Ultrasonography as a useful modality for documenting sacroiliitis in radiographically negative inflammatory back pain: a comparative evaluation with MRI

Ghosh, Alakendu; Mondal, Sumantro; Sinha, Debanjali; Nag, Arijit; Chakraborty, Sumit

doi:10.1093/rheumatology/keu220

Cited by 17 publications

(9 citation statements)

References 24 publications

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“…In fact, two radiographically negative but MRI positive cases for sacroiliitis showed vascularity on CDUS, suggesting the positive role in diagnosis of sacroiliitis in radiographically negative cases (Image 2, 3). This was in concordance to study done by Ghosh et al 30 However, in our study RI values between the range of 0.4 -0.7 were utilized, while they used RI values <0.605 as the cutoff for diagnosis of sacroiliitis. While the majority of patient (48%) showed at least 4 vascular foci, we set the lower limit at 2 foci as they formed 10% of the cases showing vascularity compared to those showing 5 foci (4%).…”

Section: Discussionsupporting

confidence: 90%

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Role of Ultrasound and Colour Doppler in Sacroiliitis and Correlation With Age Matched Population

Paruchuri¹,

Padmini²,

Rajasekhar³

2018

jebmh

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BACKGROUND Sacroiliitis is an important feature of several spondyloarthropathies. While findings on conventional radiographs are delayed, the cost and availability of MRI are still important negative factors. The objectives of the study were-1) to evaluate the role of ultrasound and colour doppler (CD) in the detection of sacroiliitis and 2) to compare these findings with those of normal age matched population. MATERIALS AND METHODS In this prospective study, bilateral sacroiliac joints of 25 patients with suspected sacroiliitis were studied. Radiographs were taken for all patients. MRI was performed for patients with normal or unilateral disease on radiographs. USG and CD were performed for bilateral SI joints. Presence of fluid, echogenic joint space, hypervascularity and low-resistance flow (<0.7) were considered as USG features of sacroiliitis. RESULTS The mean age of the test population was 30.84 years with 76% males, compared to a mean age of 31 years and 81% males in control group. The most common presenting complaint was low back ache with a mean duration of 2.997 years (S.D. 2.17). On grey scale, the width of the diseased SI joint was statistically wider than the control group with fluid seen in 44% of 50 joints evaluated. 88% of the 50 joints were hyperechoic. On CDUS vascularity was identified in 68% with RI values of ≥0.4 to <0.7 in 70% of joints. In the control group, vascularity (at least 2 foci) was identified in 32% joints. However, none showed RI values of <0.7. CONCLUSION Features of inflammation within and around the sacroiliac joints on grey scale were identified as joint widening, increased echogenicity with fluid and on CD as low resistance vascularity patterns. Radiographically negative but MRI positive cases also showed positive CDUS findings, suggesting increased sensitivity. Thus, USG with CD of the sacroiliac joints can prove to be an adjunct to the clinical examination and may be used as an alternative to MRI, when it is not available or feasible.

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Section: Discussionsupporting

confidence: 90%

“…The procedure was performed for both sides. 30 The studies were performed by two radiologists having experience of 11 and 3 years, who were blinded to the clinical and radiography findings. In case of any contention, the findings were discussed to arrive at a mutual consent.…”

Section: Methodsmentioning

confidence: 99%

Role of Ultrasound and Colour Doppler in Sacroiliitis and Correlation With Age Matched Population

Paruchuri¹,

Padmini²,

Rajasekhar³

2018

jebmh

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“…3. Can show some abnormal features of sacroiliac joints like effusion, bone surface erosion, and soft tissue swellings [9].…”

Section: Diagnostic Valuementioning

confidence: 99%

Imaging in Low Back Pain

Al-Tameemi¹

2020

Novel Imaging and Spectroscopy

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Medical imaging plays an important role in the evaluation of low back pain (LBP). The choice of certain radiological method over other depends on many factors like patient's presentation, presence of contraindication, availability, relative cost of the test, and the expected impact of the results on management. Radiological evaluation helps the physician reach the most likely cause of LBP, confirm the provisional diagnosis, provide alternative one, or narrow the differential diagnosis. Plain X-ray radiograph is useful in initial general assessment. Magnetic resonance imaging (MRI) is the imaging modality of choice in the evaluation of LBP because of elegant demonstration of anatomical details and many pathologies. Computerized tomography (CT) can provide high-resolution images of the bony structures and is particularly invaluable in trauma. Other imaging modalities are rarely used usually as problem-solving or in selected conditions. For example, sonography may have a role in the evaluation of soft tissue lesions and the sacroiliac joints. Angiography is useful for vascular evaluation. Isotope imaging may be used in the elucidation of of hidden cause of pain (tumors or fracture). Conventional myelography and discography are virtually obsolete in current clinical practice because of the presence of much safer and accurate new modalities. Finally, interventional radiology has an increasing role in treating certain conditions.

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“…Finally, Ghosh et al conducted a study that combined CD and grey scale US of the sacroiliac joints in 29 patients with inflammatory LBP and normal X-ray and 32 controls, comparing the findings with MRI [33]. They found that the observation of three or more flow signals on CDUS and a RI below 0.605 correlated well with the MRI proven cases of sacroiliitis.…”

Section: Sij Dysfunctionmentioning

confidence: 99%

Diagnostic value of musculoskeletal ultrasound in patients with low back pain – a review of the literature

2018

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Low back pain (LBP) occurs in various groups of the population, affects men and women equally, and is among the major reasons for rheumatological or orthopedic consultations. Its prevalence increases steadily with age and the rate of recurrence within one year could reach 44% [1]. Many imaging modalities are available to clinicians for evaluating LBP. The application of these modalities depends mainly on the working diagnosis, the urgency of the clinical problem, the availability, and the comorbidities of the patient [2]. Conventional radiography (CR) and computerized tomography (CT) are associated with radiation exposure and show primarily the bony elements of the lower back. Their widespread use in the 20th century might be among the reasons why paraspinal soft tissues have somehow been neglected as a cause for LBP [1]. Magnetic resonance imaging (MRI) shows both bony and soft tissue structures in the axial skeleton, but its use is hampered by the duration of the examination, its relatively high costs, its limited availability (mainly in the tertiary centers) and the contraindications for this diagnostic modality [2].Musculoskeletal ultrasound (US) is a safe, fast, inexpensive, and widely available imaging modality that is very well tolerated by patients [3]. It allows multiplanar and dynamic examinations of the musculoskeletal system and can show the soft tissues in great anatomical detail. US is used by a growing number of physicians and the list of its applications in rheumatology and orthopedics is growing [4].Therefore, the question of the possible diagnostic application of US in such a common condition as LBP is very relevant to the clinical practice. On one hand, this could decrease the radiation exposure associated with CR and CT, and reduce the costs paid for MRI. The effect could be even bigger in time, as LBP is frequently a chronic or recurrent disease [1]. On the other hand, by AbstractPatients with low back pain (LBP) frequently undergo various imaging studies in the pursuit of a more precise diagnosis. Ultrasound (US) has the advantage of being a widely available, multiplanar, fast and radiation-free diagnostic tool. Moreover, compared to most of the other imaging modalities, it is particularly efficient in the visualization and assessment of soft tissues. Consequently, the question about the possible diagnostic application of US in such a common pathology as LBP is very relevant to the clinical practice. For this reason, we performed a review of the literature on the diagnostic value of US in different conditions that could cause LBP. We hereby discuss available studies on the diagnostic application of US in spinal canal stenosis and disc herniation (probably of historical significance only), as well as in the pathology of soft tissue structures like the lumbar and pelvic ligaments, muscles and entheses, the thoracolumbar fascia and the sacroiliac joints (maybe of greater importance nowadays). The evidence for the diagnostic value of US is not equivocal, though promising for some of the causati...

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Ultrasonography as a useful modality for documenting sacroiliitis in radiographically negative inflammatory back pain: a comparative evaluation with MRI

Abstract: Three or more flow signals and a RI ≤0.605 can be applied as USG criteria for sacroiliitis. USG can be a cost-effective and non-inferior modality compared with MRI in documenting sacroiliitis in early SpA.

Cited by 17 publications

References 24 publications

Role of Ultrasound and Colour Doppler in Sacroiliitis and Correlation With Age Matched Population

Role of Ultrasound and Colour Doppler in Sacroiliitis and Correlation With Age Matched Population

Imaging in Low Back Pain

Diagnostic value of musculoskeletal ultrasound in patients with low back pain – a review of the literature

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