Quantitative sacroiliac joint scintigraphy in normal subjects and patients with sacroiliitis

Kaçar, Gülizar; Kaçar, Cahit; Karayalçın, Binnur; Güngör, Fırat; Tuncer, Tiraje; Erkılıç, Metin

doi:10.1007/bf03164785

Cited by 17 publications

(11 citation statements)

References 11 publications

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“…Combination of Tc-99m methylene diphosphonate (MDP) bone scintigraphy and Tc-99m nanocolloid bone marrow scintigraphy has showed that Tc-99m nanocolloid scintigraphy can diagnose acute inflammatory sacroiliitis ( 1 ). It has been demonstrated that the addition of quantitative methods (comparing the sacroiliac joint activity with background activity like sacrum) to bone scintigraphy has revealed increase in the sensitivity and has pointed the results in agreement with clinical findings ( 2 ).…”

Section: Introductionmentioning

confidence: 80%

“…Quantitative methods have been utilized in order to increase diagnostic power of scintigraphy ( 2 , 24 , 25 ). Recently SPECT/CT analysis has been performed by Cusi et al in order to investigate patients with peri-partum pain for >2 years and revealed 95% sensitivity and 99% specificity ( 26 ).…”

Section: Discussionmentioning

confidence: 99%

“…Recently SPECT/CT analysis has been performed by Cusi et al in order to investigate patients with peri-partum pain for >2 years and revealed 95% sensitivity and 99% specificity ( 26 ). The most important point in evaluation of index values are firstly every laboratory must has own index values and secondly age and sex factors should be considered during the evaluation ( 2 ). Zaferiakis et al have observed differences between different age groups in a homogenous group of young male population ( 27 ).…”

Section: Discussionmentioning

confidence: 99%

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Sacroiliac Indicis Increase the Specificity of Bone Scintigraphy in the Diagnosis of Sacroiliitis

Koç¹,

Cengiz²,

Aydın³

et al. 2015

Mirt

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Objective: Bone scintigraphy is a highly sensitive method in the evaluation of sacroiliitis. Aim of this study is firstly to evaluate interobserver variation of partial and whole sacroiliac indicis, secondly investigation of clinical importance of these indicis in the diagnosis of sacroiliitis. Methods: Fourty-six subjects (24 female: 35.4±11.9; 22 male: 43.1±12.4) without sacroiliitis 45 subjects with low back pain (33 female: 43.3±11.5, 11 male: 35.5±17.2) were included in the study. For right (R) and left (L) whole indices (WSI) irregular region of interest (ROI), for partial indices superior (S) and inferior (I) rectangular ROI were used. For background activity, rectangular ROI was drawn from the sacral region. Indices were calculated from ratio of average counts of sacroiliac and background regions. Two independent observers calculated sacroiliac indices. Interobserver agreement was evaluated by Pearson analysis. Results: There was no significant interobserver difference (p>0.05). Significant correlation existed between all calculated indices. Among 45 patients with suspicion of sacroiliitis 15 had final diagnosis of sacroiliitis and all of the Tc-99m methilenediphosphonate planar and SPECT bone scintigraphy results of these patients were concordant with sacroiliitis. There were 8 false positive results in other 30 patients. Seven of these eight patients had normal index values. If the scintigraphy would be evaluated in conjuction with indicis the specificity would increase from 73% to 97% but sensitivity decreases from 100% to 80%. There was significant correlation between the observers calculated indicis (p<0.001).Conclusion: Superior and inferior sacroiliac index values can be used with confidence. If we use sacroiliac index values to confirm positive results; index values can increase the specificity of bone scintigraphy.

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Section: Introductionmentioning

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Sacroiliac Indicis Increase the Specificity of Bone Scintigraphy in the Diagnosis of Sacroiliitis

Koç¹,

Cengiz²,

Aydın³

et al. 2015

Mirt

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“…There are difficulties in attributing scintigraphic abnormalities to SI joint disease in some horses because of a degree of overlap in quantitative ROI data between these and both normal horses and those lame due to an unrelated cause. There is also controversy about the usefulness of nuclear scintigraphy for the identification of pathological abnormalities of the SI joint in man (Miron et al 1983;Vesterskold et al 1994;Slipman et al 1996;Kacar et al 1998;Braun et al 2000). Various age-and sexrelated changes have been described, but there is lack of consensus.…”

Section: Discussionmentioning

confidence: 99%

The sacroiliac joints: evaluation using nuclear scintigraphy. Part 2: Lame horses

Dyson

Murray

Branch

et al. 2003

Equine Veterinary Journal

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Summary Reasons for performing study: Sacroiliac (SI) joint disease is difficult to diagnose definitively on clinical grounds. Hypotheses: Lameness not attributable to SI joint pain may result in asymmetrical uptake of radiopharmaceutical in the tubera sacrale and SI joints; and that horses with clinical signs suggestive of sacroiliac joint disease would have differences in the ratios of radiopharmaceutical uptake between the fifth lumbarvertebra (L5) and either the tubera sacrale or SI joints compared with normal horses. Objectives: To determine whether differences in radiopharmaceutical activity could identify individuals with presumed SI joint region pain. Methods: The scintigraphic appearance of the pelvic region of 234 horses (Group I) with lameness unrelated to the SI joints was compared with that for 40 normal horses (Group N) in full work and that for 41 horses with suspected SI joint disease (Group II). The effect of age, sex, lame limb and discipline were assessed in Group I. Motion‐corrected scintigraphic images were assessed grossly, using profile analysis and by comparing ratios of uptake of mean count per pixel between L5 and each of the left (L) tuber sacrale (TS), right (R) TS, LSI and RSI joints. Left‐right symmetry was compared. Results: Lame horses (Group I) had greater asymmetry of radiopharmaceutical uptake in the tubera sacrale compared with normal horses. Horses with right hindlimb lameness had a larger RSI/LSI ratio compared to normal horses. In Group I L5/LTS, L5/RTS and L5/RSI increased with age, and there was a trend for L5/LSI to increase with age. In horses with presumed sacroiliac joint disease (Group II), L5/LTS, L5/RTS and L5/RSI were all greater compared with normal horses. Detection of marked left‐right asymmetry by quantitative analysis or profile analysis was helpful in discriminating between those horses with clinical signs compatible with SI joint disease and either normal horses or those lame due to another cause. Conclusions and potential relevance: Scintigraphic evaluation of the SI region is useful to identify SI joint disease in combination with other clinical signs supportive of the diagnosis. However, diagnosis should not be based on this alone because of some degree of overlap in the range of radiopharmaceutical uptake between horses with SI joint disease and both normal horses and those with other causes of lameness.

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“…Previous studies in the nuclear medicine field had some drawbacks in quantifying the SIS ratio due to overlapping of the adjacent structures without a definite demarcation of the bony structure [ 8 ]. Some papers have insisted the usefulness of early detection of AS by bone scintigraphy [ 31 , 32 ] or SPECT alone [ 33 ]; however, their conclusions are not commonly accepted, and shows limited value for diagnosing probable or suspected AS as well as established AS [ 8 ]. SPECT offers more information than planar imaging of the SI joint; however, accurate delineation of the SI joint or sacrum is nearly impossible.…”

Section: Discussionmentioning

confidence: 99%

The usefulness of bone SPECT/CT imaging with volume of interest analysis in early axial spondyloarthritis

Kim

Suh

Kim

et al. 2015

BMC Musculoskelet Disord

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BackgroundThe role of conventional bone scintigraphy in diagnosing early axial spondyloarthritis (SpA) is yet controversial. Single positron emission computed tomography (SPECT) plus CT is an imaging modality that adds better anatomical information to scintigraphy of the sacroiliac (SI) joint. Our aim was to investigate the usefulness of bone SPECT/CT with volume of interest (VOI) analysis in early axial SpA patients.MethodsTwenty patients (male: female ratio = 12:8; age range = 17–65 years) presenting with inflammatory back pain meeting the Amor criteria of early axial SpA were recruited from a single center in South Korea. Bone scintigraphy was performed 180 min after intravenous injection of 1110 MBq of Tc-99 m-HDP, followed by bone SPECT/CT. The ratio between the entire SI joint and sacrum (SIS ratio) was measured by both bone SPECT/CT and bone scintigraphy. Data from 13 controls were also evaluated. Receiver operating characteristic (ROC) curve was plotted for further analysis, and the correlation between the SIS ratio and SI joint grade by plain radiography was assessed.ResultsThe SIS ratio of early axial SpA patients vs. control subjects was significantly increased in bone SPECT/CT (p < 0.001). However, no significant difference was detected in bone scintigraphy. ROC curve analysis showed a significant difference in the area under curve (AUC) of bone SPECT/CT vs. bone scintigraphy (0.862 vs. 0.523, respectively; p < 0.001). With a cut-off SIS ratio of 1.50, ROC curve analysis showed a sensitivity of 80.0% and specificity of 84.6% in bone SPECT/CT. The SIS ratio measured in SPECT/CT, but not that measured in bone scintigraphy, was significantly increased with a higher grade of SI joint changes in plain radiography (p = 0.014).ConclusionBone SPECT/CT is more useful than conventional bone scintigraphy in identifying sacroiliitis in early axial SpA patients, even with mild SI joint changes in plain radiography. By combining CT, we can accurately delineate the sacrum and SI joint uptake with our VOI method.

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Quantitative sacroiliac joint scintigraphy in normal subjects and patients with sacroiliitis

Cited by 17 publications

References 11 publications

Sacroiliac Indicis Increase the Specificity of Bone Scintigraphy in the Diagnosis of Sacroiliitis

Sacroiliac Indicis Increase the Specificity of Bone Scintigraphy in the Diagnosis of Sacroiliitis

The sacroiliac joints: evaluation using nuclear scintigraphy. Part 2: Lame horses

The usefulness of bone SPECT/CT imaging with volume of interest analysis in early axial spondyloarthritis

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