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Current Rheumatology Reports
Published in: Current Rheumatology Reports 8/2013

01-08-2013 | SERONEGATIVE ARTHRITIS (MA KHAN, SECTION EDITOR)

Advances and Challenges in Spondyloarthritis Imaging for Diagnosis and Assessment of Disease

Authors: Ulrich Weber, Walter P. Maksymowych

Published in: Current Rheumatology Reports | Issue 8/2013

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Abstract

In recent years there has been an increased focus on use of imaging for diagnosis and assessment of spondyloarthritis (SpA). Magnetic resonance imaging (MRI) has attracted particular interest for its potential to improve diagnostic certainty for early, non-radiographic disease and to assist clinical decision-making. This report summarizes recent developments toward definition of positive sacroiliac joint and spine MRIs for SpA, with erosion as the major determinant for disease classification. The report also highlights recent SpA imaging work relevant to daily practice, focusing on limitations and challenges of SpA imaging and, in particular, on unsolved practical difficulties of using MRI in SpA. Recent data suggest that SpA imaging in daily practice may not be confined to identification and assessment of disease; it may also become essential for monitoring, clinical decision making, and selecting the most appropriate treatment for patients with SpA. Improved use of imaging may have much potential to enable better management of SpA.
Literature
1.
Rudwaleit M, van der Heijde D, Landewé R, Listing J, Akkoc N, Brandt J, et al. The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): validation and final selection. Ann Rheum Dis. 2009;68:777–83.PubMedCrossRef
2.
Robinson PC, Wordsworth BP, Reveille JD, Brown MA. Axial spondyloarthritis: a new disease entity, not necessarily early ankylosing spondylitis. Ann Rheum Dis. 2013;72:162–4.PubMedCrossRef
3.
Sieper J, van der Heijde D. Nonradiographic axial spondyloarthritis. New definition of an old disease? Arthritis Rheum. 2013;65:543–51.PubMedCrossRef
4.
Jang JH, Ward MM, Rucker AN, Reveille JD, Davis Jr JC, Weisman MH, et al. Ankylosing spondylitis: patterns of radiographic involvement—a re-examination of accepted principles in a cohort of 769 patients. Radiology. 2011;258:192–8.PubMedCrossRef
5.
Del Grande F, Carrino JA, Zanetti M. Magnetic resonance imaging of spondyloarthritis. Top Magn Reson Imaging. 2011;22:83–8.PubMedCrossRef
6.
Weber U, Østergaard M, Lambert RGW, Maksymowych WP. The impact of MRI on the clinical management of inflammatory arthritides. Skeletal Radiol. 2011;40:1153–73.PubMedCrossRef
7.
• Lambert RGW, Dhillon SS, Jaremko JL. Advanced imaging of the axial skeleton in spondyloarthropathy: techniques, interpretation, and utility. Semin Musculoskelet Radiol. 2012;16:389–400. This review article summarizes advances in MR image acquisition and interpretation of the sacroiliac joints and the spine in spondyloarthritis from a radiologist’s perspective.PubMedCrossRef
8.
Madsen KB, Egund N, Jurik AG. Grading of inflammatory disease activity in the sacroiliac joints with magnetic resonance imaging: comparison between short-tau inversion recovery and gadolinium contrast-enhanced sequences. J Rheumatol. 2010;37:393–400.PubMedCrossRef
9.
De Hooge M, van den Berg R, Navarro-Compan V, van Gaalen F, van der Heijde D, Huizinga T, et al. Magnetic resonance imaging of the sacroiliac joints in the early detection of spondyloarthritis: no added value of gadolinium compared with short tau inversion recovery sequence. Rheumatology. 2013. doi:10.​1093/​rheumatology/​ket012.
10.
Rudwaleit M, Jurik AG, Hermann KGA, Landewé R, van der Heijde D, Baraliakos X, et al. Defining active sacroiliitis on magnetic resonance imaging (MRI) for classification of axial spondyloarthritis: a consensual approach by the ASAS/OMERACT MRI Group. Ann Rheum Dis. 2009;68:1520–7.PubMedCrossRef
11.
Marzo-Ortega H, McGonagle D, O’Connor P, Hensor EMA, Bennett AN, Green MJ, et al. Baseline and 1-year magnetic resonance imaging of the sacroiliac joint and lumbar spine in very early inflammatory back pain. Relationship between symptoms, HLA-B27 and disease extent and persistence. Ann Rheum Dis. 2009;68:1721–7.PubMedCrossRef
12.
Weber U, Lambert RGW, Østergaard M, Hodler J, Pedersen SJ, Maksymowych WP. The diagnostic utility of magnetic resonance imaging in spondyloarthritis. An international multicenter evaluation of one hundred eighty-seven subjects. Arthritis Rheum. 2010;62:3048–58.PubMedCrossRef
13.
Weber U, Zubler V, Pedersen SJ, Rufibach K, Lambert RGW, Chan SM, et al. Development and validation of a magnetic resonance imaging reference criterion for defining a positive sacroiliac joint magnetic resonance imaging in spondyloarthritis. Arthritis Care Res (Hoboken) 2013; 65: doi: 10.​1002/​acr.​21893
14.
Solmaz D, Onen F, Balci A, Akar S. Clinical images: Pelvic Ewing sarcoma mimicking sacroiliitis. Arthritis Rheum. 2013;65:290.PubMedCrossRef
15.
Modaressi K, Fuchs B, Bode P, Sutter R, Meili S, Weber U. Clinical images: Osteoblastoma of the ilium mimicking sacroiliitis. Arthritis Rheum 2013; 65: doi 10.​1002/​art.​37915
16.
Wick MC, Weiss RJ, Jaschke W, Klauser AS. Erosions are the most relevant magnetic resonance imaging features in quantification of sacroiliac joints in ankylosing spondylitis. J Rheumatol. 2010;37:622–7.PubMedCrossRef
17.
Weber U, Lambert RGW, Pedersen SJ, Hodler J, Østergaard M, Maksymowych WP. Assessment of structural lesions in sacroiliac joints enhances diagnostic utility of magnetic resonance imaging in early spondyloarthritis. Arthritis Care Res (Hoboken). 2010;62:1763–71.CrossRef
18.
Gong Y, Zheng N, Chen SB, Xiao ZY, Wu MY, Liu Y, et al. Ten years’ experience with needle biopsy in the early diagnosis of sacroiliitis. Arthritis Rheum. 2012;64:1399–406.PubMedCrossRef
19.
• Arnbak B, Leboeuf-Yde C, Jensen TS. A systematic critical review on MRI in spondyloarthritis. Arthritis Res Ther. 2012;14:R55. This systematic literature review highlights the limited evidence regarding diagnostic utility of MRI in spondyloarthritis because of an only small number of high-quality studies.PubMedCrossRef
20.
Althoff CE, Sieper J, Song IH, Haibel H, Weiss A, Diekhoff T, et al. Active inflammation and structural change in early active axial spondyloarthritis as detected by whole-body MRI. Ann Rheum Dis. 2012;0:1–7. doi:10.​1136/​annrheumdis-2012-201545.
21.
Weber U, Pedersen SJ, Østergaard M, Rufibach K, Lambert RGW, Maksymowych WP. Can erosions on MRI of the sacroiliac joints be reliably detected in patients with ankylosing spondylitis—a cross-sectional study. Arthritis Res Ther. 2012;14:R124.PubMedCrossRef
22.
Berrington de Gonzalez A, Mahesh M, Kim KP, Bhargavan M, Lewis R, Mettler F, et al. Projected cancer risks from computed tomographic scans performed in the United States in 2007. Arch Intern Med. 2009;169:2071–7.PubMedCrossRef
23.
Smith-Bindman R, Lipson J, Marcus R, Kim KP, Mahesh M, Gould R. Berrington de Gonzalez A, Miglioretti DL. Radiation dose associated with common computed tomography examinations and the associated lifetime attributable risk of cancer. Arch Intern Med. 2009;169:2078–86.PubMedCrossRef
24.
Redberg RF. Cancer risks and radiation exposure from computed tomographic scans. How can we be sure that the benefits outweigh the risks? [editorial]. Arch Intern Med. 2009;169:2049–50.PubMedCrossRef
25.
Pearce MS, Salotti JA, Little MP, McHugh K, Lee C, Kim KP, et al. Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. Lancet. 2012;380:499–505.PubMedCrossRef
26.
Hermann KGA, Baraliakos X, van der Heijde DMFM, Jurik AG, Landewé R, Marzo-Ortega H, et al. Descriptions of spinal MR lesions and definition of a positive MRI of the spine in axial spondyloarthritis: a consensual approach by the ASAS/OMERACT MRI study group. Ann Rheum Dis. 2012;71:1278–88.PubMedCrossRef
27.
Maksymowych WP, Dhillon SS, Chiowchanwisawakit P, Pedersen SJ, Martinez B, Østergaard M, et al. Development and validation of web-based training modules for systematic evaluation of active inflammatory lesions in the spine and sacroiliac joints in spondyloarthritis. J Rheumatol. 2009;36 Suppl 84:48–57.
28.
Weber U, Zubler V, Zhao Z, Lambert RGW, Chan SM, Pedersen SJ, et al. Spinal MRI has little incremental diagnostic value compared with MRI of the sacroiliac joints alone in early spondyloarthritis [abstract]. Arthritis Rheum. 2012;64(suppl):S337.
29.
Van der Heijde D, Sieper J, Maksymowych WP, Brown MA, Rathmann SS, Pangan AL. Spinal inflammation in the absence of sacroiliac joint inflammation on MRI in patients with active non-radiographic axial spondyloarthritis [abstract]. Arthritis Rheum. 2012;64(suppl):S444.
30.
Feydy A, Lavie-Brion MC, Gossec L, Lavie F, Guerini H, Nguyen C, et al. Comparative study of MRI and power Doppler ultrasonography of the heel in patients with spondyloarthritis with and without heel pain and in controls. Ann Rheum Dis. 2012;71:498–503.PubMedCrossRef
31.
Hodgson RJ, Grainger AJ, O’Connor PJ, Evans R, Coates L, Marzo-Ortega H, et al. Imaging of the Achilles tendon in spondyloarthritis: a comparison of ultrasound and conventional, short and ultrashort echo time MRI with and without intravenous contrast. Eur Radiol. 2011;21:1144–52.PubMedCrossRef
32.
Emad Y, Ragab Y, Gheita T, Anbar A, Kamal H, Saad A, et al. Knee enthesitis and synovitis on magnetic resonance imaging in patients with psoriasis without arthritic symptoms. J Rheumatol. 2012;39:1979–86.PubMedCrossRef
33.
Verdon F, Burnand B, Herzig L, Junod M, Pécoud A, Favrat B. Chest wall syndrome among primary care patients: a cohort study. BMC Fam Pract. 2007;8:51.PubMedCrossRef
34.
Ramonda R, Lorenzin M, Lo Nigro A, Vio S, Zucchetta P, Frallonardo P, et al. Anterior chest wall involvement in early stages of spondyloarthritis: advanced diagnostic tools. J Rheumatol. 2012;39:1844–9.PubMedCrossRef
35.
Weber U, Lambert RGW, Rufibach K, Maksymowych WP, Hodler J, Zejden A, et al. Anterior chest wall inflammation by whole-body magnetic resonance imaging in patients with spondyloarthritis: lack of association between clinical and imaging findings in a cross-sectional study. Arthritis Res Ther. 2012;14:R3.PubMedCrossRef
36.
37.
Song IH, Brandt H, Rudwaleit M, Sieper J. Limited diagnostic value of unilateral sacroiliitis in scintigraphy in assessing axial spondyloarthritis. J Rheumatol. 2010;37:1200–2.PubMedCrossRef
38.
Song IH, Carrasco-Fernandez J, Rudwaleit M, Sieper J. The diagnostic value of scintigraphy in assessing sacroiliitis in ankylosing spondylitis: a systematic literature research. Ann Rheum Dis. 2008;67:1535–40.PubMedCrossRef
39.
Bandinelli F, Melchiorre D, Scazzariello F, Candelieri A, Conforti D, Matucci-Cerinic M. Clinical and radiological evaluation of sacroiliac joints compared with ultrasound examination in early spondyloarthritis. Rheumatology. 2013. doi:10.​1093/​rheumatology/​ket105.PubMed
40.
Hu Y, Zhu J, Xue Q, Wang N, Hu B. Scanning of the sacroiliac joint and entheses by color Doppler ultrasonography in patients with ankylosing spondylitis. J Rheumatol. 2011;38:1651–5.PubMedCrossRef
41.
De Miguel E, Munoz-Fernandez S, Castillo C, Cobo-Ibanez T, Martin-Mola E. Diagnostic accuracy of enthesis ultrasound in the diagnosis of early spondyloarthritis. Ann Rheum Dis. 2011;70:434–9.PubMedCrossRef
42.
D’Agostino MA, Aegerter P, Bechara K, Salliot C, Judet O, Chimenti MS, et al. How to diagnose spondyloarthritis early? Accuracy of peripheral enthesitis detection by power Doppler ultrasonography. Ann Rheum Dis. 2011;70:1433–40.PubMedCrossRef
43.
Blachier M, Coutanceau B, Dougados M, Saraux A, Bastuji-Garin S, Ferkal S, et al. Does the site of magnetic resonance imaging abnormalities match the site of recent-onset inflammatory back pain? The DESIR cohort. Ann Rheum Dis. 2012;0:1–7. doi:10.​1136/​annrheumdis-2012-201427.
44.
Kiltz U, Baraliakos X, Karakostas P, Igelmann M, Kalthoff L, Klink C, et al. The degree of spinal inflammation is similar in patients with axial spondyloarthritis who report high or low levels of disease activity: a cohort study. Ann Rheum Dis. 2012;71:1207–11.PubMedCrossRef
45.
Machado P, Landewé RBM, Braun J, Baraliakos X, Hermann KGA, Hsu B, et al. MRI inflammation and its relation with measures of clinical disease activity and different treatment responses in patients with ankylosing spondylitis treated with a tumour necrosis factor inhibitor. Ann Rheum Dis. 2012;71:2002–5.PubMedCrossRef
46.
Pedersen SJ, Sorensen IJ, Hermann KGA, Madsen OR, Tvede N, Hansen MS, et al. Responsiveness of the Ankylosing Spondylitis Disease Activity Score (ASDAS) and clinical and MRI measures of disease activity in a 1-year follow-up study of patients with axial spondyloarthritis treated with tumour necrosis factor α inhibitors. Ann Rheum Dis. 2010;69:1065–71.PubMedCrossRef
47.
Briot K, Durnez A, Paternotte S, Miceli-Richard C, Dougados M, Roux C. Bone oedema on MRI is highly associated with low bone mineral density in patients with early inflammatory back pain: results from the DESIR cohort. Ann Rheum Dis. 2012;00:1–6. doi:10.​1136/​annrheumdis-2012-201845.
48.
Poddubnyy D, Rudwaleit M, Haibel H, Listing J, Märker-Hermann E, Zeidler H, et al. Effect of non-steroidal anti-inflammatory drugs on radiographic spinal progression in patients with axial spondyloarthritis: results from the German Spondyloarthritis Inception Cohort. Ann Rheum Dis. 2012;71:1616–22.PubMedCrossRef
49.
Kroon F, Landewé R, Dougados M, van der Heijde D. Continuous NSAID use reverts the effects of inflammation on radiographic progression in patients with ankylosing spondylitis. Ann Rheum Dis. 2012;71:1623–9.PubMedCrossRef
50.
• Maksymowych WP, Morency N, Connor-Spady B, Lambert RG. Suppression of inflammation and effects on new bone formation in ankylosing spondylitis: evidence for a window of opportunity in disease modification. Ann Rheum Dis. 2013;72:23–8. This report shows that new bone formation on spinal radiographs is more probable in the presence of advanced inflammatory lesions on spinal MRI compared with early inflammation on MRI. These findings support the hypothesis of a window of opportunity for disease modification, if treatment is initiated early in the disease course.PubMedCrossRef
Metadata
Title
Advances and Challenges in Spondyloarthritis Imaging for Diagnosis and Assessment of Disease
Authors
Ulrich Weber
Walter P. Maksymowych
Publication date
01-08-2013
Publisher
Springer US
Published in
Current Rheumatology Reports / Issue 8/2013
Print ISSN: 1523-3774
Electronic ISSN: 1534-6307
DOI
https://doi.org/10.1007/s11926-013-0345-z

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