Role for imaging studies in ankylosing spondylitis

doi:10.1016/j.jbspin.2010.07.008

Joint Bone Spine

Volume 78, Issue 2, March 2011, Pages 138-143

https://doi.org/10.1016/j.jbspin.2010.07.008 Get rights and content

Abstract

Although the diagnosis and structural monitoring of ankylosing spondylitis relies classically on standard radiography, recent classification criteria and recommendations issued by the ASAS-OMERACT working group give considerable weight to modern imaging methods, most notably magnetic resonance imaging (MRI). MRI and, more recently, ultrasonography, yield three major benefits: they ensure the early diagnosis of ankylosing spondylitis in the absence of radiographic sacroiliitis, they provide therapeutic guidance at any time during the course of the disease, and they supply objective information on the degree of inflammation and response to treatment. Prospective longitudinal studies are under way to determine the respective roles for MRI and ultrasonography in the diagnosis and monitoring of axial and peripheral forms of ankylosing spondylitis. The introduction of whole-body MRI, new MRI sequences and positron emission tomography can be expected to further benefit the diagnosis of ankylosing spondylitis.

Section snippets

Ultrasonography

Ultrasonography is a tool of choice for the evaluation of SpAs, as it can provide information on all the peripheral joints and entheses. Assessment of the superficial entheses requires high-frequency (12–20 MHz) linear probes and high-performance power Doppler machines.

Diagnostic usefulness of ultrasonography

As occurred with MRI, the development of standardized ultrasonography protocols and the conduct of vast prospective studies will probably allow the OMERACT-EULAR Ultrasound Task Force to validate this diagnostic tool in the near future and to define its role for the early diagnosis and monitoring of patients with axial and/or peripheral SpAs. However, in contrast to MRI, ultrasonography cannot visualize foci of bone marrow inflammation, as the cortex blocks the ultrasound beam. The most

Scores

A few ultrasound scores have been developed for evaluating patients with SpAs [11], [31]. The sites examined vary but the criteria used for the evaluation are always the same: enthesis thickness, structure, calcifications, erosions, bursae and power Doppler signal.

Correlations with clinical and laboratory variables and changes during treatment

Disease activity as evaluated by ultrasonography showed weak correlations with clinical and laboratory variables [32], [33]. TNFα antagonist therapy was associated with a decrease or the disappearance of the power Doppler signals.

Discussion and perspectives

MRI and ultrasonography clearly improve the management of patients with SpAs. These two investigations are complementary for visualizing and locating the inflammatory lesions (axial versus peripheral) (Table 2). MRI and ultrasonography not only assist in diagnosing and monitoring SpAs, but also provide information on the pathophysiology of these diseases. MRI has helped to understand the events that occur during the course of SpAs and has allowed detailed descriptions of the elemental lesions,

Conflict of interest statement

The authors declare no conflicts of interest.

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ReviewRole for imaging studies in ankylosing spondylitis

Abstract

Section snippets

Ultrasonography

Diagnostic usefulness of ultrasonography

Scores

Correlations with clinical and laboratory variables and changes during treatment

Discussion and perspectives

Conflict of interest statement

Joint Bone Spine

Joint Bone Spine

Eur J Radiol

Joint Bone Spine

Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria

Arthritis Rheum

Age at onset and diagnosis delay in HLA-B27 negative vs. positive patients with ankylosing spondylitis

Rheumatol Int

What is the most appropriate radiologic scoring method for ankylosing spondylitis? A comparison of the available methods based on the Outcome Measures in Rheumatology Clinical Trials filter

Arthritis Rheum

Radiological scoring methods for ankylosing spondylitis: a comparison between the Bath Ankylosing Spondylitis Radiology Index and the modified Stoke Ankylosing Spondylitis Spine Score

Clin Exp Rheumatol

Imaging of sacroiliitis in early seronegative spondyloarthropathy. Assessment of abnormalities by MR in comparison with radiography and CT

Acta Radiol

MR imaging of the normal sacroiliac joint with correlation to histology

Skeletal Radiol

The diagnostic value of scintigraphy in assessing sacroiliitis in ankylosing spondylitis: a systematic literature research

Ann Rheum Dis

The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part I): classification of paper patients by expert opinion including uncertainty appraisal

Ann Rheum Dis

The development of Assessment of SpondyloArthritis International Society classification criteria for axial spondyloarthritis (part II): validation and final selection

Ann Rheum Dis

Assessment of peripheral enthesitis in the spondylarthropathies by ultrasonography combined with power Doppler: a cross-sectional study

Arthritis Rheum

Ultrasonography of entheseal insertions in the lower limb in spondyloarthropathy

Ann Rheum Dis

Summary findings of a systematic review of the ultrasound assessment of synovitis

J Rheumatol

Ultrasonography of the metatarsophalangeal joints in rheumatoid arthritis, compared with magnetic resonance, conventional radiography and clinical examination

Arthritis Rheum

Defining active sacroiliitis on magnetic resonance imaging (MRI) for classification of axial spondyloarthritis: a consensual approach by the ASAS/OMERACT MRI group

Ann Rheum Dis

The Assessment of SpondyloArthritis International Society (ASAS) handbook: a guide to assess spondyloarthritis

Ann Rheum Dis

Inflammatory and structural evaluation in spondyloarthritis: magnetic resonance imaging analysis of axial and peripheral involvement

J Rheumatol

Use of immunohistologic and in situ hybridization techniques in the examination of sacroiliac joint biopsy specimens from patients with ankylosing spondylitis

Arthritis Rheum

Quantitative analyses of sacroiliac biopsies in spondyloarthropathies: T cells and macrophages predominate in early and active sacroiliitis- cellularity correlates with the degree of enhancement detected by magnetic resonance imaging

Ann Rheum Dis

Feasibility of second-generation ultrasound contrast media in the detection of active sacroiliitis

Arthritis Rheum

The development of a preliminary ultrasonographic scoring system for features of hand osteoarthritis

Ann Rheum Dis

Baseline and one year magnetic resonance imaging of the sacroiliac joint and lumbar spine in very early inflammatory back pain. The relationship between symptoms, HLA-B27, and disease extent and persistence

Ann Rheum Dis

Frequent detection of sacroiliac joint abnormalities on MRI in healthy subjects and patients with non-specific back pain. [abstract]

Arthritis Rheum

Determination of the best diagnostic criteria of sacroiliitis with MRI

J Radiol

Evaluation of the diagnostic utility of spinal magnetic resonance imaging in axial spondylarthritis

Arthritis Rheum

The evidence for whole-spine MRI in the assessment of axial spondyloarthropathy

Rheumatology (Oxford)

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Ann Rheum Dis

The role of biomechanical factors and HLA-B27 in magnetic resonance imaging-determined bone changes in plantar fascia enthesopathy

Arthritis Rheum

Review
Role for imaging studies in ankylosing spondylitis