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Basra M, Patel H, Sobczak A, Ditchek J, Biglione A, Kesselman MM, Posey A. Use of Multimodality Imaging in the Evaluation of Patients With Spondyloarthropathies and Sacroiliitis. Cureus 2024; 16:e57185. [PMID: 38681346 PMCID: PMC11056229 DOI: 10.7759/cureus.57185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 03/29/2024] [Indexed: 05/01/2024] Open
Abstract
Spondyloarthropathy (SpA) is one of the most common causes of low back pain. It is caused by inflammatory arthritis in the spine, manifesting in various forms such as psoriatic arthritis (PsA), ankylosing spondylitis (AS), and sacroiliitis. A comprehensive systematic literature search was done to evaluate and compare MRI, CT, single-photon emission CT, PET, ultrasound (US) imaging, low-dose CT, and diffusion-weighted imaging (DWI) techniques in assessing SpAs. The search strategy was constructed by an analysis of key terms from relevant articles in MEDLINE ProQuest, Embase, and PubMed. The key terms used to search for these articles were "SpA," "sacroiliitis," "spondylitis," "psoriatic arthritis," "MRI," "CT scan," "x-ray," "magnetic resonance imaging," "computed tomography," "bone density," and "ultrasound." A total of 1,131 articles published in English between January 1, 2003, and October 15, 2023 were identified and screened for eligibility by members of the research team, which resulted in 69 total articles selected for the final review. US has played an important role in visualizing joint inflammation and enthesitis (inflammation of the enthesis), which are common features of PsA. Although MRI and CT are considered more reliable modalities for diagnosing active sacroiliitis, US imaging with Doppler flow can also be useful in conjunction with CT images to visualize abnormal blood flow in the sacroiliac joints, as well as other joints affected by inflammatory arthritis. MRI provides increased diagnostic confidence in the diagnosis of sacroiliitis in active AS patients when compared to CT. CT is more sensitive than plain radiographs. The PET activity score showed a good correlation in diagnosing inflammatory sacroiliitis but lacked in identifying structural lesions. CT has high diagnostic accuracy, but it exposes patients to a high radiation dose. MRI visualizes joint and tissue inflammation, bone, and bone marrow change and can identify peripheral inflammation in soft tissue and joints in patients diagnosed with PsA. MRI can also visualize bone marrow changes and subchondral edema, which can aid in the early diagnosis of ankylosing SpA and gauge disease severity. DWI and short-tau inversion recovery imaging are both MRI techniques used in detecting sacroiliitis. MRI and CT are shown to be reliable imaging modalities for the diagnosis of sacroiliitis; however, it was found that Doppler US played an accurate role in the diagnosis as well. MRI visualizes joints and tissue with the most precision, making it useful in evaluating patients with PsA, while PET CT is useful in the diagnosis of inflammatory sacroiliitis patients. There is limited literature available comparing the multiple modalities of imaging available for each SpA. The review's objective is to analyze imaging findings in patients diagnosed with sacroiliitis and SpAs. The findings in this literature review are valuable for properly assessing and diagnosing patients suffering from SpAs.
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Affiliation(s)
- Mahi Basra
- Osteopathic Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Clearwater, USA
| | - Hemangi Patel
- Sports Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| | - Alexandria Sobczak
- Osteopathic Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| | - Jordan Ditchek
- Radiology, Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Davie, USA
| | | | - Marc M Kesselman
- Rheumatology, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Davie, USA
| | - Alessandra Posey
- Sports Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Davie, USA
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Zhao YH, Cao YY, Zhang Q, Mei YJ, Xiao JJ, Hu SY, Li W, Li SL. Role of Diffusion-weighted and Contrast-enhanced Magnetic Resonance Imaging in Differentiating Activity of Ankylosing Spondylitis. Chin Med J (Engl) 2018; 130:1303-1308. [PMID: 28524829 PMCID: PMC5455039 DOI: 10.4103/0366-6999.206359] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Previous studies showed that combining apparent diffusion coefficient (ADC) value with the Spondyloarthritis Research Consortium of Canada (SPARCC) index value might provide a reliable evaluation of the activity of ankylosing spondylitis (AS), and that contrast-enhanced (CE) magnetic resonance imaging (MRI) is unnecessary. However, the results were based on confirming only a small random sample. This study aimed to assess the role of CE-MRI in differentiating the disease activity of AS by comparing ADC value with a large sample. Methods: A total of 115 patients with AS were enrolled in accordance with Bath AS Disease Activity Index and laboratory indices, and 115 patients were divided into two groups, including active group (n = 69) and inactive group (n = 46). SPARCC, ΔSI, and ADC values were obtained from the short tau inversion recovery (STIR), diffusion-weighted imaging (DWI), and CE-MRI, respectively. One-way analysis of variance and receiver operating characteristic analysis were performed for all parameters. Results: The optimal cutoff values (with sensitivity, specificity, respective area under the curve, positive likelihood ratio, and negative likelihood ratio) for the differentiation between active and inactive groups are as follows: SPARCC = 6 (72.06%, 82.61%, 0.836, 4.14, 0.34); ΔSI (%) = 153 (80.6%, 84.78%, 0.819, 5.3, 0.23); ADC value = 1.15 × 10−3 mm2/s (72.73%, 81.82%, 0.786, 4, 0.33). No statistical differences were found among the predictive values of SPARCC, ΔSI, and ADC. Multivariate analysis showed no significant difference between the combination of SPARCC and ADC values with and without ΔSI. Conclusions: Using large sample, we concluded that the combination of STIR and DWI would play significant roles in assessing the disease activity, and CE-MRI sequence is not routinely used in imaging of AS to avoid renal fibrosis and aggravation of kidney disease.
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Affiliation(s)
- Ying-Hua Zhao
- Department of Radiology, Third Affiliated Hospital of Southern Medical University, Orthopaedic Hospital of Guangdong Province, Guangzhou, Guangdong 510630, China
| | - Yan-Yan Cao
- Department of Rheumatology, Hospital of Integrated Traditional Chinese Medicine and Western Medicine of Southern Medical University, Guangzhou, Guangdong 510315, China
| | - Qun Zhang
- Department of Rheumatology, Third Affiliated Hospital of Southern Medical University, Orthopaedic Hospital of Guangdong Province, Guangzhou, Guangdong 510630, China
| | - Ying-Jie Mei
- Department of MR Clinical Science, Philips Healthcare, Guangzhou, Guangdong 510055, China
| | - Ji-Jie Xiao
- Department of Radiology, Third Affiliated Hospital of Southern Medical University, Orthopaedic Hospital of Guangdong Province, Guangzhou, Guangdong 510630, China
| | - Shao-Yong Hu
- Department of Radiology, Third Affiliated Hospital of Southern Medical University, Orthopaedic Hospital of Guangdong Province, Guangzhou, Guangdong 510630, China
| | - Wei Li
- Department of Radiology, Third Affiliated Hospital of Southern Medical University, Orthopaedic Hospital of Guangdong Province, Guangzhou, Guangdong 510630, China
| | - Shao-Lin Li
- Department of Radiology, Third Affiliated Hospital of Southern Medical University, Orthopaedic Hospital of Guangdong Province, Guangzhou, Guangdong 510630, China
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Bradbury LA, Hollis KA, Gautier B, Shankaranarayana S, Robinson PC, Saad N, Lê Cao KA, Brown MA. Diffusion-weighted Imaging Is a Sensitive and Specific Magnetic Resonance Sequence in the Diagnosis of Ankylosing Spondylitis. J Rheumatol 2018; 45:771-778. [PMID: 29449501 DOI: 10.3899/jrheum.170312] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We tested the discriminatory capacity of diffusion-weighted magnetic resonance imaging (DWI) and its potential as an objective measure of treatment response to tumor necrosis factor inhibition in ankylosing spondylitis (AS). METHODS Three cohorts were studied prospectively: (1) 18 AS patients with Bath Ankylosing Spondylitis Disease Activity Index > 4, and erythrocyte sedimentation rate > 25 and/or C-reactive protein > 10 meeting the modified New York criteria for AS; (2) 20 cases of nonradiographic axial spondyloarthritis (nr-axSpA) as defined by the Assessment of Spondyloarthritis international Society (ASAS) criteria; and (3) 20 non-AS patients with chronic low back pain, aged between 18 and 45 years, who did not meet the imaging arm of the ASAS criteria for axSpA. Group 1 patients were studied prior to and following adalimumab treatment. Patients were assessed by DWI and conventional magnetic resonance imaging (MRI), and standard nonimaging measures. RESULTS At baseline, in contrast to standard nonimaging measures, DWI apparent diffusion coefficient (ADC) values showed good discriminatory performance [area under the curve (AUC) > 80% for Group 1 or 2 compared with Group 3]. DWI ADC values were significantly lower posttreatment (0.45 ± 0.433 before, 0.154 ± 0.23 after, p = 0.0017), but had modest discriminating capacity comparing pre- and posttreatment measures (AUC = 68%). This performance was similar to the manual Spondyloarthritis Research Consortium of Canada (SPARCC) scoring system. CONCLUSION DWI is informative for diagnosis of AS and nr-axSpA, and has moderate utility in assessment of disease activity or treatment response, with performance similar to that of the SPARCC MRI score.
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Affiliation(s)
- Linda A Bradbury
- From the Institute of Health and Biomedical Innovation, Queensland University of Technology, Translational Research Institute, Princess Alexandra Hospital; University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital; Royal Brisbane and Women's Hospital; The University of Queensland, School of Medicine, Brisbane, Queensland, Australia.,L.A. Bradbury, MSc, MNPSt, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology at Translational Research Institute; K.A. Hollis, BScN, RN, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology at Translational Research Institute; B. Gautier, PhD, University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital; S. Shankaranarayana, MBBS, PhD, Princess Alexandra Hospital; P.C. Robinson, PhD, FRACP, Royal Brisbane and Women's Hospital; N. Saad, MD, FRANZCR, Princess Alexandra Hospital; K.A. Lê Cao, PhD, University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital; M.A. Brown, MD, PhD, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology at Translational Research Institute
| | - Kelly A Hollis
- From the Institute of Health and Biomedical Innovation, Queensland University of Technology, Translational Research Institute, Princess Alexandra Hospital; University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital; Royal Brisbane and Women's Hospital; The University of Queensland, School of Medicine, Brisbane, Queensland, Australia.,L.A. Bradbury, MSc, MNPSt, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology at Translational Research Institute; K.A. Hollis, BScN, RN, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology at Translational Research Institute; B. Gautier, PhD, University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital; S. Shankaranarayana, MBBS, PhD, Princess Alexandra Hospital; P.C. Robinson, PhD, FRACP, Royal Brisbane and Women's Hospital; N. Saad, MD, FRANZCR, Princess Alexandra Hospital; K.A. Lê Cao, PhD, University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital; M.A. Brown, MD, PhD, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology at Translational Research Institute
| | - Benoît Gautier
- From the Institute of Health and Biomedical Innovation, Queensland University of Technology, Translational Research Institute, Princess Alexandra Hospital; University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital; Royal Brisbane and Women's Hospital; The University of Queensland, School of Medicine, Brisbane, Queensland, Australia.,L.A. Bradbury, MSc, MNPSt, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology at Translational Research Institute; K.A. Hollis, BScN, RN, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology at Translational Research Institute; B. Gautier, PhD, University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital; S. Shankaranarayana, MBBS, PhD, Princess Alexandra Hospital; P.C. Robinson, PhD, FRACP, Royal Brisbane and Women's Hospital; N. Saad, MD, FRANZCR, Princess Alexandra Hospital; K.A. Lê Cao, PhD, University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital; M.A. Brown, MD, PhD, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology at Translational Research Institute
| | - Sateesh Shankaranarayana
- From the Institute of Health and Biomedical Innovation, Queensland University of Technology, Translational Research Institute, Princess Alexandra Hospital; University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital; Royal Brisbane and Women's Hospital; The University of Queensland, School of Medicine, Brisbane, Queensland, Australia.,L.A. Bradbury, MSc, MNPSt, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology at Translational Research Institute; K.A. Hollis, BScN, RN, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology at Translational Research Institute; B. Gautier, PhD, University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital; S. Shankaranarayana, MBBS, PhD, Princess Alexandra Hospital; P.C. Robinson, PhD, FRACP, Royal Brisbane and Women's Hospital; N. Saad, MD, FRANZCR, Princess Alexandra Hospital; K.A. Lê Cao, PhD, University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital; M.A. Brown, MD, PhD, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology at Translational Research Institute
| | - Philip C Robinson
- From the Institute of Health and Biomedical Innovation, Queensland University of Technology, Translational Research Institute, Princess Alexandra Hospital; University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital; Royal Brisbane and Women's Hospital; The University of Queensland, School of Medicine, Brisbane, Queensland, Australia.,L.A. Bradbury, MSc, MNPSt, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology at Translational Research Institute; K.A. Hollis, BScN, RN, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology at Translational Research Institute; B. Gautier, PhD, University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital; S. Shankaranarayana, MBBS, PhD, Princess Alexandra Hospital; P.C. Robinson, PhD, FRACP, Royal Brisbane and Women's Hospital; N. Saad, MD, FRANZCR, Princess Alexandra Hospital; K.A. Lê Cao, PhD, University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital; M.A. Brown, MD, PhD, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology at Translational Research Institute
| | - Nivene Saad
- From the Institute of Health and Biomedical Innovation, Queensland University of Technology, Translational Research Institute, Princess Alexandra Hospital; University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital; Royal Brisbane and Women's Hospital; The University of Queensland, School of Medicine, Brisbane, Queensland, Australia.,L.A. Bradbury, MSc, MNPSt, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology at Translational Research Institute; K.A. Hollis, BScN, RN, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology at Translational Research Institute; B. Gautier, PhD, University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital; S. Shankaranarayana, MBBS, PhD, Princess Alexandra Hospital; P.C. Robinson, PhD, FRACP, Royal Brisbane and Women's Hospital; N. Saad, MD, FRANZCR, Princess Alexandra Hospital; K.A. Lê Cao, PhD, University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital; M.A. Brown, MD, PhD, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology at Translational Research Institute
| | - Kim-Anh Lê Cao
- From the Institute of Health and Biomedical Innovation, Queensland University of Technology, Translational Research Institute, Princess Alexandra Hospital; University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital; Royal Brisbane and Women's Hospital; The University of Queensland, School of Medicine, Brisbane, Queensland, Australia.,L.A. Bradbury, MSc, MNPSt, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology at Translational Research Institute; K.A. Hollis, BScN, RN, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology at Translational Research Institute; B. Gautier, PhD, University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital; S. Shankaranarayana, MBBS, PhD, Princess Alexandra Hospital; P.C. Robinson, PhD, FRACP, Royal Brisbane and Women's Hospital; N. Saad, MD, FRANZCR, Princess Alexandra Hospital; K.A. Lê Cao, PhD, University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital; M.A. Brown, MD, PhD, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology at Translational Research Institute
| | - Matthew A Brown
- From the Institute of Health and Biomedical Innovation, Queensland University of Technology, Translational Research Institute, Princess Alexandra Hospital; University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital; Royal Brisbane and Women's Hospital; The University of Queensland, School of Medicine, Brisbane, Queensland, Australia. .,L.A. Bradbury, MSc, MNPSt, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology at Translational Research Institute; K.A. Hollis, BScN, RN, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology at Translational Research Institute; B. Gautier, PhD, University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital; S. Shankaranarayana, MBBS, PhD, Princess Alexandra Hospital; P.C. Robinson, PhD, FRACP, Royal Brisbane and Women's Hospital; N. Saad, MD, FRANZCR, Princess Alexandra Hospital; K.A. Lê Cao, PhD, University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital; M.A. Brown, MD, PhD, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology at Translational Research Institute.
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