Rheumatology International

, Volume 25, Issue 8, pp 591–594 | Cite as

The investigation of sacroiliitis with different imaging techniques in spondyloarthropathies

  • N. Inanc
  • P. Atagündüz
  • F. Şen
  • T. Biren
  • H. T. Turoğlu
  • H. Direskeneli
Original Article



The aim of this study was to compare the value of different imaging techniques in spondyloarthropathy (SpA) patients with inflammatory low back pain.

Patients and methods

We evaluated 54 patients who fulfilled the European spondyloarthropathy classification criteria and had inflammatory low back pain. They were subdivided into two groups according to changes on plain radiography rated on a 0–4 scale according to modified New York criteria. Group A patients had at least grade-2 unilateral or bilateral changes in the sacroiliac (SI) joints, whereas group B included patients with radiologic changes not exceeding grade 0–1. Quantitative SI scintigraphy and magnetic resonance imaging (MRI) were performed to investigate the value of these techniques to the diagnosis of sacroiliitis, and the sacroiliac joint:sacrum uptake ratios were calculated. Scintiscanning was done in 80 healthy subjects to define the normal range.


The sensitivities of plain radiography, quantitative SI scintigraphy, and MRI were 61%, 55%, and 89%, respectively, among the patients with SpA. MRI and quantitative SI scintigraphy detected sacroiliitis in 97% and 49% of group A, respectively. In group B, these results were 76% and 66%, respectively.


Magnetic resonance imaging is the most sensitive method for detecting acute or chronic changes in SpA patients with histories of inflammatory low back pain and normal or indeterminate findings on plain radiographs.


Magnetic resonance imaging Plain radiography Quantitative sacroiliac scintigraphy Sacroiliitis Spondyloarthropathies 


  1. 1.
    Dougados M, van der Linden S, Juhlin R, Huitfeldt B, Amor B, Calin A, Cats A, Dijkmans B, Olivieri I, Pasero G, Veys E, Zeidler H, European Spondylarthropathy Study Group (1991) The European Spondylarthropathy Study Group preliminary criteria for the classification of spondylarthropathy. Arthritis Rheum 34:1218–1227PubMedGoogle Scholar
  2. 2.
    Braun J, Bollow M, Sieper J (1998) Radiologic diagnosis and pathology of the spondyloarthropathies. Rheum Dis Clin North Am 24:697–735PubMedGoogle Scholar
  3. 3.
    Braun J, Sieper J, Bolllow M (2000) Imaging of sacroiliitis. Clin Rheumatol 19:51–57PubMedGoogle Scholar
  4. 4.
    Khan MA (2002) Thoughts concerning the early diagnosis of ankylosing spondylitis and related diseases. Clin Exp Rheumatol 20 [Suppl 28]:6–10Google Scholar
  5. 5.
    van der Linden SM, Valkenburg HA, Cats A (1984) Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum 27:361–368PubMedGoogle Scholar
  6. 6.
    Holder LE, Fogelman I, Collier BD (2000) An atlas of planar and SPECT bone scans. Second edn. Dunitz, LondonGoogle Scholar
  7. 7.
    Şen F (2003) Assessment of the effects of age and gender on obtaining normal sacroiliac index values in quantitative bone scintigraphy (thesis). University of Marmara, IstanbulGoogle Scholar
  8. 8.
    Docherty P, Mitchell MJ, MacMillan L, Mosher D, Barnes DC, Hanly JG (1992) Magnetic resonance imaging in the detection of sacroiliitis. J Rheumatol 19:393–401PubMedGoogle Scholar
  9. 9.
    van der Linden SI, Valkenburg HA, Cats A (1984) Evaluation of diagnostic criteria for ankylosing spondylitis. Arthritis Rheum 27:361–368PubMedGoogle Scholar
  10. 10.
    Khan MA (2002) Ankylosing spondylitis: introductory comments on its diagnosis and treatment. Ann Rheum Dis 61 [Suppl 3]:3–7Google Scholar
  11. 11.
    Oostveen J, Prevo R, den Boer J, van de Laar M (1999) Early detection of sacroiliitis on magnetic resonance imaging and subsequent development of sacroiliitis on plain radiography. A prospective, longitudinal study. J Rheumatol 26:1953–1958PubMedGoogle Scholar
  12. 12.
    Yu W, Feng F, Dion E, Yang H, Jiang M, Genant HK (1994) Comparison of radiography, computed tomography and magnetic resonance imaging in the detection of sacroiliitis accompanying ankylosing spondylitis. Skeletal Radiol 23:289–292PubMedGoogle Scholar
  13. 13.
    Miron SD, Khan MA, Wiesen EJ, Kushner I, Bellon EM (1983) The value of quantitative sacroiliac scintigraphy in detection of sacroiliitis. Clin Rheumatol 2:407–414PubMedGoogle Scholar
  14. 14.
    Kacar G, Kacar C, Karayalcin B, Gungor F, Tuncer T, Erkilic M (1998) Quantitative sacroiliac joint scintigraphy in normal subjects and patients with sacroiliitis. Ann Nucl Med 12:169–173PubMedGoogle Scholar
  15. 15.
    Esdaile JM, Rosenthall L, Terkeltaub R, Kloiber R (1980) Prospective evaluation of sacroiliac scintigraphy in chronic inflammatory back pain. Arthritis Rheum 23:998–1003PubMedGoogle Scholar
  16. 16.
    Battafarano DF, West SD, Rak KM, Fortenbery EJ, Chantelois AE (1993) Comparison of bone scan, computed tomography and magnetic resonance imaging in the diagnosis of sacroiliitis. Semin Arthritis Rheum 23:161–176PubMedGoogle Scholar
  17. 17.
    Blum U, Buitrago-Tellez C, Mundinger A, Krause T, Laubenberger J, Vaith P, Peter HH, Langer M (1996) Magnetic resonance imaging (MRI) for detection of active sacroiliitis—a prospective study comparing conventional radiography, scintigraphy and contrast enhanced MRI. J Rheumatol 23:2107–2115PubMedGoogle Scholar
  18. 18.
    Gran JT, Ostensen M (1998) Spondyloarthritides in females. Baillieres Clin Rheumatol 12:695–715PubMedGoogle Scholar
  19. 19.
    Hanly JG, Mitchell MJ, Barnes DC, MacMillan L (1994) Early recognition of sacroiliitis by magnetic resonance imaging and single photon emission computed tomography. J Rheumatol 21:2088–2095PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • N. Inanc
    • 1
    • 4
  • P. Atagündüz
    • 1
  • F. Şen
    • 2
  • T. Biren
    • 3
  • H. T. Turoğlu
    • 2
  • H. Direskeneli
    • 1
  1. 1.Division of RheumatologyUniversity of Marmara School of MedicineIstanbulTurkey
  2. 2.Department of Nuclear MedicineUniversity of Marmara School of MedicineIstanbulTurkey
  3. 3.Department of RadiologyUniversity of Marmara School of MedicineIstanbulTurkey
  4. 4.Fahrettin Kerim Gökay Cad. GülAp. No: 168/13IstanbulTurkey

Personalised recommendations