Addition of CT to Improve the Diagnostic Confidence for the Detection of Sacroiliac Joint Erosions in Patients with Equivocal MRI Findings

Nadeem, Irfan Ahmed; Munir, Sohaib; Leung, Vincent; Stubbs, Euan

doi:10.1177/08465371211056552

Cited by 1 publication

(4 citation statements)

References 23 publications

(68 reference statements)

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“…However, because radiographic changes occur in the later stages of AS, the classification based on the NY criteria is not used to determine the early stages of the disease [ 2 ]. The early stages of the disease include SIJ and spinal inflammation, which is not present on radiographs, while the late stages of the disease include inflammatory and structural changes, which can be seen on radiographs [ 8 ]. Although conventional radiography is the imaging technique of choice for diagnosing SpAs, the oblique and curved contour of the SIJ makes conventional radiography difficult when detecting anatomic changes such as erosions, sclerosis, bony bridges, and ankylosis [ 9 ].…”

Section: Reviewmentioning

confidence: 99%

“…The study conducted by Nadeem et al consisted of patients over the age of 18 at a tertiary care center who had an SIJ MRI and then an SIJ CT completed within 12 months, with 14 weeks between the CT and MRI. The results concluded that SIJ CT has greater diagnostic confidence in relation to SIJ MRI [ 8 ]. Further, of the patients that had equivocal findings on MRI, 73.2% had a definitive diagnosis on CT, which demonstrates the increased confidence in detecting the presence of erosions on CTs [ 8 ].…”

Section: Reviewmentioning

confidence: 99%

“…The results concluded that SIJ CT has greater diagnostic confidence in relation to SIJ MRI [ 8 ]. Further, of the patients that had equivocal findings on MRI, 73.2% had a definitive diagnosis on CT, which demonstrates the increased confidence in detecting the presence of erosions on CTs [ 8 ]. Dual-energy CT in particular has the ability to visualize inflammation and structural changes as well as edema and subchondral bone marrow better than MRI, which can be used to evaluate the initial stages of SpA [ 8 ].…”

Section: Reviewmentioning

confidence: 99%

“…In this study, disease activity could not fully be confirmed because there was an absence of pathological tissue to evaluate, which affected the results. The study conducted by Nadeem et al determined if CT could improve the diagnosis of SIJ erosions when patients had equivocal MRI findings [ 8 ]. In this study, the patients were rheumatology-referred patients, so the findings may not be accurate in routinely referred patients.…”

Section: Reviewmentioning

confidence: 99%

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Use of Multimodality Imaging in the Evaluation of Patients With Spondyloarthropathies and Sacroiliitis

Basra,

Patel,

Sobczak

et al. 2024

Cureus

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Spondyloarthropathy (SpA) is one of the most common causes of low back pain. It is caused by inflammatory arthritis in the spine, manifesting in various forms such as psoriatic arthritis (PsA), ankylosing spondylitis (AS), and sacroiliitis. A comprehensive systematic literature search was done to evaluate and compare MRI, CT, single-photon emission CT, PET, ultrasound (US) imaging, low-dose CT, and diffusion-weighted imaging (DWI) techniques in assessing SpAs. The search strategy was constructed by an analysis of key terms from relevant articles in MEDLINE ProQuest, Embase, and PubMed. The key terms used to search for these articles were “SpA,” “sacroiliitis,” “spondylitis,” “psoriatic arthritis,” “MRI,” “CT scan,” “x-ray,” “magnetic resonance imaging,” “computed tomography,” “bone density,” and “ultrasound.” A total of 1,131 articles published in English between January 1, 2003, and October 15, 2023 were identified and screened for eligibility by members of the research team, which resulted in 69 total articles selected for the final review. US has played an important role in visualizing joint inflammation and enthesitis (inflammation of the enthesis), which are common features of PsA. Although MRI and CT are considered more reliable modalities for diagnosing active sacroiliitis, US imaging with Doppler flow can also be useful in conjunction with CT images to visualize abnormal blood flow in the sacroiliac joints, as well as other joints affected by inflammatory arthritis. MRI provides increased diagnostic confidence in the diagnosis of sacroiliitis in active AS patients when compared to CT. CT is more sensitive than plain radiographs. The PET activity score showed a good correlation in diagnosing inflammatory sacroiliitis but lacked in identifying structural lesions. CT has high diagnostic accuracy, but it exposes patients to a high radiation dose. MRI visualizes joint and tissue inflammation, bone, and bone marrow change and can identify peripheral inflammation in soft tissue and joints in patients diagnosed with PsA. MRI can also visualize bone marrow changes and subchondral edema, which can aid in the early diagnosis of ankylosing SpA and gauge disease severity. DWI and short-tau inversion recovery imaging are both MRI techniques used in detecting sacroiliitis. MRI and CT are shown to be reliable imaging modalities for the diagnosis of sacroiliitis; however, it was found that Doppler US played an accurate role in the diagnosis as well. MRI visualizes joints and tissue with the most precision, making it useful in evaluating patients with PsA, while PET CT is useful in the diagnosis of inflammatory sacroiliitis patients. There is limited literature available comparing the multiple modalities of imaging available for each SpA. The review’s objective is to analyze imaging findings in patients diagnosed with sacroiliitis and SpAs. The findings in this literature review are valuable for properly assessing and diagnosing patients suffering from SpAs.

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Section: Reviewmentioning

confidence: 99%

Section: Reviewmentioning

confidence: 99%