A Worthwhile Measurement of Early Vigilance and Therapeutic Monitor in Axial Spondyloarthritis: A Literature Review of Quantitative Sacroiliac Scintigraphy

Abstract

Background: Back pain a common cause for hospital visits. Nuclear skeletal scintigraphy, at a high sensitivity, provides a functional imaging for detecting bone diseases. Sacroiliitis is an inflammation of the sacroiliac joint. Bone scan with quantitative sacroiliac scintigraphy (QSS) has been a useful inflammation indicator for sacroiliac joints. However, QSS has been ignored in the rehabilitation practice. Objective: To present the background, mechanisms, and current clinical applications of bone scan with QSS in spondyloarthropathy (SpA). Methods: The authors performed a literature review of QSS through database searching of MEDLINE, Embase, CINAHL, HaPI, Cochrane Review, and citation mining. Studies were included if they had QSS in the methodology performed in adult patients with various diseases. Any articles, including the authors’, that can be performed in a clinical setting were enrolled. Articles explicitly referencing QSS were retained for screening. Results: QSS appearance of SpA, including ankylosing spondylitis, may give rise to early detection. The specificity of sacroiliitis based on QSS increases from 73% to 97%. After investigating the relationship between serum C-reactive protein and sacroiliac joint inflammation in patients with SpA, there appeared to be a significant difference between serum C-reactive protein in serum and in sacroiliac ratio (particularly the middle part of the both joints), indicating a systemic inflammatory response to flair-up of SpA, for example, serum C-reactive protein as an indicator of inflammation. Sacroiliitis also occurs in post-streptococcal reactive arthritis. The involvement of sacroiliac joints in the development of post-streptococcal reactive arthritis had been demonstrated a significant correlation between anti-streptolysin O titres and QSS in patients with post-streptococcal reactive arthritis. Lower extremity periostitis acts as a human model in the study of bottom-up processing for periostitis-induced sacroiliac pain. The use of QSS can also monitor sacroiliac joint dysfunction before and after laser therapy. Improvements of the sacroiliac joint after convalescing of foot periostitis have been reported. Conclusions: Bone scan using QSS is a good screening measurement in scintigraphy rehabilitation for early detection of SpA and raises awareness of physicians toward the next step of diagnosis.

Appearance of facet joint syndrome in a case of chronic sacroiliitis: Evidenced from quantitative sacroiliac scintigraphy and dual images of SPECT-CT

“…SPECT-CT is a hybrid imaging technique that incorporates molecular and anatomical imaging from SPECT and CT to provide more detailed information on the anatomical and functional characteristics of the target tissues. SPECT-CT has been found to have superior diagnostic value in several aspects such as precise foci localization and identification of serendipitous lesions, which may not be evident in plain radiographs alone 3,6,7 . In our case, although manifestations of degenerative change in the SI region were observable through x-ray and CT, lesions on the facet joints were not evident.…”

“…The QSS examination yielded sacroiliac joint/sacrum (SI/S) ratios of 1.14, 1.00, and 1.13 for the left side, and corresponding values of 1.16, 1.06, and 1.20 for the right side (see Figure 2). With a cutoff value of 1.30 at our facility 6 , the left side indicated typical values, while the right was borderline, indicating possible benign lesion. The hybrid SPECT-CT findings confirmed the bilateral LFJ of the L3 and L4 as the source of LBP, as supported by the intense radiotracer uptake in this specific area (see Figure 2A).…”