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Imaging in Spondyloarthritis

  • Walter P. Maksymowych
Part of the Advances in Experimental Medicine and Biology book series (volume 649)

Abstract

The role of imaging in the evaluation and management of SpA has experienced a resurgence of interest with the introduction of MRI and more sophisticated sonographic technologies. Several approaches have been developed to score plain radiographic abnormalities in the spine and sacroiliac joints of patients with SpA and this approach remains the standard for assessment of structural damage. The modified Stoke AS Spinal Score (mSASSS) is the most responsive outcome instrument for scoring damage in the spine although responsiveness is limited and requires a minimum of 2 years before significant change becomes apparent in patients on standard therapies. Magnetic resonance imaging (MRI) is the most sensitive imaging abnormality for the detection of inflammation and the advent of fat suppression imaging allows detection of bone marrow inflammation in the sacroiliac joints as one of the earliest abnormalities in AS. Spinal inflammation can now be reliably scored using MRI-based outcome instruments that are highly sensitive to change and this represents a major advance in the objective evaluation of new therapeutic interventions. Moreover, MRI now allows the detection of patients at an earlier stage of their disease course with the potential for new insights into the pathogenesis of disease. Ultrasound provides a more feasible and cost-effective approach to the assessment of peripheral inflammation, especially enthesitis.

Keywords

Ankylose Spondylitis Sacroiliac Joint Plain Radiography Inflammatory Back Pain Spinal Inflammation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Battistone MJ, Manaster BJ, Reda DJ et al. Radiographic diagnosis of sacroiliitis-are sacroiliac views really better? J Rheumatol 1998; 25:2395–401.PubMedGoogle Scholar
  2. 2.
    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
  3. 3.
    Mau W, Zeidler H, Mau R et al. Clinical features and prognosis of patients with possible ankylosing spondylitis: results of a 10-year follow-up. J Rheumatol 1988; 15:1109–14.PubMedGoogle Scholar
  4. 4.
    Van Tubergen A, Heuft-Dorenbosch L, Schulpen G et al. Radiographic assessment of sacroiliitis by radiologists and rheumatologists: does training improve quality? Ann Rheum Dis 2003; 62:519–25.PubMedCrossRefGoogle Scholar
  5. 5.
    Wanders AJ, Landewe RB, Spoorenberg A et al. What is the most appropriate radiologic scoring method for ankylosing spondylitis? A comparison of the available methods based on the outcome measures in rheumatology clinical trials filter. Arthritis Rheum 2004; 50:2622–32.PubMedCrossRefGoogle Scholar
  6. 6.
    Wanders A, Landewe R, Dougados M et al. Association between radiographic damage of the spine and spinal mobility for individual patients with ankylosing spondylitis: can assessment of spinal mobility be a proxy for radiographic evaluation. Ann Rheum Dis 2005; 64:988–94.PubMedCrossRefGoogle Scholar
  7. 7.
    MacKay K, Mack C, Brophy S et al. The bath ankylosing spondylitis radiology index (BASRI): a new, validated approach to disease assessment. Arthritis Rheum 1998; 41:2263–70.PubMedCrossRefGoogle Scholar
  8. 8.
    Averns HL, Oxtoby J, Taylor HG et al. Radiological outcome in ankylosing spondylitis: use of the stoke ankylosing spondylitis spine score (SASSS). Br J Rheumatol 1996; 35:373–6.PubMedCrossRefGoogle Scholar
  9. 9.
    Creemers MC, Franssen MJ, van’t Hof MA et al. Assessment of outcome in ankylosing spondylitis: an extended radiographic scoring system. Ann Rheum Dis 2005; 64:127–9.PubMedCrossRefGoogle Scholar
  10. 10.
    Spoorenberg A, de Vlam K, van der Linden S et al. Radiological scoring methods in ankylosing spondylitis. Reliability and change over 1 and 2 years. J Rheumatol 2004; 31:125–32.PubMedGoogle Scholar
  11. 11.
    Wanders A, Heijde D, Landewe R et al. Nonsteroidal antiinflammatory drugs reduce radiographic progression in patients with ankylosing spondylitis: a randomized clinical trial. Arthritis Rheum 2005; 52:1756–65.PubMedCrossRefGoogle Scholar
  12. 12.
    Maksymowych WP, Landewe R, Conner-Spady B et al. Serum matrix metalloproteinase 3 is an independent predictor of structural damage progression in patients with ankylosing spondylitis. Arthritis Rheum 2007; 56:1846–53.PubMedCrossRefGoogle Scholar
  13. 13.
    Powell A, Keeling SO, Lambert RGS et al. Scoring of radiographic progression over 2 years with the mSASSS in ankylosing spondylitis: does training improve reliability? Arthritis Rheum 2007; 56(9):S256.CrossRefGoogle Scholar
  14. 14.
    Baraliakos X, Listing J, Rudwaleit M et al. Progression of radiographic damage in patients with ankylosing spondylitis: defining the central role of syndesmophytes. Ann Rheum Dis 2007; 66:910–5.PubMedCrossRefGoogle Scholar
  15. 15.
    Battafarano DF, West SG, Rak KM et al. Comparison of bone scan, computed tomography and magnetic resonance imaging in the diagnosis of active sacroiliitis. Semin Arthritis Rheum 1993; 23:161–76.PubMedCrossRefGoogle Scholar
  16. 16.
    Geijer M, Sihlbom H, Göthlin JH et al. The role of CT in the diagnosis of sacroliitis. Acta Radiol 1998; 39:265–8.PubMedGoogle Scholar
  17. 17.
    Carrera GF, Foley WD, Kozin F et al. CT of sacroiliitis. AJR Am J Roentgenol 1981; 136:41–6.PubMedGoogle Scholar
  18. 18.
    Elgafy H, Semaan HB, Ebraheim NA et al. Computed tomography findings in patients with sacroiliac pain. Clin Orthop Relat Res 2001; 382:112–8.PubMedCrossRefGoogle Scholar
  19. 19.
    Geijer M, Gothlin GG, Gothlin JH. The clinical utility of computed tomography compared to conventional radiography in diagnosing sacroiliitis. A retrospective study on 910 patients and literature review. J Rheumatol 2007; 34:1561–5.PubMedGoogle Scholar
  20. 20.
    Puhakka KB, Jurik AG, Egund N et al. Imaging of sacroiliitis in early seronegative spondylarthropathy. Assessment of abnormalities by MR in comparison with radiography and CT. Acta Radiol 2003;44:218–29.PubMedCrossRefGoogle Scholar
  21. 21.
    Yu W, Feng F, Dion E et al. Comparison of radiography, computed tomography and magnetic resonance imaging in the detection of sacroiliitis accompanying ankylosing spondylitis. Skeletal Radiol 1998;27:311–20.PubMedCrossRefGoogle Scholar
  22. 22.
    Friedman L, Silberberg PJ, Rainbow A et al. A limited, low-dose computed tomography protocol to examine the sacroiliac joints. Can Assoc Radiol J 1993; 44:267–72.PubMedGoogle Scholar
  23. 23.
    Verlooy H, Mortelmans L, Vleugels S et al. Quantitative scintigraphy of the sacroiliac joints. Clin Imaging 1992; 16:230–3.PubMedCrossRefGoogle Scholar
  24. 24.
    Goei The HS, Lemmens AJ, Goedhard G et al. Radiological and scintigraphic findings in patients with a clinical history of chronic inflammatory back pain. Skeletal Radiol 1985; 14:243–8.PubMedCrossRefGoogle Scholar
  25. 25.
    Davis MC, Turner DA, Charters JR et al. Quantitative sacroiliac scintigraphy. The effect of method of selection of region of interest. Clin Nucl Med 1984; 9:334–40.PubMedCrossRefGoogle Scholar
  26. 26.
    Ayres J, Hilson AJ, Maisey MN et al. An improved method for sacro-iliac joint imaging: a study of normal subjects, patients with sacro-iliitis and patients with low back pain. Clin Radiol 1981; 32:441–5.PubMedCrossRefGoogle Scholar
  27. 27.
    Miron SD, Khan MA, Wiesen EJ et al. The value of quantitative sacroiliac scintigraphy in detection of sacroiliitis. Clin Rheumatol 1983; 2:407–14.PubMedCrossRefGoogle Scholar
  28. 28.
    Blum U, Buitrago Tellez C, Mundinger A et al. Magnetic resonance imaging (MRI) for detection of active sacroiliitis-a prospective study comparing conventional radiography, scintigraphy and contrast enhanced MRI. J Rheumatol 1996; 23:2107–15.PubMedGoogle Scholar
  29. 29.
    Song IH, Carrasco JA, Rudwaleit M et al. The diagnostic value of scintigraphy in ankylosing spondylitis and patients with clinically probable sacroiliitis-a systematic literature search. Arthritis Rheum 2007; 56(Suppl):S475.CrossRefGoogle Scholar
  30. 30.
    Lin WY, Wang SJ, Lang JL et al. Bone scintigraphy in evaluation of heel pain in Reiter’s disease: compared with radiography and clinical examination. Scand J Rheumatol 1995; 24:18–21.PubMedCrossRefGoogle Scholar
  31. 31.
    Olivieri I, Barozzi L, Padula A. Enthesiopathy: clinical manifestations, imaging and treatment. Baillieres Clin Rheumatol 1998; 12:665–81.PubMedCrossRefGoogle Scholar
  32. 32.
    Balint PV, Kane D, Wilson H et al. Ultrasonography of entheseal insertions in the lower limb in spondyloarthropathy. Ann Rheum Dis 2002; 61:905–10.PubMedCrossRefGoogle Scholar
  33. 33.
    Kamel M, Eid H, Mansour R. Ultrasound detection of heel enthesitis: a comparison with magnetic resonance imaging. J Rheumatol 2003; 30:774–8.PubMedGoogle Scholar
  34. 34.
    D’Agostino MA, Said-Nahal R, Hacquard-Bouder C et al. Assessment of peripheral enthesitis in the spondylarthropathies by ultrasonography combined with power doppler: a cross-sectional study. Arthritis Rheum 2003; 48:523–33.PubMedCrossRefGoogle Scholar
  35. 35.
    Alcalde M, Acebes JC, Cruz M et al. A sonographic enthesitic index of lower limbs is a valuable tool in the assessment of ankylosing spondylitis. Ann Rheum Dis 2007; 66:1015–9.PubMedCrossRefGoogle Scholar
  36. 36.
    Kamel M, Eid H, Mansour R. Ultrasound detection of knee patellar enthesitis: a comparison with magnetic resonance imaging. Ann Rheum Dis 2004; 63:213–14.PubMedCrossRefGoogle Scholar
  37. 37.
    Kamel M, Eid H, Mansour R. Ultrasound detection of heel enthesitis: a comparison with magnetic resonance imaging. J Rheumatol 2003; 30:774–8.PubMedGoogle Scholar
  38. 38.
    Olivieri I, Barozzi L, Padula A et al. Retrocalcaneal bursitis in spondyloarthropathy: assessment by ultrasonography and magnetic resonance imaging. J Rheumatol 1998; 25:1352–7.PubMedGoogle Scholar
  39. 39.
    Ünlu E, Pamuk ON, Çakir 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; 34:110–6.PubMedGoogle Scholar
  40. 40.
    Klauser A, Halpern EJ, Frauscher F et al. Inflammatory low back pain: high negative predictive value of contrast-enhanced color doppler ultrasound in the detection of inflamed sacroiliac joints. Arthritis Care Res 2005; 53:440–4.CrossRefGoogle Scholar
  41. 41.
    Muche B, Bollow M, Francois RJ et al. Ariatomic structures involved in early-and late-stage sacroiliitis in spondyloarthritis. Arthritis Rheum 2003; 48:1374–84.PubMedCrossRefGoogle Scholar
  42. 42.
    Puhakka KB, Jurik AG, Schiottz-Christensen B et al. Magnetic resonance imaging of sacroiliitis in early seronegative spondylarthropathy. Abnormalities correlated to clinical and laboratory findings. Rheumatol 2004; 43:234–7.CrossRefGoogle Scholar
  43. 43.
    Ahlstrom H, Feltelius N, Nyman R et al. Magnetic resonance imaging of sacroiliac joint inflammation. Arthritis Rheum 1990; 33:1763–1769.PubMedCrossRefGoogle Scholar
  44. 44.
    Braun J, Bollow M, Eggens U et al. Use of dynamic magnetic resonance imaging with fast imaging in the detection of early and advanced sacroiliitis in spondyloarthropathy patients. Arthritis Rheum 1994; 37:1039–45.PubMedCrossRefGoogle Scholar
  45. 45.
    Braun J, Bollow M, Seyrekbasan F et al. Computed tomography guided corticosteroid injection of the sacroiliac joint in patients with spondyloarthropathy with sacroiliitis: Clinical outcome and followup by dynamic magnetic resonance imaging. J Rheumatol 1996; 23:659–664.PubMedGoogle Scholar
  46. 46.
    Bollow M, Fischer T, Reisshauer H et al. Quantitative analyses of sacroiliac biopsies in spondylarthropathies: T-cells and macrophages predominate in early and active sacroiliitis—cellularity correlates with the degree of enhancement detected by magnetic resonance imaging. Ann Rheum Dis 2000; 59:135–40.PubMedCrossRefGoogle Scholar
  47. 47.
    Bollow M, Biedermann T, Kannenberg J et al. Use of dynamic magnetic resonance imaging to detect sacroiliitis in HLA-B27 positive and negative children with juvenile arthritides. J Rheumatol 1998; 25:556–64.PubMedGoogle Scholar
  48. 48.
    Bollow M, Braun J, Hamm B et al. Early sacroiliitis in patients with spondyloarthropathy: evaluation with dynamic gadolinium-enhanced MR imaging. Radiology 1995; 194:529–36.PubMedGoogle Scholar
  49. 49.
    Heuft-Dorenbosch L, Landewe R, Weijers R et al. Combining information obtained from magnetic resonance imaging and conventional radiographs to detect sacroiliitis in patients with recent onset inflammatory back pain. Ann Rheum Dis 2006; 65:804–8.PubMedCrossRefGoogle Scholar
  50. 50.
    Oostveen J, Prevo R, den Boer J et al. Early detection of sacroiliitis on magnetic resonance imaging and subsequent development of sacroiliitis on plain radiography. A prospective, longitudinal study. J Rheumatol 1999; 26:1953–8.PubMedGoogle Scholar
  51. 51.
    van der Heijde DM, Landewe RB, Hermann KG et al. Application of the OMERACT filter to scoring methods for magnetic resonance imaging of the sacroiliac joints and the spine. Recommendations for a research agenda at OMERACT 7. J Rheumatol 2005; 32:2042–7.PubMedGoogle Scholar
  52. 52.
    Maksymowych WP, Inman RD, Salonen D et al. Spondyloarthritis research consortium of canada magnetic resonance imaging index for assessment of sacroiliac joint inflammation in ankylosing spondylitis. Arthritis Rheum 2005; 53:703–9.PubMedCrossRefGoogle Scholar
  53. 53.
    Landewe RB, Hermann KG, van der Heijde DM et al. Scoring sacroiliac joints by magnetic resonance imaging. A multiple-reader reliability experiment. J Rheumatol 2005; 32:2050–5.PubMedGoogle Scholar
  54. 54.
    Lambert RGW, Salonen D, Rahman P et al. Adalimumab significantly reduces both spinal and sacroiliac joint inflammation in patients with ankylosing spondylitis. Arthritis Rheum 2007; 56:4005–14.PubMedCrossRefGoogle Scholar
  55. 55.
    Crowther SM, Lambert RGW, Dhillon SS et al. High frequency of inflmmatory lesions in the posterior structures of the spine in patients with ankylosing spondylitis (AS): A systematic evaluation by MRI. Arthritis Rheum 2006; 54(Suppl 9):S793.Google Scholar
  56. 56.
    Braun J, Baraliakos X, Golder W et al. Magnetic resonance imaging examinations of the spine in patients with ankylosing spondylitis, before and after successful therapy with infliximab: evaluation of a new scoring system. Arthritis Rheum 2003; 48:1126–36.PubMedCrossRefGoogle Scholar
  57. 57.
    Maksymowych WP, Dhillon SS, Park R et al. Validation of the spondyloarthritis research consortium of canada (SPARCC) MRI spinal inflammation index: Is it necessary to score the entire spine? Arthritis Rheum 2007; 57(3):501–07.PubMedCrossRefGoogle Scholar
  58. 58.
    Appel H, Loddenkemper C, Grozdanovic Z et al. Correlation of histopathological findings and magnetic resonance imaging in the spine of patients with ankylosing spondylitis. Arthritis Res and Ther 2006;8R143.Google Scholar
  59. 59.
    Baraliakos X, Landewe R, Hermann KG et al. Inflammation in ankylosing spondylitis: a systematic description of the extent and frequency of acute spinal changes using magnetic resonance imaging. Ann Rheum Dis 2005; 64:730–4.PubMedCrossRefGoogle Scholar
  60. 60.
    Braun J, Landewe R, Hermann KGA et al. Major reduction in spinal inflammation in patients with ankylosing spondylitis after treatment with infliximab. Arthritis Rheum 2006; 54:1646–1652.PubMedCrossRefGoogle Scholar
  61. 61.
    Baraliakos X, Davis J, Tsuji W et al. Magnetic resonance imaging examinations of the spine in patients with ankylosing spondylitis before and after therapy with the tumor necrosis factor alpha receptor fusion protein etanercept. Arthritis Rheum 2005; 52:1216–1223.PubMedCrossRefGoogle Scholar
  62. 62.
    Maksymowych WP, Inman RD, Salonen D et al. Spondyloarthritis research consortium of canada magnetic resonance imaging index for assessment of spinal inflammation in ankylosing spondylitis. Arthritis Rheum 2005; 53:502–9.PubMedCrossRefGoogle Scholar
  63. 63.
    Maksymowych WP, Salonen D, Inman RD et al. Canadian evaluation of low dosE infliximab in ankylosing spondylitis (CANDLE)-12 week magnetic resonance imaging evaluation of spinal inflammation with the SPARCC MRI method. Arthritis Rheum 2007; 56:S473.CrossRefGoogle Scholar
  64. 64.
    Lukas C, Braun J, van der Heijde D et al. ASAS/OMERACT MRI in AS Working Group. Scoring inflammatory activity of the spine by magnetic resonance imaging in ankylosing spondylitis: a multireader experiment. J Rheumatol 2007; 34:862–70.PubMedGoogle Scholar
  65. 65.
    van der Heijde D, Landewe R, Hermann KG et al. ASAS/OMERACT MRI in AS working group. Is there a preferred method for scoring activity of the spine by magnetic resonance imaging in ankylosing spondylitis? J Rheumatol 2007; 34:871–3.PubMedGoogle Scholar
  66. 66.
    Baraliakos X, Hermann KG, Landewe R et al. Assessment of acute spinal inflammation in patients with ankylosing spondylitis by magnetic resonance imaging: a comparison between contrast enhanced T1 and short tau inversion recovery (STIR) sequences. Ann Rheum Dis 2005; 64:1141–4.PubMedCrossRefGoogle Scholar
  67. 67.
    Braun J, Baraliakos X, Golder W et al. Analysing chronic spinal changes in ankylosing spondylitis: a systematic comparison of conventinal x rays with magnetic resonance imaging using established and new scoring systems. Ann Rheum Dis 2004; 63:1046–55.PubMedCrossRefGoogle Scholar
  68. 68.
    Lambert RG, Dhillon SS, Jhangri GS et al. High prevalence of symptomatic enthesopathy of the shoulder in ankylosing spondylitis: deltoid origin involvement constitutes a hallmark of disease. Arthritis Rheum 2004; 51:681–90.PubMedCrossRefGoogle Scholar
  69. 69.
    McGonagle D, Gibbon W, O’Connor P et al. Characteristic magnetic resonance imaging entheseal changes of knee synovitis in spondylarthropathy. Arthritis Rheum 1998; 41:694–700.PubMedCrossRefGoogle Scholar
  70. 70.
    McGonagle D, Marzo-Ortega H, O’Connor P et al. The role of biomechanical factors and HLA-B27 in magnetic resonance imaging determined bone changes in plantar fascia enthesopathy. Arthritis Rheum 2002; 46:489–93.PubMedCrossRefGoogle Scholar
  71. 71.
    Burgos-Vargas R, Pacheco-Tena C, Vazquez-Mellado J. A short-term follow-up of enthesitis and arthritis in the active phase of juvenile onset spondyloarthropathies. Clin Exp Rheumatol 2002; 20:727–31.PubMedGoogle Scholar

Copyright information

© Landes Bioscience and Springer Science+Business Media 2009

Authors and Affiliations

  • Walter P. Maksymowych
    • 1
  1. 1.Alberta Heritage Foundation for Medical ResearchUniversity of AlbertaEdmontonCanada

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