Objective. To assess the clinical utility of repeat sacroiliac joint computed tomography (CT) in sacroiliitis by assessing the proportion of patients changing from normal to pathologic at CT and to which degree there is progression of established sacroiliitis at repeat CT. Methods. In a retrospective analysis of 334 patients (median age 34 years) with symptoms suggestive of inflammatory back pain, CT had been performed twice, in 47 of these thrice, and in eight patients four times. The studies were scored as normal, equivocal, unilateral sacroiliitis, or bilateral sacroiliitis. Results. There was no change in 331 of 389 repeat examinations. Ten patients (3.0%) had progressed from normal or equivocal to unilateral or bilateral sacroiliitis. Of 43 cases with sacroiliitis on the first study, 36 (83.7%) progressed markedly. Two normal cases had changed to equivocal. Eight equivocal cases were classified as normal on the repeat study. In further two patients, only small changes within the scoring grade equivocal were detected. Conclusions. CT is a valuable examination for diagnosis of sacroiliitis, but a repeated examination detects only a few additional cases of sacroiliitis. Most cases with already established sacroiliitis showed progression of disease. 1. Introduction Radiology plays an important role in diagnostic criteria for ankylosing spondylitis (AS) such as the New York (NY) criteria [1] and the modified NY criteria [2]. In classification criteria of spondyloarthropathies, it has been of minor importance [3, 4]. However, the recent Assessment of SpondyloArthritis International Society (ASAS) criteria from 2009 require sacroiliitis on imaging plus one or more spondyloarthritis features or positive serology for HLA-B27 plus two or more spondyloarthritis features for spondyloarthropathy classification [5]. Computed tomography (CT) has notably higher accuracy than radiography in imaging of the sacroiliac joints [6], especially for evaluation of chronic changes from sacroiliitis. Even though both sensitivity and specificity of CT are high, some examinations cannot with certainty be classified as either normal (i.e., showing no or only incidental degenerative or other findings) or as showing unequivocal sacroiliitis, as is the case with all imaging modalities. A review of the literature reveals the usually long delay between onset of clinical symptoms and definite radiographic signs of sacroiliitis [7–9]. It has, however, been reported that patients with spondyloarthropathy may show significantly increased inflammatory joint changes already at one-year
References
[1]
P. H. Bennett and T. A. Burch, “New York symposium on population studies in the rheumatic diseases: new diagnostic criteria,” Bulletin on the Rheumatic Diseases, vol. 17, pp. 453–458, 1967.
[2]
S. van der Linden, H. A. Valkenburg, and A. Cats, “Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria,” Arthritis and Rheumatism, vol. 27, no. 4, pp. 361–368, 1984.
[3]
B. Amor, M. Dougados, and M. Mijiyawa, “Classification criteria of spondylarthropathies,” Revue du Rhumatisme et des Maladies Osteo-Articulaires, vol. 57, no. 2, pp. 85–89, 1990.
[4]
M. Dougados, S. van der Linden, R. Juhlin et al., “The European Spondylarthropathy Study Group preliminary criteria for the classification of spondylarthropathy,” Arthritis and Rheumatism, vol. 34, no. 10, pp. 1218–1227, 1991.
[5]
M. Rudwaleit, D. van der Heijde, R. Landewé et al., “The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): validation and final selection,” Annals of the Rheumatic Diseases, vol. 68, no. 6, pp. 777–783, 2009.
[6]
M. Geijer, G. G. G？thlin, and J. H. G？thlin, “The clinical utility of computed tomography compared to conventional radiography in diagnosing sacroiliitis. A retrospective study on 910 patients and literature review,” Journal of Rheumatology, vol. 34, no. 7, pp. 1561–1565, 2007.
[7]
E. Feldtkeller, M. A. Khan, D. van der Heijde, S. van der Linden, and J. Braun, “Age at disease onset and diagnosis delay in HLA-B27 negative vs. positive patients with ankylosing spondylitis,” Rheumatology International, vol. 23, no. 2, pp. 61–66, 2003.
[8]
W. Mau, H. Zeidler, R. Mau et al., “Clinical features and prognosis of patients with possible ankylosing spondylitis. Results of a 10-year follow-up,” Journal of Rheumatology, vol. 15, no. 7, pp. 1109–1114, 1988.
[9]
F. O'Shea, D. Salonen, and R. Inman, “The challenge of early diagnosis in ankylosing spondylitis,” Journal of Rheumatology, vol. 34, no. 1, pp. 5–7, 2007.
[10]
K. B. Puhakka, A. G. Jurik, B. Schi？ttz-Christensen et al., “MRI abnormalities of sacroiliac joints in early spondylarthropathy: a 1-year follow-up study,” Scandinavian Journal of Rheumatology, vol. 33, no. 5, pp. 332–338, 2004.
[11]
M. Geijer, G. Gadeholt G？thlin, and J. H. G？thlin, “Observer variation in computed tomography of the sacroiliac joints: a retrospective analysis of 1383 cases,” Acta Radiologica, vol. 48, no. 6, pp. 665–671, 2007.
[12]
M. Cammisa, M. Lomuto, and M. G. Bonetti, “Sacroiliitis in seronegative polyarthritis: CT analysis,” Clinical and Experimental Rheumatology, vol. 5, no. 1, pp. 105–107, 1987.
[13]
H. E. Fewins, G. H. Whitehouse, and R. C. Bucknall, “Role of computed tomography in the evaluation of suspected sacroiliac joint disease,” Journal of the Royal Society of Medicine, vol. 83, no. 7, pp. 430–432, 1990.
[14]
M. Geijer, G. Gadeholt G？thlin, and J. H. G？thlin, “The validity of the New York radiological grading criteria in diagnosing sacroiliitis by computed tomography,” Acta Radiologica, vol. 50, no. 6, pp. 664–673, 2009.
[15]
M. Geijer, H. Sihlbom, J. H. G？thlin, and E. Nordborg, “The role of CT in the diagnosis of sacro-iliitis,” Acta Radiologica, vol. 39, no. 3, pp. 265–268, 1998.
[16]
P. Jeandel, P. Y. Chouc, J. F. Briant, et al., “Valeur et limites de la tomodensitométrie appliquée au diagnostic des sacro-iliites chez l'adulte jeune: étude de 200 dossiers,” Revue du Rhumatisme et des Maladies Ostéo-Articulaires, vol. 59, no. 6, pp. 413–420, 1992.
[17]
Y.-H. Lee, J. Y. Hwang, S. W. Lee, and J. Lee, “The clinical usefulness of multidetector computed tomography of the sacroiliac joint for evaluating spondyloarthropathies,” Korean Journal of Internal Medicine, vol. 22, no. 3, pp. 171–177, 2007.
[18]
W. W. Scott Jr., E. K. Fishman, J. E. Kulhman et al., “Computed tomography evaluation of the sacroiliac joints in Crohn disease. Radiologic/clinical correlation,” Skeletal Radiology, vol. 19, no. 3, pp. 207–210, 1990.
[19]
Y. H. Lee, Y. S. Hong, W. Park, et al., “Value of multidetector computed tomography for the radiologic grading of sacroiliitis in ankylosing spondylitis,” Rheumatology International, vol. 33, no. 4, pp. 1005–1011, 2013.
[20]
U. Weber, M. ？stergaard, R. G. W. Lambert, and W. P. Maksymowych, “The impact of MRI on the clinical management of inflammatory arthritides,” Skeletal Radiology, vol. 40, no. 9, pp. 1153–1173, 2011.
[21]
D. Poddubnyy, M. Rudwaleit, H. Haibel et al., “Rates and predictors of radiographic sacroiliitis progression over 2 years in patients with axial spondyloarthritis,” Annals of the Rheumatic Diseases, vol. 70, no. 8, pp. 1369–1374, 2011.
[22]
D. Poddubnyy and J. Sieper, “Radiographic progression in ankylosing spondylitis/axial spondyloarthritis: how fast and how clinically meaningful?” Current Opinion in Rheumatology, vol. 24, no. 4, pp. 363–369, 2012.
[23]
A. Calin, “Reactive arthritis and Reiter's syndrome—the clinical spectrum,” in The Spondylarthritides, A. Calin and J. D. Taurog, Eds., pp. 41–57, Oxford University Press, Oxford, UK, 1998.
[24]
M. Geijer, D. Dunker, D. Collin, and J. H. G？thlin, “Bone bruise, lipohemarthrosis, and joint effusion in CT of non-displaced hip fracture,” Acta Radiologica, vol. 53, no. 2, pp. 197–202, 2012.
[25]
G. Pache, B. Krauss, P. Strohm et al., “Dual-energy CT virtual noncalcium technique: detecting posttraumatic bone marrow lesions—feasibility study,” Radiology, vol. 256, no. 2, pp. 617–624, 2010.
[26]
M. C. Wick, R. J. Weiss, W. Jaschke, and A. S. Klauser, “Erosions are the most relevant magnetic resonance imaging features in quantification of sacroiliac joints in ankylosing spondylitis,” Journal of Rheumatology, vol. 37, no. 3, pp. 622–627, 2010.
[27]
G. Slobodin, S. Croitoru, N. Starikov et al., “Incidental computed tomography sacroiliitis: clinical significance and inappropriateness of the New York radiological grading criteria for the diagnosis,” Clinical Rheumatology, vol. 31, no. 3, pp. 425–428, 2012.
[28]
G. S. Borlaza, R. Seigel, L. R. Kuhns, A. E. Good, R. Rapp, and W. Martel, “Computed tomography in the evaluation of sacroiliac arthritis,” Radiology, vol. 139, no. 2, pp. 437–440, 1981.
[29]
G. F. Carrera, W. D. Foley, F. Kozin, L. Ryan, and T. L. Lawson, “CT of sacroiliitis,” American Journal of Roentgenology, vol. 136, no. 1, pp. 41–46, 1981.
[30]
A. G. Jurik, J. Hansen, and K. B. Puhakka, “Effective radiation dose from semicoronal CT of the sacroiliac joints in comparison with axial CT and conventional radiography,” European Radiology, vol. 12, no. 11, pp. 2820–2825, 2002.
[31]
D. van der Heijde, M. Boers, and M. Lassere, “Methodological issues in radiographic scoring methods in rheumatoid arthritis,” Journal of Rheumatology, vol. 26, no. 3, pp. 726–730, 1999.
[32]
A. Wanders, R. Landewé, A. Spoorenberg et al., “Scoring of radiographic progression in randomised clinical trials in ankylosing spondylitis: a preference for paired reading order,” Annals of the Rheumatic Diseases, vol. 63, no. 12, pp. 1601–1604, 2004.
[33]
K. Bruynesteyn, D. van der Heijde, M. Boers et al., “Detecting radiological changes in rheumatoid arthritis that are considered important by clinical experts: influence of reading with or without known sequence,” Journal of Rheumatology, vol. 29, no. 11, pp. 2306–2312, 2002.
