Low-dose computed tomography for axial spondyloarthritis: update on use and limitations

Lambert, Robert G.; Hermann, Kay-Geert A.; Diekhoff, Torsten

doi:10.1097/bor.0000000000000803

Cited by 14 publications

(11 citation statements)

References 20 publications

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“…Historically, the use of CT in axSpA imaging has been hindered by its high radiation exposure. Recent technical advances in scanner technology and acquisition protocols have decreased effective radiation close to the level of plain radiography and low-dose CT can thus be considered a practicable method in rheumatologic imaging 8. A recent investigation by our group confirmed CT as a highly specific imaging alternative whenever MRI is inconclusive or unavailable 9…”

Section: Introductionmentioning

confidence: 95%

What amount of structural damage defines sacroiliitis: a CT study

et al. 2022

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ObjectivesTo propose a data-driven definition for structural changes of sacroiliac (SI) joints in the context of axial spondyloarthritis (axSpA) imaging on a large collective of CT datasets.Methods546 individuals (102 axSpA, 80 non-axSpA low back pain and 364 controls without back pain) with SI joint CTs were evaluated for erosions, sclerosis and ankylosis using a structured scoring system. Lesion frequencies and spatial distribution were compared between groups. Diagnostic performance (sensitivity (SE), specificity (SP), positive predictive values, negative predictive values and positive and negative likelihood ratios) was calculated for different combinations of imaging findings. Clinical diagnosis served as standard of reference.ResultsAnkylosis and/or erosions of the middle and dorsal joint portions yielded the best diagnostic performance with SE 67.6% and SP 96.3%. Inclusion of ventral erosions and sclerosis resulted in lower diagnostic performance with SE 71.2%/SP 92.5% and SE 70.6%/SP 90.0%, respectively.ConclusionsSclerosis and ventrally located erosions of SI joints have lower specificity on CT of the SI joint in the context of axSpA imaging. Ankylosis and/or erosions of the middle and dorsal joint portions show a strong diagnostic performance and are appropriate markers of a positive SI joint by CT.

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Section: Introductionmentioning

confidence: 95%

What amount of structural damage defines sacroiliitis: a CT study

et al. 2022

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“…When collimated specifically to the SIJs, ldCT can be performed with a radiation dose of less than 1 mSv, which is similar to that of a single AP pelvic radiograph [34,35]. Further major dose reduction has been reported for the use of iterative and artificial intelligence-based reconstruction algorithms [36,37 ▪ ,38].…”

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

confidence: 98%

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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“…Here, ankylosis of the SIJs is of particular importance, as the radiographic representation of backfill is currently not known – or backfill is simply not effectively detected by projection radiography. However, in recent years, many experts have started to advocate replacing the initial X-ray with MRI, especially for early diagnosis 56 57 58 . MRI will clearly detect most structural lesions and especially new bone formation 59 .…”

Section: Imagingmentioning

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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Low-dose computed tomography for axial spondyloarthritis: update on use and limitations

Cited by 14 publications

References 20 publications

What amount of structural damage defines sacroiliitis: a CT study

What amount of structural damage defines sacroiliitis: a CT study

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

New Bone Formation in Axial Spondyloarthritis: A Review

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