Abstract
Objective:Seronegative spondyloarthritis (SpA) is characterized by chronic inflammation affecting the axial skeleton, entheses and occasionally peripheral joints. The involvement of the sacroiliac joints, sacroiliitis, is considered as a pathognomonic radiographic finding. Magnetic resonance imaging (MRI) is the method of choice for its early detection. Bone scintigraphy (BS) is characterized by high sensitivity in the diagnosis of bone and articular diseases. Limited value of BS in the diagnosis of sacroiliitis may be attributed to the use of planar imaging. In the present study, we aimed to investigate the role of SPECT in SpA, compared to MRI.Methods:Forty-three patients suffering from inflammatory back pain underwent MRI evaluation of the sacroiliac joints and BS, combined with SPECT in the same region, for the assessment of sacroiliitis.Results:Bone SPECT revealed no findings of sacroiliitis in 11 patients, with total agreement with MRI. Findings of chronic lesions were demonstrated from both modalities in 2 patients. Bone SPECT and MRI findings were in concordance regarding the investigation of active sacroiliitis, with the exception of one patient with mild SPECT findings and negative MRI examination; the diagnosis of AS however, was established one year later, after a positive follow-up MRI. The evaluation of the planar imaging of the whole skeleton and SPECT imaging, revealed additional lesions.Conclusion:Bone SPECT is a reliable imaging method in the diagnosis of active sacroiliitis. Its application on planar BS, an economic and widely available diagnostic technique, appears to be a valuable aid for the clinician.
Highlights
Ankylosing spondylitis (AS) is the most common form of seronegative spondyloarthritis (SpA)
Findings of active sacroiliitis were recorded in 30 patients; 23 patients with definite findings of active sacroiliitis (Table 1) and seven patients with mildly increased radiotracer uptake at the sacroiliac joints indicating low-grade sacroiliitis (Table 2)
Bone SPECT revealed no findings of sacroiliitis in eleven patients
Summary
Ankylosing spondylitis (AS) is the most common form of seronegative spondyloarthritis (SpA). It is characterized by chronic inflammation affecting the axial skeleton, entheses and occasionally peripheral joints. A broader term, axial spondyloarthritis (ax-SpA), has been introduced in order to describe all SpA types affecting the axial joints, including those without radiographic findings [2]. Magnetic resonance imaging (MRI) is the method of choice for the early detection of sacroiliitis [3]. MRI can detect acute (and chronic) inflammation, even before the radiographic depiction of structural changes (erosions, sclerosis, ankylosis). The interpretation of radiographic images regarding sacroiliitis is quite difficult, and the corresponding findings are present only after significant disease progression [4]
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