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2.
Zhonghua Nei Ke Za Zhi ; 60(4): 368-372, 2021 Apr 01.
Artigo em Chinês | MEDLINE | ID: mdl-33765708

RESUMO

To investigate the clinical manifestations and imaging characteristics of patients with different types of infectious sacroiliitis. Clinical data of 40 patients diagnosed with infectious sacroiliitis were retrospectively analyzed. Among the 40 patients, 16 patients were diagnosed as non-brucellar and non-tuberculous infectious sacroiliitis (ISI), 13 with tuberculous infectious sacroiliitis (TSI), and 11 with brucellar sacroiliitis (BSI). In the ISI and TSI group, female patients accounted for 11/16, 12/13, while the proportion of unilateral involvement was 15/16 and 12/13, respectively. Compared with ISI and TSI group, BSI patients were mainly male (8/11) and presented more bilateral involvement (6/11) (P<0.05). Bone erosion was more common in ISI and TSI groups than in BSI group (6/15, 7/11 and 2/10), as well as abscess formation (3/15, 4/11 and 1/10, respectively). Symptoms in all patients relieved 1-2 weeks after administration of antibiotics or anti-tuberculosis treatment, but the resolution of the magnetic resonance imaging findings delayed about 6 (3-9) months. ISI and TSI patients with infectious sacroiliitis should be differentiated from spondyloarthritis, with a characteristic of more female patients, unilateral sacroiliitis, bone erosion, soft tissue involvement and abscess formation. However, BSI patients are mainly male, more bilateral involvement and less bone destruction and abscess formation. Antibiotic therapy demonstrates significant therapeutic effects, but resolution of the magnetic resonance imaging findings responses late.


Assuntos
Doenças Transmissíveis , Sacroileíte , Espondilartrite , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Estudos Retrospectivos , Articulação Sacroilíaca , Sacroileíte/diagnóstico por imagem
3.
Radiology ; 298(2): 343-349, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33350891

RESUMO

Background Evaluation of structural lesions in the sacroiliac (SI) joints can improve the accuracy for diagnosis of spondyloarthritis. However, structural lesions, such as erosions, are difficult to assess on routine T1-weighted MRI scans. Purpose To determine the diagnostic performance of MRI-based synthetic CT (sCT) in the depiction of erosions, sclerosis, and ankylosis of the SI joints compared with T1-weighted MRI, with CT as the reference standard. Materials and Methods A prospective study (clinical trial registration no. B670201837885) was performed from February 2019 to November 2019. Adults were referred from a tertiary hospital rheumatology outpatient clinic with clinical suspicion of inflammatory sacroiliitis. MRI and CT of the SI joints were performed on the same day. SCT images were generated from MRI scans using a commercially available deep learning-based image synthesis method. Two readers independently recorded if structural lesions (erosions, sclerosis, and ankylosis) were present on T1-weighted MRI, sCT, and CT scans in different reading sessions, with readers blinded to clinical information and other images. Diagnostic performance of sCT and T1-weighted MRI scans were analyzed using generalized estimating equation models, with consensus results of CT as the reference standard. Results Thirty participants were included (16 men, 14 women; mean age, 40 years ± 10 [standard deviation]). Diagnostic accuracy of sCT was higher than that of T1-weighted MRI for erosion (94% vs 86%, P = .003), sclerosis (97% vs 81%, P < .001), and ankylosis (92% vs 84%, P = .04). With sCT, specificity for erosion detection (96% [95% CI: 90, 98] vs 89% [95% CI: 81, 94], P = .01] and sensitivity for detection of sclerosis [94% [95% CI: 87, 97] vs 20% [95% CI: 10, 35], P < .001] and ankylosis (93% [95% CI: 78, 98] vs 70% [95% CI: 47, 87], P = .001) were improved. Conclusion With CT as the reference standard, synthetic CT of the sacroiliac joints has better diagnostic performance in the detection of structural lesions in individuals suspected of having sacroiliitis compared with routine T1-weighted MRI. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Fritz in this issue.


Assuntos
Imagem por Ressonância Magnética/métodos , Sacroileíte/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Reprodutibilidade dos Testes , Articulação Sacroilíaca/diagnóstico por imagem , Sensibilidade e Especificidade , Adulto Jovem
4.
Ann Rheum Dis ; 79(8): 1063-1069, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32522743

RESUMO

OBJECTIVES: To determine the prevalence of bone marrow oedema (BME) at the sacroiliac joint (SIJ) in early postpartum (EPP), nulliparous (NP) and late postpartum (LPP) women, and to identify factors associated with BME presence at the SIJ. METHODS: Three groups were obtained: NP (never given birth), EPP (given birth within 12 months) and LPP (given birth more than 24 months). The primary outcome was the presence of BME and/or structural lesions (erosions, osteophytes, ankylosis and sclerosis) at the SIJ MRI. RESULTS: BME prevalence was greater among EPP (33%) than NP (14%, p=0.001), but was not different to LPP (21%, p=0.071). The Assessment of SpondyloArthritis international Society (ASAS) MRI criteria for sacroiliitis were positive in 75%, 71% and 80%, respectively, of EPP, NP and LPP women with BME. EPP (38%) had similar prevalence of sclerosis than LPP (28%, p=0.135), but greater than NP (18%, p=0.001). Lastly, EPP (28%) had similar prevalence of osteophytes than LPP (42%) and NP (27%), although there was a difference between LPP and NP (p=0.006). CONCLUSIONS: EPP have higher BME prevalence at the SIJ than NP, EPP tend to have higher BME prevalence compared with LPP and BME presence decreases with time from delivery. Three-quarters of women with BME at the SIJ had a positive ASAS MRI criteria for sacroiliitis, indicating that BME presence as the main criterion for a positive diagnosis can lead to false-positive results. SIJ MRIs should not be interpreted in isolation, since age, time from delivery and other factors may outweigh the pertinence of MRI findings. Trial registration number NCT02956824.


Assuntos
Período Pós-Parto , Sacroileíte/diagnóstico por imagem , Espondilartrite/diagnóstico por imagem , Dor nas Costas/etiologia , Medula Óssea/diagnóstico por imagem , Medula Óssea/patologia , Edema/diagnóstico por imagem , Edema/patologia , Feminino , Humanos , Inflamação/diagnóstico por imagem , Inflamação/etiologia , Inflamação/patologia , Imagem por Ressonância Magnética , Paridade , Gravidez , Prevalência , Articulação Sacroilíaca/patologia , Sacroileíte/etiologia , Sacroileíte/patologia , Espondilartrite/patologia
5.
Ann Rheum Dis ; 79(7): 935-942, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32371388

RESUMO

OBJECTIVES: The Assessment of SpondyloArthritis international Society (ASAS) MRI working group conducted a multireader exercise on MRI scans from the ASAS classification cohort to assess the spectrum and evolution of lesions in the sacroiliac joint and impact of discrepancies with local readers on numbers of patients classified as axial spondyloarthritis (axSpA). METHODS: Seven readers assessed baseline scans from 278 cases and 8 readers assessed baseline and follow-up scans from 107 cases. Agreement for detection of MRI lesions between central and local readers was assessed descriptively and by the kappa statistic. We calculated the number of patients classified as axSpA by the ASAS criteria after replacing local detection of active lesions by central readers and replacing local reader radiographic sacroiliitis by central reader structural lesions on MRI. RESULTS: Structural lesions, especially erosions, were as frequent as active lesions (≈40%), the majority of patients having both types of lesions. The ASAS definitions for active MRI lesion typical of axSpA and erosion were comparatively discriminatory between axSpA and non-axSpA. Local reader overcall for active MRI lesions was about 30% but this had a minor impact on the number of patients (6.4%) classified as axSpA. Substitution of radiography with MRI structural lesions also had little impact on classification status (1.4%). CONCLUSION: Despite substantial discrepancy between central and local readers in interpretation of both types of MRI lesion, this had a minor impact on the numbers of patients classified as axSpA supporting the robustness of the ASAS criteria for differences in assessment of imaging.


Assuntos
Imagem por Ressonância Magnética/classificação , Reumatologia/normas , Sacroileíte/classificação , Espondilartrite/classificação , Adulto , Estudos de Coortes , Diagnóstico Diferencial , Feminino , Humanos , Agências Internacionais , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Reumatologia/métodos , Articulação Sacroilíaca/diagnóstico por imagem , Sacroileíte/diagnóstico por imagem , Sociedades Médicas , Espondilartrite/diagnóstico por imagem
6.
Ann Rheum Dis ; 79(7): 929-934, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32299794

RESUMO

OBJECTIVES: Bone marrow oedema (BMO) on MRI of sacroiliac joints (SIJs) represents a hallmark of axial spondyloarthritis (SpA), yet such lesions may also occur under augmented mechanical stress in healthy subjects. We therefore sought to delineate the relationship between pregnancy/delivery and pelvic stress through a prospective study with repeated MRI. Results were matched with maternal, child and birth characteristics. METHODS: Thirty-five women underwent a baseline MRI-SIJ within the first 10 days after giving birth. MRI was repeated after 6 months and, if positive for sacroiliitis according to the Assessment of SpondyloArthritis International Society (ASAS) definition, after 12 months. BMO and structural lesions were scored by three trained readers using the Spondyloarthritis Research Consortium of Canada (SPARCC) method. RESULTS: Seventy-seven per cent of the subjects (27/35) displayed sacroiliac BMO immediately postpartum, 60% fulfilled the ASAS definition of a positive MRI. After 6 months, 46% of the subjects (15/33) still showed BMO, representing 15% (5/33) with a positive MRI. After 12 months, MRI was still positive in 12% of the subjects (4/33). Few structural lesions were detected. Intriguingly, in this study, the presence of BMO was related to a shorter duration of labour and lack of epidural anaesthesia. CONCLUSION: A surprisingly high prevalence of sacroiliac BMO occurs in women immediately postpartum. Our data reveal a need for a waiting period of at least 6 months to perform an MRI-SIJ in postpartum women with back pain. This study also underscores the importance of interpreting MRI-SIJ findings in the appropriate clinical context.


Assuntos
Parto Obstétrico/efeitos adversos , Imagem por Ressonância Magnética/métodos , Transtornos Puerperais/epidemiologia , Sacroileíte/epidemiologia , Adulto , Dor nas Costas/diagnóstico por imagem , Dor nas Costas/etiologia , Doenças da Medula Óssea/diagnóstico por imagem , Doenças da Medula Óssea/epidemiologia , Doenças da Medula Óssea/etiologia , Canadá/epidemiologia , Diagnóstico Diferencial , Edema/diagnóstico por imagem , Edema/epidemiologia , Edema/etiologia , Feminino , Humanos , Parto/fisiologia , Ossos Pélvicos/diagnóstico por imagem , Ossos Pélvicos/fisiopatologia , Período Pós-Parto , Gravidez , Prevalência , Estudos Prospectivos , Transtornos Puerperais/diagnóstico por imagem , Transtornos Puerperais/etiologia , Sacroileíte/diagnóstico por imagem , Sacroileíte/etiologia , Estresse Fisiológico
7.
Clin Exp Rheumatol ; 38(5): 1021-1028, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32167879

RESUMO

OBJECTIVES: To determine and compare the effectiveness of history, physical examination, conventional radiography and magnetic resonance imaging (MRI) in the detection of sacroiliitis in juvenile spondyloarthropathies. METHODS: One hundred and one patients with JSpA, 33 patients with other diseases and 24 children without rheumatologic complaints were included in the study. Subjects were evaluated using physical examination, laboratory findings, pelvic radiography and MRI. Abdominal or pelvic MRIs of 24 control patients who were obtained in the last 6 months were reevaluated and multivariate logistic regression analyses were used to calculate probability ratios of variables. RESULTS: In our study, the rate of active sacroiliitis was 52.4% and in most of them, erosive and sclerotic changes indicating destruction of the sacroiliac joints were recorded. The presence of sacroiliitis on direct x-ray, high JSPADAI score, and hip involvement on MRI were independent risk factors with high predictive potential for active sacroiliitis. Inflammatory lumbar pain, sacroiliac tenderness, modified Schober's limitation, acute phase elevation, HLA-B27 positivity and presence of uveitis failed to predict sacroiliitis. The best specificity was 100% with a high BASFI score (>5), then 94% with a high JSPADAI score (>4). None of the patients in the control group showed active sacroiliitis. CONCLUSIONS: All patients with possible JSpA should undergo sacroiliac MRI whether HLA-B27 positive or not. In this way, early diagnosis and treatment of axial joint involvement could be possible and it prevents unnecessary examination and loss of time.


Assuntos
Sacroileíte , Espondilite Anquilosante , Criança , Humanos , Imagem por Ressonância Magnética , Exame Físico , Radiografia , Articulação Sacroilíaca/diagnóstico por imagem , Sacroileíte/diagnóstico por imagem
8.
Medicine (Baltimore) ; 99(8): e19132, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32080089

RESUMO

The osteoporosis was common complication of ankylosing spondylitis (AS), but it was frequently unrecognized in the initial stage of the disease. This study was to compare areal bone mineral density (BMD) of hip joints in early AS patients with that in healthy controls, to explore the progress of bone loss in cortex and spongiosa in early AS.Quantitative computed tomography (QCT) of hip was performed in 60 AS patients (modified New York criteria for AS, with grade 2 sacroiliitis in computed tomography) and 57 healthy controls. The QCT measurements of AS patients were compared with the measurements of healthy controls.The AS patients had lower areal BMD in cortical bone and total bone of proximal femur in early AS patients (P < .01), than the controls. But there were not significant different of areal BMD in spongiosa of proximal femur between the early AS patients and healthy controls. Strong correlations were found between body mass index BMI, areal BMD in cortical bone (rs = 0.410, P < .001; rs = 0.422, P < .001) and total bone (rs = 0.368, P < .001; rs = 0.266, P = .003) both in AS patients and healthy controls.The results indicate that osteopenia/osteoporosis is general in early stage of AS. What is more, the osteopenia/osteoporosis in cortex is earlier than in spongiosa of proximal femur in early AS.


Assuntos
Densidade Óssea/fisiologia , Articulação do Quadril/metabolismo , Osteoporose/etiologia , Espondilite Anquilosante/complicações , Adulto , Índice de Massa Corporal , Doenças Ósseas Metabólicas/complicações , Doenças Ósseas Metabólicas/diagnóstico por imagem , Feminino , Fêmur/anatomia & histologia , Fêmur/patologia , Articulação do Quadril/diagnóstico por imagem , Articulação do Quadril/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Sacroileíte/classificação , Sacroileíte/complicações , Sacroileíte/diagnóstico por imagem , Espondilite Anquilosante/classificação , Tomografia Computadorizada por Raios X/métodos
9.
AJR Am J Roentgenol ; 214(4): 923-929, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32045310

RESUMO

OBJECTIVE. The purpose of this study was to investigate the prevalence of various MRI findings of infectious sacroiliitis in children and with respect to age. MATERIALS AND METHODS. This institutional review board-approved, HIPAA-compliant retrospective study included children with infectious sacroiliitis who underwent MRI examination between December 1, 2002, and September 30, 2018. Two radiologists blinded to the clinical outcome reviewed each MRI examination to determine the presence or absence of periarticular marrow edema, erosions, capsular bulge, extracapsular edema, and soft-tissue abscess. If available, pelvic radiographs were retrospectively reviewed by a third radiologist. Mann-Whitney U, chi-square, and Fisher exact tests were used to compare MRI findings between younger and older children. RESULTS. The study included 40 children (19 boys and 21 girls; mean age, 8.6 ± 6.2 [SD] years). Sixteen children presented at or below 5 years of age (mean age, 1.7 ± 1.4 years) and 24 children presented at or above 8 years of age (mean age, 13.3 + 2.6 years). Periarticular marrow edema and anterior extracapsular edema were present in all children. Posterior extracapsular edema (p = 0.01) was statistically significantly more common in younger children when compared with older children. There was no significant difference in the presence of erosions (p = 0.60), capsule bulge (p = 0.63), or abscess (p = 0.34) between younger and older children. Pelvic radiographs (n = 28; obtained 1.6 days ± 1.7 from MRI) allowed the correct identification of the abnormal joint in only 50% of the studies. CONCLUSION. MRI findings of infectious sacroiliitis are common in children of all ages with posterior extracapsular edema statistically significantly more prevalent in younger children.


Assuntos
Imagem por Ressonância Magnética/métodos , Sacroileíte/diagnóstico por imagem , Adolescente , Fatores Etários , Criança , Pré-Escolar , Meios de Contraste , Feminino , Humanos , Masculino , Meglumina/análogos & derivados , Compostos Organometálicos , Estudos Retrospectivos
11.
Magn Reson Imaging ; 68: 30-35, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31978516

RESUMO

OBJECTIVE: To prospectively evaluate the ability of IVIM-DWI and DCE-MRI in detecting early activity of sacroiliitis in rat model of ankylosing spondylitis by comparing with pathological results. METHODS: 20 wistar male rats were induced by bovine proteoglycan combined with complete/incomplete Freund's adjuvant as model group, and 20 healthy male rats were used as the control group. The parameters of IVIM-DWI and DCE-MRI in synovial regions of SIJ were measured respectively at 7th, 12th, 17th, and 22th weeks after the last induction, and the pathological features of SIJ were taken also, further studying the pathological characteristics of sacroiliac region. Independent sample t-test and one-way ANOVA were used for statistical analysis. The prediction parameters and diagnostic efficiency were compared by ROC curve. RESULTS: There was no significant difference of image parameters between the model and control groups at the 7th, 12th weeks after the last induction, and there were no positive findings in histopathological examination at the same time. At the 17th week after induction, the f and Fenh%, Senh% between the model and the control groups were statistically significant. At the 22th week, there was a statistically significant increase all the values in model group than those in control group (P < 0.05). Histologic examination confirmed inflmmtorycell infiitrtion at the 17th week and pannus forming of synovium on the surface of cartilage at the 22th week in the model groups. The Fenh%, Senh%, Dslow and f had the moderate diagnostic efficiency and the areas under the curve were 0.77, 0.75, 0.77 and 0.82 respectively. The Senh% demonstrated the highest sensitivity (71.4%) and f demonstrated the highest specificity (95.0%). CONCLUSION: IVIM-DWI and DCE-MRI can be used as the sensitive imaging methods to detect and accurate diagnosis the early activity of sacroiliitis in AS.


Assuntos
Meios de Contraste , Processamento de Imagem Assistida por Computador/métodos , Sacroileíte/diagnóstico por imagem , Espondilite Anquilosante/diagnóstico por imagem , Análise de Variância , Animais , Área Sob a Curva , Bovinos , Imagem de Difusão por Ressonância Magnética , Modelos Animais de Doenças , Masculino , Movimento (Física) , Variações Dependentes do Observador , Proteoglicanas/química , Curva ROC , Ratos , Ratos Wistar , Sensibilidade e Especificidade
12.
Yonsei Med J ; 61(2): 198-200, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31997630

RESUMO

Pyogenic sacroiliitis is a relatively rare condition that often leads to surgical treatment, including debridement and arthrodesis. Here we introduce a new surgical technique using bilateral dual iliac screws to secure early ambulation and maximal fusion success rate for the treatment of pyogenic sacroiliitis. We retrospectively reported a case and technical reports of pyogenic sacroiliitis treated by a new bilateral dual iliac screw fixation arthrodesis technique using radiologic outcomes, including plain X-rays and MRI scans, as well as outcomes based on the visual analogue scale for pain measurement. This technique improved uncontrolled pyogenic sacroiliitis with immediate stability that enabled ambulation and secured firm fixation for extensive evacuation of infected debris and subsequent autograft bone arthrodesis. In conclusion, we recommend bilateral dual iliac screw fixation for the treatment of pyogenic sacroiliitis, as this technique can improve uncontrolled pyogenic sacroiliitis with immediate stability.


Assuntos
Artrodese , Parafusos Ósseos , Transplante Ósseo , Ílio/cirurgia , Sacroileíte/cirurgia , Pontos de Referência Anatômicos , Feminino , Humanos , Imagem por Ressonância Magnética , Estudos Retrospectivos , Sacroileíte/diagnóstico por imagem , Transplante Autólogo , Adulto Jovem
13.
Scand J Rheumatol ; 49(3): 200-209, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31847676

RESUMO

Objectives: The Spondyloarthritis Research Consortium of Canada (SPARCC) sacroiliac joint (SIJ) scoring system assesses six or five (6/5) semicoronal magnetic resonance imaging (MRI) slices for inflammation/structural lesions in patients with axial spondyloarthritis (axSpA). However, the cartilaginous SIJ compartment may be visible in a few additional slices. The objective was to investigate interreader reliability, sensitivity to change, and classification of MRI scans as positive or negative for various lesion types using an 'all slices' approach versus standard SPARCC scoring of 6/5 slices.Method: Fifty-three axSpA patients were treated with the tumour necrosis factor inhibitor golimumab and followed with serial MRI scans at weeks 0, 4, 16, and 52. The most anterior and posterior slices covering the cartilaginous compartment and the transitional slice were identified. Scores for inflammation, fat metaplasia, erosion, backfill, and ankylosis in the cartilaginous SIJ compartment were calculated for the 'all slices' approach and the 6/5 slices standard.Results: By the 'all slices' approach, three readers scored mean 7.2, 7.7, and 7.0 slices per MRI scan. Baseline and change scores for the various lesion types closely correlated between the two approaches (Pearson's rho ≥ 0.95). Inflammation score was median 13 (interquartile range 6-21, range 0-49) for 6/5 slices versus 14 (interquartile range 6-23, range 0-69) for all slices at baseline. Interreader reliability, sensitivity to change, and classification of MRI scans as positive or negative for various lesion types were similar.Conclusion: The standardized 6/5 slices approach showed no relevant differences from the 'all slices' approach and, therefore, is equally suited for monitoring purposes.


Assuntos
Articulação Sacroilíaca/diagnóstico por imagem , Sacroileíte/diagnóstico por imagem , Espondiloartropatias/diagnóstico por imagem , Tecido Adiposo/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anquilose/diagnóstico por imagem , Anticorpos Monoclonais/uso terapêutico , Medula Óssea/diagnóstico por imagem , Cartilagem Articular/diagnóstico por imagem , Osso Cortical/diagnóstico por imagem , Edema/diagnóstico por imagem , Feminino , Humanos , Inflamação , Imagem por Ressonância Magnética/métodos , Masculino , Metaplasia , Pessoa de Meia-Idade , Variações Dependentes do Observador , Sacroileíte/tratamento farmacológico , Espondiloartropatias/tratamento farmacológico , Inibidores do Fator de Necrose Tumoral/uso terapêutico , Adulto Jovem
14.
Rheumatology (Oxford) ; 59(6): 1381-1390, 2020 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-31600395

RESUMO

OBJECTIVE: Assessment of combined semi-axial and semi-coronal SI joint MRI in two cohorts of young athletes to explore frequency and topography of non-specific bone marrow oedema (BMO), its association with four constitutional SI joint features, and potential restriction of false-positive assignments of Assessment of SpondyloArthritis International Society-defined sacroiliitis on standard semi-coronal scans alone. METHODS: Combined semi-axial and semi-coronal SI joint MRI scans of 20 recreational runners before/after running and 22 elite ice-hockey players were evaluated by three blinded readers for BMO and its association with four constitutional SI joint features: vascular partial volume effect, deep iliac ligament insertion, fluid-filled bone cyst and lumbosacral transitional anomaly. Scans of TNF-treated spondyloarthritis patients served to mask readers. We analysed distribution and topography of BMO and SI joint features across eight anatomical SI joint regions (upper/lower ilium/sacrum, subdivided in anterior/posterior slices) descriptively, as concordantly recorded by ⩾2/3 readers on both MRI planes. BMO confirmed on both scans was compared with previous evaluation of semi-coronal MRI alone, which met the Assessment of SpondyloArthritis International Society definition for active sacroiliitis. RESULTS: Perpendicular semi-axial and semi-coronal MRI scans confirmed BMO in the SI joint of every fourth young athlete, preferentially in the anterior upper sacrum. BMO associated with four constitutional SI joint features was observed in 20-36% of athletes, clustering in the posterior lower ilium. The proportion of Assessment of SpondyloArthritis International Society-positive sacroiliitis recorded on the semi-coronal plane alone decreased by 33-56% upon amending semi-axial scans. CONCLUSION: Semi-axial combined with standard semi-coronal scans in MRI protocols for sacroiliitis facilitated recognition of non-specific BMO, which clustered in posterior lower ilium/anterior upper sacrum.


Assuntos
Doenças da Medula Óssea/diagnóstico por imagem , Edema/diagnóstico por imagem , Hóquei/lesões , Imagem por Ressonância Magnética/estatística & dados numéricos , Corrida/lesões , Sacroileíte/diagnóstico por imagem , Adolescente , Adulto , Atletas , Doenças da Medula Óssea/etiologia , Diagnóstico Diferencial , Edema/etiologia , Reações Falso-Positivas , Feminino , Humanos , Ílio/diagnóstico por imagem , Região Lombossacral/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Imagem por Ressonância Magnética/normas , Masculino , Articulação Sacroilíaca/diagnóstico por imagem , Sacroileíte/etiologia , Sacro/diagnóstico por imagem , Método Simples-Cego , Adulto Jovem
15.
Rheumatology (Oxford) ; 59(7): 1679-1683, 2020 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31670801

RESUMO

OBJECTIVE: Lumbosacral transitional vertebras (LSTVs) are common in the general population, but their potential impact on the sacroiliac joints is unclear. We aimed to determine the prevalence of LSTVs and to assess their associations with sacroiliitis by standard radiography and MRI in a population with suspected axial spondyloarthritis. METHODS: The data were from the DESIR cohort of 688 patients aged 18-50 years with inflammatory low back pain for ⩾3 months but <3 years suggesting axial spondyloarthritis. The baseline pelvic radiographs were read by two blinded readers for the presence and type (Castellvi classification) of LSTVs. Associations between LSTVs and other variables collected at baseline and at the diagnosis were assessed using the χ2 test (or Fisher's exact test) or the Mann-Whitney test. RESULTS: LSTV was found in 200/688 (29.1%) patients. Castellvi type was Ia in 54 (7.8%), Ib in 76 (11.0%), IIa in 20 (2.9%), IIb in 12 (1.7%), IIIa in 7 (1.0%), IIIb in 21 (3.0%) and IV in 10 (1.4%) patients. Compared with the group without LSTVs, the group with LSTVs had higher proportions of patients meeting modified New York criteria for radiographic sacroiliitis (19% vs 27%, respectively; P = 0.013) and Assessment of SpondyloArthritis international Society MRI criteria for sacroiliitis (29% vs 39%, respectively; P = 0.019). CONCLUSION: In patients with inflammatory back pain suggesting axial spondyloarthritis, LSTVs are associated with both radiographic and MRI sacroiliitis.


Assuntos
Dor nas Costas/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem , Sacroileíte/diagnóstico por imagem , Sacro/diagnóstico por imagem , Espondilartrite/diagnóstico por imagem , Adolescente , Adulto , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Radiografia , Índice de Gravidade de Doença , Adulto Jovem
16.
Rheumatology (Oxford) ; 59(1): 84-89, 2020 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31236597

RESUMO

OBJECTIVE: To assess associations of spinal-pelvic orientation with clinical and imaging-study findings suggesting axial SpA (axSpA) in patients with recent-onset inflammatory back pain. METHODS: Spinal-pelvic orientation was assessed in DESIR cohort patients with recent-onset inflammatory back pain and suspected axSpA, by using lateral lumbar-spine radiographs to categorize sacral horizontal angle (<40° vs ⩾40°), lumbosacral angle (<15° vs ⩾15°) and lumbar lordosis (LL, <50° vs ⩾50°). Associations between these angle groups and variables collected at baseline and 2 years later were assessed using the χ2 test (or Fisher's exact) and the Mann-Whitney test. With Bonferroni's correction, P < 0.001 indicated significant differences. RESULTS: Of 362 patients, 358, 356 and 357 had available sacral horizontal angle, lumbosacral angle and LL values, respectively; means were 39.3°, 14.6° and 53.0°, respectively. The prevalence of sacroiliitis on both radiographs and MRI was higher in the LL < 50° group than in the LL ⩾50° group, but the difference was not statistically significant. Clinical presentation and confidence in a diagnosis of axSpA did not differ across angle groups. No significant differences were identified for degenerative changes according to sacral horizontal angle, lumbosacral angle or LL. CONCLUSION: Spinal-pelvic balance was not statistically associated with the clinical or imaging-study findings suggesting axSpA in patients with recent-onset inflammatory back pain.


Assuntos
Imagem por Ressonância Magnética/estatística & dados numéricos , Pelvimetria/estatística & dados numéricos , Radiografia/estatística & dados numéricos , Sacroileíte/diagnóstico por imagem , Espondilartrite/diagnóstico por imagem , Adulto , Dor nas Costas/diagnóstico por imagem , Dor nas Costas/fisiopatologia , Feminino , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/fisiopatologia , Masculino , Orientação Espacial , Ossos Pélvicos/diagnóstico por imagem , Ossos Pélvicos/fisiopatologia , Equilíbrio Postural , Estudos Prospectivos , Reprodutibilidade dos Testes , Sacroileíte/fisiopatologia
17.
Clin Exp Rheumatol ; 38(2): 329-332, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31577217

RESUMO

OBJECTIVES: To compare the magnetic resonance imaging (MRI) morphology of inflammatory and chronic lesions in the sacroiliac joints (SIJs) and spine between patients with non-psoriatic and psoriatic non-radiographic axial spondyloarthritis (axSpA and p-axSpA, respectively). METHODS: Patients from the EMBARK trial (NCT01258738) with axSpA (n=179) and p-axSpA (n=24) who had MRI data available were compared in terms of baseline demographics, clinical characteristics, and the frequency (n/N [%]) and distribution of inflammatory and structural SIJ and spinal lesions. RESULTS: Patients with p-axSpA were on average older (35.1 years vs. 31.7 years, p=0.047), had a higher occurrence of asymmetric sacroiliitis (54.2% vs. 29.6%, p=0.042), and a lower occurrence of human leukocyte antigen (HLA)-B27 positivity (41.7% vs. 73.7%, p=0.010) than patients with axSpA. There were no significant differences in the frequency of lesions in any of the SIJ or spinal quadrants between the two subgroups. CONCLUSIONS: These data suggest that differences between axSpA and p-axSpA extend beyond presence of psoriasis, and include age, SI symmetry, and HLAB27 status. These findings may help explain the morphotype-phenotype relationship across axSpA, similar to those described in older radiographic studies.


Assuntos
Antígeno HLA-B27/análise , Sacroileíte , Espondilartrite , Adulto , Feminino , Antígeno HLA-B27/sangue , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Fenótipo , Articulação Sacroilíaca/patologia , Sacroileíte/diagnóstico por imagem , Sacroileíte/imunologia , Sacroileíte/patologia , Espondilartrite/diagnóstico por imagem , Espondilartrite/imunologia , Espondilartrite/patologia
18.
Adv Rheumatol ; 60: 25, 2020. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1130789

RESUMO

Abstract Background: Currently, magnetic resonance imaging (MRI) is used to evaluate active inflammatory sacroiliitis related to axial spondyloarthritis (axSpA). The qualitative and semiquantitative diagnosis performed by expert radiologists and rheumatologists remains subject to significant intrapersonal and interpersonal variation. This encouraged us to use machine-learning methods for this task. Methods: In this retrospective study including 56 sacroiliac joint MRI exams, 24 patients had positive and 32 had negative findings for inflammatory sacroiliitis according to the ASAS group criteria. The dataset was randomly split with ∼ 80% (46 samples, 20 positive and 26 negative) as training and ∼ 20% as external test (10 samples, 4 positive and 6 negative). After manual segmentation of the images by a musculoskeletal radiologist, multiple features were extracted. The classifiers used were the Support Vector Machine, the Multilayer Perceptron (MLP), and the Instance-Based Algorithm, combined with the Relief and Wrapper methods for feature selection. Results: Based on 10-fold cross-validation using the training dataset, the MLP classifier obtained the best performance with sensitivity = 100%, specificity = 95.6% and accuracy = 84.7%, using 6 features selected by the Wrapper method. Using the test dataset (external validation) the same MLP classifier obtained sensitivity = 100%, specificity = 66.7% and accuracy = 80%. Conclusions: Our results show the potential of machine learning methods to identify SIJ subchondral bone marrow edema in axSpA patients and are promising to aid in the detection of active inflammatory sacroiliitis on MRI STIR sequences. Multilayer Perceptron (MLP) achieved the best results.(AU)


Assuntos
Humanos , Imagem por Ressonância Magnética/instrumentação , Sacroileíte/diagnóstico por imagem , Aprendizado de Máquina , Inteligência Artificial , Estudos Retrospectivos , Diagnóstico por Computador/instrumentação
19.
Rheumatol Int ; 39(12): 2119-2127, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31535169

RESUMO

The objective of our study was to standardize magnetic resonance imaging (MRI) assessment of spine and sacroiliac joints in patients with axial spondyloarthritis (axSpA) and/or inflammatory spinal pain, by creating checklists and templates based on the opinions of rheumatologists and radiologists. A scientific committee developed a series of questionnaires with multiple items regarding MRI in patients with axial inflammatory pain and/or axSpA. Then an expert panel of rheumatologists and radiologists rated all items in a 9-point Likert scale. Finally, the scientific committee and the expert panel met to create the definitive documents. Several definitive checklists and templates were generated for rheumatologist-requested MRI and for radiologist-requested MRI reports of sacroiliac joint and spinal examinations. A technical requirement protocol was also agreed on. Our results could be useful in increasing understanding between rheumatologists and radiologists regarding MRI in axSpA diagnosis and follow-up.


Assuntos
Lista de Checagem , Imagem por Ressonância Magnética , Articulação Sacroilíaca/diagnóstico por imagem , Coluna Vertebral/diagnóstico por imagem , Espondilartrite/diagnóstico por imagem , Humanos , Sacroileíte/diagnóstico por imagem , Inquéritos e Questionários
20.
J Orthop Surg Res ; 14(1): 313, 2019 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-31533751

RESUMO

BACKGROUND: This study aimed to assess the efficacy of water-filtered infrared A (wIRA) in sacroiliitis in male patients with ankylosing spondylitis (AS) and the effect of wIRA therapy on serum vascular endothelial growth factor (VEGF). METHODS: One hundred twenty male AS patients with active sacroiliitis were randomly divided into wIRA group and control group. wIRA treatment was performed twice daily for 5 consecutive days with 24-h interval before switching the treatment (crossover design). Bath ankylosing spondylitis disease activity index (BASDAI) scores, pain visual analogue scale (VAS), and morning stiffness VAS were recorded prior to and after each treatment period. Additionally, C-reactive protein (CRP), serum VEGF, and resistance index (RI) of sacroiliac joints detected by ultrasonography were recorded at baseline and after the first and second treatment period, respectively. The efficacy was examined by using repeated measures analysis of variance (ANOVA). RESULTS: BASDAI, pain VAS, and morning stiffness VAS scores decreased significantly (P < 0.001) after wIRA treatment and no-wIRA treatment (control group), and the difference between the two groups was significant (P < 0.001). CRP declined and RI increased during the wIRA treatment as compared with the no-wIRA treatment (P < 0.001). The increase in RI was associated with improvement of pain VAS scores (P = 0.018), while serum VEGF was unaffected by the treatment. CONCLUSIONS: wIRA treatment achieved symptom and pain relief for AS patients with active sacroiliitis. wIRA treatment also improved RI revealed by ultrasonography, and this effect was associated with improved pain VAS scores.


Assuntos
Raios Infravermelhos/uso terapêutico , Sacroileíte/radioterapia , Espondilite Anquilosante/radioterapia , Fator A de Crescimento do Endotélio Vascular/sangue , Adulto , Proteína C-Reativa/metabolismo , Estudos Cross-Over , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor/métodos , Amplitude de Movimento Articular , Articulação Sacroilíaca/diagnóstico por imagem , Articulação Sacroilíaca/fisiopatologia , Sacroileíte/sangue , Sacroileíte/diagnóstico por imagem , Sacroileíte/fisiopatologia , Índice de Gravidade de Doença , Espondilite Anquilosante/sangue , Espondilite Anquilosante/diagnóstico por imagem , Espondilite Anquilosante/fisiopatologia , Resultado do Tratamento , Ultrassonografia , Adulto Jovem
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