SLIDE 1 AXIAL SPONDYLARTHROPATHIES
Med School Ege Univ, Radiology Izmir, TR
SLIDE 2 Axial skeleton: SIJ/ spine
Romatoid arthritis Seronegative spondylarthropaties
- AS
- PsA
- Reactive arthritis
- Spondylitis associated with IBD
- Undifferenciated SpA
- Juvenile chronic arthritis
SLIDE 3 Inflammatory changes in SpA
- Enthesitis/ subchondral osteitis/ synovitis
- arthropathy, enthesopathy, extraskeletal findings
may exist in any combination in individual patients Inflammation of bone at sites
- f ligament insertions = Enthesitis
SLIDE 4
Garg N. Best Prac & Research Clin Rheumatol 28 (2014) 663-672
SLIDE 5
Rudwaleit M. J Arthritis Rheum 52 (2005) 1000-1008
SLIDE 6 Imaging
- Initial diagnosis
- Assessment of involvements
- Follow-up of the diesease
- Estimation of prognosis
- Detection of complications
SLIDE 7
Loss of sharpness of subchondral line/ synovial/ on iliac side Histology: synovitis/ subchondral inflammation Erosions/ sclerosis/ pseudo-widening Histology: cartilage-bone destruction/ fibrosis/ proliferative bony changes
SIJ
SLIDE 8 Total ankylosis/ ligament ossification
Changes in synovial and ligamentous portion
SIJ
SLIDE 9 Spine
- Discovertebral/ apophyseal/ costovertebral/
atlantoaxial joints
- Small erosions
- Shiny corners (Romanus lesions)
- Squaring of vertebral bodies
SLIDE 10 Spine
Ossification, outer layer annulus fibrosus deep layers of longitudinal lig.
François RJ
SLIDE 11 Spine
and destruction Andersson lesions Discovertebral inflammation İntraosseous discal displacement
SLIDE 12
SLIDE 13 Early detection and treatment of SpAs
- Biologic agents blocking (TNF-a), and possibly interleukin
- Studies since 2008 -- anti-TNF therapy also highly effective
in nonradiographic axSpA
- ASAS consensus recommendation on use of anti-TNF
agents in AS was extended to patients with nr-axSpA
→ objective verification of disease activity
is more important now
SLIDE 14
Sacroiliitis on imaging and ≥ 1 SpA features HLA-B27 and ≥ 2 SpA features Sacroiliitis on imaging: MRI: active (acute) inflammation Radiography: findings according to mNew York criteria SpA features: Inflammatory back pain Psoriasis Arthritis NSAID response Enthesitis Family history Uveitis Inflammatory bowel Dactilitis Elavated CRP
Inflammatory back pain≥ 3 months With age at onset <45
ASAS classification criteria for axial SpA
SLIDE 15 Positive MRI Bone marrow edema
- 2 lesions on same SIJ slice
- 1 lesion in same SIJ quadr
- n at least two consecutive
slices Enthesitis Synovitis Capsulitis
ASAS classification
SLIDE 16
T1 STIR T1+C fs (ESSR) arthritis subcommittee consensus paper:
+C is of diagnostic importance should be applied in doubtful cases Schueller-Weidekamm C, et al. Semin Musculoskelet Radiol (2014)
SLIDE 17
Diagnostic value of pelvic enthesitis Jans L. Eur Radiol (2014) 24:866–871
SLIDE 18
T1+C fs
SLIDE 19
Erosions Subchondral sclerosis Periarticular fat deposition Ankylosis
Sacroiliitis: Structural lesions
T1 T1 STIR
SLIDE 20
T2 GRE T1 fat sat 3D FLASH DESS
Cartilage sequences
SLIDE 21
Acute inflammatory lesions in spine ‘Corner sign’
ant/post spondylitis in at least three sites Sensitivity 44%-67% Specifity 81%-97%
Hermann KGA. Ann Rheum Dis 2012;71:1278–1288 Canella C. AJR 2013; 200:149-157
T1 STR
SLIDE 22
T1 T1+C spondylodiscitis ‘Andersson lesions’
33% in patients with SpA 59% specificity
Canella C. AJR 2013; 200:149-157
SLIDE 23
T1
Fat deposition at vertebral corners Erosions Syndesmophytes Ankylosis
Spondylitis: Structural lesions
SLIDE 24
36 E
Spondylitis occurs in 50-67% of AS Rarely - in spine alone
SLIDE 25
STIR
13.09.2012 22.01.2013
Monitoring
SLIDE 26
- Development of a definition of what constitutes a positive MRI
for classification of axial SpA *Incorporating structural lesions in the SIJs / inflammatory lesions in the spine *WSM (whole spine MR) and whole body MRI to assess inflammatory lesions outside the SIJs
- Development / validation of MRI based quantifying and scoring
methodologies *Diffusion-w MRI /dynamic CE MRI for inflammatory changes *Methodologies for scoring structural change
Imaging research on SpA
Weckbach et al. Semin Musculoskelet Radiol 2012
SLIDE 27
- Development of a definition of what constitutes a positive MRI
for classification of axial SpA *Incorporating structural lesions in the SIJs / inflammatory lesions in the spine *WSM (whole spine MR) and whole body MRI to assess inflammatory lesions outside the SIJs
- Development / validation of MRI based quantifying and scoring
methodologies *Diffusion-w MRI /dynamic CE MRI for inflammatory changes *Methodologies for scoring structural change
Imaging research on SpA
SLIDE 28
Thank you
