Comparative study of Imaging of Sacroiliitis by CT and MRI scan with power Doppler Ultrasound in Spondyloarthropathies.

Samikrishnan, P (2009) Comparative study of Imaging of Sacroiliitis by CT and MRI scan with power Doppler Ultrasound in Spondyloarthropathies. Masters thesis, Madras Medical College, Chennai.


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INTRODUCTION : In 1850, Brodie described the clinical features of a 31-year-old man with an ankylosed spine who “occasionally suffered severe inflammation of the eye”. In 1884, Struempell from Leipzig, Germany, described two patients with complete ankylosis of the spine and hip joints. This report was soon followed by descriptions of the disease by von Bechterew from St. Petersburg, Russia, and Marie from Paris, France. Although Roentgen had developed his radiographic technique by 1896, it was not until 1930 that sacroiliac disease, now considered the radiographic hallmark of AS, was fully recognized. Spondyloarthropathy is a group of chronic inflammatory disorders of unknown cause often associated with human leukocyte antigen (HLA)-B27 (Schumacher and Bardin 1998) which includes ankylosing spondylitis (van der Linden and van der Heijde 1998), reactive arthritis (Keat 1999), psoriatic arthritis (Espinoza et al. 1992), arthritis associated with inflammatory bowel disease (De Keyser et al. 1998), acute anterior uveitis (Rosenbaum 1992), and undifferentiated spondyloarthropathies (Zeidler et al. 1992). A childhood form juvenile spondyloarthropathy also exists (Veys et al. 1995). The spondyloarthropathies share common clinical, radiological, and genetic features that are clearly distinct from other inflammatory rheumatic diseases. AIMS AND OBJECTIVES : 1. Early diagnosis of SpA by imaging before radiological erosions. 2. To compare Power Doppler imaging of sacroiliitis with conventional CT and MRI scan of Pelvis. AS/SpA is a significant health burden. Symptoms of AS commonly begin in late adolescence and early adulthood, at a normal productive time of life. If undiagnosed or inadequately untreated, continuous pain, stiffness, and fatigue are the consequences. Further, a potentially progressive loss of spinal mobility and function result in a reduction in the quality of life. Sacroiliitis is seen mostly in all patients of SpA and limits their mobility and rapidly goes for ankylosis of these joints and permanently incapacitates them in their day to day activities including sexual life. MATERIALS AND METHODS : In this prospective case control study from January 2007 to February 2009, one hundred and eight patients (84 males, 24 females) were included from those who had presented with signs and symptoms and clinical features of Spondyloarthropathies to the Department of Rheumatology, Madras Medical College and Govt. General Hospital, Chennai. 3. 35 age and sex matched asymptomatic controls were selected from patient’s attender’s who were not I or II relatives of the patients and were included as the controls for Power Doppler US of the sacroiliac joints. Inclusion Criteria : Age of onset of disease from16 years to 40 years and Patient’s with Ankylosing spondylitis, Reactive arthritis, Psoriatic arthritis, IBD associated arthritis, Undifferentiated spondyloarthritis Exclusion Criteria : Age of onset of disease < 16 years and > 40 years, Pregnant females, Diseases mimicking as AS- such as Flourosis of spine, Diffuse idiopathic skeletal hyperostosis (DISH), Degenerative spinal diseases (spondylosis deformans). The musculoskeletal examination and including axial joints and SIJ and other systems examination was done. Disease activity indices like ESR, CRP levels were determined. Detailed Bath AS Disease Activity Index (BASDAI) scores were calculated. In addition, chest expansion, finger-to-floor distance, occiput-to-wall distance, tragus-to-wall distance, modified Schober (mSchober), lateral spinal flexion, cervical rotation and intermalleolar distance were measured; and Bath AS Metrology Index (BASMI) was calculated using cervical rotation, tragus-to-wall distance, lateral spinal flexion, mSchober, and intermalleolar distance. RESULTS : One hundred and eight patients were recruited in this study. Among these, 84 were males and 24 were females (3.5:1). The mean age of patients was 30 11.10 years (range from 16 to 59 years). The average disease duration was 3.46 5.23 years (range from one month to 23 years). There were 35 age and sex matched controls (27 males, 8 females, mean age 30 ± 11). CONCLUSION : Both MRI and Power Doppler Ultrasound are 100% sensitive in the diagnosis of sacroiliitis. * Though MRI scan is a time tested and the best method of detecting sacroiliitis, the availability of MRI is often limited and the technique is time consuming and costly, imposing practical difficulties in patients with metal implants, pace makers and claustrophobia. * Occasionally closed MRI may not be suitable for obese patients and in severe inflammatory back pain with limitation of movements of spine. * CT scan, a useful modality of imaging in sacroiliitis, may not be suitable for early spondyloarthritis (less than 1 yr) and in addition, it is associated with radiation hazards. * Power Doppler Ultrasound can be used instead of MRI scan in spondyloarthritis, preferably with disease duration of less than 1year. * Power Doppler Ultrasound is a dynamic real time scanning with, absence of radiation. Multiple joints can be seen on the same day with exact localization of symptoms, the most important factor being the patient’s acceptance due to lesser cost. Therefore Power Doppler ultrasound is “Poor Man’s MRI.” * Power Doppler Ultrasound has become a potent imaging modality in diagnosing subclinical inflammatory arthritis states and comparison of ultrasound images with the contralateral side can be done immediately. Hence, Power Doppler is considered as an “extended arm of the rheumatologist and rheumatologist’s stethoscope.” * Power Doppler Ultrasound has proved to be a less time consuming, non invasive tool for assessing and monitoring the response to therapy at multiple joints and entheses in a single sitting at the bed side. * Power Doppler Ultra sound is preferable but cannot replace MRI, because internal cortical bone pathology cannot be made out by Power Doppler US. * Despite this, a number of issues including a lack of standardization of Power Doppler Ultrasound in musculoskeletal disorders, warrant more studies to satisfy the usefulness of Power Doppler Ultrasound in diagnosing sacroiliitis.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Sacroiliitis ; CT ; MRI Scan ; Power Doppler Ultrasound ; Spondyloarthropathies ; Comparative study.
Subjects: MEDICAL > Rheumatology
Depositing User: Subramani R
Date Deposited: 16 Aug 2017 00:47
Last Modified: 16 Aug 2017 06:38

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