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Huber MK, Valim V, Serrano ÉV, Mendonça JA, Lourenço RB, Espírito Santo TMR, Nordal H, de Fátima Bissoli M, de Oliveira Gavi MBR. Prevalence of spondyloarthritis in inflammatory bowel disease according ASAS and ultrassonography and its correlation with plasma calprotectin. Adv Rheumatol 2024; 64:27. [PMID: 38622711 DOI: 10.1186/s42358-023-00348-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 12/24/2023] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND Enteropathic spondyloarthritis is underdiagnosed and inflammatory biomarkers and ultrasonography (US) could be useful for screening inflammatory bowel disease (IBD) patients. The objective of this study was to evaluate the prevalence of spondyloarthritis (SpA) in IBD patients, according to the Assessment of SpondyloArthritis International Society (ASAS) criteria and the correlation of results of US of entheses and joints with plasma calprotectin levels. METHODS This was an observational cross-sectional study. Patients from the IBD outpatient clinic of a reference center were evaluated according to ASAS criteria classification, results of US of entheses and joints, and inflammatory biomarker measurements (erythrocyte sedimentation rates, C-reactive protein levels, fecal and plasma calprotectin levels). A p value lower than 0.05 was considered significant. RESULTS A total of 30.5% of the studied sample (n = 118) of patients with IBD presented at least one inflammatory musculoskeletal manifestation. The overall prevalence of enteropathic SpA was 13.55%, with 10.16% axial SpA and 4.23% peripheral SpA according to the ASAS criteria. A total of 42.1% of patients had an MASEI score greater than 18, 35.2% had synovitis, and 14.7% had tenosynovitis on US, increasing the frequency of diagnosis of enteropathic SpA to 22.8%. Plasma calprotectin levels were similar to those in healthy controls, and correlated only with the fecal calprotectin level (p 0.041). CONCLUSIONS A total of 13.5% of patients met the criteria in accordance with the ASAS criteria for enteropathic SpA, which increased to 22.8% with the addition of US. The prevalence of enthesitis, synovitis and tenosynovitis by US of symptomatic joints and entheses were 42%, 35% and 14.7% respectively. Plasma calprotectin was correlated with fecal calprotectin but not with inflammatory biomarkers or US or ASAS criteria.
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Affiliation(s)
- Míriam Küster Huber
- Program in Public Health of Health Science Center of Federal University of Espírito Santo (PPGSC-UFES), Vitoria, Espírito Santo, Brazil
| | - Valeria Valim
- Program in Public Health of Health Science Center of Federal University of Espírito Santo (PPGSC-UFES), Vitoria, Espírito Santo, Brazil.
- Medicine Department of Federal University of Espírito Santo (UFES), University Hospital of the Federal University of Espírito Santo (Hucam-Ufes/Ebserh), Vitoria, Espírito Santo, Brazil.
| | - Érica Vieira Serrano
- University Hospital of the Federal University of Espírito Santo (Hucam-Ufes/Ebserh), Vitoria, Espírito Santo, Brazil
| | | | - Rafael Burgomeister Lourenço
- University Hospital of the Federal University of Espírito Santo (Hucam-Ufes/Ebserh), Vitoria, Espírito Santo, Brazil
| | | | - Hilde Nordal
- Haukeland Hospital, University of Bergen, Bergen, Norway
| | - Maria de Fátima Bissoli
- University Hospital of the Federal University of Espírito Santo (Hucam-Ufes/Ebserh), Vitoria, Espírito Santo, Brazil
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Vereecke E, Diekhoff T, Eshed I, Herregods N, Morbée L, Jaremko JL, Jans L. ESR Essentials: Imaging of sacroiliitis-practice recommendations by ESSR. Eur Radiol 2024:10.1007/s00330-024-10653-3. [PMID: 38459347 DOI: 10.1007/s00330-024-10653-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/23/2024] [Accepted: 01/25/2024] [Indexed: 03/10/2024]
Abstract
Sacroiliitis is commonly seen in patients with axial spondyloarthritis, in whom timely diagnosis and treatment are crucial to prevent irreversible structural damage. Imaging has a prominent place in the diagnostic process and several new imaging techniques have been examined for this purpose. We present a summary of updated evidence-based practice recommendations for imaging of sacroiliitis. MRI remains the imaging modality of choice for patients with suspected sacroiliitis, using at least four sequences: coronal oblique T1-weighted and fluid-sensitive sequences, a perpendicular axial oblique sequence, and a sequence for optimal evaluation of the bone-cartilage interface. Both active inflammatory and structural lesions should be described in the report, indicating location and extent. Radiography and CT, especially low-dose CT, are reasonable alternatives when MRI is unavailable, as patients are often young. This is particularly true to evaluate structural lesions, at which CT excels. Dual-energy CT with virtual non-calcium images can be used to depict bone marrow edema. Knowledge of normal imaging features in children (e.g., flaring, blurring, or irregular appearance of the articular surface) is essential for interpreting sacroiliac joint MRI in children because these normal processes can simulate disease. CLINICAL RELEVANCE STATEMENT: Sacroiliitis is a potentially debilitating disease if not diagnosed and treated promptly, before structural damage to the sacroiliac joints occurs. Imaging has a prominent place in the diagnostic process. We present a summary of practice recommendations for imaging of sacroiliitis, including several new imaging techniques. KEY POINTS: • MRI is the modality of choice for suspected inflammatory sacroiliitis, including a joint-line-specific sequence for optimal evaluation of the bone-cartilage interface to improve detection of erosions. • Radiography and CT (especially low-dose CT) are reasonable alternatives when MRI is unavailable. • Knowledge of normal imaging features in children is mandatory for interpretation of MRI of pediatric sacroiliac joints.
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Affiliation(s)
- Elke Vereecke
- Department of Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Torsten Diekhoff
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität Zu Berlin, Freie Universität Berlin, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Iris Eshed
- Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, 5262000, Ramat Gan, Israel
| | - Nele Herregods
- Department of Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Lieve Morbée
- Department of Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Jacob L Jaremko
- Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta Hospital, Edmonton, AB, T6G 2B7, Canada
| | - Lennart Jans
- Department of Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
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Radny F, Ziegeler K, Eshed I, Greese J, Deppe D, Stelbrink C, Biesen R, Haibel H, Rios Rodriguez V, Rademacher J, Protopopov M, Proft F, Hermann KGA, Poddubnyy D, Diekhoff T, Ulas ST. Learning imaging in axial spondyloarthritis: more than just a matter of experience. RMD Open 2024; 10:e003944. [PMID: 38443089 DOI: 10.1136/rmdopen-2023-003944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 02/19/2024] [Indexed: 03/07/2024] Open
Abstract
OBJECTIVE Reliable interpretation of imaging findings is essential for the diagnosis of axial spondyloarthritis (axSpA) and requires a high level of experience. We investigated experience-dependent differences in diagnostic accuracies using X-ray (XR), MRI and CT. METHODS This post hoc analysis included 163 subjects with low back pain. Eighty-nine patients had axSpA, and 74 patients had other conditions (mechanical, degenerative or non-specific low back pain). Final diagnoses were established by an experienced rheumatologist before the reading sessions. Nine blinded readers (divided into three groups with different levels of experience) scored the XR, CT and MRI of the sacroiliac joints for the presence versus absence of axSpA. Parameters for diagnostic performance were calculated using contingency tables. Differences in diagnostic performance between the reader groups were assessed using the McNemar test. Inter-rater reliability was assessed using Fleiss kappa. RESULTS Diagnostic performance was highest for the most experienced reader group, except for XR. In the inexperienced and semi-experienced group, diagnostic performance was highest for CT&MRI (78.5% and 85.3%, respectively). In the experienced group, MRI showed the highest performance (85.9%). The greatest difference in diagnostic performance was found for MRI between the inexperienced and experienced group (76.1% vs 85.9%, p=0.001). Inter-rater agreement was best for CT in the experienced group with κ=0.87. CONCLUSION Differences exist in the learnability of the imaging modalities for axSpA diagnosis. MRI requires more experience, while CT is more suitable for inexperienced radiologists. However, diagnosis relies on both clinical and imaging information.
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Affiliation(s)
- Felix Radny
- Department of Radiology, Charité Universitätsmedizin Berlin Campus Charité Mitte, Berlin, Germany
| | - Katharina Ziegeler
- Department of Radiology, Charité Universitätsmedizin Berlin Campus Charité Mitte, Berlin, Germany
- Department of Hematology, Oncology, Tumor Immunology, Charité Universitätsmedizin Berlin Campus Charité Mitte, Berlin, Germany
| | - Iris Eshed
- Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Israel
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Juliane Greese
- Department of Radiology, Charité Universitätsmedizin Berlin Campus Charité Mitte, Berlin, Germany
| | - Dominik Deppe
- Department of Radiology, Charité Universitätsmedizin Berlin Campus Charité Mitte, Berlin, Germany
| | - Carsten Stelbrink
- Department of Radiology, Charité Universitätsmedizin Berlin Campus Charité Mitte, Berlin, Germany
| | - Robert Biesen
- Department of Rheumatology, Charité Universitätsmedizin Berlin Campus Charité Mitte, Berlin, Germany
| | - Hildrun Haibel
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité Universitatsmedizin Berlin Campus Benjamin Franklin, Berlin, Germany
| | - Valeria Rios Rodriguez
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité Universitatsmedizin Berlin Campus Benjamin Franklin, Berlin, Germany
| | - Judith Rademacher
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité Universitatsmedizin Berlin Campus Benjamin Franklin, Berlin, Germany
- Berlin Institute of Health at Charité, Berlin, Germany
| | - Mikhail Protopopov
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité Universitatsmedizin Berlin Campus Benjamin Franklin, Berlin, Germany
| | - Fabian Proft
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité Universitatsmedizin Berlin Campus Benjamin Franklin, Berlin, Germany
| | - Kay Geert A Hermann
- Department of Radiology, Charité Universitätsmedizin Berlin Campus Charité Mitte, Berlin, Germany
| | - Denis Poddubnyy
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité Universitatsmedizin Berlin Campus Benjamin Franklin, Berlin, Germany
| | - Torsten Diekhoff
- Department of Radiology, Charité Universitätsmedizin Berlin Campus Charité Mitte, Berlin, Germany
- Berlin Institute of Health at Charité, Berlin, Germany
| | - Sevtap Tugce Ulas
- Department of Radiology, Charité Universitätsmedizin Berlin Campus Charité Mitte, Berlin, Germany
- Berlin Institute of Health at Charité, Berlin, Germany
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Chmielińska M, Olesińska M, Felis-Giemza A, Paradowska-Gorycka A, Palej K, Rejmer-Szcześniak J, Szukiewicz D. Predictors of treatment failure of non-steroidal anti-inflammatory drugs in patients with axial spondyloarthritis with focus on haptoglobin, haptoglobin polymorphism and zonulin. Rheumatol Int 2024; 44:483-495. [PMID: 37847388 DOI: 10.1007/s00296-023-05484-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 09/26/2023] [Indexed: 10/18/2023]
Abstract
According to the Assessment of SpondyloArthritis International Society-European Alliance of Associations for Rheumatology (ASAS-EULAR) recommendations for the management of axial spondyloarthritis (axSpA), patients should undergo at least two courses of non-steroidal anti-inflammatory drugs (NSAIDs) therapy. In our study, we enrolled axSpA patients both at onset and in a flare who had already been treated with NSAIDs ineffectively. Subsequently, according to the recommendations, they received modified NSAID treatment as another attempt to the first-line drug therapy and were monitored from there. We aimed to identify risk factors for treatment failure after 4 weeks (Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score ≥ 4) especially amongst zonulin and haptoglobin concentrations, and haptoglobin polymorphism. Treatment failure was observed in 71% of patients, and the following variables were contributed for occurrence of this state: higher zonulin levels, ankylosing spondylitis, X-ray sacroiliitis, magnetic resonance imaging sacroiliitis, long duration of symptoms, high BASDAI, and high value of spinal pain intensity on visual analogue scale. In addition, the following positive correlations were found: haptoglobin concentration with C-reactive protein (r = 0.56; p = 0.0004), and erythrocyte sedimentation rate (r = 0.62; p < 0.0001), as well as between zonulin levels and white blood count (r = 0.5; p = 0.0003). The results of the study presented the identified factors related to the standard treatment failure in axSpA, amongst them zonulin levels. They might be applied to point out the patients for whom the search for a more appropriate method of treatment should be considered.
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Affiliation(s)
- Magdalena Chmielińska
- Department of Biophysics, Physiology and Pathophysiology, Faculty of Health Sciences, Medical University of Warsaw, 02-004, Warsaw, Poland.
- Department of Outpatient Clinics, National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637, Warsaw, Poland.
| | - Marzena Olesińska
- Department of Connective Tissue Diseases, National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637, Warsaw, Poland
| | - Anna Felis-Giemza
- Biologic Therapy Center, National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637, Warsaw, Poland
| | - Agnieszka Paradowska-Gorycka
- Department of Molecular Biology, National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637, Warsaw, Poland
| | - Karolina Palej
- Department of Outpatient Clinics, National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637, Warsaw, Poland
- Biologic Therapy Center, National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637, Warsaw, Poland
| | - Julita Rejmer-Szcześniak
- Department of Connective Tissue Diseases, National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637, Warsaw, Poland
| | - Dariusz Szukiewicz
- Department of Biophysics, Physiology and Pathophysiology, Faculty of Health Sciences, Medical University of Warsaw, 02-004, Warsaw, Poland
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Braun J. Why are the classification and diagnosis of axial spondyloarthritis sometimes so difficult? Rheumatology (Oxford) 2024; 63:264-266. [PMID: 37773984 DOI: 10.1093/rheumatology/kead532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 09/21/2023] [Accepted: 09/25/2023] [Indexed: 10/01/2023] Open
Affiliation(s)
- Jürgen Braun
- Ruhr Universität Bochum, Rheumapraxis Berlin, Berlin, Germany
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6
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Nicoara AI, Sas LM, Bita CE, Dinescu SC, Vreju FA. Implementation of artificial intelligence models in magnetic resonance imaging with focus on diagnosis of rheumatoid arthritis and axial spondyloarthritis: narrative review. Front Med (Lausanne) 2023; 10:1280266. [PMID: 38173943 PMCID: PMC10761482 DOI: 10.3389/fmed.2023.1280266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 12/04/2023] [Indexed: 01/05/2024] Open
Abstract
Early diagnosis in rheumatoid arthritis (RA) and axial spondyloarthritis (axSpA) is essential to initiate timely interventions, such as medication and lifestyle changes, preventing irreversible joint damage, reducing symptoms, and improving long-term outcomes for patients. Since magnetic resonance imaging (MRI) of the wrist and hand, in case of RA and MRI of the sacroiliac joints (SIJ) in case of axSpA can identify inflammation before it is clinically discernible, this modality may be crucial for early diagnosis. Artificial intelligence (AI) techniques, together with machine learning (ML) and deep learning (DL) have quickly evolved in the medical field, having an important role in improving diagnosis, prognosis, in evaluating the effectiveness of treatment and monitoring the activity of rheumatic diseases through MRI. The improvements of AI techniques in the last years regarding imaging interpretation have demonstrated that a computer-based analysis can equal and even exceed the human eye. The studies in the field of AI have investigated how specific algorithms could distinguish between tissues, diagnose rheumatic pathology and grade different signs of early inflammation, all of them being crucial for tracking disease activity. The aim of this paper is to highlight the implementation of AI models in MRI with focus on diagnosis of RA and axSpA through a literature review.
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Affiliation(s)
| | - Lorena-Mihaela Sas
- Radiology and Medical Imaging Laboratory, Craiova Emergency County Clinical Hospital, Craiova, Romania
- Department of Human Anatomy, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Cristina Elena Bita
- Department of Rheumatology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Stefan Cristian Dinescu
- Department of Rheumatology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Florentin Ananu Vreju
- Department of Rheumatology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
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Lee S, Jeon U, Lee JH, Kang S, Kim H, Lee J, Chung MJ, Cha HS. Artificial intelligence for the detection of sacroiliitis on magnetic resonance imaging in patients with axial spondyloarthritis. Front Immunol 2023; 14:1278247. [PMID: 38022576 PMCID: PMC10676202 DOI: 10.3389/fimmu.2023.1278247] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 10/25/2023] [Indexed: 12/01/2023] Open
Abstract
Background Magnetic resonance imaging (MRI) is important for the early detection of axial spondyloarthritis (axSpA). We developed an artificial intelligence (AI) model for detecting sacroiliitis in patients with axSpA using MRI. Methods This study included MRI examinations of patients who underwent semi-coronal MRI scans of the sacroiliac joints owing to chronic back pain with short tau inversion recovery (STIR) sequences between January 2010 and December 2021. Sacroiliitis was defined as a positive MRI finding according to the ASAS classification criteria for axSpA. We developed a two-stage framework. First, the Faster R-CNN network extracted regions of interest (ROIs) to localize the sacroiliac joints. Maximum intensity projection (MIP) of three consecutive slices was used to mimic the reading of two adjacent slices. Second, the VGG-19 network determined the presence of sacroiliitis in localized ROIs. We augmented the positive dataset six-fold. The sacroiliitis classification performance was measured using the sensitivity, specificity, and area under the receiver operating characteristic curve (AUROC). The prediction models were evaluated using three-round three-fold cross-validation. Results A total of 296 participants with 4,746 MRI slices were included in the study. Sacroiliitis was identified in 864 MRI slices of 119 participants. The mean sensitivity, specificity, and AUROC for the detection of sacroiliitis were 0.725 (95% CI, 0.705-0.745), 0.936 (95% CI, 0.924-0.947), and 0.830 (95%CI, 0.792-0.868), respectively, at the image level and 0.947 (95% CI, 0.912-0.982), 0.691 (95% CI, 0.603-0.779), and 0.816 (95% CI, 0.776-0.856), respectively, at the patient level. In the original model, without using MIP and dataset augmentation, the mean sensitivity, specificity, and AUROC were 0.517 (95% CI, 0.493-0.780), 0.944 (95% CI, 0.933-0.955), and 0.731 (95% CI, 0.681-0.780), respectively, at the image level and 0.806 (95% CI, 0.729-0.883), 0.617 (95% CI, 0.523-0.711), and 0.711 (95% CI, 0.660-0.763), respectively, at the patient level. The performance was improved by MIP techniques and data augmentation. Conclusion An AI model was developed for the detection of sacroiliitis using MRI, compatible with the ASAS criteria for axSpA, with the potential to aid MRI application in a wider clinical setting.
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Affiliation(s)
- Seulkee Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Uju Jeon
- Medical AI Research Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Ji Hyun Lee
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seonyoung Kang
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyungjin Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jaejoon Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Myung Jin Chung
- Medical AI Research Center, Samsung Medical Center, Seoul, Republic of Korea
- Department of Data Convergence and Future Medicine, Sungkyunkwan University School of Medicine, Suwon, Republic of Korea
| | - Hoon-Suk Cha
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Ulas ST, Deppe D, Ziegeler K, Diekhoff T. New Bone Formation in Axial Spondyloarthritis: A Review. ROFO-FORTSCHR RONTG 2023. [PMID: 37944938 DOI: 10.1055/a-2193-1970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
BACKGROUND Axial spondyloarthritis (axSpA) is a chronic inflammatory disease primarily affecting the sacroiliac joints (SIJs) and the spine. Imaging plays a crucial role in the diagnosis of axSpA, with magnetic resonance imaging (MRI) and radiography being the primary modalities used in clinical practice. New bone formation occurs in both the spine (non-bridging and bridging syndesmophytes, transdiscal ankylosis, and ankylosis of small joints and posterior elements) and the SIJs (backfill and ankylosis). New bone formation indicates advanced axSpA. METHOD This review explores the role of imaging in the diagnosis and monitoring of axSpA, focusing on the significance of new bone formation, and provides an overview of the characteristic imaging findings of new bone formation in axSpA in each imaging modality. CONCLUSION Imaging methods, such as X-ray, MRI, and CT, have different diagnostic accuracies for detecting structural lesions and new bone formation. Each modality has its strengths and weaknesses, and the choice depends on the specific clinical context. Imaging is crucial for the diagnosis and monitoring of axSpA, particularly for the detection of new bone formation. Different imaging techniques provide valuable information about disease progression and treatment response. Understanding the significance of new bone formation and its detection using imaging modalities is essential for the accurate diagnosis and effective management of patients with axSpA. KEY POINTS · New bone formation is a hallmark feature of advanced axial spondyloarthritis.. · New bone formation occurs both in the spine and in the sacroiliac joints.. · Differentiation of new bone formation in axial spondyloarthritis from that in other conditions such as diffuse idiopathic skeletal hyperostosis and from osteophytes is essential.. · Imaging methods, such as X-ray, MRI, and CT, have different diagnostic accuracies for detecting new bone formation..
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Affiliation(s)
- Sevtap Tugce Ulas
- Department of Radiology (Campus Charité Mitte), Charité Universitätsmedizin Berlin, Germany
- Charité - Universitätsmedizin, Berlin Institute of Health at Charite, Berlin, Germany
| | - Dominik Deppe
- Department of Radiology (Campus Charité Mitte), Charité Universitätsmedizin Berlin, Germany
| | - Katharina Ziegeler
- Department of Radiology (Campus Charité Mitte), Charité Universitätsmedizin Berlin, Germany
| | - Torsten Diekhoff
- Department of Radiology (Campus Charité Mitte), Charité Universitätsmedizin Berlin, Germany
- Charité - Universitätsmedizin, Berlin Institute of Health at Charite, Berlin, Germany
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9
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Hermann KGA, Diekhoff T. [Computed tomography versus magnetic resonance imaging : Pros and cons in axial spondyloarthritis]. Z Rheumatol 2023; 82:638-645. [PMID: 37815608 DOI: 10.1007/s00393-023-01415-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2023] [Indexed: 10/11/2023]
Abstract
The diagnosis of axial spondyloarthritis depends on direct visualization of the sacroiliitis in addition to clinical assessment and determination of the histocompatibility antigen HLA-B27. While the value of conventional radiographic images has meanwhile been described in many studies as insufficient to diagnose the disease at an early stage, magnetic resonance imaging and also computed tomography now offer the possibility to visualize findings, such as bone marrow edema, erosion, fat metaplasia, backfill and ankylosis. Thus, it is necessary to decide which procedure should be used and when. Furthermore, both cross-sectional imaging techniques are currently undergoing major changes, and technical advancements are making great strides every year. This article provides an overview of which future technologies will be included in the rheumatological diagnostics of the sacroiliac joints. This overview also illustrates which standard methods are established in the diagnostics of axial spondyloarthritis and how they are used.
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Affiliation(s)
- Kay Geert A Hermann
- Klinik für Radiologie, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
| | - Torsten Diekhoff
- Klinik für Radiologie, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
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10
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Triantafyllou M, Klontzas ME, Koltsakis E, Papakosta V, Spanakis K, Karantanas AH. Radiomics for the Detection of Active Sacroiliitis Using MR Imaging. Diagnostics (Basel) 2023; 13:2587. [PMID: 37568950 PMCID: PMC10416894 DOI: 10.3390/diagnostics13152587] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/27/2023] [Accepted: 08/01/2023] [Indexed: 08/13/2023] Open
Abstract
Detecting active inflammatory sacroiliitis at an early stage is vital for prescribing medications that can modulate disease progression and significantly delay or prevent debilitating forms of axial spondyloarthropathy. Conventional radiography and computed tomography offer limited sensitivity in detecting acute inflammatory findings as these methods primarily identify chronic structural lesions. Conversely, Magnetic Resonance Imaging (MRI) is the preferred technique for detecting bone marrow edema, although it is a complex process requiring extensive expertise. Additionally, ascertaining the origin of lesions can be challenging, even for experienced medical professionals. Machine learning (ML) has showcased its proficiency in various fields by uncovering patterns that are not easily perceived from multi-dimensional datasets derived from medical imaging. The aim of this study is to develop a radiomic signature to aid clinicians in diagnosing active sacroiliitis. A total of 354 sacroiliac joints were segmented from axial fluid-sensitive MRI images, and their radiomic features were extracted. After selecting the most informative features, a number of ML algorithms were utilized to identify the optimal method for detecting active sacroiliitis, leading to the selection of an Extreme Gradient Boosting (XGBoost) model that accomplished an Area Under the Receiver-Operating Characteristic curve (AUC-ROC) of 0.71, thus further showcasing the potential of radiomics in the field.
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Affiliation(s)
- Matthaios Triantafyllou
- Department of Medical Imaging, University Hospital of Heraklion, 71110 Heraklion, Greece; (M.T.); (M.E.K.); (E.K.); (V.P.); (K.S.)
- Department of Radiology, School of Medicine, University of Crete, Voutes Campus, 71500 Heraklion, Greece
| | - Michail E. Klontzas
- Department of Medical Imaging, University Hospital of Heraklion, 71110 Heraklion, Greece; (M.T.); (M.E.K.); (E.K.); (V.P.); (K.S.)
- Department of Radiology, School of Medicine, University of Crete, Voutes Campus, 71500 Heraklion, Greece
| | - Emmanouil Koltsakis
- Department of Medical Imaging, University Hospital of Heraklion, 71110 Heraklion, Greece; (M.T.); (M.E.K.); (E.K.); (V.P.); (K.S.)
- Department of Radiology, Karolinska University Hospital, 17164 Stockholm, Sweden
| | - Vasiliki Papakosta
- Department of Medical Imaging, University Hospital of Heraklion, 71110 Heraklion, Greece; (M.T.); (M.E.K.); (E.K.); (V.P.); (K.S.)
| | - Konstantinos Spanakis
- Department of Medical Imaging, University Hospital of Heraklion, 71110 Heraklion, Greece; (M.T.); (M.E.K.); (E.K.); (V.P.); (K.S.)
| | - Apostolos H. Karantanas
- Department of Medical Imaging, University Hospital of Heraklion, 71110 Heraklion, Greece; (M.T.); (M.E.K.); (E.K.); (V.P.); (K.S.)
- Department of Radiology, School of Medicine, University of Crete, Voutes Campus, 71500 Heraklion, Greece
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Muellner M, Ziegeler K, Diekhoff T, Haffer H, Schömig F, Leopold VJ, Pumberger M, Göhler F. Clustered Occurrence of Osteitis Condensans Ilii in Patients with Symptomatic Hip Dysplasia. Diagnostics (Basel) 2023; 13:diagnostics13101701. [PMID: 37238185 DOI: 10.3390/diagnostics13101701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/06/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Osteitis condensans ilii (OCI) is a relatively rare benign disease of the lower anterior sacroiliac joint (SIJ) region that can cause symptoms such as low back pain (LBP), lateral hip pain and nonspecific hip or thigh pain. Its exact pathoetiology remains to be clarified. The aim of this study is to determine the prevalence of OCI in patients with symptomatic developmental dysplasia of the hip (DDH) undergoing periacetabular osteotomy (PAO) to identify potential clustering of OCI in a with altered biomechanics of hip and SIJs. METHODS A retrospective investigation of all patients who underwent periacetabular osteotomy in a tertiary reference hospital from January 2015 to December 2020. Clinical and demographic data were retrieved from the hospital's internal medical records. Radiographs and magnetic resonance images (MRIs) were reviewed for the presence of OCI. A t-test for independent variables was conducted to identify differences between patients with and without OCI. A binary logistic regression model was established to determine the influence of age, sex and body mass index (BMI) on the presence of OCI. RESULTS The final analysis included 306 patients (81% female). In 21.2% of the patients (f: 22.6%; m: 15.5%), OCI was present. BMI was significantly higher in patients with OCI (23.7 kg/m2 vs. 25.0 kg/m2; p = 0.044). Binary logistic regression revealed that a higher BMI increased the likelihood of sclerosis in typical osteitis condensans locations, OR = 1.104 (95%-CI [1.024, 1.191]), as did female sex, OR = 2.832 (95%-CI [1.091, 7.352]. CONCLUSIONS Our study revealed a considerably higher prevalence of OCI in patients with DDH than in the general population. Furthermore, BMI was shown to have an influence on the occurrence of OCI. These results support the theory that OCI is attributable to altered mechanical loading of the SIJs. Clinicians should be aware that OCI is common in patients with DDH and a potential cause of LBP, lateral hip pain and nonspecific hip or thigh pain.
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Affiliation(s)
- Maximilian Muellner
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Katharina Ziegeler
- Department of Radiology, Charité-University Medicine Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Torsten Diekhoff
- Department of Radiology, Charité-University Medicine Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Henryk Haffer
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Friederike Schömig
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Vincent Justus Leopold
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Matthias Pumberger
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Friedemann Göhler
- Department of Radiology, Charité-University Medicine Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
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Chang CH, Ma KSK, Wei JCC. Imaging modalities for the diagnosis of axial spondyloarthritis. Int J Rheum Dis 2023; 26:819-822. [PMID: 37126392 DOI: 10.1111/1756-185x.14617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 01/17/2023] [Accepted: 02/06/2023] [Indexed: 05/02/2023]
Affiliation(s)
- Chun-Han Chang
- School of Medicine, Chung-Shan Medical University, Taichung, Taiwan
| | - Kevin Sheng-Kai Ma
- Center for Global Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Orthodontics and Dentofacial Orthopedics, Henry M. Goldman School of Dental Medicine, Boston University, Boston, Massachusetts, USA
| | - James Cheng-Chung Wei
- Department of Allergy, Immunology & Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
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13
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Bittar M, Khan MA, Magrey M. Axial Spondyloarthritis and Diagnostic Challenges: Over-diagnosis, Misdiagnosis, and Under-diagnosis. Curr Rheumatol Rep 2023; 25:47-55. [PMID: 36602692 DOI: 10.1007/s11926-022-01096-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2022] [Indexed: 01/06/2023]
Abstract
PURPOSE OF REVIEW This article aims to review the challenges in axial spondyloarthritis diagnosis and identify the possible contributing factors. RECENT FINDINGS The inability to reach an accurate diagnosis in a timely fashion can lead to treatment delays and worse disease outcomes. The lack of validated diagnostic criteria and the misuse of the currently available classification criteria could be contributing. There is also significant inter-reader variability in interpreting images, and the radiologic definitions of axial spondyloarthritis continue to be re-defined to improve their positive predictive value. The role of inflammatory back pain features, serologic biomarkers, genetics, and their diagnostic contribution to axial spondyloarthritis continues to be investigated. There is still a significant amount of delay in the diagnosis of axial spondyloarthritis. Appreciating the factors that contribute to this delay is of utmost importance to close the gap. It is similarly important to recognize other conditions that may present with symptoms that mimic axial spondyloarthritis so that misdiagnosis and wrong treatment can be avoided.
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He Q, Chen JQ, Yu XB, Liao JH, Huang ZW, Yang JY, Wu TH, Song WJ, Luo J, Tao QW. Knowledge mapping of biological disease-modifying anti-rheumatic drugs for axial spondyloarthritis: a bibliometric study. Clin Rheumatol 2023. [PMID: 36849850 DOI: 10.1007/s10067-023-06540-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 01/14/2023] [Accepted: 02/04/2023] [Indexed: 03/01/2023]
Abstract
Various biological disease-modifying anti-rheumatic drugs (bDMARDs) have been applied for treating axial spondyloarthritis (axSpA). However, there is a glaring absence of a bibliometric analysis on bDMARDs against axSpA. Articles related to use of bDMARDs in treating axSpA published from 2004 to 2022 were searched from the Web of Science Core Collection. VOS viewer 1.6.18 and CiteSpace 6.1.R2 were used to analyze and visualize the quantity and citations of publications, as well as to identify "research hotspots" and trends in this field. BibExcel version 1.0.0 and gCLUTO version 1.0 were used to build matrices for bi-clustering analysis. A total of 2546 articles referring to bDMARDs for treatment of axSpA were included in this bibliometric analysis. Overall, the number of publications has been increasing steadily annually. The USA (23.21%, 591 publications) ranked first with the largest output of papers, followed by Germany, and the Netherlands. Rheumazentrum Ruhrgebiet ranked first as the most frequent publisher (119 articles). Annals of the Rheumatic Diseases published the most documents (6.76%, 172 publications) in this field. The predominant hotspots have been "tuberculosis," "IL-17," and "quality of life" in the field until 2020. Since 2015, "biosimilar pharmaceuticals" has retained the popularity. Current research hotspots are "spinal radiographic progression," Janus kinase (JAK) inhibitors, and adverse events (AEs). Machine learning has become popular gradually. Globally, there has been a steady increase in the number of studies on bDMARDs use against axSpA. JAK inhibitors, spinal radiographic progression, biosimilar pharmaceuticals, and AEs are current research hotspots. Machine learning is emerging research hotspots and trends in this field.
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Ulas ST, Diekhoff T, Ziegeler K. Sex Disparities of the Sacroiliac Joint: Focus on Joint Anatomy and Imaging Appearance. Diagnostics (Basel) 2023; 13:diagnostics13040642. [PMID: 36832130 PMCID: PMC9955570 DOI: 10.3390/diagnostics13040642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/03/2023] [Accepted: 02/07/2023] [Indexed: 02/11/2023] Open
Abstract
The sacroiliac joint (SIJ) is an anatomically complex joint which, as a functional unit with the pelvis and spine, is of decisive biomechanical importance for the human body. It is also a commonly overlooked source of lower back pain. Like the entire bony pelvis, the SIJ exhibits major sexual dimorphisms; thus, the sex-dependent evaluation of this joint is becoming increasingly important in clinical practice, both anatomically with joint shape variations and biomechanical differences as well as in terms of image appearance. The influence of the SIJ shape, which differs in women and men, is crucial for the different biomechanical joint properties. These differences are important in the development of joint diseases at the SIJ, which shows a specific difference between the sexes. This article aims to provide an overview of sex disparities of the SIJ regarding different anatomical and imaging appearances to further understand the insights into the interplay of sex differences and SIJ disease.
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Affiliation(s)
- Sevtap Tugce Ulas
- Department of Radiology, Charité–Universitätsmedizin Berlin, Campus Mitte, Humboldt–Universität zu Berlin, Freie Universität Berlin, 10117 Berlin, Germany
- Berlin Institute of Health, Charité–Universitätsmedizin Berlin, 10117 Berlin, Germany
- Correspondence: ; Tel.: +0049-30-450-627044
| | - Torsten Diekhoff
- Department of Radiology, Charité–Universitätsmedizin Berlin, Campus Mitte, Humboldt–Universität zu Berlin, Freie Universität Berlin, 10117 Berlin, Germany
- Berlin Institute of Health, Charité–Universitätsmedizin Berlin, 10117 Berlin, Germany
| | - Katharina Ziegeler
- Department of Radiology, Charité–Universitätsmedizin Berlin, Campus Mitte, Humboldt–Universität zu Berlin, Freie Universität Berlin, 10117 Berlin, Germany
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Jurik AG. Diagnostics of Sacroiliac Joint Differentials to Axial Spondyloarthritis Changes by Magnetic Resonance Imaging. J Clin Med 2023; 12:jcm12031039. [PMID: 36769687 PMCID: PMC9917960 DOI: 10.3390/jcm12031039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/22/2023] [Accepted: 01/25/2023] [Indexed: 01/31/2023] Open
Abstract
The diagnosis of axial spondyloarthritis (axSpA) is usually based on a pattern of imaging and clinical findings due to the lack of diagnostic criteria. The increasing use of magnetic resonance imaging (MRI) of the sacroiliac joints (SIJ) to establish the diagnosis early in the pre-radiographic phase has resulted in a shift in the paradigm with an increasing frequency of axSpA diagnoses and a changed sex distribution. Non-radiographic axSpA affects males and females nearly equally, whereas ankylosing spondylitis predominantly occurs in males. The MRI-based increasing frequency of axSpA in women is mainly due to the presence of subchondral bone marrow edema (BME) on fluid-sensitive MR sequences, which may be a non-specific finding in both women and men. Due to the somewhat different pelvic tilt and SIJ anatomy, women are more prone than men to develop strain-related MRI changes and may have pregnancy-related changes. Awareness of non-specific subchondral BME at the SIJ is important as it can imply a risk for an incorrect SpA diagnosis, especially as the clinical manifestations of axSpA may also be non-specific. Knowledge of relevant MRI and clinical features of differential diagnoses is needed in the diagnostic workout of patients with suspected axSpA considering that non-SpA-related SIJ conditions are more common in patients with low back or buttock pain than axSpA sacroiliitis. The purpose of this review was to present current knowledge of the most frequent differential diagnoses to axSpA sacroiliitis by MRI taking the clinical characteristics into account.
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Affiliation(s)
- Anne Grethe Jurik
- Department of Radiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus, Denmark;
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200 Aarhus, Denmark
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Chen M, Yu K, Hu X, Van Den Berghe T, Qi Y, Jin B, Liu X, Cheng G. Proton density fat fraction (PDFF) maps aid fat metaplasia evaluation in the sacroiliac joints in additional to T1WI: Improved diagnostic accuracy in axial spondyloarthritis. Eur J Radiol 2022; 157:110569. [DOI: 10.1016/j.ejrad.2022.110569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 10/10/2022] [Accepted: 10/15/2022] [Indexed: 11/03/2022]
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