Value of Color Doppler Ultrasound Assessment of Sacroiliac Joints in Patients with Inflammatory Low Back Pain.

OBJECTIVE: To evaluate the diagnostic value of color Doppler ultrasound (CDUS) for the detection of sacroiliitis, in patients with inflammatory back pain (IBP). METHODS: Consecutive patients with IBP and suspected axial spondyloarthritis (SpA), but without a definitive diagnosis, were included. Consecutive patients with defined SpA and axial involvement were included as a control group. All patients underwent clinical evaluation, magnetic resonance imaging (MRI), and CDUS of sacroiliac joints (SIJ) within the same week. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for the diagnosis of sacroiliitis by CDUS were calculated, using MRI as the gold standard. RESULTS: There were 198 SIJ evaluated in 99 patients (36 with previous SpA). There were 61 men (61.6%), with a mean age of 39.8 years (SD 11.3) and median disease duration of 24 months (IQR 12-84). At the patient level, CDUS had a sensitivity of 63% (95% CI 48.7-75.7%) and a specificity of 89% (95% CI 76-96%). The PPV was 87.2% (95% CI 72.6-95.7%) and the NPV was 66.7% (95% CI 53.3-78.3%). At joint level, CDUS had a sensitivity of 60% (95% CI 49-70%) and a specificity of 93% (95% CI 88-98%). The PPV was 83% (95% CI 78-95%) and the NPV was 43% (95% CI 33-56%). The sensitivity of CDUS for the diagnosis of axial SpA was 54% (95% CI 36.6-71.2%), specificity was 82% (95% CI 63.1-93.9%), PPV was 79% (95% CI 57.8-92.9%), and NPV was 59% (95% CI 42.1-74.4%). CONCLUSION: CDUS showed adequate diagnostic properties for detection of sacroiliitis and is a useful tool in patients with IBP.

Responsiveness to therapy change of a global ultrasound assessment in spondyloarthritis patients.

The objective of this study is to evaluate the responsiveness to therapy change of a global ultrasound (US) assessment in the short-term monitoring of spondyloarthritis (SpA) patients with peripheral involvement. Consecutive SpA patients with both clinical peripheral involvement and active disease (initiating or changing therapy) were included. All patients underwent both clinical and US assessment in day entering the study and after 3 months of follow-up. Peripheral global US assessment included the recognition of abnormal inflammatory findings at joint, tendon, and entheseal level according to standardized scanning methods. A total of 34 patients completed both basal and 3-month follow-up assessments. Acute phase reactants, both erythrocyte sedimentation rate and C-reactive protein, tenderness (68) and swollen (66) joint counts, Bath Ankylosing Spondylitis Disease Activity Index and Health Assessment Questionnaire decreased significantly at 3-month follow-up. Total score for the global US assessment also decreased significantly between basal and 3-month follow-up assessment [mean difference, 12.33 (IC 95 %, 9.23-15.42); p < 0.0001]. All individual component, joint, tendon, and enthesis scores, also showed a significant decrease during the follow-up period. A high degree of intra-observer reliability was found for the global US assessment (ICC [95 % CI]: 0.977 [0.961-0.993]). This global US assessment, including joints, tendons, and entheses, showed a good responsiveness to clinical changes and might be useful for monitoring SpA patients with peripheral involvement.

Elastografía transicional (fibroscan): nuevo método para la evaluación no invasiva de la fibrosis hepática / Transitional elastography (fibroscan): new method for noninvasive assessment of liver fibrosis

Los grandes avances realizados en la biomedicina y biotecnología durante la última década han puesto en escenamétodos rápidos e incruentos que desafían el ôgold standardõ de los procedimientos diagnósticos y terapéuticos invasivos. Algunos ejemplos de esto incluyen estudioscomo la angiografía coronaria mediante tomografía computada (TC), la resonancia magnética cardíaca (RMcardíaca) para la evaluación no invasiva de las miocardiopatías, y la colonoscopia virtual mediante TC.De esta forma, varios grupos de investigación han desarrolladométodos de imágenes para evaluar la elasticidad de los tejidos de manera no invasiva, teniendo en cuenta las propiedades mecánicas de estos. La elastografía transicional (TE) fue el primer método utilizado, hace unosocho años, en pacientes con enfermedad hepática crónica.Muchos estudios han evaluado la eficacia de este método para el diagnóstico de la fibrosis hepática y la cirrosis, y el Fibroscan es ahora una herramienta utilizada por hepatólogos de todo el mundo, teniendo en cuenta que el pronóstico y tratamiento de las enfermedades crónicas del hígado dependen en gran medida de la extensión y progresión de la fibrosis.