clue found suggesting the diagnosis of a probable stress related sacroiliitis. A thorough review of the literature will be provided stating the different causes of sacroiliitis described till now, with discussion of this new reported entity.
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Affiliation(s)
- Tonine Younan-Farah
- Department of Radiology, Hotel-Dieu de France Hospital and Faculty of Medicine-Saint Joseph University, Beirut, Lebanon
| | - Mohamed Zibawi
- Department of Radiology, Hotel-Dieu de France Hospital and Faculty of Medicine-Saint Joseph University, Beirut, Lebanon
| | - Leila Abs
- Department of Radiology, Hotel-Dieu de France Hospital and Faculty of Medicine-Saint Joseph University, Beirut, Lebanon
| | - Fouad Fayad
- Department of Rheumatology, Hotel-Dieu de France Hospital and Faculty of Medicine-Saint Joseph University, Beirut, Lebanon
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Abstract
The osteoporosis was common complication of ankylosing spondylitis (AS), but it was frequently unrecognized in the initial stage of the disease. This study was to compare areal bone mineral density (BMD) of hip joints in early AS patients with that in healthy controls, to explore the progress of bone loss in cortex and spongiosa in early AS.Quantitative computed tomography (QCT) of hip was performed in 60 AS patients (modified New York criteria for AS, with grade 2 sacroiliitis in computed tomography) and 57 healthy controls. The QCT measurements of AS patients were compared with the measurements of healthy controls.The AS patients had lower areal BMD in cortical bone and total bone of proximal femur in early AS patients (P < .01), than the controls. But there were not significant different of areal BMD in spongiosa of proximal femur between the early AS patients and healthy controls. Strong correlations were found between body mass index BMI, areal BMD in cortical bone (rs = 0.410, P < .001; rs = 0.422, P < .001) and total bone (rs = 0.368, P < .001; rs = 0.266, P = .003) both in AS patients and healthy controls.The results indicate that osteopenia/osteoporosis is general in early stage of AS. What is more, the osteopenia/osteoporosis in cortex is earlier than in spongiosa of proximal femur in early AS.
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Affiliation(s)
- Peng Li Cai
- Department of Radiology, The third Hospital of Hebei Medical University, Hebei Province Biomechanical Key Laborary of Orthopedics
| | - Yun Yu Yan
- Department of Radiology, The third Hospital of Hebei Medical University, Hebei Province Biomechanical Key Laborary of Orthopedics
| | - Wei Wei
- Department of Radiology, The third Hospital of Hebei Medical University, Hebei Province Biomechanical Key Laborary of Orthopedics
| | - Xiao Shuai Chen
- Department of Radiology, The third Hospital of Hebei Medical University, Hebei Province Biomechanical Key Laborary of Orthopedics
| | - Jian Zhao
- Department of Radiology, The third Hospital of Hebei Medical University, Hebei Province Biomechanical Key Laborary of Orthopedics
| | - Ze Kun Zhang
- Department of Radiology, Chinese medicine hospital of Hebei Provience, Shijiazhuang, Hebei, China
| | - Ping Zhang
- Department of Radiology, The third Hospital of Hebei Medical University, Hebei Province Biomechanical Key Laborary of Orthopedics
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Kwon JW, Shin JK, Moon SH, Lee HM, Lee BH. Arthrodesis Using Bilateral Dual Iliac Screws with Autologous Iliac Bone Transfer for the Treatment of Pyogenic Sacroiliitis. Yonsei Med J 2020; 61:198-200. [PMID: 31997630 PMCID: PMC6992461 DOI: 10.3349/ymj.2020.61.2.198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 12/29/2019] [Accepted: 12/31/2019] [Indexed: 11/27/2022] Open
Abstract
Pyogenic sacroiliitis is a relatively rare condition that often leads to surgical treatment, including debridement and arthrodesis. Here we introduce a new surgical technique using bilateral dual iliac screws to secure early ambulation and maximal fusion success rate for the treatment of pyogenic sacroiliitis. We retrospectively reported a case and technical reports of pyogenic sacroiliitis treated by a new bilateral dual iliac screw fixation arthrodesis technique using radiologic outcomes, including plain X-rays and MRI scans, as well as outcomes based on the visual analogue scale for pain measurement. This technique improved uncontrolled pyogenic sacroiliitis with immediate stability that enabled ambulation and secured firm fixation for extensive evacuation of infected debris and subsequent autograft bone arthrodesis. In conclusion, we recommend bilateral dual iliac screw fixation for the treatment of pyogenic sacroiliitis, as this technique can improve uncontrolled pyogenic sacroiliitis with immediate stability.
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Affiliation(s)
- Ji Won Kwon
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea
- Department of Orthopaedic Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Jong Kwan Shin
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Seong Hwan Moon
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Hwan Mo Lee
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Byung Ho Lee
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea.
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