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Current Rheumatology Reports Jun 2022Recent technical advances in computed tomography (CT) such as low-dose CT and dual-energy techniques open new applications for this imaging modality in clinical practice... (Review)
Review
PURPOSE OF REVIEW
Recent technical advances in computed tomography (CT) such as low-dose CT and dual-energy techniques open new applications for this imaging modality in clinical practice and for research purposes. This article will discuss the latest innovations and give a perspective on future developments.
RECENT FINDINGS
Low-dose CT has increasingly been used for assessing structural changes at the sacroiliac joints and the spine. It has developed into a method with similar or even lower radiation exposure than radiography while outperforming radiography for lesion detection. Despite being incompatible with low-dose scanning, some studies have shown that dual-energy CT can provide additional information that is otherwise only assessable with magnetic resonance imaging (MRI). However, it is unclear whether this additional information is reliable enough and if it would justify the additional radiation exposure, i.e. whether the performance of dual-energy CT is close enough to MRI to replace it in clinical practice. While the role of dual-energy CT in patients with axial spondyloarthritis remains to be established, low-dose CT has developed to an appropriate modality that should replace radiography in many circumstances and might supplement MRI.
Topics: Axial Spondyloarthritis; Humans; Magnetic Resonance Imaging; Radiography; Sacroiliac Joint; Sacroiliitis; Spondylarthritis; Tomography, X-Ray Computed
PubMed: 35397047
DOI: 10.1007/s11926-022-01075-5 -
The Korean Journal of Internal Medicine Jul 2021Sacroiliitis is a frequent extraintestinal manifestation of inflammatory bowel diseases (IBDs). This study aimed to assess the prevalence of sacroiliitis using a...
BACKGROUND/AIMS
Sacroiliitis is a frequent extraintestinal manifestation of inflammatory bowel diseases (IBDs). This study aimed to assess the prevalence of sacroiliitis using a validated screening tool based on abdominopelvic computed tomography (APCT) in Korean patients with Crohn's disease (CD) and examine potential associations between clinical characteristics and sacroiliitis.
METHODS
One hundred five patients with CD undergoing APCT for any indication at an IBD clinic were matched 1:1 for age and sex with 105 controls without underlying chronic illnesses. Using a validated APCT screening tool that defines sacroiliitis as either ankylosis or a total erosion score (TES) ≥ 3, all computed tomography scans were assessed by two independent, blinded radiologists. We compared the prevalence of sacroiliitis between CD patients and controls and clinical characteristics between CD patients with and without sacroiliitis.
RESULTS
The prevalence of sacroiliitis was significantly higher in CD patients than in controls (13.3% vs. 4.8%, p = 0.030). All subjects with sacroiliitis had a TES ≥ 3, but no ankylosis. The assessment of sacroiliitis in APCT showed excellent interreader reliability (Cohen's kappa = 0.933 for presence of sacroiliitis). Sacroiliitis in CD patients was bilateral and asymptomatic. There were no significant associations between sacroiliitis and any demographic data or clinical characteristics in these patients.
CONCLUSION
The prevalence of APCT-detected sacroiliitis in CD patients was higher than that in controls, but the condition was asymptomatic. The clinical significance of asymptomatic sacroiliitis in Korean CD patients remains unclear.
Topics: Crohn Disease; Humans; Reproducibility of Results; Republic of Korea; Sacroiliac Joint; Sacroiliitis; Tomography, X-Ray Computed
PubMed: 32872747
DOI: 10.3904/kjim.2020.199 -
Zeitschrift Fur Rheumatologie Jun 2021Although musculoskeletal system involvement is a well-known manifestation in systemic lupus erythematosus (SLE), the probability of sacroiliac joint involvement and its...
OBJECTIVE
Although musculoskeletal system involvement is a well-known manifestation in systemic lupus erythematosus (SLE), the probability of sacroiliac joint involvement and its effect on patients might be ignored. The aim of the study was to investigate the association between SLE and sacroiliitis and to evaluate the relationship between clinical parameters and sacroiliitis in SLE.
METHODS
The study was designed as a case-control study. A total of 63 patients with SLE and 31 age- and sex-matched healthy controls were included in the study. The clinical and demographic variables of the study population were documented. The sacroiliac joints of patients and controls were evaluated with sacroiliac magnetic resonance imaging. Human leukocyte antigen (HLA) B27 was assessed using flow cytometry (Beckman Coulter Navios-model 3, Beckman Coulter Inc., Brea, CA, USA). Multinomial logistic regression analysis was used to determine the clinical risk factors related to sacroiliitis.
RESULTS
Among the 63 patients, acute sacroiliitis was found in 25 patients (39.7%) and chronic sacroiliitis was found in 21 patients (33.3%). Sacroiliitis was higher in patients than in controls (p = 0.001). Acute sacroiliitis was more frequently observed in patients when compared with the control group (p = 0.001). Higher C‑reactive protein (CRP) concentrations (odds ratio = 1.75, 95% confidence interval: 1.30-2.35; p < 0.001) were found to be a risk factor for acute sacroiliitis.
CONCLUSION
The ratio of sacroiliitis was higher in patients with SLE than in controls. Increased CRP concentrations were determined as a risk factor for acute sacroiliitis. Thus, one should keep in mind that patients with SLE and higher CRP concentrations may have sacroiliitis.
Topics: Case-Control Studies; Humans; Lupus Erythematosus, Systemic; Magnetic Resonance Imaging; Sacroiliac Joint; Sacroiliitis
PubMed: 32945953
DOI: 10.1007/s00393-020-00879-z -
Therapeutic Advances in Infectious... 2024Brucellosis is a common global zoonotic disease with a wide range of complex and nonspecific clinical manifestations that may lead to misdiagnosis and delayed treatment....
INTRODUCTION
Brucellosis is a common global zoonotic disease with a wide range of complex and nonspecific clinical manifestations that may lead to misdiagnosis and delayed treatment. Osteoarticular involvement is the most common complaint in brucellosis.
OBJECTIVE
This present study aims to describe the clinical and laboratory characteristics and treatment of brucellosis patients with arthritis and sacroiliitis.
METHODS
This retrospective descriptive study was performed on patients presenting to a teaching hospital in Kermanshah, Iran with a diagnosis of brucellosis from 2011 to 2019. The demographic and clinical characteristics, complications, laboratory findings, and treatment were recorded during the study period. Then, the difference in the collected data was investigated between brucellosis patients with and without arthritis or sacroiliitis.
RESULTS
Of 425 patients studied, 130 (30.58%) had osteoarticular involvement. Among them, 41 (9.64%) and 58 (13.6%) patients were diagnosed with arthritis and sacroiliitis, respectively. There were no significant demographic differences between patients with and without brucellar arthritis or sacroiliitis ( > 0.05). The patients with arthritis had a significantly higher frequency of arthralgia and radiculopathy ( ⩽ 0.05). Sacroiliitis was significantly more common in patients with arthralgia, neck pain, and low back pain, positive flexion-abduction-external rotation (FABER) test, radiculopathy, and vertebral tenderness compared to patients without sacroiliitis ( ⩽ 0.05), while fever and headache were significantly more common in patients without sacroiliitis ( ⩽ 0.05). The median Wright and 2-Mercapto Ethanol titers were higher in brucellosis patients with arthritis or sacroiliitis patients without arthritis or sacroiliitis, but the difference was not significant ( > 0.05). Synovial fluid had been analyzed in 20 cases. The mean white blood cell count, glucose, and protein level were 3461 ± 2.70 cells/mm, 58.54 ± 31.43 mg/dL, and 8.6 ± 11.85 g/dL, respectively. In 80% of the subjects, neutrophil cells were predominant. There were no significant laboratory differences between patients with and without brucellar arthritis or sacroiliitis, except for a higher median platelet count in patients with arthritis and higher median levels of aspartate aminotransferase (AST) and alkaline phosphatase (ALP) in patients with sacroiliitis. Most cases of arthritis and sacroiliitis were diagnosed with ultrasound (31.8%) and FABER test (79.3%), respectively.
CONCLUSION
Arthritis and sacroiliitis were the two most important and common manifestations of brucellar osteoarthritis with a frequency of 9.64% and 13.6%, respectively. Any complaints of low back pain and radiculopathy as well as the presence of spondylitis in patients should raise suspicion of sacroiliitis. High levels of AST and ALP and a high platelet count may be associated with brucellar sacroiliitis and arthritis, respectively. The use of imaging methods such as MRI and bone scan seems necessary for the diagnosis of sacroiliitis.
PubMed: 38716079
DOI: 10.1177/20499361241246937 -
Clinical Rheumatology Feb 2021
Topics: Humans; Longitudinal Studies; Magnetic Resonance Imaging; Sacroiliac Joint; Sacroiliitis; Spondylarthritis
PubMed: 33405013
DOI: 10.1007/s10067-020-05527-0 -
Clinical Rheumatology Feb 2022Osteitis condensans ilii (OCI) is a benign condition characterised by triangular sclerosis of the iliac bone which may mimic radiographic sacroiliitis. Prevalence is...
OBJECTIVES
Osteitis condensans ilii (OCI) is a benign condition characterised by triangular sclerosis of the iliac bone which may mimic radiographic sacroiliitis. Prevalence is estimated between 0.9 and 2.5%, with female predominance, but the most recent article reporting original epidemiological data in the general population was published in 1971. The aim of our study is to contribute updated figures about prevalence of OCI in Italy.
METHOD
A retrospective review of pelvic radiographs was conducted. Consecutive patients visiting the emergency department of our Institution between 1st January and 31st December 2020 were enrolled. Individuals with a past diagnosis of axial spondyloarthritis were excluded. Presence of OCI was evaluated by two musculoskeletal radiologists. Clinical and radiologic features such as osteoarthritis and insertional enthesopathy were also assessed.
RESULTS
We included 1047 individuals (61% female) with a median age of 74 years. OCI was present in 10 cases, accounting for a prevalence in the general population of 1.0% (95% CI 0.5-1.7). All patients with OCI were women and, in the female sample, prevalence was 1.6% (95% CI 0.7-2.8). Clinical characteristics and associated radiographic features were not different between patients with OCI and women without OCI.
CONCLUSIONS
The prevalence of OCI observed in our study is consistent with previous literature, and we confirm that it is more frequently retrieved in women. Longitudinal research is warranted to elucidate the evolution, while knowledge about the disorder is needed to raise the awareness of rheumatologists and radiologists and to properly identify and report the condition. Key Points • OCI may mimic sacroiliitis and is a major differential diagnosis of radiographic axial spondyloarthritis. • Prevalence of OCI in our sample is 1.0%, in line with previous literature. • OCI predominantly affects women, and our study suggests that the disorder can be incidentally identified even after childbearing age. • Increased awareness of the characteristics of OCI can facilitate identification and reporting of the disorder.
Topics: Aged; Axial Spondyloarthritis; Female; Humans; Male; Osteitis; Prevalence; Retrospective Studies; Sacroiliac Joint; Sacroiliitis
PubMed: 34568992
DOI: 10.1007/s10067-021-05925-y -
International Journal of Computer... Oct 2020To evaluate the performance of texture-based biomarkers by radiomic analysis using magnetic resonance imaging (MRI) of patients with sacroiliitis secondary to...
PURPOSE
To evaluate the performance of texture-based biomarkers by radiomic analysis using magnetic resonance imaging (MRI) of patients with sacroiliitis secondary to spondyloarthritis (SpA).
RELEVANCE
The determination of sacroiliac joints inflammatory activity supports the drug management in these diseases.
METHODS
Sacroiliac joints (SIJ) MRI examinations of 47 patients were evaluated. Thirty-seven patients had SpA diagnoses (27 axial SpA and ten peripheral SpA) which was established previously after clinical and laboratory follow-up. To perform the analysis, the SIJ MRI was first segmented and warped. Second, radiomics biomarkers were extracted from the warped MRI images for associative analysis with sacroiliitis and the SpA subtypes. Finally, statistical and machine learning methods were applied to assess the associations of the radiomics texture-based biomarkers with clinical outcomes.
RESULTS
All diagnostic performances obtained with individual or combined biomarkers reached areas under the receiver operating characteristic curves ≥ 0.80 regarding SpA related sacroiliitis and and SpA subtypes classification. Radiomics texture-based analysis showed significant differences between the positive and negative SpA groups and differentiated the axial and peripheral subtypes (P < 0.001). In addition, the radiomics analysis was also able to correctly identify the disease even in the absence of active inflammation.
CONCLUSION
We concluded that the application of the radiomic approach constitutes a potential noninvasive tool to aid the diagnosis of sacroiliitis and for SpA subclassifications based on MRI of sacroiliac joints.
Topics: Adult; Biomarkers; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Sacroiliac Joint; Sacroiliitis; Spondylarthritis
PubMed: 32607695
DOI: 10.1007/s11548-020-02219-7 -
Revista Da Associacao Medica Brasileira... 2024Familial Mediterranean fever is the most common monogenic autoinflammatory disease. This study aimed to evaluate the relationship between sacroiliitis observed in...
OBJECTIVE
Familial Mediterranean fever is the most common monogenic autoinflammatory disease. This study aimed to evaluate the relationship between sacroiliitis observed in familial Mediterranean fever and hematological inflammatory markers.
METHODS
In this study, 168 familial Mediterranean fever patients were examined. A total of 61 familial Mediterranean fever patients who had sacroiliac magnetic resonance imaging due to waist and hip pain were included in the study. According to the magnetic resonance imaging findings, patients were divided into two groups: with and without sacroiliitis. The relationship between hematological inflammatory markers and sacroiliitis was investigated.
RESULTS
The frequency of sacroiliitis was found to be 13.6% in all familial Mediterranean fever patients and 37.8% in patients with low back pain who underwent sacroiliac magnetic resonance imaging. Neutrophil count, neutrophil/lymphocyte ratio, monocyte/lymphocyte ratio, and systemic immune-inflammatory index were significantly higher in the sacroiliitis group than in the other group, and this difference was found to be statistically significant (p<0.05). As a result of the receiver operating characteristic analysis, it was observed that neutrophil/lymphocyte ratio, monocyte/lymphocyte ratio, and systemic immune-inflammatory index were very sensitive parameters in determining sacroiliitis in patients with familial Mediterranean fever.
CONCLUSION
It was observed that the frequency of sacroiliitis was increased in familial Mediterranean fever patients. It is predicted that hematological inflammatory markers such as neutrophil/lymphocyte ratio, monocyte/lymphocyte ratio, and systemic immune-inflammatory index can be used in the diagnosis of sacroiliitis.
Topics: Humans; Familial Mediterranean Fever; Sacroiliitis; Female; Male; Adult; Magnetic Resonance Imaging; Biomarkers; Young Adult; Neutrophils; Adolescent; Low Back Pain; ROC Curve; Leukocyte Count; Monocytes; Lymphocytes; Middle Aged
PubMed: 38775516
DOI: 10.1590/1806-9282.20240068 -
Medical Image Analysis Oct 2019Early diagnosis of sacroiliitis may lead to preventive treatment which can significantly improve the patient's quality of life in the long run. Oftentimes, a CT scan of...
Early diagnosis of sacroiliitis may lead to preventive treatment which can significantly improve the patient's quality of life in the long run. Oftentimes, a CT scan of the lower back or abdomen is acquired for suspected back pain. However, since the differences between a healthy and an inflamed sacroiliac joint in the early stages are subtle, the condition may be missed. We have developed a new automatic algorithm for the diagnosis and grading of sacroiliitis CT scans as incidental findings, for patients who underwent CT scanning as part of their lower back pain workout. The method is based on supervised machine and deep learning techniques. The input is a CT scan that includes the patient's pelvis. The output is a diagnosis for each sacroiliac joint. The algorithm consists of four steps: (1) computation of an initial region of interest (ROI) that includes the pelvic joints region using heuristics and a U-Net classifier; (2) refinement of the ROI to detect both sacroiliiac joints using a four-tree random forest; (3) individual sacroiliitis grading of each sacroiliiac joint in each CT slice with a custom slice CNN classifier, and; (4) sacroiliitis diagnosis and grading by combining the individual slice grades using a random forest. Experimental results on 484 sacroiliiac joints yield a binary and a 3-class case classification accuracy of 91.9% and 86%, a sensitivity of 95% and 82%, and an Area-Under-the-Curve of 0.97 and 0.57, respectively. Automatic computer-based analysis of CT scans has the potential of being a useful method for the diagnosis and grading of sacroiliitis as an incidental finding.
Topics: Algorithms; Deep Learning; Humans; Incidental Findings; Radiographic Image Interpretation, Computer-Assisted; Sacroiliitis; Sensitivity and Specificity; Supervised Machine Learning; Tomography, X-Ray Computed
PubMed: 31323597
DOI: 10.1016/j.media.2019.07.007 -
Acta Clinica Belgica Aug 2021: Familial Mediterranean fever (FMF) is an autosomal recessive disease characterized by recurrent, self-limited attacks of fever with serositis. Acute recurrent...
: Familial Mediterranean fever (FMF) is an autosomal recessive disease characterized by recurrent, self-limited attacks of fever with serositis. Acute recurrent arthritis is the most common form of musculoskeletal involvement in FMF; however, ≤5% of FMF patients can develop chronic arthritis, including sacroiliitis. It is difficult to determine if sacroiliitis is a musculoskeletal finding of FMF or if they are concomitant diseases-FMF and juvenile spondyloarthropathy (JSpA). The present study aimed to compare clinical and laboratory findings in FMF patients with concomitant sacroiliitis and JSpA patients with concomitant sacroiliitis.: The medical files of patients diagnosed with FMF and JSpA with concomitant sacroiliitis were retrospectively evaluated. All patients had MRI findings consistent with sacroiliitis. Patient demographic data, clinical features, and laboratory findings were compared between the patients with FMF and concomitant sacroiliitis, and those with JSpA and concomitant sacroiliitis.: The study included 18 patients with FMF and sacroiliitis, and 38 patients with JSpA and sacroiliitis. The median (range) age at diagnosis of FMF accompanied by sacroiliitis and JSpA accompanied by sacroiliitis was 12.0 years (3.5-18 years) and 13 years (4-18 years), respectively. There weren't any significant differences in HLA-B27 positivity, family history of ankylosing spondylitis, presenting complaints, arthritis, enthesitis, or treatment between the 2 patient groups.: The present findings show that pediatric patients with FMF and sacroiliitis, and those with JSpA and sacroiliitis have the same clinical and laboratory findings.
Topics: Child; Familial Mediterranean Fever; Humans; Magnetic Resonance Imaging; Retrospective Studies; Sacroiliitis; Spondylitis, Ankylosing
PubMed: 32009575
DOI: 10.1080/17843286.2020.1724450