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. 2017 Oct 3;26(3):101-109.
doi: 10.4274/mirt.50570.

Bone Single Photon Emission/Computed Tomography in the Detection of Sacroiliitis in Seronegative Spondyloarthritis: A Comparison with Magnetic Resonance Imaging

Theodoros Pipikos  1 , Dimitrios Kassimos  2 , George Angelidis  3 , John Koutsikos  3
Affiliations

Bone Single Photon Emission/Computed Tomography in the Detection of Sacroiliitis in Seronegative Spondyloarthritis: A Comparison with Magnetic Resonance Imaging

Theodoros Pipikos et al. Mol Imaging Radionucl Ther. .

Abstract
in English, Turkish

Objective: Seronegative spondyloarthritis (SpA) is characterized by chronic inflammation affecting the axial skeleton, entheses and occasionally peripheral joints. The involvement of the sacroiliac joints, sacroiliitis, is considered as a pathognomonic radiographic finding. Magnetic resonance imaging (MRI) is the method of choice for its early detection. Bone scintigraphy (BS) is characterized by high sensitivity in the diagnosis of bone and articular diseases. Limited value of BS in the diagnosis of sacroiliitis may be attributed to the use of planar imaging. In the present study, we aimed to investigate the role of SPECT in SpA, compared to MRI.

Methods: Forty-three patients suffering from inflammatory back pain underwent MRI evaluation of the sacroiliac joints and BS, combined with SPECT in the same region, for the assessment of sacroiliitis.

Results: Bone SPECT revealed no findings of sacroiliitis in 11 patients, with total agreement with MRI. Findings of chronic lesions were demonstrated from both modalities in 2 patients. Bone SPECT and MRI findings were in concordance regarding the investigation of active sacroiliitis, with the exception of one patient with mild SPECT findings and negative MRI examination; the diagnosis of AS however, was established one year later, after a positive follow-up MRI. The evaluation of the planar imaging of the whole skeleton and SPECT imaging, revealed additional lesions.

Conclusion: Bone SPECT is a reliable imaging method in the diagnosis of active sacroiliitis. Its application on planar BS, an economic and widely available diagnostic technique, appears to be a valuable aid for the clinician.

Amaç: Seronegatif spondiloartrit (SpA) aksiyal iskelet, entezler ve nadiren perifer eklemlerin kronik enflamasyonu ile karakterizedir. Sakroiliak eklem tutulumu, sakroiliit, patognomonik bir radyografik bulgu olarak kabul edilir. Manyetik rezonans görüntüleme (MRG) erken tanı için tercih edilen yöntemdir. Kemik sintigrafisi (KS) kemik ve eklem hastalığının tanısında yüksek duyarlılığa sahiptir. KS’nin sakroiliit tanısındaki kısıtlı değeri planar görüntüleme kullanılmasına bağlı olabilir. Bu çalışmada SpA’da SPECT’in rolünün MRG ile karşılaştırılması amaçlandı. Yöntem: Enflamatuvar sırt ağrısı olan 43 hastaya sakroiliak değerlendirme için MRG ve KS uygulandı, sakroiliit tanısı için aynı bölgenin SPECT değerlendirilmesi ile kombine edildi. Bulgular: Kemik SPECT, MRG ile tam tutarlılıkla, 11 hastada herhangi bir sakroiliit bulgusu ortaya koymadı. İki hastada kronik lezyonlara ait bulgular her iki modalitede de görüldü. Kemik SPECT ve MRG bulguları aktif sakroiliit değerlendirmesi açısından hafif SPECT bulguları ve negatif MRG değerlendirmesi olan ancak bir yıl sonra pozitif takip MRG’si ile AS tanısı konulan bir hasta haricinde, tamamen uyumlu idi. Tüm iskelet sistemi planar görüntülemesi ve SPECT ile değerlendirme ek lezyonlar ortaya koydu. Sonuç: Kemik SPECT aktif sakroiliit tanısı için güvenilir bir görüntüleme yöntemidir. Ekonomik ve yaygın olarak erişilebilen bir tanı yöntemi olan planar KS ile kullanımı klinisyene yardımcı olabilecek değerli bir yöntem olarak gözükmektedir. Anahtar kelimeler: Kemik sintigrafisi, SPECT, sakroiliit, spondiloartrit, manyetik rezonans görüntüleme.

Keywords: Bone scintigraphy; SPECT; sacroiliitis; spondyloarthritis magnetic resonance imaging..

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Conflict of interest statement

Conflict of Interest: No potential conflicts of interest were disclosed.

Figures

Figure 1
Figure 1. Intense focal uptake of the radiotracer at the base of the sacroiliac joints (synovial part), indicating the presence of active sacroiliitis (positive study). Also, enthesopathy of the T12-L1 vertebrae is noted (syndesmophytosis)
Figure 2
Figure 2. Absence of focal radiopharmaceutical uptake at the lower part of the sacroiliac joints (synovial part), excluding the presence of active sacroiliitis in a patient with negative magnetic resonance imaging findings
Figure 3
Figure 3. Diffuse increase in radiopharmaceutical uptake at the sacroiliac joints as a sign of chronic inflammation, co-existing with active disease
See this image and copyright information in PMC

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