Diagnostics of Sacroiliitis According to ASAS Criteria: A Comparative Evaluation of Conventional Radiographs and MRI in Patients with a Clinical Suspicion of Spondyloarthropathy. Preliminary Results

Sudoł‐Szopińska, Iwona; Kwiatkowska, Brygida; Włodkowska-Korytkowska, Monika; Matuszewska, Genowefa; Grochowska, Elzbieta

doi:10.12659/pjr.892529

Cited by 22 publications

(10 citation statements)

References 36 publications

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“…These results are of considerable significance in the light of further management and indicate that basing the diagnosis on radiographs according to the current ASAS classification criteria carries the risk of establishing an erroneous diagnosis of sacroiliitis. This is also confirmed by recent analyses [ 12 , 13 ]. Van der Berg et al [ 12 ] found that in patients with a recent-onset inflammatory back pain, both trained readers and local rheumatologists and radiologists agreed only moderately on the recognition of radiographic sacroiliitis.…”

Section: Discussionsupporting

confidence: 90%

Spectrum of Inflammatory Changes in the SIJs on Radiographs and MR Images in Patients with Suspected Axial Spondyloarthritis

Sudoł‐Szopińska

Włodkowska-Korytkowska

Kwiatkowska

2016

Pol J Radiol

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SummaryBackgroundThe aim of the paper was to compare radiographs and MRI in assessment of active and chronic inflammatory changes in the sacroiliac joints in patients with chronic back pain and suspected axial spondyloarthritis.Moreover, the aim was to determine which of the two methods is more accurate in diagnosing individual inflammatory changes in the sacroiliac joints and whether there is a correlation between radiographs and MRI in their identification.Material/MethodsThe analysis was conducted in a group of 101 patients, including 61 women and 40 men, referred to radiographs and MR examinations by rheumatologists due to chronic back pain.AP images of the lumbar region of the spine were performed in each patient in the supine position. The images included the sacroiliac joints. Changes in the SIJs were assessed based on the New York criteria of 1966. In MR examination, the SIJs were assessed in terms of the presence of active and chronic inflammatory changes described by the ASAS. The statistical analysis of the variables tested was conducted in the Excel and Statistica systems.ResultsIn relation to the final clinical diagnosis of axSpA, MRI had higher sensitivity and specificity than radiography in diagnosing sacroiliitis (sensitivity: 71% vs. 22%, specificity: 90% vs. 94% on radiographs according to New York criteria. In relation to MRI, radiographs resulted in 40% of incorrect sacroiliitis diagnoses (both false positive and false negative results). In as many as 50% of cases (7/14), MRI failed to confirm the presence of inflammatory changes in the sacroiliac joints observed in radiography according to the modNY criteria (false positive results on radiographs).Both examinations are characterised by very low agreement, which is near to random, in assessing individual features of sacroiliitis, such as sclerosis, change in the joint space width, erosions and ankylosis.Conclusions1. Radiographs do not allow early inflammatory lesions indicating sacroiliitis to be diagnosed, which leads to diagnostic delay. MRI is the method of choice in diagnosing early sacroiliitis and detecting structural lesions, in particular sclerosis and erosions. 2. Radiographs and MRI are characterised by low, near to random, agreement in the detectability of the individual inflammatory changes in the sacroiliac joints.

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Section: Discussionsupporting

confidence: 90%

Spectrum of Inflammatory Changes in the SIJs on Radiographs and MR Images in Patients with Suspected Axial Spondyloarthritis

Sudoł‐Szopińska

Włodkowska-Korytkowska

Kwiatkowska

2016

Pol J Radiol

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“…In the entire group of 130 children, active and chronic inflammatory lesions were detected in 41% of children whereas chronic changes were visualized only in patients with clinically suspected JSpA. Chronic inflammatory changes were detected on MRI more frequently than on radiographs (14.3% vs 6.7%), which is consistent with our studies conducted in adults ( 11 ) . Children with suspected JSpA, in whom active lesions were detected in MRI, also had considerably higher levels of C-reactive protein (p = 0.01) and significantly longer medical history (p = 0.01) compared to children without features of sacroiliitis in MRI: 63.2 ± 44.1 months vs 28.2 ± 29.7 months.…”

Section: Magnetic Resonance Imagingsupporting

confidence: 90%

Imaging of juvenile spondyloarthritis. Part II: Ultrasonography and magnetic resonance imaging

et al. 2017

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Juvenile spondyloarthropathies are mainly manifested by symptoms of peripheral arthritis and enthesitis. Early involvement of sacroiliac joints and spine is exceptionally rare in children; this usually happens in adulthood. Conventional radiographs visualize late inflammatory lesions. Early diagnosis is possible with the use of ultrasonography and magnetic resonance imaging. The first part of the article presented classifications and radiographic presentation of juvenile spondyloarthropathies. This part discusses changes seen on ultrasonography and magnetic resonance imaging. In patients with juvenile spondyloarthropathies, these examinations are conducted to diagnose inflammatory lesions in peripheral joints, tendon sheaths, tendons and bursae. Moreover, magnetic resonance also shows subchondral bone marrow edema, which is considered an early sign of inflammation. Ultrasonography and magnetic resonance imaging do not show specific lesions for any rheumatic disease. Nevertheless, they are conducted for early diagnosis, treatment monitoring and identifying complications. This article presents a spectrum of inflammatory changes and discusses the diagnostic value of ultrasonography and magnetic resonance imaging.

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“…These criteria have recently been updated with the inclusion of more radiologists on the ASAS consensus panel [19]. Recent studies have shown that administration of contrast is not recommended due to the cost, risks of side effects and prolonged scanning time [314202122]. …”

Section: Discussionmentioning

confidence: 99%

Classification Terminology and Definitions in Reporting of MRI in Axial Spondyloarthritis

Ramdin

Moorthy

Rennie

2017

Journal of the Belgian Society of Radiology

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Spondyloarthritis (SpA) is a group of chronic inflammatory conditions which severely impact quality of life. Several criteria have been developed in the past to aid the diagnosis of SpA based on symptoms and radiographic changes during the course of the disease. However, it takes several years before structural changes manifest on conventional radiographs, leading to a diagnostic delay of 6 to 10 years. The use of MRI and its incorporation into the Assessment of Spondyloarthritis (ASAS) criteria, has radically changed the diagnosis of SpA in the last decade by allowing visualisation of both active and chronic inflammatory changes and enabling clinicians to recognise SpA during it’s early stage and initiate treatment. An understanding of the various terminology used in the divisions of disease presentations and their relevant imaging findings are key, along with the use of clear definitions of structural and inflammatory changes on MRI, in ensuring accurate diagnosis and classification of SpA.

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Diagnostics of Sacroiliitis According to ASAS Criteria: A Comparative Evaluation of Conventional Radiographs and MRI in Patients with a Clinical Suspicion of Spondyloarthropathy. Preliminary Results

Cited by 22 publications

References 36 publications

Spectrum of Inflammatory Changes in the SIJs on Radiographs and MR Images in Patients with Suspected Axial Spondyloarthritis

Spectrum of Inflammatory Changes in the SIJs on Radiographs and MR Images in Patients with Suspected Axial Spondyloarthritis

Imaging of juvenile spondyloarthritis. Part II: Ultrasonography and magnetic resonance imaging

Classification Terminology and Definitions in Reporting of MRI in Axial Spondyloarthritis

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