Skip to main content
Top
Published in: Current Rheumatology Reports 5/2011

01-10-2011

Diagnostic Utility of MRI in Early Spondyloarthritis

Authors: Walter P. Maksymowych, Ulrich Weber

Published in: Current Rheumatology Reports | Issue 5/2011

Login to get access

Abstract

The introduction of MRI in spondyloarthritis (SpA) constitutes a major advance and is increasingly being implemented in clinical practice in cases in which clinical suspicion of SpA is high yet pelvic radiography is equivocal. Recent studies and development of consensus by international experts support the routine use of specific MRI sequences and scanning protocols for the evaluation of the sacroiliac joints in diagnostic work-up. There is also agreement that the finding of bone marrow edema in the sacroiliac joints carries a high probability of SpA, and emerging data indicate that the finding of erosion may also be diagnostically helpful, even in preradiographic SpA. Recent studies suggest that the diagnostic role of MRI may be further enhanced through the study of additional MRI sequences and prospective studies using systematic methodologies aimed at further scrutiny of structural lesions and the contribution of spinal imaging. Interest in MRI for SpA is poised for substantial growth.
Literature
1.
go back to reference • Rudwaleit M, Haibel H, Baraliakos X, Listing J, et al. The early disease stage in axial Spondylarthritis. Results from the German Spondyloarthritis Inception Cohort. Arthritis Rheum 2009; 60:717–727. This prospective study shows that SpA patients with preradiographic disease experience similar severity of symptoms to those with established AS. • Rudwaleit M, Haibel H, Baraliakos X, Listing J, et al. The early disease stage in axial Spondylarthritis. Results from the German Spondyloarthritis Inception Cohort. Arthritis Rheum 2009; 60:717–727. This prospective study shows that SpA patients with preradiographic disease experience similar severity of symptoms to those with established AS.
2.
go back to reference • Barkham N, Keen HI, Coates LC, et al. Clinical and imaging efficacy of infliximab in HLA-B27–positive patients with magnetic resonance imaging–determined early sacroiliitis. Arthritis Rheum 2009; 60: 946–954. This randomized controlled trial in very early SpA diagnosed by MRI demonstrated exceptional clinical responses to infliximab. PubMedCrossRef • Barkham N, Keen HI, Coates LC, et al. Clinical and imaging efficacy of infliximab in HLA-B27–positive patients with magnetic resonance imaging–determined early sacroiliitis. Arthritis Rheum 2009; 60: 946–954. This randomized controlled trial in very early SpA diagnosed by MRI demonstrated exceptional clinical responses to infliximab. PubMedCrossRef
3.
go back to reference • Hildrun H, Rudwaleit M, Listing J, et al. Efficacy of adalimumab in the treatment of axial spondylarthritis without radiographically defined sacroiliitis. Arthritis Rheum 2008; 58: 1981–1991. This randomized controlled trial of adalimumab showed that ASAS20 responses are even higher in preradiographic SpA than previously demonstrated in pivotal phase 3 trials of anti-TNF agents. CrossRef • Hildrun H, Rudwaleit M, Listing J, et al. Efficacy of adalimumab in the treatment of axial spondylarthritis without radiographically defined sacroiliitis. Arthritis Rheum 2008; 58: 1981–1991. This randomized controlled trial of adalimumab showed that ASAS20 responses are even higher in preradiographic SpA than previously demonstrated in pivotal phase 3 trials of anti-TNF agents. CrossRef
4.
go back to reference •• Rudwaleit M, van der Heijde D, Landewé R, et al. The development of assessment of SpondyloArthritis international Society (ASAS) Classification Criteria for axial spondyloarthritis (Part II): validation and final selection. Ann Rheum Dis 2009; 68: 777–783. This final study report describes the final selection of items and validation of the new ASAS axial SpA criteria. A notable inclusion is the addition of MRI as an imaging criterion for patients who do not have radiographic sacroiliitis. PubMedCrossRef •• Rudwaleit M, van der Heijde D, Landewé R, et al. The development of assessment of SpondyloArthritis international Society (ASAS) Classification Criteria for axial spondyloarthritis (Part II): validation and final selection. Ann Rheum Dis 2009; 68: 777–783. This final study report describes the final selection of items and validation of the new ASAS axial SpA criteria. A notable inclusion is the addition of MRI as an imaging criterion for patients who do not have radiographic sacroiliitis. PubMedCrossRef
5.
go back to reference Rudwaleit M, Jurik AG, Hermann KG, Landewé R, 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 Rudwaleit M, Jurik AG, Hermann KG, Landewé R, 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
6.
go back to reference Weber U, Maksymowych WP. How does imaging help the clinician in the evaluation and management of spondyloarthritis? Skeletal Radiol. 2008;37:487–90.PubMedCrossRef Weber U, Maksymowych WP. How does imaging help the clinician in the evaluation and management of spondyloarthritis? Skeletal Radiol. 2008;37:487–90.PubMedCrossRef
7.
go back to reference Christian EA, Feist E, Burovaa E, et al. Magnetic resonance imaging of active sacroiliitis: do we really need gadolinium? Eur J Rad. 2009;71:232–6.CrossRef Christian EA, Feist E, Burovaa E, et al. Magnetic resonance imaging of active sacroiliitis: do we really need gadolinium? Eur J Rad. 2009;71:232–6.CrossRef
8.
go back to reference Muche B, Bollow M, Francois RJ, Sieper J, Hamm B, Braun J. Anatomic structures involved in early- and late-stage sacroiliitis in spondylarthritis. A detailed analysis by contrast-enhanced magnetic resonance imaging. Arthritis Rheum. 2003;48:1374–84.PubMedCrossRef Muche B, Bollow M, Francois RJ, Sieper J, Hamm B, Braun J. Anatomic structures involved in early- and late-stage sacroiliitis in spondylarthritis. A detailed analysis by contrast-enhanced magnetic resonance imaging. Arthritis Rheum. 2003;48:1374–84.PubMedCrossRef
9.
go back to reference Puhakka KB, Melsen F, Jurik AG, Boel LW, Vesterby A, Egund N. MR imaging of the normal sacroiliac joint with correlation to histology. Skelet Radiol. 2004;33:15–28.CrossRef Puhakka KB, Melsen F, Jurik AG, Boel LW, Vesterby A, Egund N. MR imaging of the normal sacroiliac joint with correlation to histology. Skelet Radiol. 2004;33:15–28.CrossRef
10.
go back to reference 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 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
11.
go back to reference Baraliakos X, Hermann KG, Landewe R, et al. Assessment of acute spinal inflammation in patients with ankylosing spondylitis by magnetic resonance imaging: a comparison between contrast enhanced T1 and short tau inversion recovery (STIR) sequences. Ann Rheum Dis. 2005;64:1141–4.PubMedCrossRef Baraliakos X, Hermann KG, Landewe R, et al. Assessment of acute spinal inflammation in patients with ankylosing spondylitis by magnetic resonance imaging: a comparison between contrast enhanced T1 and short tau inversion recovery (STIR) sequences. Ann Rheum Dis. 2005;64:1141–4.PubMedCrossRef
12.
go back to reference Madsen KB, Jurik AG. Magnetic resonance imaging grading system for active and chronic spondylarthritis changes in the sacroiliac joint. Arthritis Care Res. 2010;62:11–8.CrossRef Madsen KB, Jurik AG. Magnetic resonance imaging grading system for active and chronic spondylarthritis changes in the sacroiliac joint. Arthritis Care Res. 2010;62:11–8.CrossRef
13.
go back to reference Weber U, Maksymowych WP, Jurik AG, et al. Validation of whole-body against conventional magnetic resonance imaging for scoring acute inflammatory lesions in the sacroiliac joints of patients with spondyloarthritis. Arthritis Rheum. 2009;61:893–9.PubMedCrossRef Weber U, Maksymowych WP, Jurik AG, et al. Validation of whole-body against conventional magnetic resonance imaging for scoring acute inflammatory lesions in the sacroiliac joints of patients with spondyloarthritis. Arthritis Rheum. 2009;61:893–9.PubMedCrossRef
14.
go back to reference Weber U, Hodler J, Jurik AG, et al. Assessment of active spinal inflammatory changes in patients with axial spondyloarthritis: validation of whole body MRI against conventional MRI. Ann Rheum Dis. 2010;69:648–53.PubMedCrossRef Weber U, Hodler J, Jurik AG, et al. Assessment of active spinal inflammatory changes in patients with axial spondyloarthritis: validation of whole body MRI against conventional MRI. Ann Rheum Dis. 2010;69:648–53.PubMedCrossRef
15.
go back to reference Bollow M, Hermann KG, Biedermann T, Sieper J, Schontube M, Braun J. Very early spondyloarthritis: where the inflammation in the sacroiliac joints starts. Ann Rheum Dis. 2005;64:1644–6.PubMedCrossRef Bollow M, Hermann KG, Biedermann T, Sieper J, Schontube M, Braun J. Very early spondyloarthritis: where the inflammation in the sacroiliac joints starts. Ann Rheum Dis. 2005;64:1644–6.PubMedCrossRef
16.
go back to reference Lambert RGW, Salonen D, Rahman P, et al. Adalimumab significantly reduces both spinal and sacroiliac joint inflammation in patients with ankylosing spondylitis. Arthritis Rheum. 2007;56:4005–14.PubMedCrossRef Lambert RGW, Salonen D, Rahman P, et al. Adalimumab significantly reduces both spinal and sacroiliac joint inflammation in patients with ankylosing spondylitis. Arthritis Rheum. 2007;56:4005–14.PubMedCrossRef
17.
go back to reference Maksymowych W, Dhillon SS, Chiowchanwisawakit P, 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. Maksymowych W, Dhillon SS, Chiowchanwisawakit P, 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.
18.
go back to reference Algin O, Gokalp G, Ocakoglu G. Evaluation of bone cortex and cartilage of spondyloarthropathic sacroiliac joint. Acad Radiol. 2010;17:1292–8.PubMedCrossRef Algin O, Gokalp G, Ocakoglu G. Evaluation of bone cortex and cartilage of spondyloarthropathic sacroiliac joint. Acad Radiol. 2010;17:1292–8.PubMedCrossRef
19.
go back to reference Wick MC, Weiss RJ, Jaschke W, Klauser A. Erosions are the most relevant magnetic resonance imaging features in quantification of sacroiliac joints in ankylosing spondylitis. J Rheumatol. 2010;37:622–7.PubMedCrossRef Wick MC, Weiss RJ, Jaschke W, Klauser A. Erosions are the most relevant magnetic resonance imaging features in quantification of sacroiliac joints in ankylosing spondylitis. J Rheumatol. 2010;37:622–7.PubMedCrossRef
20.
go back to reference Weber U, Pedersen SJ, Hodler J, Ostergaard M, Lambert RGW, Maksymowych WP. Does fat infiltration in the sacroiliac joint contribute to the diagnostic utility of MRI in ankylosing spondylitis? Arthritis Rheum. 2009;60 Suppl 10:54. abstract. Weber U, Pedersen SJ, Hodler J, Ostergaard M, Lambert RGW, Maksymowych WP. Does fat infiltration in the sacroiliac joint contribute to the diagnostic utility of MRI in ankylosing spondylitis? Arthritis Rheum. 2009;60 Suppl 10:54. abstract.
21.
go back to reference Braun J, Bollow M, Eggens U, Koenig H, Distler A, Sieper J. Use of dynamic magnetic resonance imaging with fast imaging in the detection of early and advanced sacroiliitis in spondyloarthropathy patients. Arthritis Rheum. 1994;37:1039–45.PubMedCrossRef Braun J, Bollow M, Eggens U, Koenig H, Distler A, Sieper J. Use of dynamic magnetic resonance imaging with fast imaging in the detection of early and advanced sacroiliitis in spondyloarthropathy patients. Arthritis Rheum. 1994;37:1039–45.PubMedCrossRef
22.
go back to reference Hanly JG, Mitchell MJ, Barnes DC, MacMillan L. Early recognition of sacroiliitis by magnetic resonance imaging and single photon emission computed tomography. J Rheumatol. 1994;21:2088–95.PubMed Hanly JG, Mitchell MJ, Barnes DC, MacMillan L. Early recognition of sacroiliitis by magnetic resonance imaging and single photon emission computed tomography. J Rheumatol. 1994;21:2088–95.PubMed
23.
go back to reference Bollow M, Braun J, Hamm B, et al. Early sacroiliitis in patients with spondyloarthropathy: evaluation with dynamic gadolinium-enhanced MR imaging. Radiology. 1995;194:529–36.PubMed Bollow M, Braun J, Hamm B, et al. Early sacroiliitis in patients with spondyloarthropathy: evaluation with dynamic gadolinium-enhanced MR imaging. Radiology. 1995;194:529–36.PubMed
24.
go back to reference Blum U, Buitrago-Tellez C, Mundinger A, et al. Magnetic resonance imaging (MRI) for detection of active sacroiliitis-a prospective study comparing conventional radiography, scintigraphy, and contrast enhanced MRI. J Rheumatol. 1996;23:2107–15.PubMed Blum U, Buitrago-Tellez C, Mundinger A, et al. Magnetic resonance imaging (MRI) for detection of active sacroiliitis-a prospective study comparing conventional radiography, scintigraphy, and contrast enhanced MRI. J Rheumatol. 1996;23:2107–15.PubMed
25.
go back to reference Puhakka KB, Jurik AG, Egund N, et al. Imaging of sacroiliitis in early seronegative spondyloarthropathy. Assessment of abnormalities by MRI in comparison with radiography and CT. Acta Radiol. 2003;44:218–29.PubMedCrossRef Puhakka KB, Jurik AG, Egund N, et al. Imaging of sacroiliitis in early seronegative spondyloarthropathy. Assessment of abnormalities by MRI in comparison with radiography and CT. Acta Radiol. 2003;44:218–29.PubMedCrossRef
26.
go back to reference Rudwaleit M, van der Heijde D, Khan MA, Braun J, Sieper J. How to diagnose axial spondyloarthritis early. Ann Rheum Dis. 2004;63:535–43.PubMedCrossRef Rudwaleit M, van der Heijde D, Khan MA, Braun J, Sieper J. How to diagnose axial spondyloarthritis early. Ann Rheum Dis. 2004;63:535–43.PubMedCrossRef
27.
go back to reference •• Weber U, Lambert RG, Ostergaard M, Hodler J, Pedersen SJ, Maksymowych WP. The diagnostic utility of MRI in spondyloarthritis: an international multicentre evaluation of 187 subjects. Arthritis Rheum 2010; 62: 3048–3058. This international, multicenter evaluation represents the first study using a standardized methodology and MRI sequences used in clinical practice to assess the diagnostic utility of MRI. PubMedCrossRef •• Weber U, Lambert RG, Ostergaard M, Hodler J, Pedersen SJ, Maksymowych WP. The diagnostic utility of MRI in spondyloarthritis: an international multicentre evaluation of 187 subjects. Arthritis Rheum 2010; 62: 3048–3058. This international, multicenter evaluation represents the first study using a standardized methodology and MRI sequences used in clinical practice to assess the diagnostic utility of MRI. PubMedCrossRef
28.
go back to reference • Weber U, Lambert RGW, Pedersen SJ, Hodler J, Østergaard M, Maksymowych WP. Assessment of structural lesions in sacroiliac joints enhances diagnostic utility of MRI in early spondyloarthritis. Arthritis Care Res 2010; 62: 1763–1771. This report highlights the importance of rheumatologist training to recognize abnormalities on the T1W sequence. It shows that rheumatologist evaluation of MRI scans is heavily biased toward interpretation of STIR images. CrossRef • Weber U, Lambert RGW, Pedersen SJ, Hodler J, Østergaard M, Maksymowych WP. Assessment of structural lesions in sacroiliac joints enhances diagnostic utility of MRI in early spondyloarthritis. Arthritis Care Res 2010; 62: 1763–1771. This report highlights the importance of rheumatologist training to recognize abnormalities on the T1W sequence. It shows that rheumatologist evaluation of MRI scans is heavily biased toward interpretation of STIR images. CrossRef
29.
go back to reference Maksymowych WP, Inman RD, Salonen D, et al. Spondyloarthritis Research Consortium of Canada magnetic resonance imaging index for assessment of sacroiliac joint inflammation in ankylosing spondylitis. Arthritis Rheum (Arthritis Care Res). 2005;53:703–9.CrossRef Maksymowych WP, Inman RD, Salonen D, et al. Spondyloarthritis Research Consortium of Canada magnetic resonance imaging index for assessment of sacroiliac joint inflammation in ankylosing spondylitis. Arthritis Rheum (Arthritis Care Res). 2005;53:703–9.CrossRef
30.
go back to reference • Lambert RGW, Pedersen SJ, Maksymowych WP, Chiowchanwisawakit P, Østergaard M. Active inflammatory lesions detected by magnetic resonance imaging in the spine of patients with spondyloarthritis—definitions, assessment system, and reference image set. J Rheumatol 2009; 36 suppl 84: 3–17. This report elaborates on the standardized definitions for active inflammatory lesions in the spine developed by the Canada-Denmark MRI International Working Group. • Lambert RGW, Pedersen SJ, Maksymowych WP, Chiowchanwisawakit P, Østergaard M. Active inflammatory lesions detected by magnetic resonance imaging in the spine of patients with spondyloarthritis—definitions, assessment system, and reference image set. J Rheumatol 2009; 36 suppl 84: 3–17. This report elaborates on the standardized definitions for active inflammatory lesions in the spine developed by the Canada-Denmark MRI International Working Group.
31.
go back to reference • Østergaard M, Maksymowych WP, Pedersen SJ, Chiowchanwisawakit P, Lambert RGW. Structural lesions detected by magnetic resonance imaging in the spine of patients with spondyloarthritis—definitions, assessment system, and reference image set. J Rheumatol 2009; 36 suppl 84: 18–34. This report elaborates on the standardized definitions for structural lesions in the spine developed by the Canada-Denmark MRI International Working Group. • Østergaard M, Maksymowych WP, Pedersen SJ, Chiowchanwisawakit P, Lambert RGW. Structural lesions detected by magnetic resonance imaging in the spine of patients with spondyloarthritis—definitions, assessment system, and reference image set. J Rheumatol 2009; 36 suppl 84: 18–34. This report elaborates on the standardized definitions for structural lesions in the spine developed by the Canada-Denmark MRI International Working Group.
32.
go back to reference • Pedersen SJ, Østergaard M, Chiowchanwisawakit P, Lambert RGW, Maksymowych WP. Validation of definitions for active inflammatory lesions detected by magnetic resonance imaging in the spine of patients with spondyloarthritis. J Rheumatol 2009; 36(suppl 84): 35–38. This report outlines the validation of definitions for active lesions of the spine, which constitutes an essential preliminary step prior to their implementation in clinical practice and research. • Pedersen SJ, Østergaard M, Chiowchanwisawakit P, Lambert RGW, Maksymowych WP. Validation of definitions for active inflammatory lesions detected by magnetic resonance imaging in the spine of patients with spondyloarthritis. J Rheumatol 2009; 36(suppl 84): 35–38. This report outlines the validation of definitions for active lesions of the spine, which constitutes an essential preliminary step prior to their implementation in clinical practice and research.
33.
go back to reference • Chiowchanwisawakit P, Østergaard M, Pedersen SJ, Lambert RGW, Conner-Spady B, Maksymowych WP. Validation of definitions for structural lesions detected by magnetic resonance imaging in the spine of patients with spondyloarthritis. J Rheumatol 2009; 36(suppl 84): 39–47. This report outlines the validation of definitions for structural lesions of the spine, which constitutes an essential preliminary step prior to their implementation in clinical practice and research. • Chiowchanwisawakit P, Østergaard M, Pedersen SJ, Lambert RGW, Conner-Spady B, Maksymowych WP. Validation of definitions for structural lesions detected by magnetic resonance imaging in the spine of patients with spondyloarthritis. J Rheumatol 2009; 36(suppl 84): 39–47. This report outlines the validation of definitions for structural lesions of the spine, which constitutes an essential preliminary step prior to their implementation in clinical practice and research.
34.
go back to reference • Weber U, Hodler J, Kubik RA, et al. Sensitivity and specificity of spinal inflammatory lesions assessed by whole-body magnetic resonance imaging in patients with ankylosing spondylitis or recent-onset inflammatory back pain. Arthritis Rheum 2009; 61: 900–908. This report using WBMRI shows that a vertebral corner inflammatory lesion may be seen in about one third of healthy controls, and that diagnostic utility of these lesions is optimal when at least two are present, especially in the thoracic spine. PubMedCrossRef • Weber U, Hodler J, Kubik RA, et al. Sensitivity and specificity of spinal inflammatory lesions assessed by whole-body magnetic resonance imaging in patients with ankylosing spondylitis or recent-onset inflammatory back pain. Arthritis Rheum 2009; 61: 900–908. This report using WBMRI shows that a vertebral corner inflammatory lesion may be seen in about one third of healthy controls, and that diagnostic utility of these lesions is optimal when at least two are present, especially in the thoracic spine. PubMedCrossRef
35.
go back to reference Bennett AN, Rehman A, Hensor EM, Marzo-Ortega H, Emery P, McGonagle D. The fatty Romanus lesion: a non-inflammatory spinal MRI lesion specific for axial spondyloarthropathy. Ann Rheum Dis. 2010;69:891–4.PubMedCrossRef Bennett AN, Rehman A, Hensor EM, Marzo-Ortega H, Emery P, McGonagle D. The fatty Romanus lesion: a non-inflammatory spinal MRI lesion specific for axial spondyloarthropathy. Ann Rheum Dis. 2010;69:891–4.PubMedCrossRef
36.
go back to reference •• Rennie WJ, Dhillon SS, Conner-Spady B, Maksymowych WP, Lambert RGW. MRI assessment of spinal inflammation in ankylosing spondylitis: standard clinical protocols may omit inflammatory lesions in thoracic vertebrae. Arthritis Rheum 2009; 61: 1187–1193. This report has major clinical practice implications in that it highlights the importance of using appropriate MRI scanning protocols that ensure adequate visualization of the lateral segments of the spine, where inflammatory lesions are frequently observed and are highly specific for SpA. PubMedCrossRef •• Rennie WJ, Dhillon SS, Conner-Spady B, Maksymowych WP, Lambert RGW. MRI assessment of spinal inflammation in ankylosing spondylitis: standard clinical protocols may omit inflammatory lesions in thoracic vertebrae. Arthritis Rheum 2009; 61: 1187–1193. This report has major clinical practice implications in that it highlights the importance of using appropriate MRI scanning protocols that ensure adequate visualization of the lateral segments of the spine, where inflammatory lesions are frequently observed and are highly specific for SpA. PubMedCrossRef
Metadata
Title
Diagnostic Utility of MRI in Early Spondyloarthritis
Authors
Walter P. Maksymowych
Ulrich Weber
Publication date
01-10-2011
Publisher
Current Science Inc.
Published in
Current Rheumatology Reports / Issue 5/2011
Print ISSN: 1523-3774
Electronic ISSN: 1534-6307
DOI
https://doi.org/10.1007/s11926-011-0190-x

Other articles of this Issue 5/2011

Current Rheumatology Reports 5/2011 Go to the issue
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.