ABSTRACT
OBJECTIVE: We aimed to assess: 1. The frequency of axial spondyloarthritis (axSpA) according to extra-articular presentation and HLA-B27 status; 2. Clinical and imaging features that distinguish axSpA from non-axSpA; 3. The impact of MRI on diagnosis and classification of axSpA. METHODS: The Screening in Axial Spondyloarthritis in Psoriasis, Iritis, Colitis, (SASPIC) study enrolled patients in two multicenter cohorts. Consecutive patients with undiagnosed chronic back pain attending dermatology, ophthalmology, and gastroenterology clinics with PsO, AAU, or IBD, were referred to a local rheumatologist with special expertise in axSpA for a structured diagnostic evaluation. The primary outcome was proportion of patients diagnosed with axSpA by final global evaluation. RESULTS: Frequency of axSpA was 46.7%, 61.6%, and 46.8% in SASPIC-1 cases (n=212) and 23.5%, 57.9%, and 23.3% in SASPIC-2 cases (n=151) with PsO, AAU, or IBD, respectively. Among B27 positives, axSpA was diagnosed in 70%, 74.5%, and 66.7% in SASPIC-1, and in 71.4%, 87.8%, and 55.6% in SASPIC-2 in patients with PsO, AAU, or IBD, respectively. All musculoskeletal clinical features were non-discriminatory. MRI was indicative of axSpA in 60-80% of patients and MRI in all patients (SASPIC-2) versus on-demand (SASPIC-1) led to 25% fewer diagnoses of axSpA in HLA B27 negatives with PsO or IBD. Performance of the ASAS classification criteria was greater with routine MRI (SASPIC-2) though sensitivity was lower than previously reported. CONCLUSIONS: Optimal management of patients presenting with PsO, AAU, IBD, and undiagnosed chronic back pain should include referral to a rheumatologist. Conducting MRI in all patients enhances diagnostic accuracy.
ABSTRACT
Purpose: To determine the feasibility of meniscal imaging using virtual monochromatic images obtained through dualenergy computed tomography (DECT) technique, and to determine which keV levels optimise contrast resolution. Material and methods: All DECT exams were performed on a Discovery CT750 HD system from GE Healthcare. Virtual monochromatic images were reconstructed at 40 keV, 73 keV, 106 keV, and 139 keV. Contrast resolution of the medial and lateral menisci using a 5-point Likert scale at each keV level was determined through a consensus agreement by 2 fellowship-trained musculoskeletal radiologists. Friedman's and Wilcoxon signed rank tests were used to compare visualisation scores across different keV levels. Results: Seventeen knee exams from 10 patients met criteria for inclusion in the study. All patients included in the study cohort were male. The median age of patients was 46 years (interquartile range, 35-53 years). Virtual monochromatic images at 40 keV demonstrated highest contrast resolution of the menisci, with a statistically significant difference between contrast resolution scores at 40 keV and 76 keV, Friedman test: p < 0.0001. Conclusions: Meniscal imaging is feasible using DECT virtual monochromatic images at low keV levels. Improved contrast resolution at these specified KeV values could pave the way for further research in this field to determine its role in the future as an alternative option for assessment of the menisci in patients with contraindications to MRI or in the setting of a periarticular ferromagnetic foreign body obscuring the field of view.