Article

A systematic critical review on MRI in spondyloarthritis

Research Department, Spine Centre of Southern Denmark, Hospital Lillebaelt, Clinical Locomotion Network, Oestre Hougvej 55, Middelfart 5500, Denmark. .
Arthritis research & therapy (Impact Factor: 4.12). 03/2012; 14(2):R55. DOI: 10.1186/ar3768
Source: PubMed

ABSTRACT Magnetic resonance imaging (MRI) has been proven capable of showing inflammatory and structural changes in patients with spondyloarthritis (SpA) and has become widely used in the diagnosis of SpA. Despite this, no systematic reviews evaluate the diagnostic utility of MRI for SpA. Therefore, the objective of this systematic review was to determine the evidence for the utility of MRI in the clinical diagnosis of SpA. The aims were to identify which MRI findings are associated with the diagnosis of SpA and to quantify this association.
MEDLINE and EMBASE were electronically searched. Inclusion criteria were cross-sectional or longitudinal case-control or cohort MRI studies. The studies required a group with either SpA or inflammatory back pain (IBP) and a non-case group without SpA or IBP. Each group required a minimum of 20 participants. The included articles had to report results containing raw numbers suitable for the construction of two-by-two tables or report results by sensitivity and specificity for cross-sectional studies or odds ratios, relative risk ratios, or likelihood ratios for longitudinal studies. Method quality was assessed by using criteria based on the QUADAS tool.
In total, 2,395 articles were identified in MEDLINE and EMBASE before November 2011. All articles were reviewed by title and abstract. Seventy-seven articles were reviewed by full text, and 10 met the inclusion criteria. Two were considered of high quality: one evaluated the sacroiliac joints, and the other, the spine. Because of the small number of high-quality studies, a meta-analysis was not performed. The two high-quality studies found a positive association between MRI findings (bone marrow edema, erosions, fat infiltrations, global assessment of sacroiliitis, and ankylosis) and the diagnosis of IBP and SpA.
In this review, several MRI findings were found to be associated with SpA. However, because of the small number of high-quality studies, the evidence for the utility of MRI in the diagnosis of SpA must be considered limited. Therefore, caution should be taken to ensure that inflammatory and structural MRI findings are not interpreted as being more specific for SpA than is supported by research.

Download full-text

Full-text

Available from: Tue Secher Jensen, Aug 01, 2015
0 Followers
 · 
246 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: The development of available treatments for spondyloarthritis increases the need for accurate diagnosis and objective monitoring of response to therapy. Advances in MRI technology are improving the effectiveness of imaging of the sacroiliac joints and spine in spondyloarthritis. We discuss best practice techniques for MR image acquisition and interpretation with a view to optimizing the diagnostic utility of MRI in spondyloarthritis.
    Seminars in Musculoskeletal Radiology 11/2012; 16(5):389-400. DOI:10.1055/s-0032-1329882
  • [Show abstract] [Hide abstract]
    ABSTRACT: The aim of the present study was to describe the outcomes of Brazilian patients with undifferentiated spondyloarthritis during an eight-year follow-up period. Patients fulfilling the European Spondyloarthritis (SpA) Study Group Classification Criteria were enrolled. Forty patients were seen at baseline, and 36 participated in the follow-up study. Twenty-three (58 %) were female, and there were 24 (60 %) African Brazilians enrolled. HLA-B27 was positive in 18 (45 %) patients. At disease onset, the first presenting symptoms were pure peripheral manifestations in 26 (72.2 %) patients. After the study period, mixed disease (axial + peripheral) predominated occurring in 25 (69.4 %) patients. The Assessment of SpA International society (ASAS) classification criteria for axial SpA were fulfilled by 77 % of patients, and the ASAS criteria for peripheral SpA were fulfilled by 59 % of patients. After 2.5 years, 6 (16.7 %) of the 36 patients fulfilled the modified New York Criteria for ankylosing spondylitis and 1 (2.7 %) progressed to psoriatic arthritis. A total of 10 (27.8 %) patients progressed to definite SpA during the eight-year study period. Buttock pain (p = 0.006, OR 10.55; 95 % CI 2.00-65.90) and low-grade radiographic sacroiliitis (p = 0.025, OR = 11.50; 95 % CI 1.33-83.39) at baseline were associated with definite SpA. Thus, in this Brazilian cohort, which had a predominance of female African-Brazilian patients, prevalent peripheral onset symptoms were followed by a high frequency of axial manifestations during the follow-up period. Evidence of clinical or radiological sacroiliitis was associated with progression to definite SpA.
    Rheumatology International 06/2013; 34(7). DOI:10.1007/s00296-013-2797-x
  • [Show abstract] [Hide abstract]
    ABSTRACT: In recent years there has been an increased focus on use of imaging for diagnosis and assessment of spondyloarthritis (SpA). Magnetic resonance imaging (MRI) has attracted particular interest for its potential to improve diagnostic certainty for early, non-radiographic disease and to assist clinical decision-making. This report summarizes recent developments toward definition of positive sacroiliac joint and spine MRIs for SpA, with erosion as the major determinant for disease classification. The report also highlights recent SpA imaging work relevant to daily practice, focusing on limitations and challenges of SpA imaging and, in particular, on unsolved practical difficulties of using MRI in SpA. Recent data suggest that SpA imaging in daily practice may not be confined to identification and assessment of disease; it may also become essential for monitoring, clinical decision making, and selecting the most appropriate treatment for patients with SpA. Improved use of imaging may have much potential to enable better management of SpA.
    Current Rheumatology Reports 08/2013; 15(8):345. DOI:10.1007/s11926-013-0345-z
Show more