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Skeletal Radiology

, Volume 42, Issue 2, pp 219–224 | Cite as

Evaluation of disease activity in ankylosing spondylitis; diagnostic value of color Doppler ultrasonography

  • Afshin Mohammadi
  • Mohammad Ghasemi-rad
  • Miramir Aghdashi
  • Nikol Mladkova
  • Paria Baradaransafa
Scientific Article

Abstract

Introduction

Spondyloarthropathies including ankylosing spondylitis (AS) require early diagnosis to prevent irreversible changes. Sacroiliitis is a common initial manifestation of AS and is frequently diagnosed by magnetic resonance imaging (MRI). The goal of our study was to assess color Doppler ultrasonography as a potential diagnostic tool in suspected sacroiliitis in comparison with MRI representing the gold standard.

Materials and methods

Fifty-one consecutive patients with AS and sacroiliitis and 30 control subjects underwent contrast-enhanced MRI and high resolution color Doppler and duplex ultrasonography of both sacroiliac joints (SIJ) for the detection of vascularization and blood flow spectral Doppler waveform analysis.

Results

MRI demonstrated active disease in 27 and inactive disease in 24 patients. CDUS detected pulsatile monophasic wave spectral waveform flow in 22 patients with the active disease, and triphasic in 7 patients with inactive disease and in 8 control patients. The sensitivity, specificity, positive predictive value and negative predictive value for active sacroiliitis detection with CDUS were 82 % (95 % CI, 68–91 %), 92 % (95 % CI, 85–96 %), 91 % (95 % CI, 84–96 %), and 84 % (95 % CI, 70–92 %), respectively, for pulsatile monophasic wave spectral waveform Doppler sonography. MRI of SIJ was negative in all 30 (60 SIJ) control participants.

Conclusions

Our results show that CDUS is a practical and useful tool in the diagnosis of active sacroiliitis.

Keywords

Ankylosing spondylitis Sacroiliitis MRI Color Doppler ultrasound 

References

  1. 1.
    Fauci ALD. In: Fauci ABE, Kasper D, Hauser S, Longo D, Jameson J, Loscalzo J, editors. Harrison's principles of internal medicine. 17th ed. Philadeiphia: McGraw-Hill; 2008.Google Scholar
  2. 2.
    Braun J, Bollow M, Remlinger G, Eggens U, Rudwaleit M, Distler A, et al. Prevalence of spondylarthropathies in HLA-B27 positive and negative blood donors. Arthritis Rheum. 1998;41(1):58–67.PubMedCrossRefGoogle Scholar
  3. 3.
    Arslan H, Sakarya ME, Adak B, Unal O, Sayarlioglu M. Duplex and color Doppler sonographic findings in active sacroiliitis. AJR Am J Roentgenol. 1999;173(3):677–80.PubMedGoogle Scholar
  4. 4.
    Sieper J, Braun J, Rudwaleit M, Boonen A, Zink A. Ankylosing spondylitis: an overview. Ann Rheum Dis. 2002;61 Suppl 3:iii8–iii18.PubMedGoogle Scholar
  5. 5.
    Van der Linden S, Valkenburg HA, Cats A. Evaluation of diagnostic criteria for ankylosing spondylitis: a proposal for modification of the New York criteria. Arthritis Rheum. 1984;27:361–8.PubMedCrossRefGoogle Scholar
  6. 6.
    Jarvik JG, Deyo RA. Diagnostic evaluation of low back pain with emphasis on imaging. Ann Intern Med. 2002;137(7):586–97.PubMedGoogle Scholar
  7. 7.
    Unlu E, Pamuk ON, Cakir N. Color and duplex Doppler sonography to detect sacroiliitis and spinal inflammation in ankylosing spondylitis. Can this method reveal response to anti-tumor necrosis factor therapy? J Rheumatol. 2007;34(1):110–6.PubMedGoogle Scholar
  8. 8.
    Dougados M, van der Linden S, Juhlin R, Huitfeldt B, Amor B, Calin A, et al. The European Spondylarthropathy Study Group preliminary criteria for the classification of spondylarthropathy. Arthritis Rheum. 1991;34(10):1218–27.PubMedCrossRefGoogle Scholar
  9. 9.
    Braun J, Sieper J, Bollow M. Imaging of sacroiliitis. Clin Rheumatol. 2000;19(1):51–7.PubMedGoogle Scholar
  10. 10.
    Ryan LM, Carrera GF, Lightfoot Jr RW, Hoffman RG, Kozin F. The radiographic diagnosis of sacroiliitis. A comparison of different views with computed tomograms of the sacroiliac joint. Arthritis Rheum. 1983;26(6):760–3.PubMedCrossRefGoogle Scholar
  11. 11.
    Vogler 3rd JB, Brown WH, Helms CA, Genant HK. The normal sacroiliac joint: a CT study of asymptomatic patients. Radiology. 1984;151(2):433–7.PubMedGoogle Scholar
  12. 12.
    Bollow M, Braun J, Hamm B, Eggens U, Schilling A, Konig H, et al. Early sacroiliitis in patients with spondyloarthropathy: evaluation with dynamic gadolinium-enhanced MR imaging. Radiology. 1995;194(2):529–36.PubMedGoogle Scholar
  13. 13.
    Oostveen J, Prevo R, den Boer J, van de Laar M. Early detection of sacroiliitis on magnetic resonance imaging and subsequent development of sacroiliitis on plain radiography. A prospective, longitudinal study. J Rheumatol. 1999;26(9):1953–8.PubMedGoogle Scholar
  14. 14.
    Wittram C, Whitehouse GH, Williams JW, Bucknall RC. A comparison of MR and CT in suspected sacroiliitis. J Comput Assist Tomogr. 1996;20(1):68–72.PubMedCrossRefGoogle Scholar
  15. 15.
    Muche B, Bollow M, Francois RJ, Sieper J, Hamm B, Braun J. Anatomic structures involved in early- and late-stage sacroiliitis in spondylarthritis: a detailed analysis by contrast-enhanced magnetic resonance imaging. Arthritis Rheum. 2003;48(5):1374–84.PubMedCrossRefGoogle Scholar
  16. 16.
    Levine DS, Forbat SM, Saifuddin A. MRI of the axial skeletal manifestations of ankylosing spondylitis. Clin Radiol. 2004;59(5):400–13.PubMedCrossRefGoogle Scholar
  17. 17.
    Zhu J, Xing C, Jiang Y, Hu Y, Hu B, Wang N. Evaluation of complex appearance in vascularity of sacroiliac joint in ankylosing spondylitis by color Doppler ultrasonography. Rheumatol Int. 2010;32(1):69–72.Google Scholar
  18. 18.
    Klauser A, Halpern EJ, Frauscher F, Gvozdic D, Duftner C, Springer P, et al. Inflammatory low back pain: high negative predictive value of contrast-enhanced color Doppler ultrasound in the detection of inflamed sacroiliac joints. Arthritis Rheum. 2005;53(3):440–4.PubMedCrossRefGoogle Scholar
  19. 19.
    Klauser AS, De Zordo T, Bellmann-Weiler R, Feuchtner GM, Sailer-Höck M, Sögner P, et al. Feasibility of second-generation ultrasound contrast media in the detection of active sacroiliitis. Arthritis Rheum. 2009;61(7):909–16.PubMedCrossRefGoogle Scholar

Copyright information

© ISS 2012

Authors and Affiliations

  • Afshin Mohammadi
    • 1
  • Mohammad Ghasemi-rad
    • 2
  • Miramir Aghdashi
    • 3
  • Nikol Mladkova
    • 4
  • Paria Baradaransafa
    • 5
  1. 1.Department of RadiologyUrmia University of Medical SciencesUrmiaIran
  2. 2.Genius and Talented Student Organization, Student Research CommitteeUrmia University of Medical SciencesUrmiaIran
  3. 3.Department of RheumatologyUrmia University of Medical SciencesUrmiaIran
  4. 4.Blizard Institute of Cell and Molecular ScienceQueen Mary University LondonLondonUK
  5. 5.Student Research CommitteeTabriz Azad UniversityTabrizIran

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