Anatomic structures involved in early- and late-stage sacroiliitis in spondylarthritis: A detailed analysis by contrast-enhanced magnetic resonance imaging (original) (raw)
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Polish Journal of Radiology, 2015
Background: The objective of this study was a comparative evaluation of radiography and MRI in the diagnostics of sacroiliitis in patients with a clinical diagnosis of spondyloartropathy, according to the current ASAS criteria. Material/Methods: Sacroiliac joints radiograms and MRI were conducted in 101 consecutive patients, aged 19-71 yrs (mean age: 40.6 yrs). The patients were referred by a senior rheumatologist, with symptoms of the chronic back pain. The sacroiliac joints were assessed on AP radiograms of the pelvis according to the modified New York criteria for ankylosing spondylitis. MRI was performed to look for active and chronic inflammatory lesions. Results: Of 14 patients with radiographic sacroiliitis according to modified New York criteria, only 50% had sacroiliitis on MRI. The sensitivity and specificity of conventional radiography were 22% and 94% and of MRI were 71% and 90%. Cohen's kappa coefficient was k=0.0187, agreement of radiograms and MRI was 58%. Among 86 patients displaying no sacroiliitis on radiograms, MRI showed sacroiliitis in 34 patients (39.5%). Positive predictive value was 0.429, negative predictive value was 0.605. Conclusions: MRI allowed to diagnose sacroiliitis in 39,5 % of patients in preradiographic stage. MRI ruled out the presence of active inflammatory lesions in 60.4% of patients with sacroiliitis on radiograms according to modified New York criteria.
Diagnostic imaging of sacroiliac joints and the spine in the course of spondyloarthropathies
Polish Journal of Radiology, 2013
Spondyloarthropathies belong to a group of rheumatic diseases, in which inflammatory changes affect mainly the sacroiliac joints, spine, peripheral joints, tendon, ligaments and capsule attachments (entheses). This group includes 6 entities: ankylosing spondylitis, arthritis associated with inflammatory bowel disease, reactive arthritis, undifferentiated spondyloarthropathy, psoriatic arthritis and juvenile spondyloarthropathy. In 2009, ASAS (Assessment in SpondyloArthritis international Society) association, published classification criteria for spondyloarthropathies, which propose standardization of clinicaldiagnostic approach in the case of sacroiliitis, spondylitis and arthritis. Radiological diagnosis of inflammatory changes of sacroiliac joints is based on a 4 step radiographic grading method from 1966. According to modified New York criteria, the diagnosis of ankylosing spondylitis is made based on the presence of advanced lesions, sacroiliitis of at least 2 grade bilaterally or 3-4 unilaterally. In case of other types of spondyloarthropathies diagnosis is made based on presence of at least grade 1 changes. In MRI, active inflammation of sacroiliac joints is indicated by the presence of subchondral bone marrow edema, synovitis, bursitis, or enthesitis. ASAS discusses only the classic form of axial spondyloarthropathies, which is ankylosing spondylitis. To quantify radiological inflammatory changes in the course of the disease, Stoke Ankylosing spondylitis classification Spinal Score (SASSS) is recommended. The signs of inflammation and scarrying of the spinal cord in the course of ankylosing spondylitis, present in MRI include: bone marrow edema, sclerosis, fat metaplasia, formation of syndesmophytes, and ankylosis.
Rheumatology, 2003
To compare a new MRI scoring system of the sacroiliac joints (SIJs) in early spondylarthropathy (SpA) with clinical and laboratory parameters. Forty-one patients (24 males, 17 females) with a median age of 26 yr and a median duration of inflammatory low back pain of 19 months were included. They all fulfilled the ESSG-criteria for SpA. The patients were examined by MRI of the SIJs using a new scoring system. Clinical examinations, biochemical tests, functional score (BASFI), and pain score (BASDAI) were also performed. 95% of the patients had inflammation and/or destructive bone changes of the SIJs at MRI. No correlation was found between MRI pathology and clinical findings. MRI demonstrated significantly greater severity of both inflammation and destruction of the SIJs in HLA B27 positive patients than in the HLA B27 negative patients. In patients with early SpA, MRI was able to detect inflammatory and destructive changes of the SIJs, but the changes were not associated to clinical findings. Our results suggest a role of MRI in the detection of early-stage sacroiliitis.
Spondyloarthropathy - Is sacroiliac joint imaging sufficient? A study of 431 patients
Indian Journal of Radiology and Imaging, 2019
Background: Sacroiliac (SI) joint involvement (sacroiliitis) is considered as major criteria for diagnosing Spondyloarthropathy (SpA), although involvement of spine and hip can also occur. The aim of our study was to assess the utility of including sagittal short-tau inversion recovery (STIR) sequence of dorsolumbar spine and coronal STIR/proton density (PD) fat saturated sequence through both hips, to routine SI joint magnetic resonance (MR) imaging protocol, in patients clinically suspected to have SpA. Material and Methods: A retrospective observational study was conducted between February 2013 and February 2018 on clinically suspected SpA patients referred to our department for imaging. The images obtained using this new SI joint protocol were evaluated for findings suggesting SpA diagnosis as per the Assessment of SpondyloArthritis international Society criteria. Other differentials for similar symptoms were also looked for. Results: Of the 431 patients (313 M and 118 F), 255 had features confirming the diagnosis of SpA and 176 had no radiological manifestations of SpA (56 were normal and 120 had other findings to suggest clinical symptoms; e.g., degenerative SpA, Pott's spine, skeletal metastases, early AVN of hip, cysticercus, iliofemoral impingement). 19/255 patients had normal SI joints but other findings to suggest diagnosis of SpA, e.g. romanus lesions, costovertebritis/costotransversitis, pubic symphysitis, inflammatory hip arthropathy, enthesitis, iliofemoral/trochanteric bursitis. 33/61 patients with chronic sacroiliitis had disease activity in spine or hip. Conclusion: Inclusion of sections through dorsolumbar spine and both hips to routine SI joint protocol, helped in identifying: (a) early disease in 19 patients, who had normal SI joints and may have otherwise been missed with routine only SI joint imaging, (b) additional findings in SpA-related sacroiliitis, (c) disease activity in chronic sacroiliitis, and (d) other causes of low back pain and thus helped in further patient management.