Imaging of Joints and Bones in Autoinflammation

Abstract

Autoinflammatory disorders are commonly characterized by seemingly unprovoked systemic inflammation mainly driven by cells and cytokines of the innate immune system. In many disorders on this spectrum, joint and bone involvement may be observed and imaging of these manifestations can provide essential diagnostic information. This review aimed to provide a comprehensive overview of the imaging characteristics for major diseases and disease groups on the autoinflammatory spectrum, including familial Mediterranean fever (FMF), Behçet disease (BD), crystal deposition diseases (including gout), adult-onset Still's disease (AoSD), and syndromatic synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO)/chronic recurrent multifocal osteomyelitis (CRMO). Herein, we discuss common and distinguishing imaging characteristics, phenotypical overlaps with related diseases, and promising fields of future research.

Keywords: arthritis; autoinflammation; imaging.

Figure 1

MRI in Familial Mediterranean fever (FMF). Sagittal T2 weighted with fat saturation image of an ankle of an 18 years old male with known FMF and exertional leg pain. There is characteristic enthesitis (black arrowhead) with extensive calcaneal bone marrow edema (white arrow heads) at the insertion of the long plantar tendon.

Figure 2

Multimodality imaging for gout. (Left): Virtual calcium subtraction imaging from dual-energy computed tomography. The arrowhead indicates bone marrow edema in the first metacarpal head. (Right): Ultrasound image of the same patient. The arrow indicates double-contour sign and arrowheads indicate synovitis on the power Doppler.

Figure 3

Multimodality imaging in Calcium Pyrophosphate Dihydrate Deposition (CPPD). (Left): Crowned dens syndrome with flake-like calcifications in the CT image (arrowhead) and concurring bone marrow edema on MRI (arrowhead). (Right): CPPD of the wrist, showing calcifications of the luno-triquetral ligament on radiography and additional calcifications of the scapho-lunate ligament on CT (arrowhead).

Figure 4

BCP deposition. (Left): White arrowheads indicate calcific deposition on radiography. (Right): Axial and 3D reconstructions of the same shoulder with better visualization of the depositions.

Figure 5

MRI in CRMO. Coronal T2 weighted with fat saturation images of a whole-body MRI in a 12 year old boy with chronic recurrent multifocal osteomyelitis (CRMO). There is evidence of bilateral bone marrow edema in the distal femur, distal/proximal tibia and talus, triradiate cartilage, and unilateral BME on the right distal radius (indicated by arrowheads. In the case of bilateral lesions, only one side was annotated).