Sacroiliitis detected by bone scintiscanning: a clinical, radiological, and scintigraphic follow-up study.

Abstract

SUMMARY Twenty-four patients had abnormal sacroiliac joints detected by quantitative sacroiliac scintigraphy but no radiological evidence of sacroiliitis on original investigation. We studied them again after intervals of 12 to 36 months. Four patients developed radiological change. Two young, HLA B27-positive men had undoubted ankylosing spondylitis, and a young woman had possible ankylosing spondylitis. A middle-aged man had changes that could be attributed to post-traumatic osteoarthrosis. Of the remaining 20 cases 15 had symptoms and signs suggestive of inflammatory disease of the axial skeleton (and peripheral arthropathy in 5 cases). The sexes were affected equally (8 females, 7 males), and only 2 of the 15 were B27-positive. The response to anti-inflammatory medication was generally good to excellent, and scintiscans tended to improve. Of the remaining 5 patients, 3 had mechanical or traumatic problems, and in 2 there was no explanation for the abnormal sacroiliac scintiscan. We conclude that quantitative sacroiliac scintigraphy may detect ankylosing spondylitis prior to the development of radiological change and that it can identify an organic basis for backache in patients with a spondylitis-like syndrome. The clinical circumstances must be taken into account, as scintigraphic abnormalities are not diagnostic of any specific disease entity.Bone scanning with 99mtechnetium-labelled stannous pyrophosphate is a sensitive means of detecting disease of the axial skeleton (Lentle et al., 1976). The technique is particularly applicable to the sacroiliac joints, where the uptake of radiotracer can be accurately quantitated in relation to the uptake by the central sacrum (Lentle et al., 1977a;Namey et al., 1977 tool for the early diagnosis of ankylosing spondylitis and similar conditions. To test this postulate we have followed up a number of patients with scintigraphic sacroiliitis and radiologically normal sacroiliac joints, and we report our findings in this paper. Patients and methodsOur cases were selected from a series of 172 patients seen prior to 1976 who had abnormal sacroiliac joints on bone scanning. We excluded all those with radiological abnormalities and all who had a diagnosis of psoriatic spondylitis or Reiter's syndrome and were left with 37 names. From these we traced 27 patients who were willing to participate in the project. Three were found on review not to fulfil the criteria for inclusion: 2 had scintiscans that were probably normal for the patients' degree of skeletal immaturity, and 1 had radiological abnormalities evident on the original films.The final study population of 24

The diagnostic value of scintigraphy in assessing sacroiliitis in ankylosing spondylitis: a systematic literature research

“…Early reports in the 1970s about the diagnostic role of scintigraphy to detect sacroiliitis were promising;21 – 24 however, subsequent studies have suggested that clear separation of active AS from controls is difficult 25 – 32. Thus, data about the diagnostic value of scintigraphy to detect acute inflammatory changes in the sacroiliac joint (SIJ) for the diagnosis of non-radiographic axial spondyloarthritis (early forms of axial spondyloarthritis) and radiographic axial spondyloarthritis (AS) are conflicting.…”

Prospective evaluation of sacroiliac scintigraphy in chronic inflammatory back pain

“…Our quantitative scintigraphy results are in conflict with those reports demonstrating an excellent separation of patients with early ankylosing spondylitis from normal controls (14,16) as well as with those that failed to show any difference in SIJ/S values between these two populations (22,23,25). It is possible that these latter negative studies included a large number of patients receiving antiinflammatory medications, since this was not specifically stated and we found a significant influence of such drugs on SIJ/S as has been reported by others (16,24,33). Our results tend to confirm the results of others who found that from 20-57% of patients considered to have early spondylitis or sacroiliitis had normal SIJ/ S ratios (13,15,17,19,21,26).…”

Radionuclide bone scanning in females with chronic low back pain.

“…'-3 Caution in the interpretation of scintiscan data has been emphasised.10 11 We feel that those disorders, apart from sacroiliac disease, found by Ho et al to yield a positive scintiscan result (namely, rheumatoid arthritis, degenerative disease of the lumbrosacral spine, and metabolic bone disease) have been excluded in our patients with positive QSS results. The progression ofradiographs from normal to abnormal in patients whose scans were the only initial objective abnormality and the return to normal of scan activity following anti-inflammatory treatment in some patients suggests that abnormal scans may reflect sacroiliac inflammation.2 6 Our results indicate that sacroiliac disease is a frequent cause of organic low back pain in women. In searching for possible associations with abnormal scintigraphy we found that clinical evidence of a sacroiliac disorder did not necessarily parallel Ecan evidence of inflammation.…”