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Ushio Y, Wakiya R, Kameda T, Nakashima S, Shimada H, Miyagi T, Sugihara K, Mino R, Mizusaki M, Chujo K, Kagawa R, Yamaguchi H, Yamamoto Y, Norikane T, Nishiyama Y, Kadowaki N, Dobashi H. Effects of anti-interleukin-17 treatment on osteoblastic activity as assessed by 18F-sodium fluoride positron emission tomography/computed tomography in ankylosing spondylitis: a case report. Scand J Rheumatol 2023; 52:710-712. [PMID: 37485843 DOI: 10.1080/03009742.2023.2232176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 06/29/2023] [Indexed: 07/25/2023]
Affiliation(s)
- Y Ushio
- Faculty of Medicine, Division of Hematology, Rheumatology and Respiratory Medicine, Department of Internal Medicine, Kagawa University, Kagawa, Japan
| | - R Wakiya
- Faculty of Medicine, Division of Hematology, Rheumatology and Respiratory Medicine, Department of Internal Medicine, Kagawa University, Kagawa, Japan
| | - T Kameda
- Faculty of Medicine, Division of Hematology, Rheumatology and Respiratory Medicine, Department of Internal Medicine, Kagawa University, Kagawa, Japan
| | - S Nakashima
- Faculty of Medicine, Division of Hematology, Rheumatology and Respiratory Medicine, Department of Internal Medicine, Kagawa University, Kagawa, Japan
| | - H Shimada
- Faculty of Medicine, Division of Hematology, Rheumatology and Respiratory Medicine, Department of Internal Medicine, Kagawa University, Kagawa, Japan
| | - T Miyagi
- Faculty of Medicine, Division of Hematology, Rheumatology and Respiratory Medicine, Department of Internal Medicine, Kagawa University, Kagawa, Japan
| | - K Sugihara
- Faculty of Medicine, Division of Hematology, Rheumatology and Respiratory Medicine, Department of Internal Medicine, Kagawa University, Kagawa, Japan
| | - R Mino
- Faculty of Medicine, Division of Hematology, Rheumatology and Respiratory Medicine, Department of Internal Medicine, Kagawa University, Kagawa, Japan
| | - M Mizusaki
- Faculty of Medicine, Division of Hematology, Rheumatology and Respiratory Medicine, Department of Internal Medicine, Kagawa University, Kagawa, Japan
| | - K Chujo
- Faculty of Medicine, Division of Hematology, Rheumatology and Respiratory Medicine, Department of Internal Medicine, Kagawa University, Kagawa, Japan
| | - R Kagawa
- Faculty of Medicine, Division of Hematology, Rheumatology and Respiratory Medicine, Department of Internal Medicine, Kagawa University, Kagawa, Japan
| | - H Yamaguchi
- Faculty of Medicine, Division of Hematology, Rheumatology and Respiratory Medicine, Department of Internal Medicine, Kagawa University, Kagawa, Japan
| | - Y Yamamoto
- Faculty of Medicine, Department of Radiology, Kagawa University, Kagawa, Japan
| | - T Norikane
- Faculty of Medicine, Department of Radiology, Kagawa University, Kagawa, Japan
| | - Y Nishiyama
- Faculty of Medicine, Department of Radiology, Kagawa University, Kagawa, Japan
| | - N Kadowaki
- Faculty of Medicine, Division of Hematology, Rheumatology and Respiratory Medicine, Department of Internal Medicine, Kagawa University, Kagawa, Japan
| | - H Dobashi
- Faculty of Medicine, Division of Hematology, Rheumatology and Respiratory Medicine, Department of Internal Medicine, Kagawa University, Kagawa, Japan
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de Jongh J, Verweij NJF, Yaqub M, van Denderen CJ, van der Horst-Bruinsma IE, Bot JCJ, Boden BJH, Hemke R, Smithuis FF, Lems WF, Lammertsma AA, Voskuyl AE, Boers M, Zwezerijnen GJC, van der Laken CJ. [ 18F]Fluoride PET provides distinct information on disease activity in ankylosing spondylitis as compared to MRI and conventional radiography. Eur J Nucl Med Mol Imaging 2023; 50:1351-1359. [PMID: 36508028 PMCID: PMC10027810 DOI: 10.1007/s00259-022-06080-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 12/04/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE To relate [18F]fluoride uptake on PET with abnormalities on magnetic resonance imaging (MRI) and conventional radiography (CR) in ankylosing spondylitis (AS) patients. METHODS Ten clinically active AS patients (female 6/10, age 38 ± 11 years) were included, and both spine and SI-joints were examined. PET scans were dichotomously scored for enhanced [18F]fluoride uptake, MRI scans were scored for fatty lesions, erosions, ankylosis, and bone marrow edema (BME), and CR was scored for erosions, syndesmophytes, and ankylosis. The overlap of lesions across all modalities was evaluated through univariate and multivariate analyses using a generalized mixed model. RESULTS In the spine, 69 lesions with enhanced [18F]fluoride uptake, 257 MRI lesions, and 88 CR lesions were observed. PET lesions were mostly located in costovertebral and facet joints, outside the field of view (FOV) of the MRI and CR. However, PET lesions inside the FOV of MRI and CR partially showed no abnormality on MRI and CR. In lesions with abnormalities on multiple modalities, both univariate and multivariate analysis showed that PET activity had the strongest association with BME on MRI and ankylosis on CR. In the SI joints, 15 lesions (75%) with PET uptake were found, with 87% showing abnormalities on MRI and CR. CONCLUSION [18F]fluoride PET lesions are often found outside the scope of MRI and CR, and even in the same location show only partial overlap with abnormalities on MRI (especially BME) and CR (especially ankylosis). This suggests that [18F]fluoride PET partially visualizes aspects of AS separate from MRI and CR, providing novel information. CLINICAL TRIAL REGISTRATION NL43223.029.13 registered at 02-05-2013. https://www.toetsingonline.nl/to/ccmo_search.nsf/fABRpop?readform&unids=C1257BA2002CC066C1257B4E0049A65A.
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Affiliation(s)
- Jerney de Jongh
- Amsterdam Rheumatology and Immunology Center (ARC), Amsterdam UMC, Amsterdam, the Netherlands.
| | - Nicki J F Verweij
- Amsterdam Rheumatology and Immunology Center (ARC), Amsterdam UMC, Amsterdam, the Netherlands
| | - Maqsood Yaqub
- Department of Radiology & Nuclear Medicine, Amsterdam UMC, location VUmc, Amsterdam, the Netherlands
| | | | | | - Joost C J Bot
- Department of Radiology & Nuclear Medicine, Amsterdam UMC, location VUmc, Amsterdam, the Netherlands
| | - Bouke J H Boden
- OLVG, Radiology & Nuclear Medicine, Amsterdam, the Netherlands
| | - Robert Hemke
- Radiology & Nuclear Medicine, Amsterdam UMC, location AMC, Amsterdam, the Netherlands
| | - Frank F Smithuis
- Radiology & Nuclear Medicine, Amsterdam UMC, location AMC, Amsterdam, the Netherlands
| | - Willem F Lems
- Amsterdam Rheumatology and Immunology Center (ARC), Amsterdam UMC, Amsterdam, the Netherlands
| | - Adriaan A Lammertsma
- Department of Radiology & Nuclear Medicine, Amsterdam UMC, location VUmc, Amsterdam, the Netherlands
| | - Alexandre E Voskuyl
- Amsterdam Rheumatology and Immunology Center (ARC), Amsterdam UMC, Amsterdam, the Netherlands
| | - Maarten Boers
- Epidemiology & Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
| | - Gerben J C Zwezerijnen
- Department of Radiology & Nuclear Medicine, Amsterdam UMC, location VUmc, Amsterdam, the Netherlands
| | - Conny J van der Laken
- Amsterdam Rheumatology and Immunology Center (ARC), Amsterdam UMC, Amsterdam, the Netherlands
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Jamar F, van der Laken CJ, Panagiotidis E, Steinz MM, van der Geest KSM, Graham RNJ, Gheysens O. Update on Imaging of Inflammatory Arthritis and Related Disorders. Semin Nucl Med 2023; 53:287-300. [PMID: 36155690 DOI: 10.1053/j.semnuclmed.2022.08.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 08/30/2022] [Indexed: 11/11/2022]
Abstract
Arthritis and other rheumatic disorders are very frequent in the general population and responsible for a huge physical and disability burden to affected patients as well as a major cost to the society. Precise evaluation often relies on clinical data only but additional imaging may be required i) for a more objective assessment of the disease status, such as in rheumatoid arthritis (RA) or ankylosing spondyloarthritis (AS), ii) for providing prognostic information and evaluating response to treatment or iii) for establishing diagnosis, in patients with unclear clinical picture, such as polymyalgia rheumatica (PMR) and large-vessel vasculitis (LVV). Besides radiological techniques (x-rays, ultrasound, and MRI), functional and molecular imaging has emerged as a valid tool for this purpose in several disorders. Bone scanning has long been a method of choice but is now more used as a triage tool in patients with unclear complaints, including degenerative disorders (eg osteoarthritis). 18F-FDG-PET/CT (FDG) proved efficient in assessing the extent of the disease and response to treatment in RA and related disorders, and to provide accurate diagnosis in some systemic disorders, including PMR and LVV. Based on glucose metabolism, FDG-PET/CT is able to show increased metabolism in peripheral cells involved in inflammation (eg neutrophils, lymphocytes or monocytes/macrophages) but also in fibroblasts that proliferate in the pannus. The lack of specificity of FDG is a limitation and many alternative tracers were developed at the preclinical stage or applied in the clinics, especially within clinical trials. They include imaging of macrophages using translocator protein (TSPO), folate-receptors or other targets on activated cells. These new tools will undoubtedly become more and more available in the everyday clinical workup of patients with rheumatisms. Finally, it should be kept in mind that a very simple tracer, 18F-fluoride is widely more performant in AS than FDG.
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Affiliation(s)
- François Jamar
- Department of Nuclear Medicine, Cliniques universitaires St-Luc and Institute for Experimental and Clinical Research (IREC), Université Catholique de Louvain, Brussels, Belgium.
| | - Conny J van der Laken
- Department of Rheumatology, Amsterdam University Medical Center - location VU Medical Center, Amsterdam, The Netherlands
| | | | - Maarten M Steinz
- Department of Rheumatology, Amsterdam University Medical Center - location VU Medical Center, Amsterdam, The Netherlands
| | - Kornelis S M van der Geest
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Richard N J Graham
- Radiology Department, Royal United Hospitals Bath NHS Foundation Trust, Bath, United Kingdom
| | - Olivier Gheysens
- Department of Nuclear Medicine, Cliniques universitaires St-Luc and Institute for Experimental and Clinical Research (IREC), Université Catholique de Louvain, Brussels, Belgium
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de Jongh J, Hemke R, Zwezerijnen GJC, Yaqub M, van der Horst-Bruinsma IE, van de Sande MGH, van Kuijk AWR, Voskuyl AE, van der Laken CJ. 18F-sodium fluoride PET-CT visualizes both axial and peripheral new bone formation in psoriatic arthritis patients. Eur J Nucl Med Mol Imaging 2023; 50:756-764. [PMID: 36370181 PMCID: PMC9852163 DOI: 10.1007/s00259-022-06035-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 11/02/2022] [Indexed: 11/13/2022]
Abstract
PURPOSE As bone formation is associated with psoriatic arthritis (PsA), positron emission tomography (PET) using a 18F-Fluoride tracer may enable sensitive detection of disease activity. Our primary aim was to determine the feasibility of whole-body 18F-sodium fluoride PET-CT in clinically active PsA patients to depict new bone formation (as a reflection of disease activity) at peripheral joints and entheses. Our secondary aim was to describe 18F-sodium fluoride findings in the axial skeleton. METHODS Sixteen patients (female 10/16, age 50.6 ± 8.9 years) with PsA fulfilling CASPAR criteria or with a clinical diagnosis of PsA according to the treating rheumatologist and with ≥ 1 clinically active enthesitis site were included. Of each patient, a whole-body 18F-sodium fluoride PET-CT scan was performed. All scans were scored for PET-positive lesions at peripheral joints, enthesis sites and the spine. Clinical disease activity was assessed by swollen/tender joint count 44, enthesitis according to MASES and SPARCC scores. RESULTS Out of 1088 evaluated joints, 109 joints showed PET enhancement, mainly in the interphalangeal and metatarsal joints of the feet (14/109, 12.9%) and the distal interphalangeal joints of the hands (14/109, 12.9%). PET positivity was found at 44/464 enthesis sites, mainly at the patella tendon insertion (11/44, 25%) and quadriceps tendon insertion (10/44, 22.7%). Of the PET-positive joints and enthesis sites, respectively 18.2% and 29.5% were clinically positive; 81.8% and 70.5% of the PET-positive joints and entheses respectively were clinically asymptomatic. In 11 patients, ≥ 1 axial PET-positive lesion was observed, mainly in the cervical spine. CONCLUSIONS New molecular bone formation was observed on 18F-sodium fluoride PET-CT scans, in all domains in which PsA disease activity can be observed, with a substantial part showing no clinical symptoms. CLINICAL TRIAL REGISTRATION EudraCT: 2017-004,850-40, registered on 13 December 2017.
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Affiliation(s)
- Jerney de Jongh
- Department of Rheumatology and Clinical Immunology, Amsterdam UMC, Location VUmc, P.O. Box 7057, Amsterdam, the Netherlands.
| | - Robert Hemke
- Department of Radiology & Nuclear Medicine, Amsterdam UMC, Location AMC, 1007 MB, Amsterdam, The Netherlands
| | - Gerben J C Zwezerijnen
- Department of Radiology & Nuclear Medicine, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
| | - Maqsood Yaqub
- Department of Radiology & Nuclear Medicine, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
| | | | - Marleen G H van de Sande
- Department of Rheumatology and Clinical Immunology, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands
| | | | - Alexandre E Voskuyl
- Department of Rheumatology and Clinical Immunology, Amsterdam UMC, Location VUmc, P.O. Box 7057, Amsterdam, the Netherlands
| | - Conny J van der Laken
- Department of Rheumatology and Clinical Immunology, Amsterdam UMC, Location VUmc, P.O. Box 7057, Amsterdam, the Netherlands
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Pean De Ponfilly – Sotier M, Seror R, Nocturne G, Besson FL. 18F-FDG PET molecular imaging: A relevant tool to investigate chronic inflammatory rheumatisms in clinical practice? Front Med (Lausanne) 2022; 9:1070445. [PMID: 36530882 PMCID: PMC9748427 DOI: 10.3389/fmed.2022.1070445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 11/15/2022] [Indexed: 12/31/2023] Open
Abstract
18F-Labeled Fluorodeoxyglucose-Positron Emission Tomography (18F-FDG PET) is a molecular imaging tool commonly used in practice for the assessment of many cancers. Thanks to its properties, its use has been progressively extended to numerous inflammatory conditions, including chronic inflammatory rheumatism (CIR) such as rheumatoid arthritis (RA), spondylarthritis (SpAs) and polymyalgia rheumatica (PMR). 18F-FDG PET is currently not recommended for the diagnostic of CIRs. However, this whole-body imaging tool has emerged in clinical practice, providing a general overview of systemic involvement occurring in CIRs. Numerous studies have highlighted the capacity of 18F-FDG PET to detect articular and extra articular involvements in RA and PMR. However, the lack of specificity of 18F-FDG limits its use for diagnosis purpose. Finally, the key question is the definition of the best way to integrate this whole-body imaging tool in the patient's management workflow.
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Affiliation(s)
| | - Raphaële Seror
- Rheumatology, AP-HP. Université Paris-Saclay, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- Faculté de Médecine, Université Paris-Saclay, Le Kremlin-Bicêtre, France
- Université Paris-Saclay, INSERM, CEA, Centre de Recherche en Immunologie des Infections Virales et des Maladies Auto-immunes, Le Kremlin-Bicêtre, France
| | - Gaetane Nocturne
- Rheumatology, AP-HP. Université Paris-Saclay, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- Faculté de Médecine, Université Paris-Saclay, Le Kremlin-Bicêtre, France
- Université Paris-Saclay, INSERM, CEA, Centre de Recherche en Immunologie des Infections Virales et des Maladies Auto-immunes, Le Kremlin-Bicêtre, France
| | - Florent L. Besson
- Faculté de Médecine, Université Paris-Saclay, Le Kremlin-Bicêtre, France
- Biophysics and Nuclear Medicine-Molecular Imaging, AP-HP. Université Paris-Saclay, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- Université Paris-Saclay, CEA, CNRS, Inserm, BioMaps, Orsay, France
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Use of Imaging in Axial Spondyloarthritis for Diagnosis and Assessment of Disease Remission in the Year 2022. Curr Rheumatol Rep 2022; 24:383-397. [PMID: 36242738 DOI: 10.1007/s11926-022-01091-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2022] [Indexed: 11/03/2022]
Abstract
Medical imaging remains the cornerstone of diagnostics and follow-up of axial spondyloarthritis (axSpA) patients. With the lack of specific biomarkers allowing monitoring of disease activity and progression, clinicians refer to imaging modalities for accurate evaluation of the axSpA burden. Technological advances and increasing availability of modern imaging techniques such as MRI have enabled faster diagnosis of the disease, hence dramatically changed the diagnostic delay and improved the prognosis and functional outcomes for axSpA patients.Active sacroiliitis as visualized by MRI has been widely accepted as a diagnostic tool, and definitions of inflammatory and structural lesions within the axial skeleton have been developed. Recently, it has been acknowledged that bone marrow edema, suggestive of sacroiliitis, is a common finding among non-SpA patients, and could be attributed to mechanical loading or accumulate with age in healthy individuals. Therefore, it is crucial to distinguish between true pathological and concealing imaging findings, not only for diagnostic but also for disease remission purposes. New imaging modalities, aimed for in vivo visualization of specific molecular processes, could be employed to cross-validate findings from techniques used in daily clinical practice. This review critically evaluates the use of different imaging modalities for diagnosis and assessment of disease remission in axSpA in the year 2022.
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Kaijasilta JP, Kerola AM, Tuompo R, Relas H, Loimaala A, Koivu H, Schildt J, Kerola T, Eklund K, Kauppi MJ, Nieminen TVM. Adalimumab and sulfasalazine in alleviating sacroiliac and aortic inflammation detected in PET/CT in patients with axial spondyloarthritis: PETSPA. IMMUNITY INFLAMMATION AND DISEASE 2021; 10:155-162. [PMID: 34755937 PMCID: PMC8767522 DOI: 10.1002/iid3.552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 10/07/2021] [Accepted: 10/14/2021] [Indexed: 12/24/2022]
Abstract
Aim Inflammatory signals in the sacroiliac (SI) joints and the aorta of patients with axial spondyloarthritis (axSpA) were graded by positron emission tomography/computed tomography (PET/CT) imaging before and after treatment with sulfasalazine (SSZ) or adalimumab (ADA). Methods Patients with axSpA, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) ≥ 4, were recruited. Disease‐modifying antirheumatic drug‐naïve patients started SSZ for 12 weeks, whereas those with prestudy treatment with or contraindication to SSZ commenced ADA for 16 weeks. In addition, those patients in the SSZ group with insufficient response commenced ADA for 16 weeks. 18F‐fluorodeoxyglucose PET/CT was performed after inclusion and after treatment with SSZ and ADA. Maximum standardized uptake value (SUVmax) was assessed for the aorta and the SI joints, and maximal target‐to‐blood‐pool ratio (TBRmax) only for the aorta. Results Among five SSZ patients, mean ± SD BASDAI was 4.7 ± 1.6 before and 3.5 ± 1.4 after treatment (p = .101). In 13 ADA patients, the BASDAI decreased from 5.4 ± 1.6 to 2.8 ± 2.2 (p < .001). Among the SSZ patients, SUVmax in SI joints decreased from 2.35 ± 0.55 to 1.51 ± 0.22 (−35.8%, p = .029). Aortic TBRmax decreased from 1.59 ± 0.43 to 1.26 ± 0.26 (−33.2%, p = .087). In the ADA patients, SUVmax in the SI joints was 1.92 ± 0.65 before and 1.88 ± 0.54 after treatment (−1.8%, p = .808) and TBRmax in the aorta 1.50 ± 0.60 before and 1.40 ± 0.26 after treatment (−6.7%, p = .485). Conclusions Our small open‐label study showed that SSZ may reduce PET‐CT‐detectable inflammation in the SI joints, with a trend towards a reduction in the aorta.
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Affiliation(s)
- Juha-Pekka Kaijasilta
- Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Department of Internal Medicine, Päijät-Häme Central Hospital, Lahti, Finland
| | - Anne M Kerola
- Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Department of Internal Medicine, Päijät-Häme Central Hospital, Lahti, Finland
| | - Riitta Tuompo
- Department of Rheumatology, Inflammation Center, Helsinki University Hospital, Helsinki, Finland
| | - Heikki Relas
- Department of Rheumatology, Inflammation Center, Helsinki University Hospital, Helsinki, Finland
| | - Antti Loimaala
- Medical Imaging Center, Helsinki University Hospital, Helsinki, Finland
| | - Hannu Koivu
- Department of Nuclear Medicine, Päijät-Häme Central Hospital, Lahti, Finland
| | - Jukka Schildt
- Medical Imaging Center, Helsinki University Hospital, Helsinki, Finland
| | - Tuomas Kerola
- Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Department of Internal Medicine, Päijät-Häme Central Hospital, Lahti, Finland
| | - Kari Eklund
- Department of Rheumatology, Inflammation Center, Helsinki University Hospital, Helsinki, Finland.,Orton Hospital, Helsinki, Finland.,Translational Immunology Program (TRIMM), Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Markku J Kauppi
- Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Department of Internal Medicine, Päijät-Häme Central Hospital, Lahti, Finland
| | - Tuomo V M Nieminen
- Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Department of Internal Medicine, Helsinki University Hospital, Helsinki, Finland.,Department of Internal Medicine, South Karelia Central Hospital, Lappeenranta, Finland.,Päijät-Häme Joint Authority for Health and Wellbeing, Lahti, Finland
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Czuczman GJ, Mandell JC, Wessell DE, Lenchik L, Ahlawat S, Baker JC, Cassidy RC, Demertzis JL, Garner HW, Klitzke A, Maynard JR, Pierce JL, Reitman C, Thiele R, Yost WJ, Beaman FD. ACR Appropriateness Criteria® Inflammatory Back Pain: Known or Suspected Axial Spondyloarthritis: 2021 Update. J Am Coll Radiol 2021; 18:S340-S360. [PMID: 34794593 DOI: 10.1016/j.jacr.2021.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 08/26/2021] [Indexed: 02/07/2023]
Abstract
Inflammatory back pain is a hallmark feature of axial spondyloarthritis, a heterogeneous group of inflammatory disorders which affects the sacroiliac joints and spine. Imaging plays a key role in diagnosis of this disease and in facilitating appropriate treatment. This document provides evidence-based recommendations on the appropriate use of imaging studies during multiple stages of the clinical evaluation of patients with suspected or known axial spondyloarthritis. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Jacob C Mandell
- Research Author, Brigham & Women's Hospital & Harvard Medical School, Boston, Massachusetts
| | | | - Leon Lenchik
- Panel Vice-Chair, Wake Forest University School of Medicine, Winston Salem, North Carolina
| | - Shivani Ahlawat
- Musculoskeletal Fellowship Director; and Chair, REiNS Whole Body MRI Committee, Johns Hopkins Hospital, Baltimore, Maryland
| | - Jonathan C Baker
- Mallinckrodt Institute of Radiology Washington University School of Medicine, Saint Louis, Missouri
| | - R Carter Cassidy
- UK Healthcare Spine and Total Joint Service, Lexington, Kentucky; Executive Board, Kentucky Orthopaedic Society; and American Academy of Orthopaedic Surgeons
| | | | | | - Alan Klitzke
- Roswell Park Comprehensive Cancer Center, Buffalo, New York; Board of Directors, American College of Nuclear Medicine; Board of Directors, SNMMI Correlative Imaging Council; and Delegate, American Medical Association House of Delegates
| | - Jennifer R Maynard
- Program Director Sports Medicine Fellowship, Mayo Clinic Florida, Jacksonville, Florida; Primary care physician; Medical Advisor Women's Tennis Association; Vice-Chair, Jacksonville Sports Medicine Program Executive Board; Chair, Florida High School Athletic Association Sports; and Medicine Advisory Committee
| | | | - Charles Reitman
- Medical University of South Carolina, Charleston, South Carolina; and Board of Directors, North American Spine Society
| | - Ralf Thiele
- University of Rochester School of Medicine and Dentistry, Rochester, New York, American College of Rheumatology
| | - William J Yost
- UnityPoint Health, Des Moines, Iowa, American College of Physicians
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Bauckneht M, Raffa S, Leale G, Sambuceti V, De Cesari M, Donegani MI, Marini C, Drakonaki E, Orlandi D. Molecular imaging in MSK radiology: Where are we going? Eur J Radiol 2021; 140:109737. [PMID: 33951567 DOI: 10.1016/j.ejrad.2021.109737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 02/18/2021] [Accepted: 04/25/2021] [Indexed: 11/15/2022]
Abstract
Musculoskeletal (MSK) pathologies are one of the leading causes of disability worldwide. However, treatment options and understanding of pathogenetic processes are still partially unclear, mainly due to a limited ability in early disease detection and response to therapy assessment. In this scenario, thanks to a strong technological advancement, structural imaging is currently established as the gold-standard of diagnosis in many MSK disorders but each single diagnostic modality (plain films, high-resolution ultrasound, computed tomography and magnetic resonance) still suffer by a low specificity regarding the characterization of inflammatory processes, the quantification of inflammatory activity levels, and the degree of response to therapy. To overcome these limitations, molecular imaging techniques may play a promising role. Starting from the strengths and weaknesses of structural anatomical imaging, the present narrative review aims to highlight the promising role of molecular imaging in the assessment of non-neoplastic MSK diseases with a special focus on its role to monitor treatment response.
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Affiliation(s)
- Matteo Bauckneht
- Nuclear Medicine, IRCCS Ospedale Policlinico San Martino, Genoa, Italy; Department of Health Sciences (DISSAL), Genoa University, Genoa, Italy
| | - Stefano Raffa
- Nuclear Medicine, IRCCS Ospedale Policlinico San Martino, Genoa, Italy; Department of Health Sciences (DISSAL), Genoa University, Genoa, Italy
| | - Giacomo Leale
- Private MSK Imaging Institution, Heraklion, Crete, Greece & European University of Cyprus Medical School, Nicosia, Cyprus
| | - Virginia Sambuceti
- Postgraduate School of Radiology, Genoa University, Via Alberti 4, 16132, Genoa, Italy
| | | | - Maria Isabella Donegani
- Nuclear Medicine, IRCCS Ospedale Policlinico San Martino, Genoa, Italy; Department of Health Sciences (DISSAL), Genoa University, Genoa, Italy
| | - Cecilia Marini
- Nuclear Medicine, IRCCS Ospedale Policlinico San Martino, Genoa, Italy; Institute of Molecular Bioimaging and Physiology (IBFM), National Research Council (CNR), Segrate (MI), Italy
| | - Eleni Drakonaki
- Private MSK Imaging Institution, Heraklion, Crete, Greece & European University of Cyprus Medical School, Nicosia, Cyprus
| | - Davide Orlandi
- Department of Radiology, Ospedale Evangelico Internazionale, Corso Solferino, 1a, 16122, Genoa, Italy.
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Raynor WY, Borja AJ, Hancin EC, Werner TJ, Alavi A, Revheim ME. Novel Musculoskeletal and Orthopedic Applications of 18F-Sodium Fluoride PET. PET Clin 2021; 16:295-311. [PMID: 33589389 DOI: 10.1016/j.cpet.2020.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PET imaging with 18F-sodium fluoride (NaF), combined with computed tomography or magnetic resonance, is a sensitive method of assessing bone turnover. Although NaF-PET is gaining popularity in detecting prostate cancer metastases to bone marrow, osseous changes represent secondary effects of cancer cell growth. PET tracers more appropriate for assessing prostate cancer metastases directly portray malignant activity and include 18F-fluciclovine and prostatic specific membrane antigen ligands. Recent studies investigating NaF-PET suggest utility in the assessment of benign musculoskeletal disorders. Emerging applications in assessing traumatic injuries, joint disease, back pain, orthopedic complications, and metabolic bone disease are discussed.
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Affiliation(s)
- William Y Raynor
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA; Drexel University College of Medicine, 2900 West Queen Lane, Philadelphia, PA 19129, USA
| | - Austin J Borja
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA; Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Emily C Hancin
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA; Lewis Katz School of Medicine at Temple University, 3500 North Broad Street, Philadelphia, PA 19140, USA
| | - Thomas J Werner
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Abass Alavi
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Mona-Elisabeth Revheim
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA; Division of Radiology and Nuclear Medicine, Oslo University Hospital, Sognsvannsveien 20, Oslo 0372, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Problemveien 7, Oslo 0315, Norway.
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11
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Aouad K, Maksymowych WP, Baraliakos X, Ziade N. Update of imaging in the diagnosis and management of axial spondyloarthritis. Best Pract Res Clin Rheumatol 2020; 34:101628. [PMID: 33257146 DOI: 10.1016/j.berh.2020.101628] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Imaging of the spine and sacroiliac joints has acquired a central role in the diagnosis and classification of axial spondyloarthritis (axSpA) in the earliest phases of the disease. New definitions of specific imaging lesions, particularly in magnetic resonance imaging (MRI), have been recently updated and revised by the ASAS MRI working group to reach a standardized understanding and diagnosis of axSpA among rheumatologists. Recognizing the misleading pitfalls of MRI lesions and differential diagnosis also represents an essential issue in clinical practice to avoid false-positive findings and establish the diagnosis of axSpA with careful regard to the clinical context, clinical signs, and biological tests. This review summarizes the current evidence on the different imaging modalities of the sacroiliac joints and the spine with their application in the clinical setting of SpA and their main pitfalls; it also highlights the newest emerging imaging techniques.
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Affiliation(s)
- Krystel Aouad
- Department of Rheumatology, Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Saint-Joseph University, Faculty of Medicine, Beirut, Lebanon.
| | - Walter P Maksymowych
- Department of Medicine, Division of Rheumatology, University of Alberta, 568A Heritage Medical Research Centre, Edmonton, Alberta T6G2R3, Canada.
| | - Xenofon Baraliakos
- Department of Rheumatology, Rheumazentrum Ruhrgebiet, Ruhr-University Bochum, Claudiusstr. 45, 44649 Herne, Germany.
| | - Nelly Ziade
- Saint-Joseph University, Faculty of Medicine, Beirut, Lebanon; Department of Rheumatology, Hotel-Dieu de France Hospital, Beirut, Lebanon.
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12
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Kleinrensink NJ, Foppen W, Ten Katen I, van der Veen PH, de Klerk B, Diepstraten SCE, Radstake TRDJ, Lafeber FPJG, de Jong PA, Leijten EFA. Comparison of the Heel Enthesitis MRI Scoring System (HEMRIS) with clinical enthesitis and local metabolic activity on PET-CT. RMD Open 2020; 6:e001424. [PMID: 33277402 PMCID: PMC7856158 DOI: 10.1136/rmdopen-2020-001424] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 10/15/2020] [Accepted: 11/11/2020] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE To compare the Heel Enthesitis MRI Scoring model (HEMRIS) with clinical and PET/CT outcomes in patients with cutaneous psoriasis (Pso), psoriatic arthritis (PsA) or ankylosing spondylitis (AS). METHODS This prospective, observational study included 38 patients with Pso, PsA and AS. Patients were included regardless of presence or absence of clinical heel enthesitis. MRI-scans of both ankles and a whole-body 18F-FDG PET/CT were acquired. MRIs were assessed for enthesitis by two independent and blinded observers according to the HEMRIS. A physician, blinded for imaging results, performed clinical evaluations of enthesitis at the Achilles tendon and plantar fascia. RESULTS In total, 146 entheses were scored according to the HEMRIS and clinically assessed for enthesitis (6 entheses were clinically affected). In Achilles tendons with clinical enthesitis, the HEMRIS structural damage score was significantly higher, compared to Achilles tendons without clinical enthesitis (respective median scores 1.0 and 0.5; p=0.04). In clinically unaffected entheses, HEMRIS abnormalities occurred in 44/70 (63%) of Achilles tendons and in 23/70 (33%) of plantar fascia. At the Achilles tendon, local metabolic activity measured on PET/CT was weakly associated with the structural (rs=0.25, p=0.03) and total HEMRIS (rs=0.26, p=0.03). CONCLUSION This study revealed a high prevalence of subclinical HEMRIS abnormalities and discrepancy between HEMRIS and clinical and PET/CT findings. This may suggest that the HEMRIS is a sensitive method for detection of inflammatory and structural disease of enthesitis at the Achilles tendon and plantar fascia, although the clinical significance of these MRI findings remains to be determined in longitudinal studies.
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Affiliation(s)
- Nienke J Kleinrensink
- Department of Rheumatology and Clinical Immunology, UMC Utrecht, Utrecht, Netherlands
- Department of Radiology, UMC Utrecht, Utrecht, Netherlands
| | - Wouter Foppen
- Department of Radiology, UMC Utrecht, Utrecht, Netherlands
| | - Iris Ten Katen
- Department of Radiology, UMC Utrecht, Utrecht, Netherlands
| | | | - Bo de Klerk
- Department of Rheumatology and Clinical Immunology, UMC Utrecht, Utrecht, Netherlands
| | | | - Timothy R D J Radstake
- Department of Rheumatology and Clinical Immunology, UMC Utrecht, Utrecht, Netherlands
- Center for Translational Immunology, UMC Utrecht, Utrecht, Netherlands
| | - Floris P J G Lafeber
- Department of Rheumatology and Clinical Immunology, UMC Utrecht, Utrecht, Netherlands
| | - Pim A de Jong
- Department of Radiology, UMC Utrecht, Utrecht, Netherlands
| | - Emmerik F A Leijten
- Department of Rheumatology and Clinical Immunology, UMC Utrecht, Utrecht, Netherlands
- Center for Translational Immunology, UMC Utrecht, Utrecht, Netherlands
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Hancin EC, Borja AJ, Nikpanah M, Raynor WY, Haldar D, Werner TJ, Morris MA, Saboury B, Alavi A, Gholamrezanezhad A. PET/MR Imaging in Musculoskeletal Precision Imaging - Third wave after X-Ray and MR. PET Clin 2020; 15:521-534. [DOI: 10.1016/j.cpet.2020.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Giraudo C, Kainberger F, Boesen M, Trattnig S. Quantitative Imaging in Inflammatory Arthritis: Between Tradition and Innovation. Semin Musculoskelet Radiol 2020; 24:337-354. [PMID: 32992363 DOI: 10.1055/s-0040-1708823] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Radiologic imaging is crucial for diagnosing and monitoring rheumatic inflammatory diseases. Particularly the emerging approach of precision medicine has increased the interest in quantitative imaging. Extensive research has shown that ultrasound allows a quantification of direct signs such as bone erosions and synovial thickness. Dual-energy X-ray absorptiometry and high-resolution peripheral quantitative computed tomography (CT) contribute to the quantitative assessment of secondary signs such as osteoporosis or lean mass loss. Magnetic resonance imaging (MRI), using different techniques and sequences, permits in-depth evaluations. For instance, the perfusion of the inflamed synovium can be quantified by dynamic contrast-enhanced imaging or diffusion-weighted imaging, and cartilage injury can be assessed by mapping (T1ρ, T2). Furthermore, the increased metabolic activity characterizing the inflammatory response can be reliably assessed by hybrid imaging (positron emission tomography [PET]/CT, PET/MRI). Finally, advances in intelligent systems are pushing forward quantitative imaging. Complex mathematical algorithms of lesions' segmentation and advanced pattern recognition are showing promising results.
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Affiliation(s)
- Chiara Giraudo
- Department of Medicine, DIMED, Radiology Institute, University of Padova, Padova, Italy
| | - Franz Kainberger
- Division of Neuro- and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Mikael Boesen
- Department of Radiology, Copenhagen University Hospital Bispebjerg-Frederiksberg, Frederiksberg, Denmark
| | - Siegfried Trattnig
- Department of Biomedical Imaging and Image-Guided Therapy, High-Field MR Centre, Medical University of Vienna, Vienna, Austria
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Son SM, Kim K, Pak K, Kim SJ, Goh TS, Lee JS. Evaluation of the diagnostic performance of 18F-NaF positron emission tomography/computed tomography in patients with suspected ankylosing spondylitis according to the Assessment of SpondyloArthritis International Society criteria. Spine J 2020; 20:1471-1479. [PMID: 32198119 DOI: 10.1016/j.spinee.2020.03.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/11/2020] [Accepted: 03/12/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Positron emission tomography (PET) is a potential imaging technique for the diagnosis of AS. The visualization of physiological change makes PET potentially suitable for early detection of inflammatory processes, even before anatomical changes occur. Thus, PET might provide specificity via the use of receptor targeting tracers and allows quantification of disease activity in order to accurately monitor therapeutic effects. PURPOSE To examine fluorine-18 sodium fluoride (18F-NaF) PET/computed tomography (PET/CT) findings in patients with inflammatory low back pain and evaluate the utility of this modality in the diagnosis of ankylosing spondylitis (AS) according to the Assessment of SpondyloArthritis International Society (ASAS) criteria. STUDY DESIGN Retrospective cohort study. PATIENTS SAMPLE Sixty-eight patients who underwent 18F-NaF PET/CT imaging between April 2015 and April 2017 for evaluation of inflammatory low back pain. OUTCOME MEASURES We defined AS-positive lesions on PET/CT as symmetric sacroiliac joint uptake that suggests sacroiliitis, syndesmophytes on the spine, and enthesopathy at any site. METHODS All patients were evaluated using the ASAS criteria and assigned to either the AS or the control group. The diagnostic criteria of AS on PET/CT images were defined as 18F-NaF PET/CT images with at least one of AS-positive findings. RESULTS The diagnostic rate of AS was 72.1% among the 68 patients according to the ASAS criteria. The baseline characteristics between the two groups differed significantly in terms of serum C-reactive protein levels and the presence of human leucocyte antigen-B27. Compared to the control group, in the AS group, 39 patients (79.5%) exhibited typical 18F-NaF PET/CT-positive findings, such as enthesopathy (65.3%, p=.003), syndesmophytes (61.2%, p=.006) and symmetric sacroiliitis (67.3%, p=.001). PET-positive findings had significantly higher area under the curve values than did single 18F-NaF PET/CT- positive findings, and they had the best performance for concordant diagnosis according to the ASAS criteria. CONCLUSIONS 18F-NaF PET/CT yielded significantly different findings between the two groups according to the ASAS criteria and is useful for diagnosing AS.
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Affiliation(s)
- Seung Min Son
- Department of Orthopaedic Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Keunyoung Kim
- Department of Nuclear Medicine, BioMedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Kyoungjune Pak
- Department of Nuclear Medicine, BioMedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Seong-Jang Kim
- Department of Nuclear Medicine, BioMedical Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Tae Sik Goh
- Department of Orthopaedic Surgery, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Republic of Korea
| | - Jung Sub Lee
- Department of Orthopaedic Surgery, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Republic of Korea.
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Zhang V, Koa B, Borja AJ, Padmanhabhan S, Bhattaru A, Raynor WY, Rojulpote C, Seraj SM, Werner TJ, Rajapakse C, Alavi A, Revheim ME. Diagnosis and Monitoring of Osteoporosis with Total-Body 18F-Sodium Fluoride-PET/CT. PET Clin 2020; 15:487-496. [PMID: 32768370 DOI: 10.1016/j.cpet.2020.06.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
In recent years, 18F-Sodium Fluoride (NaF)-PET/CT has seen its role in the detection and management of osteoporosis increase. This article reviews the extent of this application in the literature, its efficacy compared with other comparable imaging tools, and how total-body PET/CT combined with global disease assessment can revolutionize measurement of total osteoporotic disease activity. NaF-PET/CT eventually can be the modality of choice for metabolic bone disorders, especially with these advances in technology and computation.
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Affiliation(s)
- Vincent Zhang
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Benjamin Koa
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA; Drexel University College of Medicine, Philadelphia, PA, USA
| | - Austin J Borja
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Sayuri Padmanhabhan
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Abhijit Bhattaru
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - William Y Raynor
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA; Drexel University College of Medicine, Philadelphia, PA, USA
| | - Chaitanya Rojulpote
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA; Department of Internal Medicine, The Wright Center for Graduate Medical Education, Scranton, PA, USA
| | | | - Thomas J Werner
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Chamith Rajapakse
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Abass Alavi
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
| | - Mona-Elisabeth Revheim
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA; Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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Aouad K, De Craemer AS, Carron P. Can Imaging Be a Proxy for Remission in Axial Spondyloarthritis? Rheum Dis Clin North Am 2020; 46:311-325. [DOI: 10.1016/j.rdc.2020.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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19
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Presence of active MRI lesions in patients suspected of non-radiographic axial spondyloarthritis with high disease activity and chance at conversion after a 6-month follow-up period. Clin Rheumatol 2020; 39:1521-1529. [PMID: 31916108 DOI: 10.1007/s10067-019-04885-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 12/04/2019] [Accepted: 12/09/2019] [Indexed: 01/17/2023]
Abstract
OBJECTIVES The primary aim is to evaluate signs of inflammation on MRI of sacroiliac joints (SIJ)/spine in inflammatory back pain (IBP) patients suspected of nr-axSpA with high disease activity. Secondary aims are to describe the onset of new inflammatory lesions at MRI after 6 months and to evaluate gender differences in the presence of inflammation. METHOD Consecutively, patients with IBP with at least two spondyloarthritis features, high disease activity (BASDAI ≥ 4), and who were TNFi naïve, had a MRI of SIJ and spine. In the absence of active lesions, MRI was repeated after 6 months. MRI images were scored according to the Spondyloarthritis Research Consortium of Canada method. RESULTS Sixty-nine patients were included (53% female), of whom 39% showed signs of inflammation at the first MRI: 30.9% of the SIJ, 19.1% of the spine and 2.4% at both sites, irrespective of the CRP levels. Males more often showed inflammatory signs at the MRI of the SIJ and spine compared with females (45.5% vs. 33.3%). Consistently, the median SPARCC score was higher in males: for SIJ 14.0 (IQR 2.3-25.0) and for spine 11.5 (IQR 8.5-25.6). Only one patient (4.7%) without baseline inflammatory signs showed active lesions of SIJ after 6 months. CONCLUSIONS Almost 40% of the IBP patients suspected of nr-axSpA, with high disease activity, showed inflammatory lesions on MRI of SIJ and/or spine, which occurred more often in males compared with females. In the majority (95.3%), an MRI without inflammatory lesions remained negative after 6 months despite high disease activity.Key Points• Forty percent of inflammatory back pain patients with high disease activity showed inflammatory signs on MRI of the SIJ and/or spine.• Only 4% of baseline MRIs without inflammatory signs at baseline conversed to an MRI with inflammatory signs after 6 months.• Male inflammatory back pain patients with high disease activity showed more often inflammatory signs on MRI compared with females.
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20
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Raynal M, Bouderraoui F, Ouichka R, Melchior J, Morel O, Blum A, Chary-Valckenaere I, Ngueyon Sime W, Roch V, Maksymowych W, Lambert RG, Olivier P, Loeuille D. Performance of 18F-sodium fluoride positron emission tomography with computed tomography to assess inflammatory and structural sacroiliitis on magnetic resonance imaging and computed tomography, respectively, in axial spondyloarthritis. Arthritis Res Ther 2019; 21:119. [PMID: 31088514 PMCID: PMC6515602 DOI: 10.1186/s13075-019-1903-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 04/25/2019] [Indexed: 01/16/2023] Open
Abstract
PURPOSE To assess increased sacroiliac joint (SIJ) uptake on 18F-NaF PET/CT and to compare with MRI for inflammation and with CT scan for structural damages in a population of 23 patients with spondyloarthritis (SpA). METHODS Twenty-three patients with active SpA according to the Assessment of SpondyloArthritis international Society (ASAS) and/or modified NY criteria were included. All patients had a pelvic radiograph, MRI, and CT scan of the SIJ and 18F-NaF PET/CT examinations within a month, analyzed by three blinded readers. MRIs were assessed according to the ASAS criteria and SPARCC method. On CT scans, erosion and ankylosis were quantified using the same methodology. On the 18F-NaF PET, abnormal uptake was assessed using a qualitative method inspired by the ASAS criteria and two quantitative approaches (the PET-activity score according to the SPARCC method and Maximum Standardized Uptake Value (SUVmax)). RESULTS Structural sacroiliitis was observed on 7 radiographs and 10 CT scans; 10 MRIs showed inflammatory sacroiliitis, and 20 patients had a positive PET. The inter-reader reliability was good for the PET activity score and good to excellent for the SUVmax. A positive PET was not correlated with a positive MRI or with a structural sacroiliitis on CT scan. The PET-activity score and SUVmax were correlated with the SPARCC inflammation score but not with erosion or ankylosis scores on CT scan. CONCLUSION Abnormal uptake by the SIJ on 18F-NaF PET is more frequent than inflammatory and structural sacroiliitis in a population of SpA patients. The PET activity score and SUVmax had good correlations with inflammatory sacroiliitis but not with structural lesions on CT scan.
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Affiliation(s)
- Marie Raynal
- Department of Rheumatology, CHRU Nancy, 5 Rue du Morvan, 54500, Vandœuvre-lès-Nancy, France.
| | - Fehd Bouderraoui
- Department of Nuclear Medicine, CHRU Nancy, Vandœuvre-lès-Nancy, France
| | - Remy Ouichka
- Department of Rheumatology, CHRU Nancy, 5 Rue du Morvan, 54500, Vandœuvre-lès-Nancy, France
| | - Julian Melchior
- Department of Rheumatology, CHRU Nancy, 5 Rue du Morvan, 54500, Vandœuvre-lès-Nancy, France
| | - Olivier Morel
- Department of Nuclear Medicine, CHRU Nancy, Vandœuvre-lès-Nancy, France
| | - Alain Blum
- Department of Radiology, CHRU Nancy, Vandœuvre-lès-Nancy, France
| | | | - Willy Ngueyon Sime
- Department of Epidemiology, CIC 1433, CHRU Nancy, Vandœuvre-lès-Nancy, France
| | - Véronique Roch
- Department of Nuclear Medicine, CHRU Nancy, Vandœuvre-lès-Nancy, France
| | | | - Robert G Lambert
- Department of Radiology, University of Alberta, Edmonton, Canada
| | - Pierre Olivier
- Department of Nuclear Medicine, CHRU Nancy, Vandœuvre-lès-Nancy, France
| | - Damien Loeuille
- Department of Rheumatology, CHRU Nancy, 5 Rue du Morvan, 54500, Vandœuvre-lès-Nancy, France
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Czegley C, Gillmann C, Schauer C, Seyler L, Reinwald C, Hahn M, Uder M, Jochmann K, Naschberger E, Stock M, Schett G, Bäuerle T, Hoffmann MH. A model of chronic enthesitis and new bone formation characterized by multimodal imaging. Dis Model Mech 2018; 11:dmm.034041. [PMID: 30045841 PMCID: PMC6176995 DOI: 10.1242/dmm.034041] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 07/07/2018] [Indexed: 01/15/2023] Open
Abstract
Enthesitis is a key feature of several different rheumatic diseases. Its pathophysiology is only partially known due to the lack of access to human tissue and the shortage of reliable animal models for enthesitis. Here, we aimed to develop a model that mimics the effector phase of enthesitis and reliably leads to inflammation and new bone formation. Enthesitis was induced by local injection of monosodium urate (MSU) crystals into the metatarsal entheses of wild-type (WT) or oxidative-burst-deficient (Ncf1**) mice. Quantitative variables of inflammation (edema, swelling) and vascularization (tissue perfusion) were assessed by magnetic resonance imaging (MRI), bone-forming activity by [18F]-fluoride positron emission tomography (PET), and destruction of cortical bone and new bone formation by computed tomography (CT). Non-invasive imaging was validated by histochemical and histomorphometric analysis. While injection of MSU crystals into WT mice triggered transient mild enthesitis with no new bone formation, Ncf1** mice developed chronic enthesitis accompanied by massive enthesiophytes. In MRI, inflammation and blood flow in the entheses were chronically increased, while PET/CT showed osteoproliferation with enthesiophyte formation. Histochemical analyses showed chronic inflammation, increased vascularization, osteoclast differentiation and bone deposition in the affected entheseal sites. Herein we describe a fast and reliable effector model of chronic enthesitis, which is characterized by a combination of inflammation, vascularization and new bone formation. This model will help to disentangle the molecular pathways involved in the effector phase of enthesitis.
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Affiliation(s)
- Christine Czegley
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, 91054, Erlangen, Germany
| | - Clarissa Gillmann
- Institute of Radiology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, 91054, Erlangen, Germany
| | - Christine Schauer
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, 91054, Erlangen, Germany
| | - Lisa Seyler
- Institute of Radiology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, 91054, Erlangen, Germany
| | - Christiane Reinwald
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, 91054, Erlangen, Germany
| | - Madelaine Hahn
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, 91054, Erlangen, Germany
| | - Michael Uder
- Institute of Radiology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, 91054, Erlangen, Germany
| | - Katja Jochmann
- Department of Developmental Biology, Centre of Medical Biotechnology, Faculty of Biology, University of Duisburg-Essen, 45117, Essen, Germany
| | - Elisabeth Naschberger
- Division of Molecular and Experimental Surgery, Department of Surgery, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, 91054, Erlangen, Germany
| | - Michael Stock
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, 91054, Erlangen, Germany
| | - Georg Schett
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, 91054, Erlangen, Germany
| | - Tobias Bäuerle
- Institute of Radiology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, 91054, Erlangen, Germany
| | - Markus H Hoffmann
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, 91054, Erlangen, Germany
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Bruijnen STG, Verweij NJF, van Duivenvoorde LM, Bravenboer N, Baeten DLP, van Denderen CJ, van der Horst-Bruinsma IE, Voskuyl AE, Custers M, van de Ven PM, Bot JCJ, Boden BJH, Lammertsma AA, Hoekstra OSH, Raijmakers PGHM, van der Laken CJ. Bone formation in ankylosing spondylitis during anti-tumour necrosis factor therapy imaged by 18F-fluoride positron emission tomography. Rheumatology (Oxford) 2018; 57:631-638. [PMID: 29329443 PMCID: PMC5888961 DOI: 10.1093/rheumatology/kex448] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Indexed: 01/02/2023] Open
Abstract
Objectives Excessive bone formation is an important hallmark of AS. Recently it has been demonstrated that axial bony lesions in AS patients can be visualized using 18F-fluoride PET-CT. The aim of this study was to assess whether 18F-fluoride uptake in clinically active AS patients is related to focal bone formation in spine biopsies and is sensitive to change during anti-TNF treatment. Methods Twelve anti-TNF-naïve AS patients [female 7/12; age 39 years (SD 11); BASDAI 5.5 ± 1.1] were included. 18 F-fluoride PET-CT scans were performed at baseline and in two patients, biopsies were obtained from PET-positive and PET-negative spine lesions. The remaining 10 patients underwent a second 18F-fluoride PET-CT scan after 12 weeks of anti-TNF treatment. PET scans were scored visually by two blinded expert readers. In addition, 18F-fluoride uptake was quantified using the standardized uptake value corrected for individual integrated whole blood activity concentration (SUVAUC). Clinical response to anti-TNF was defined according to a ⩾ 20% improvement in Assessment of SpondyloArthritis international Society criteria at 24 weeks. Results At baseline, all patients showed at least one axial PET-positive lesion. Histological analysis of PET-positive lesions in the spine confirmed local osteoid formation. PET-positive lesions were found in the costovertebral joints (43%), facet joints (23%), bridging syndesmophytes (20%) and non-bridging vertebral lesions (14%) and in SI joints (75%). After 12 weeks of anti-TNF treatment, 18F-fluoride uptake in clinical responders decreased significantly in the costovertebral (mean SUVAUC −1.0; P < 0.001) and SI joints (mean SUVAUC −1.2; P = 0.03) in contrast to non-responders. Conclusions 18F-fluoride PET-CT identified bone formation, confirmed by histology, in the spine and SI joints of AS patients and demonstrated alterations in bone formation during anti-TNF treatment.
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Affiliation(s)
- Stefan T G Bruijnen
- Department of Rheumatology, VU University Medical Center, Amsterdam, The Netherlands
| | - Nicki J F Verweij
- Department of Rheumatology, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Nathalie Bravenboer
- Department of Clinical Chemistry, VU University Medical Center, Amsterdam, The Netherlands
| | - Dominique L P Baeten
- Department of Rheumatology, Amsterdam Medical Center, Amsterdam, The Netherlands
| | | | | | - Alexandre E Voskuyl
- Department of Rheumatology, VU University Medical Center, Amsterdam, The Netherlands
| | - Martijn Custers
- Department of Rheumatology, Maartenskliniek, Woerden, The Netherlands
| | - Peter M van de Ven
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Joost C J Bot
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Bouke J H Boden
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Adriaan A Lammertsma
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Otto S H Hoekstra
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Pieter G H M Raijmakers
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Conny J van der Laken
- Department of Rheumatology, VU University Medical Center, Amsterdam, The Netherlands
- Correspondence to: Conny J. van der Laken, Department of Rheumatology, VU University Medical Center, room 3A-50, PO Box 7057, 1007 MB Amsterdam, The Netherlands. E-mail:
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Menendez MI, Hettlich B, Wei L, Knopp MV. Feasibility of Na 18F PET/CT and MRI for Noninvasive In Vivo Quantification of Knee Pathophysiological Bone Metabolism in a Canine Model of Post-traumatic Osteoarthritis. Mol Imaging 2018; 16:1536012117714575. [PMID: 28730928 PMCID: PMC5524230 DOI: 10.1177/1536012117714575] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Purpose: To assess and quantify by molecular imaging knee osseous metabolic changes serially in an in vivo canine model of posttraumatic osteoarthritis (PTOA) of the knee utilizing sodium fluoride (Na18F) positron emission tomography (PET)/computed tomography (CT) coregistered with magnetic resonance imaging (MRI). Materials and Methods: Sodium fluoride PET imaging of 5 canines was performed prior to anterior cruciate ligament transection (ACLT) and 2 times post-ACLT (3 and 12 weeks). The PET/CT was coregistered with MRI, enabling serial anatomically guided visual and quantitative three-dimensional (3D) region of interest (ROI) assessment by maximum standardized uptake value. Results: Prior to ACLT, every 3D ROI assessed in both knees showed no Na18F uptake above background. The uptake of Na18F in the bone of the ACLT knees increased exponentially, presenting significantly higher uptake at 12 weeks in every region compared to the ACLT knees at baseline. Furthermore, the uninjured contralateral limb and the ipsilateral distal bones and joints presented Na18F uptake at 3 and 12 weeks post-ACLT. Conclusion: This study demonstrated that Na18F PET/CT coregistered with MRI is a feasible molecular imaging biomarker to assess knee osseous metabolic changes serially in an in vivo canine model of knee PTOA. Moreover, it brings a novel musculoskeletal preclinical imaging methodology that can provide unique insights into PTOA pathophysiology.
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Affiliation(s)
- Maria I Menendez
- 1 Department of Radiology, Wright Center of Innovation in Biomedical Imaging, The Ohio State University, Columbus, OH, USA
| | - Bianca Hettlich
- 1 Department of Radiology, Wright Center of Innovation in Biomedical Imaging, The Ohio State University, Columbus, OH, USA.,2 Vetsuisse Faculty Bern, Bern, Switzerland
| | - Lai Wei
- 3 Center for Biostatistics, The Ohio State University, Columbus, OH, USA
| | - Michael V Knopp
- 1 Department of Radiology, Wright Center of Innovation in Biomedical Imaging, The Ohio State University, Columbus, OH, USA
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24
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Khmelinskii N, Regel A, Baraliakos X. The Role of Imaging in Diagnosing Axial Spondyloarthritis. Front Med (Lausanne) 2018; 5:106. [PMID: 29719835 PMCID: PMC5913283 DOI: 10.3389/fmed.2018.00106] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 03/29/2018] [Indexed: 01/12/2023] Open
Abstract
Imaging has a central role in the diagnosis, management, and follow-up of patients with axial spondyloarthritis (axSpA). For the early diagnosis of axSpA, magnetic resonance imaging is of utmost relevance. While no novel imaging techniques were developed during the past decade, improvements to the existing modalities have been introduced. This report provides an overview of the applications and limitations of the existing imaging modalities.
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Affiliation(s)
- Nikita Khmelinskii
- Rheumathology Department, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon Academic Medical Centre, Lisbon, Portugal
| | - Andrea Regel
- Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Herne, Germany
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25
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ACR Appropriateness Criteria ® Chronic Back Pain Suspected Sacroiliitis-Spondyloarthropathy. J Am Coll Radiol 2018; 14:S62-S70. [PMID: 28473095 DOI: 10.1016/j.jacr.2017.01.048] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 01/27/2017] [Accepted: 01/31/2017] [Indexed: 12/18/2022]
Abstract
Inflammatory sacroiliitis or the seronegative axial spondyloarthropathies often presents as back pain or sacroiliac joint pain of more than 3-month duration with inflammatory symptoms and typically in patients younger than 45 years of age. Imaging plays an important role in diagnosis and disease monitoring. This article addresses the appropriate sequence of initial imaging for evaluation of a suspected spondyloarthropathy, the imaging follow-up of treatment response and the special considerations for imaging of trauma in patients with ankylosis of the spine. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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26
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Jamar F, Versari A, Galli F, Lecouvet F, Signore A. Molecular Imaging of Inflammatory Arthritis and Related Disorders. Semin Nucl Med 2018; 48:277-290. [PMID: 29626944 DOI: 10.1053/j.semnuclmed.2017.12.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Rheumatic disorders comprise a number of diseases that range from benign, mildly symptomatic degenerative disease to severe systemic disorders such as giant-cell vasculitis with dramatic consequences such as acute blindness. The former is relatively common, whereas the latter is rare. In between, commonly encountered disorders such as rheumatoid arthritis and the various spondyloarthritides, with or without peripheral enthesitis, are daily challenges for the caring physician. Clinical evaluation is of utmost importance and is constantly described under the form of specialist guidelines in all parts of the world. Objective assessment of inflammatory arthritis and related disorders is of interest both for the care of the individual patient and for the assessment of the effects of the many novel experimental therapies proposed in this field, most of them being very expensive. High-resolution ultrasound, CT and spectral CT, MRI using various sequences, and molecular imaging using either gamma camera imaging (including SPECT-CT) or PET-CT are all proposed for a better assessment of these diseases. This review focuses on the several nuclear medicine techniques that are or may become useful to helping provide better patient care in this field and is mainly oriented to inflammatory rheumatic disorders, excluding mechanical degenerative diseases.
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Affiliation(s)
- François Jamar
- Nuclear Medicine Department, Cliniques Universitaires St-Luc and IREC, Université Catholique de Louvain, Brussels, Belgium.
| | - Annibale Versari
- Nuclear Medicine Unit, Oncology and High Technology Department, S. Maria Nuova Hospital, AUSL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Filippo Galli
- Nuclear Medicine Unit, Faculty of Medicine and Psychology, Department of Medical-Surgical Sciences and Translational Medicine, "Sapienza" University, Roma, Italy
| | - Frédéric Lecouvet
- Department of Diagnostic Imaging, Cliniques Universitaires St-Luc and IREC, Université Catholique de Louvain, Brussels, Belgium
| | - Alberto Signore
- Nuclear Medicine Unit, Faculty of Medicine and Psychology, Department of Medical-Surgical Sciences and Translational Medicine, "Sapienza" University, Roma, Italy
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27
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Lacout A, Carlier RY, El Hajjam M, Marcy PY. VEGF inhibition as possible therapy in spondyloarthritis patients: Targeting bone remodelling. Med Hypotheses 2017; 101:52-54. [PMID: 28351491 DOI: 10.1016/j.mehy.2017.02.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 01/26/2017] [Accepted: 02/25/2017] [Indexed: 11/18/2022]
Abstract
Spondyloarthritis refers to a group of chronic inflammatory rheumatic diseases that predominantly affects the axial skeleton, causing pain and stiffness. Human bone is highly dynamic organ that interacts with a wide array cells and tissues. Process of bone remodelling relies on a delicate balance between bone formation and bone resorption, orchestrated by osteoblasts and osteoclasts. Disruption of this homeostatic balance of bone removal and replacement can manifest as inappropriate new bone formation found in spondylarthritis. We hypothesize that VEGF may promote bone remodelling, stimulate angiogenesis, and both osteoclastic and osteoblastic activity. Anti VEGF may be tested as a dedicated therapy to prevent bone remodelling in spondyloarthritis patients, namely in cases of aggressive disease. Bone remodelling could be monitored by using [18F]Fluoride PET scan.
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Affiliation(s)
- Alexis Lacout
- Centre d'imagerie Médicale, 47, Boulevard du Pont Rouge, 15000 Aurillac, France.
| | - Robert Yves Carlier
- Service de Radiologie, Hôpital Raymond Poincaré, 104 Boulevard Raymond Poincaré, 92380 Garches, France.
| | - Mostafa El Hajjam
- Service de Radiologie, Hôpital Ambroise pare (APHP), 9, Avenue Charles De Gaulle, 92100 Boulogne Billancourt, France.
| | - Pierre Yves Marcy
- Radiodiagnostic and Interventional Radiology Department, Polyclinique Les Fleurs, Quartier Quiez, 83190 Ollioules, France.
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28
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Park EK, Pak K, Park JH, Kim K, Kim SJ, Kim IJ, Kim GT, Lee SG. Baseline increased 18F-fluoride uptake lesions at vertebral corners on positron emission tomography predict new syndesmophyte development in ankylosing spondylitis: a 2-year longitudinal study. Rheumatol Int 2017; 37:765-773. [PMID: 28154899 DOI: 10.1007/s00296-017-3660-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 01/16/2017] [Indexed: 12/24/2022]
Abstract
The goal of this study was to demonstrate whether increased 18F-fluoride uptake lesions on positron emission tomography (PET) scan can predict new syndesmophyte development in patients with ankylosing spondylitis (AS). In 12 AS patients, 18F-fluoride PET and magnetic resonance imaging (MRI) was performed at baseline, and radiography was performed at baseline and the 2-year follow-up. The following data were recorded: the presence of increased 18F-fluoride uptake lesions on PET defined as an uptake greater than the uptake in the adjacent normal vertebral body; acute (type A) and advanced (type B) corner inflammatory lesions (CILs) and fat lesions on MRI; and syndesmophytes on radiography. Of 231 anterior vertebral corners without syndesmophyte at baseline, 13 type A CILs (5.5%), 2 type B CILs (0.9%), and 20 fat lesions (8.7%) on MRI and six increased fluoride uptake lesions (2.6%) on PET were observed. At the 2-year follow-up, 16 new syndesmophytes (6.9%) in eight AS patients (66.7%) occurred. New syndesmophytes developed significantly more frequently in anterior vertebral corners with increased 18F-fluoride uptake lesions (50%) or fat lesions (25%) at baseline than in those without such lesions (5.8 and 5.2%; p = 0.005 and p = 0.007, respectively). After adjusting confounding factors, baseline increased 18F-fluoride uptake lesions was independently associated with new syndesmophytes development (OR 13.8, 95% CI 1.5-124.3, p = 0.019). Fat lesions were also associated with new syndesmophytes formation. Our data suggest that 18F-fluoride PET may be applied to identify AS patients with high risk of future syndesmophyte formation.
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Affiliation(s)
- Eun-Kyoung Park
- Division of Rheumatology, Department of Internal Medicine, Pusan National University School of Medicine, Pusan National University Hospital, 179 Gudeok-Ro, Seo-Gu, Busan, 49241, South Korea
| | - Kyoungjune Pak
- Department of Nuclear Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Ji-Heh Park
- Division of Rheumatology, Department of Internal Medicine, Pusan National University School of Medicine, Pusan National University Hospital, 179 Gudeok-Ro, Seo-Gu, Busan, 49241, South Korea
| | - Keunyoung Kim
- Department of Nuclear Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Seong-Jang Kim
- Department of Nuclear Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - In-Joo Kim
- Department of Nuclear Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Geun-Tae Kim
- Division of Rheumatology, Department of Internal Medicine, Kosin University College of Medicine, Busan, South Korea
| | - Seung-Geun Lee
- Division of Rheumatology, Department of Internal Medicine, Pusan National University School of Medicine, Pusan National University Hospital, 179 Gudeok-Ro, Seo-Gu, Busan, 49241, South Korea.
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Zilber K, Gorenberg M, Rimar D, Boulman N, Kaly L, Rozenbaum M, Rosner I, Slobodin G. Radionuclide Methods in the Diagnosis of Sacroiliitis in Patients with Spondyloarthritis: An Update. Rambam Maimonides Med J 2016; 7:RMMJ.10264. [PMID: 27824544 PMCID: PMC5101011 DOI: 10.5041/rmmj.10264] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Sacroiliitis, inflammation of the sacroiliac joint (SIJ), is the hallmark of ankylosing spondylitis and spondyloarthritis (SpA) in general. The arsenal of recommended diagnostic modalities for imaging of the SIJ is scanty and, in practice, includes only conventional X-rays and magnetic resonance imaging (MRI). This review suggests that bone scintigraphy, particularly single-photon emission computed tomography (SPECT) with calculation of indices, or SPECT in combination with low-dose computed tomography (CT) can be a sensitive and specific tool for the diagnosis of sacroiliitis and can be used as part of the individualized approach to the diagnosis of axial SpA. In addition, [18F]fluoride positron emission tomography (PET)/CT imaging and immunoscintigraphy, using labeled monoclonal anti-cytokine antibodies, are promising methods of current scientific interest in this field.
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Affiliation(s)
- Karina Zilber
- Rheumatology Unit, Bnai Zion Medical Center, Haifa, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Miguel Gorenberg
- Department of Nuclear Medicine, Bnai Zion Medical Center, Haifa, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Doron Rimar
- Rheumatology Unit, Bnai Zion Medical Center, Haifa, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Nina Boulman
- Rheumatology Unit, Bnai Zion Medical Center, Haifa, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Lisa Kaly
- Rheumatology Unit, Bnai Zion Medical Center, Haifa, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Michael Rozenbaum
- Rheumatology Unit, Bnai Zion Medical Center, Haifa, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Itzhak Rosner
- Rheumatology Unit, Bnai Zion Medical Center, Haifa, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Gleb Slobodin
- Rheumatology Unit, Bnai Zion Medical Center, Haifa, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
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Raynor W, Houshmand S, Gholami S, Emamzadehfard S, Rajapakse CS, Blomberg BA, Werner TJ, Høilund-Carlsen PF, Baker JF, Alavi A. Evolving Role of Molecular Imaging with (18)F-Sodium Fluoride PET as a Biomarker for Calcium Metabolism. Curr Osteoporos Rep 2016; 14:115-25. [PMID: 27301549 DOI: 10.1007/s11914-016-0312-5] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
(18)F-sodium fluoride (NaF) as an imaging tracer portrays calcium metabolic activity either in the osseous structures or in soft tissue. Currently, clinical use of NaF-PET is confined to detecting metastasis to the bone, but this approach reveals indirect evidence for disease activity and will have limited use in the future in favor of more direct approaches that visualize cancer cells in the read marrow where they reside. This has proven to be the case with FDG-PET imaging in most cancers. However, a variety of studies support the application of NaF-PET to assess benign osseous diseases. In particular, bone turnover can be measured from NaF uptake to diagnose osteoporosis. Several studies have evaluated the efficacy of bisphosphonates and their lasting effects as treatment for osteoporosis using bone turnover measured by NaF-PET. Additionally, NaF uptake in vessels tracks calcification in the plaques at the molecular level, which is relevant to coronary artery disease. Also, NaF-PET imaging of diseased joints is able to project disease progression in osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis. Further studies suggest potential use of NaF-PET in domains such as back pain, osteosarcoma, stress-related fracture, and bisphosphonate-induced osteonecrosis of the jaw. The critical role of NaF-PET in disease detection and characterization of many musculoskeletal disorders has been clearly demonstrated in the literature, and these methods will become more widespread in the future. The data from PET imaging are quantitative in nature, and as such, it adds a major dimension to assessing disease activity.
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Affiliation(s)
- William Raynor
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Sina Houshmand
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Saeid Gholami
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Sahra Emamzadehfard
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Chamith S Rajapakse
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Björn Alexander Blomberg
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Thomas J Werner
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | | | - Joshua F Baker
- Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA
- Division of Rheumatology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA
| | - Abass Alavi
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
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Abstract
PURPOSE OF REVIEW Syndesmophytes are characteristic components of the spine disorder of ankylosing spondylitis. Understanding their growth may reveal insights to pathogenesis and potential treatment. We review recent studies on rates of development of syndesmophytes, patient characteristics associated with more rapid syndesmophyte growth, local vertebral abnormalities that precede syndesmophytes, systemic biomarkers of syndesmophytes, and studies of medications. RECENT FINDINGS New syndesmophytes develop in one-third of patients over 2 years. Consistent clinical predictors are male sex, elevated serum C-reactive protein levels, and preexisting syndesmophytes. Concomitant vertebral inflammation and fat dysplasia on MRI predict future syndesmophytes at the same vertebral location, but most syndesmophytes do not have recognized antecedents. Associations with serum levels of Wingless pathway proteins are inconsistent, as are the results of observational studies of tumor necrosis factor-alpha inhibitors. SUMMARY Although there is better understanding of the frequency of syndesmophyte development, the pathogenesis of syndesmophytes remains unclear.
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Buchbender C, Ostendorf B, Ruhlmann V, Heusch P, Miese F, Beiderwellen K, Schneider M, Braun J, Antoch G, Baraliakos X. Hybrid 18F-labeled Fluoride Positron Emission Tomography/Magnetic Resonance (MR) Imaging of the Sacroiliac Joints and the Spine in Patients with Axial Spondyloarthritis: A Pilot Study Exploring the Link of MR Bone Pathologies and Increased Osteoblastic Activity. J Rheumatol 2015; 42:1631-7. [PMID: 26136491 DOI: 10.3899/jrheum.150250] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2015] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The biologically active molecule used in positron emission tomography (PET) for depiction of osteoblastic activity is 18F-labeled fluoride (18F-F). We examined whether inflammatory or chronic changes on magnetic resonance imaging (MRI) in the sacroiliac joints (SIJ) and the spines of patients with active ankylosing spondylitis (AS) are linked to osteoblastic activity, assessed by PET/MRI. METHODS Thirteen patients with AS (mean age 37.8 ± 11.4 yrs, Bath AS Disease Activity Index > 4, no anti-TNF treatment) underwent 3-Tesla whole-spine and SIJ PET/MRI. Two independent readers recorded pathologic changes related to vertebral (VQ) or SIJ quadrants (SQ). Final scores were based on reader agreement. RESULTS A total of 104 SQ and 1196 VQ were examined. In SIJ, bone marrow edema (BME) was seen in 44.2%, fat deposition (FD) in 42.3%, and 18F-F in 46.2% SQ. BME alone was associated with 18F-F in 78.6% and FD alone in only 7.7% SQ, while the combination BME/FD was associated with 18F-F in 72.2% SQ. Erosions, sclerosis, and ankylosis alone were rarely associated with 18F-F. In the spine, BME alone was seen in 9.9%, FD in 18.2%, and 18F-F in 5.4% VQ. BME alone was associated with 18F-F in 14.3% and FD alone in 8.7% VQ, while the combination BME/FD was associated with 18F-F in 40.6% VQ. CONCLUSION In this study of hybrid 18F-F PET/MRI of patients with active AS, we show that BME rather than chronic changes is associated with osteoblastic activity, while the combination of BME and FD showed the highest 18F-F uptake. The use of PET/MRI in prediction of future syndesmophyte formation in AS needs further exploration in prospective studies.
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Affiliation(s)
- Christian Buchbender
- From the Department of Diagnostic and Interventional Radiology, and Department of Rheumatology, Medical Faculty, University of Dusseldorf, Dusseldorf; Department of Nuclear Medicine, and Department of Diagnostic and Interventional Radiology and Neuroradiology, Medical Faculty, University of Duisburg-Essen, Essen; Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Herne, Germany.C. Buchbender, MD, Department of Diagnostic and Interventional Radiology; B. Ostendorf, MD, Department of Rheumatology, Medical Faculty, University of Dusseldorf; V. Ruhlmann, MD, Department of Nuclear Medicine, Medical Faculty, University of Duisburg-Essen; P. Heusch, MD; F. Miese, MD, Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Dusseldorf; K. Beiderwellen, MD, Department of Diagnostic and Interventional Radiology and Neuroradiology, Medical Faculty, University of Duisburg-Essen; M. Schneider, MD, Department of Rheumatology, Medical Faculty, University of Dusseldorf; J. Braun, MD, Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum; G. Antoch, MD, Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Dusseldorf; X. Baraliakos, MD, Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum
| | - Benedikt Ostendorf
- From the Department of Diagnostic and Interventional Radiology, and Department of Rheumatology, Medical Faculty, University of Dusseldorf, Dusseldorf; Department of Nuclear Medicine, and Department of Diagnostic and Interventional Radiology and Neuroradiology, Medical Faculty, University of Duisburg-Essen, Essen; Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Herne, Germany.C. Buchbender, MD, Department of Diagnostic and Interventional Radiology; B. Ostendorf, MD, Department of Rheumatology, Medical Faculty, University of Dusseldorf; V. Ruhlmann, MD, Department of Nuclear Medicine, Medical Faculty, University of Duisburg-Essen; P. Heusch, MD; F. Miese, MD, Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Dusseldorf; K. Beiderwellen, MD, Department of Diagnostic and Interventional Radiology and Neuroradiology, Medical Faculty, University of Duisburg-Essen; M. Schneider, MD, Department of Rheumatology, Medical Faculty, University of Dusseldorf; J. Braun, MD, Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum; G. Antoch, MD, Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Dusseldorf; X. Baraliakos, MD, Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum
| | - Verena Ruhlmann
- From the Department of Diagnostic and Interventional Radiology, and Department of Rheumatology, Medical Faculty, University of Dusseldorf, Dusseldorf; Department of Nuclear Medicine, and Department of Diagnostic and Interventional Radiology and Neuroradiology, Medical Faculty, University of Duisburg-Essen, Essen; Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Herne, Germany.C. Buchbender, MD, Department of Diagnostic and Interventional Radiology; B. Ostendorf, MD, Department of Rheumatology, Medical Faculty, University of Dusseldorf; V. Ruhlmann, MD, Department of Nuclear Medicine, Medical Faculty, University of Duisburg-Essen; P. Heusch, MD; F. Miese, MD, Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Dusseldorf; K. Beiderwellen, MD, Department of Diagnostic and Interventional Radiology and Neuroradiology, Medical Faculty, University of Duisburg-Essen; M. Schneider, MD, Department of Rheumatology, Medical Faculty, University of Dusseldorf; J. Braun, MD, Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum; G. Antoch, MD, Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Dusseldorf; X. Baraliakos, MD, Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum
| | - Philipp Heusch
- From the Department of Diagnostic and Interventional Radiology, and Department of Rheumatology, Medical Faculty, University of Dusseldorf, Dusseldorf; Department of Nuclear Medicine, and Department of Diagnostic and Interventional Radiology and Neuroradiology, Medical Faculty, University of Duisburg-Essen, Essen; Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Herne, Germany.C. Buchbender, MD, Department of Diagnostic and Interventional Radiology; B. Ostendorf, MD, Department of Rheumatology, Medical Faculty, University of Dusseldorf; V. Ruhlmann, MD, Department of Nuclear Medicine, Medical Faculty, University of Duisburg-Essen; P. Heusch, MD; F. Miese, MD, Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Dusseldorf; K. Beiderwellen, MD, Department of Diagnostic and Interventional Radiology and Neuroradiology, Medical Faculty, University of Duisburg-Essen; M. Schneider, MD, Department of Rheumatology, Medical Faculty, University of Dusseldorf; J. Braun, MD, Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum; G. Antoch, MD, Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Dusseldorf; X. Baraliakos, MD, Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum
| | - Falk Miese
- From the Department of Diagnostic and Interventional Radiology, and Department of Rheumatology, Medical Faculty, University of Dusseldorf, Dusseldorf; Department of Nuclear Medicine, and Department of Diagnostic and Interventional Radiology and Neuroradiology, Medical Faculty, University of Duisburg-Essen, Essen; Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Herne, Germany.C. Buchbender, MD, Department of Diagnostic and Interventional Radiology; B. Ostendorf, MD, Department of Rheumatology, Medical Faculty, University of Dusseldorf; V. Ruhlmann, MD, Department of Nuclear Medicine, Medical Faculty, University of Duisburg-Essen; P. Heusch, MD; F. Miese, MD, Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Dusseldorf; K. Beiderwellen, MD, Department of Diagnostic and Interventional Radiology and Neuroradiology, Medical Faculty, University of Duisburg-Essen; M. Schneider, MD, Department of Rheumatology, Medical Faculty, University of Dusseldorf; J. Braun, MD, Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum; G. Antoch, MD, Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Dusseldorf; X. Baraliakos, MD, Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum
| | - Karsten Beiderwellen
- From the Department of Diagnostic and Interventional Radiology, and Department of Rheumatology, Medical Faculty, University of Dusseldorf, Dusseldorf; Department of Nuclear Medicine, and Department of Diagnostic and Interventional Radiology and Neuroradiology, Medical Faculty, University of Duisburg-Essen, Essen; Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Herne, Germany.C. Buchbender, MD, Department of Diagnostic and Interventional Radiology; B. Ostendorf, MD, Department of Rheumatology, Medical Faculty, University of Dusseldorf; V. Ruhlmann, MD, Department of Nuclear Medicine, Medical Faculty, University of Duisburg-Essen; P. Heusch, MD; F. Miese, MD, Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Dusseldorf; K. Beiderwellen, MD, Department of Diagnostic and Interventional Radiology and Neuroradiology, Medical Faculty, University of Duisburg-Essen; M. Schneider, MD, Department of Rheumatology, Medical Faculty, University of Dusseldorf; J. Braun, MD, Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum; G. Antoch, MD, Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Dusseldorf; X. Baraliakos, MD, Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum
| | - Matthias Schneider
- From the Department of Diagnostic and Interventional Radiology, and Department of Rheumatology, Medical Faculty, University of Dusseldorf, Dusseldorf; Department of Nuclear Medicine, and Department of Diagnostic and Interventional Radiology and Neuroradiology, Medical Faculty, University of Duisburg-Essen, Essen; Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Herne, Germany.C. Buchbender, MD, Department of Diagnostic and Interventional Radiology; B. Ostendorf, MD, Department of Rheumatology, Medical Faculty, University of Dusseldorf; V. Ruhlmann, MD, Department of Nuclear Medicine, Medical Faculty, University of Duisburg-Essen; P. Heusch, MD; F. Miese, MD, Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Dusseldorf; K. Beiderwellen, MD, Department of Diagnostic and Interventional Radiology and Neuroradiology, Medical Faculty, University of Duisburg-Essen; M. Schneider, MD, Department of Rheumatology, Medical Faculty, University of Dusseldorf; J. Braun, MD, Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum; G. Antoch, MD, Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Dusseldorf; X. Baraliakos, MD, Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum
| | - Juergen Braun
- From the Department of Diagnostic and Interventional Radiology, and Department of Rheumatology, Medical Faculty, University of Dusseldorf, Dusseldorf; Department of Nuclear Medicine, and Department of Diagnostic and Interventional Radiology and Neuroradiology, Medical Faculty, University of Duisburg-Essen, Essen; Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Herne, Germany.C. Buchbender, MD, Department of Diagnostic and Interventional Radiology; B. Ostendorf, MD, Department of Rheumatology, Medical Faculty, University of Dusseldorf; V. Ruhlmann, MD, Department of Nuclear Medicine, Medical Faculty, University of Duisburg-Essen; P. Heusch, MD; F. Miese, MD, Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Dusseldorf; K. Beiderwellen, MD, Department of Diagnostic and Interventional Radiology and Neuroradiology, Medical Faculty, University of Duisburg-Essen; M. Schneider, MD, Department of Rheumatology, Medical Faculty, University of Dusseldorf; J. Braun, MD, Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum; G. Antoch, MD, Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Dusseldorf; X. Baraliakos, MD, Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum
| | - Gerald Antoch
- From the Department of Diagnostic and Interventional Radiology, and Department of Rheumatology, Medical Faculty, University of Dusseldorf, Dusseldorf; Department of Nuclear Medicine, and Department of Diagnostic and Interventional Radiology and Neuroradiology, Medical Faculty, University of Duisburg-Essen, Essen; Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Herne, Germany.C. Buchbender, MD, Department of Diagnostic and Interventional Radiology; B. Ostendorf, MD, Department of Rheumatology, Medical Faculty, University of Dusseldorf; V. Ruhlmann, MD, Department of Nuclear Medicine, Medical Faculty, University of Duisburg-Essen; P. Heusch, MD; F. Miese, MD, Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Dusseldorf; K. Beiderwellen, MD, Department of Diagnostic and Interventional Radiology and Neuroradiology, Medical Faculty, University of Duisburg-Essen; M. Schneider, MD, Department of Rheumatology, Medical Faculty, University of Dusseldorf; J. Braun, MD, Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum; G. Antoch, MD, Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Dusseldorf; X. Baraliakos, MD, Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum
| | - Xenofon Baraliakos
- From the Department of Diagnostic and Interventional Radiology, and Department of Rheumatology, Medical Faculty, University of Dusseldorf, Dusseldorf; Department of Nuclear Medicine, and Department of Diagnostic and Interventional Radiology and Neuroradiology, Medical Faculty, University of Duisburg-Essen, Essen; Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Herne, Germany.C. Buchbender, MD, Department of Diagnostic and Interventional Radiology; B. Ostendorf, MD, Department of Rheumatology, Medical Faculty, University of Dusseldorf; V. Ruhlmann, MD, Department of Nuclear Medicine, Medical Faculty, University of Duisburg-Essen; P. Heusch, MD; F. Miese, MD, Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Dusseldorf; K. Beiderwellen, MD, Department of Diagnostic and Interventional Radiology and Neuroradiology, Medical Faculty, University of Duisburg-Essen; M. Schneider, MD, Department of Rheumatology, Medical Faculty, University of Dusseldorf; J. Braun, MD, Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum; G. Antoch, MD, Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Dusseldorf; X. Baraliakos, MD, Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum.
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Tan S, Yao J, Flynn JA, Yao L, Ward MM. Dynamics of syndesmophyte growth in AS as measured by quantitative CT: heterogeneity within and among vertebral disc spaces. Rheumatology (Oxford) 2015; 54:972-80. [PMID: 25394620 PMCID: PMC4447840 DOI: 10.1093/rheumatology/keu423] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 09/11/2014] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Syndesmophytes in AS typically grow slowly, but it is not known whether growth is uniform among syndesmophytes in the same intervertebral disc space (IDS) or among different IDSs in the same patient or if growth is heterogeneous. We examined the dynamics of syndesmophyte growth over 24 months using CT, with the main aim of determining if syndesmophytes in the same IDS or the same patient grow at similar rates. METHODS We performed lumbar spine CT scans on 33 patients and measured syndesmophytes in four IDSs using a validated computer algorithm. Scans were done at baseline and 12 and 24 months. We compared absolute and percentage changes in volume from baseline to 12 months and to 24 months among syndesmophytes in the same IDS and among four IDSs of each patient. We also examined whether growth among all IDSs differed between study years. RESULTS Among 60 IDSs with at least two syndesmophytes at baseline (range 2-6), there was substantial heterogeneity in both absolute (P < 0.0001) and percentage (P = 0.0002) volume increases among syndesmophytes in the same IDS. Several IDSs had both syndesmophytes with no growth and syndesmophytes that increased by >100 mm(3). Similarly there was significant heterogeneity in syndesmophyte growth among IDSs of individual patients. Increases in total syndesmophyte volume for each patient also tended to differ between study years (P = 0.07). CONCLUSION Syndesmophytes in AS do not all grow continuously. Rates of growth over 24 months commonly differ between syndesmophytes in the same IDS and between different IDSs in the same patient, suggesting that local factors regulate syndesmophyte growth.
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Affiliation(s)
- Sovira Tan
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda and Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Jianhua Yao
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda and Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - John A Flynn
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda and Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Lawrence Yao
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda and Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Michael M Ward
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda and Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA
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Kim YI, Suh M, Kim YK, Lee HY, Shin K. The usefulness of bone SPECT/CT imaging with volume of interest analysis in early axial spondyloarthritis. BMC Musculoskelet Disord 2015; 16:9. [PMID: 25649319 PMCID: PMC4328061 DOI: 10.1186/s12891-015-0465-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 01/15/2015] [Indexed: 12/13/2022] Open
Abstract
Background The role of conventional bone scintigraphy in diagnosing early axial spondyloarthritis (SpA) is yet controversial. Single positron emission computed tomography (SPECT) plus CT is an imaging modality that adds better anatomical information to scintigraphy of the sacroiliac (SI) joint. Our aim was to investigate the usefulness of bone SPECT/CT with volume of interest (VOI) analysis in early axial SpA patients. Methods Twenty patients (male: female ratio = 12:8; age range = 17–65 years) presenting with inflammatory back pain meeting the Amor criteria of early axial SpA were recruited from a single center in South Korea. Bone scintigraphy was performed 180 min after intravenous injection of 1110 MBq of Tc-99 m-HDP, followed by bone SPECT/CT. The ratio between the entire SI joint and sacrum (SIS ratio) was measured by both bone SPECT/CT and bone scintigraphy. Data from 13 controls were also evaluated. Receiver operating characteristic (ROC) curve was plotted for further analysis, and the correlation between the SIS ratio and SI joint grade by plain radiography was assessed. Results The SIS ratio of early axial SpA patients vs. control subjects was significantly increased in bone SPECT/CT (p < 0.001). However, no significant difference was detected in bone scintigraphy. ROC curve analysis showed a significant difference in the area under curve (AUC) of bone SPECT/CT vs. bone scintigraphy (0.862 vs. 0.523, respectively; p < 0.001). With a cut-off SIS ratio of 1.50, ROC curve analysis showed a sensitivity of 80.0% and specificity of 84.6% in bone SPECT/CT. The SIS ratio measured in SPECT/CT, but not that measured in bone scintigraphy, was significantly increased with a higher grade of SI joint changes in plain radiography (p = 0.014). Conclusion Bone SPECT/CT is more useful than conventional bone scintigraphy in identifying sacroiliitis in early axial SpA patients, even with mild SI joint changes in plain radiography. By combining CT, we can accurately delineate the sacrum and SI joint uptake with our VOI method.
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Affiliation(s)
- Yong-il Kim
- Department of Nuclear Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, South Korea. .,Department of Molecular Medicine and Biopharmaceutical Sciences, WCU Graduate School of Convergence Science and Technology, Seoul National University, Seoul, South Korea. .,Cancer Research Institute, Seoul National University, Seoul, South Korea.
| | - Minseok Suh
- Department of Nuclear Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, South Korea.
| | - Yu Kyeong Kim
- Department of Nuclear Medicine, Seoul National University Hospital Boramae Medical Center, Seoul, South Korea.
| | - Ho-Young Lee
- Department of Nuclear Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, South Korea. .,Cancer Research Institute, Seoul National University, Seoul, South Korea.
| | - Kichul Shin
- Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Hospital Boramae Medical Center, 425 Shin-dae-bang Dong, Dong-jak Gu, Seoul, 156-707, South Korea.
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Baraliakos X, Braun J. Opinion: Perspectives on imaging in axial spondyloarthritis. Nat Rev Rheumatol 2013; 9:498-502. [DOI: 10.1038/nrrheum.2013.83] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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van der Laken CJ, Huisman MH, Voskuyl AE. Nuclear imaging of rheumatic diseases. Best Pract Res Clin Rheumatol 2013; 26:787-804. [PMID: 23273792 DOI: 10.1016/j.berh.2012.10.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Accepted: 10/12/2012] [Indexed: 01/15/2023]
Abstract
Advanced imaging techniques are promising tools to assist in the early diagnosis and monitoring of therapy in various rheumatic diseases. As there is now increasing emphasis on diagnosing inflammatory rheumatic disease in the pre-clinical stages, so that treatment may be instituted early and ideally prevent irreversible tissue damage, highly sensitive techniques are needed to detect subclinical inflammation. Moreover, there is an increasing need to develop individualised treatment protocols at reasonable cost and with optimal therapeutic effect. Tools are required that can image the therapeutic target and sensitively trace changes in disease activity. Nuclear imaging techniques have the potential to fulfil these clinical needs. Positron emission tomography is emerging as an important modality as it provides highly sensitive, quantitative imaging at a molecular level, to reveal the important pathophysiological processes underlying inflammation. This chapter provides an overview of currently available nuclear imaging techniques, including recent technical developments, and discusses their role in the diagnosis and monitoring of rheumatic disease.
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Affiliation(s)
- Conny J van der Laken
- Department of Rheumatology, VU University Medical Center, HV Amsterdam, The Netherlands.
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