Unilateral Sacroiliitis: Differential Diagnosis Between Infectious Sacroiliitis and Spondyloarthritis Based on MRI Findings

Kang, Yusuhn; Hong, Sung Hwan; Kim, Ji Young; Yoo, Hye Jin; Choi, Ja Young; Yi, Minkyung; Kang, Heung Sik

doi:10.2214/ajr.14.14217

Cited by 41 publications

(37 citation statements)

References 27 publications

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“…When bone marrow edema categories were compared statistically according to inflammatory and infective sacroiliitis, it was found to be statistically significant. On comparison our study is concordance with that of Yushuhn et al 16 which also showed the distribution of bone marrow edema showing statistically significant difference between infectious and spondyloarthritis (p < 0.001). Capsulitis was present in 6(11.5%) and 24(46.1%) subjects of inflammatory and infective sacroiliitis respectively with statistically significant difference (p< 0.01).…”

Section: Discussionsupporting

confidence: 92%

“…25 Also several trials have shown that MRI is not only capable of finding structural lesions, but they can also detect active inflammatory lesions, unlike X-Ray which can only detect structural lesions. 26 The data adds to the hypothesis that inflammation is the first event, and structural change is a subsequent feature. Depending on the lag time between inflammation and structural changes, a diagnosis of sacroiliitis could be made significantly earlier by using MRI changes of inflammation as an early sign of disease.…”

Section: Discussionmentioning

confidence: 89%

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Radiological Spectrum of Active Sacroiliitis by Conventional Radiography and MRI

Kaushik¹,

Mital²,

Thukral³

et al. 2020

Nep J Radiology

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Introduction: The aim of the present study was to compare the role of Conventional Radiography and Magnetic Resonance Imaging (MRI), in diagnosis of active sacroiliitis and differentiation between inflammatory and infective sacroiliitis.Methods: Fifty two cases of active sacroiliitis diagnosed on MRI from August 2017 to August 2019 were included in study. All the patients were subjected to conventional radiology, MRI and findings were co-related with clinical and laboratory findings. Conventional radiography was used to evaluate structural changes. MR images were evaluated for bone lesions (extent and distribution of bone marrow edema and presence of bone erosions), soft-tissue lesions (capsulitis, extra capsular fluid collections, and peri-articular muscle edema) and joint space reduction for differentiation between infective and inflammatory etiology.Results: Conventional radiography showed sclerosis, erosion, partial and complete ankylosis. Thick capsulitis, extra capsular fluid collection, and peri-articular muscle edema were all more frequently observed in infective sacroiliitis (p<0.001). Iliac-dominant bone marrow edema more common in spondyloarthritis (p<0.001). When periarticular muscle edema was the sole predictor, unilateral sacroiliitis in spondyloarthritis was correctly identified in 79.16% of cases, and infectious sacroiliitis was correctly identified in 82.14% of cases.Conclusions: MRI is the optimum imaging modality to diagnose active sacroiliitis. MRI plays an essential role in better demonstrating early alterations and inflammatory activity and aid in differentiation of infective and inflammatory sacroiliitis. Conventional radiography with low sensitivity can be used as a screening tool and follow-up of patients with sacroiliitis.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 89%

Radiological Spectrum of Active Sacroiliitis by Conventional Radiography and MRI

Kaushik¹,

Mital²,

Thukral³

et al. 2020

Nep J Radiology

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show abstract

“…The severity of sacroiliitis at baseline regardless of HLA-B27 status has been shown to be a predictor of poor prognosis for radiographic progression, but little is known specifically for acute ReA 7 . When managing such cases, it is essential not to overlook infectious sacroiliitis typified on MRI by periarticular muscle edema, although the cases presented here also demonstrate that inflammatory disease can mimic such appearances 8 . Interestingly and although within the spectrum of SpA, our cases could not be classified according to the Assessment of Spondyloarthritis international Society classification criteria given the acute onset of symptoms of < 3 months' duration 9,10 .…”

Section: Rheumatologymentioning

confidence: 79%

Acute Unilateral Sacroiliitis Mimicking Infection on Magnetic Resonance Imaging with Response to Nonsteroidal Antiinflammatory Drugs: A Distinct Presentation of Spondyloarthritis?

et al. 2018

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“…The association between ankylosing spondylitis and sacroiliitis is well known (23). Kang reported that MRI findings of iliac-dominant bone marrow edema, absent capsulitis, absent extracapsular fluid collection, and absent periarticular muscle edema indicate spondyloarthritis rather than infectious sacroiliitis (24). In the present case, MRI showed localized unilateral high density in the bone marrow before steroid therapy (Fig.…”

Section: Discussionmentioning

confidence: 99%

Tubulointerstitial Nephritis Associated with Enteritis and Sacroiliitis

et al. 2019

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The association between sacroiliitis and tubulointerstitial nephritis has not been reported. A 28-year-old man with a history of clinically diagnosed ulcerative colitis (4 years earlier) and sacroiliitis (6 months earlier) developed renal dysfunction 9 months ago, which progressed thereafter. We diagnosed him with tubulointerstitial nephritis by a renal biopsy, for which we started steroid therapy. Subsequently, his renal dysfunction, sacroiliitis, and enteritis partially improved. A pathological analysis of the kidney and intestine revealed lymphocyte infiltration and non-caseating granuloma in both organs. The similarities in the pathological findings and treatment response suggested a pathogenetic association between tubulointerstitial nephritis, enteritis, and sacroiliitis.

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Unilateral Sacroiliitis: Differential Diagnosis Between Infectious Sacroiliitis and Spondyloarthritis Based on MRI Findings

Cited by 41 publications

References 27 publications

Radiological Spectrum of Active Sacroiliitis by Conventional Radiography and MRI

Radiological Spectrum of Active Sacroiliitis by Conventional Radiography and MRI

Acute Unilateral Sacroiliitis Mimicking Infection on Magnetic Resonance Imaging with Response to Nonsteroidal Antiinflammatory Drugs: A Distinct Presentation of Spondyloarthritis?

Tubulointerstitial Nephritis Associated with Enteritis and Sacroiliitis

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