Future of Low-Dose Computed Tomography and Dual-Energy Computed Tomography in Axial Spondyloarthritis

Diekhoff, Torsten; Hermann, Kai; Lambert, Robert G.

doi:10.1007/s11926-022-01075-5

Cited by 25 publications

(16 citation statements)

References 50 publications

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“…Another imaging modality that is increasingly utilized for adult patients with suspected or confirmed sacroiliitis is low-dose CT [38]. The advantage of this imaging modality is that the radiation dose is comparable to an x-ray and it shows the bony changes/damage to the joint(s) in much greater detail.…”

Section: Future Directionsmentioning

confidence: 99%

Challenges in treating juvenile idiopathic arthritis

Twilt

Stoustrup

Rumsey

2023

Current Opinion in Rheumatology

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Purpose of review Juvenile idiopathic arthritis (JIA) diagnosis and classification is currently still based on clinical presentation and general laboratory tests. Some joints such as the temporomandibular joint (TMJ) and sacroiliac (SI) are hard to assess and define as actively inflamed based on clinical examination. This review addresses these difficult to assess joints and provides the latest evidence for diagnosis and treatment. Recent findings Recommendations on clinical examination and radiological examination are available. Recent 2021 ACR recommendations were made for TMJ arthritis and in 2019 for sacroiliitis. Summary New evidence to guide clinical suspicion and need for further investigations are available for these hard to assess joints. These guidelines will help healthcare providers in diagnosis and treatment assessment.

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Section: Future Directionsmentioning

confidence: 99%

Challenges in treating juvenile idiopathic arthritis

Twilt

Stoustrup

Rumsey

2023

Current Opinion in Rheumatology

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“…Recent technical advances significantly reduce radiation exposure, thus allowing more frequent use of this technique in the rather young patient population with axSpA [57,70]. However, standard CT techniques are not sensitive to active inflammation, ▶ Fig.…”

Section: Ctmentioning

confidence: 99%

“…No bone marrow edema is seen in the STIR sequence. and dual-energy CT or comparable techniques are neither well investigated, nor can they be performed with similarly low doses [57]. In clinical practice, CT has been mostly reserved for patients with equivocal MRI findings.…”

Section: Ctmentioning

confidence: 99%

New Bone Formation in Axial Spondyloarthritis: A Review

Ulas,

Deppe,

Ziegeler

et al. 2023

Rofo

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Background Axial spondyloarthritis (axSpA) is a chronic inflammatory disease primarily affecting the sacroiliac joints (SIJs) and the spine. Imaging plays a crucial role in the diagnosis of axSpA, with magnetic resonance imaging (MRI) and radiography being the primary modalities used in clinical practice. New bone formation occurs in both the spine (non-bridging and bridging syndesmophytes, transdiscal ankylosis, and ankylosis of small joints and posterior elements) and the SIJs (backfill and ankylosis). New bone formation indicates advanced axSpA. Method This review explores the role of imaging in the diagnosis and monitoring of axSpA, focusing on the significance of new bone formation, and provides an overview of the characteristic imaging findings of new bone formation in axSpA in each imaging modality. Conclusion Imaging methods, such as X-ray, MRI, and CT, have different diagnostic accuracies for detecting structural lesions and new bone formation. Each modality has its strengths and weaknesses, and the choice depends on the specific clinical context. Imaging is crucial for the diagnosis and monitoring of axSpA, particularly for the detection of new bone formation. Different imaging techniques provide valuable information about disease progression and treatment response. Understanding the significance of new bone formation and its detection using imaging modalities is essential for the accurate diagnosis and effective management of patients with axSpA. Key Points:

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“…This capability is preserved in ldCT of the SIJs, where, because of the high contrast of cortical bone compared with other structures, radiation dose reduction does not compromise image readability (Fig. 3) [39]. Studies have reported ldCT to be more sensitive for detection of erosions or sclerosis than plain radiography and to be highly specific for axSpA while maintaining high inter-reader reliability [19 ▪ ,21 ▪▪ ].…”

Section: Computed Tomography Of the Sacroiliac Joints: A Potential Re...mentioning

confidence: 99%

Is it time to move on from pelvic radiography as the first-line imaging modality for suspected sacroiliitis?

Eshed

Diekhoff

Hermann

2022

Current Opinion in Rheumatology

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Purpose of reviewPelvic 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, crosssectional 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 findingsDiagnosing 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. SummaryGiven 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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Future of Low-Dose Computed Tomography and Dual-Energy Computed Tomography in Axial Spondyloarthritis

Cited by 25 publications

References 50 publications

Challenges in treating juvenile idiopathic arthritis

Challenges in treating juvenile idiopathic arthritis

New Bone Formation in Axial Spondyloarthritis: A Review

Is it time to move on from pelvic radiography as the first-line imaging modality for suspected sacroiliitis?

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