nuclear medicine in spondyloarthropathies
DESCRIPTION
Is there any role for Nuclear Medicine in the investigation of Spondyloarthropathies in the era of MRI?TRANSCRIPT
NUCLEAR MEDICINE IMAGING IN SPONDYLOARTHROPATHIES:FROM SACROILIAC JOINT UPTAKE RATIO TO HYBRID IMAGING
John T. Koutsikos, MD, PhDDepartment of Nuclear Medicine401 General Military Hospital,Athens, Greece
INTRODUCTION
Spondylarthropathies (SpA) as a group have seronegative,
inflammatory arthritis with a relationship to HLA B27, characterized
by involvement of the spine, peripheral arthtitis and enthesitis.
Represent a variety of diagnoses, including ankylosing spondylitis
(AS), reactive arthritis, psoriasic arthritis (PsA), and enteropathic
arthritis.
It is now more important than ever to diagnose and treat SpA early,
since new therapeutic agents have yielded tremendous responses
not only in advanced disease but also in the early stages of the
disease.
IMAGING IImaging of the sacroiliac joints (SIJ) has an important role in the
diagnosis, classification and monitoring of patients with SpA.
Conventional radiography was given an outstanding role in the
development of classification New York (NY) criteria in 1961 and
modified NY criteria in 1984.
However, radiographic sacroiliitis reflects structural changes which
may appear late in the disease process at least in a subset of patients.
It has low specificity especially for patients at the early stages of the
disease.
To enable earlier diagnosis, highly reliable and sensitive imaging
techniques are needed.
IMAGING II
Magnetic resonance imaging (MRI) is used as a sensitive imaging
modality for the detection of sacroiliitis in early SpA.
MRI detects (early) inflammation such as bone marrow edema/osteitis,
synovitis, enthesitis and capsulitis associated with SpA
MRI has become a pivotal imaging tool for early diagnosis of axial SpA
(recently included as a major criterion in the ASAS classification
criteria)
SCINTIGRAPHY I
Four decades ago several reports about the diagnostic role of
scintigraphy to detect sacroiliitis were promising
SCINTIGRAPHY II
Four decades ago several reports about the diagnostic role of
scintigraphy to detect sacroiliitis were promising
Bone scintigraphy was the method of choice and quantification of SIJ
index has been used as a diagnostic procedure to detect early
sacroiliitis.
SCINTIGRAPHY IIIBone scintigraphy was the method of choice and quantification of SIJ
index has been used as a diagnostic procedure to detect early
sacroiliitis.
However, data about the diagnostic value of bone scan to detect
acute inflammatory changes in the SIJ are conflicting and many
studies suggest that scintigraphy of the SIJ is at most of limited
diagnostic value for the diagnosis of established SpA, including the
early diagnosis of probable/suspected sacroiliitis.
BONE SPECT
Single photon emission computed tomography (SPECT) of the bone,
compared with planar scintigraphy increases image contrast and
improves lesion detection and localization.
Studies have documented the unique diagnostic information provided
by SPECT in patients with back pain.
In several studies bone SPECT appears to be an excellent diagnostic
tool for active sacroiliitis.
2009 SNM Annual Congress
RADIOGRAPHIC SUSPICIOUS CHANGES IN THE SACROILIAC JOINTS: THE ROLE OF BONE SINGLE PHOTON EMISSION COMPUTED TOMOGRAPHY (SPECT) SCINTIGRAPHY
T. Pipikos1, J. Koutsikos1, S. Bakalis1, S. Episkopopoulou1, K. Athanasiou1, G. Koniaris1, D.
Kassimos2; 1 Nuclear Medicine dept., 2 Rheumatology dept.,401 General Military Hospital, ATHENS, GREECE
AIM To evaluate the role of bone single photon emission computed tomography (SPECT) scintigraphy in the detection of sacroiliitis in patients with SpA and suspicious changes of sacroiliitis on X-ray.
X-ray, MRI, and SPECT of the sacroiliac joints of 46 SpA patients (41 males, 5 females, mean age 28.2 y.o.) were evaluated retrospectively.
Fourteen patients were classified as grade 1
MRI detected features of sacroiliitis in 10/14 patients (71%)
SPECT FINDINGS
SPECT was (+)ve in all 10 MRI identified pts, as well as in
one more male with increased CRP and ECR.
In a 2-year follow up period, ankylosing spondylitis was
established for this patient.
(-)VE SPECT
(+)VE SPECT
SCINTIGRAPHY II
Other radiopharmaceuticals such as Ga-67, radiolabelled leucocytes, In-111
chloride, 99mTc labelled liposomes were demonstrated to accumulate in
inflamed area in arthritis
However these agents have not been used in routine clinical practice.
99mTc labeled nonspecific polyclonal human immunoglobulin (HIG)
accumulates in infection and sterile inflammatory processes. HIG being a
nonspecific marker of inflammation and infection may help to detect active
inflammation in SpA.
HIG SCINTIGRAPHY
HIG SCINTIGAPHY
EANM Annual Congress 2007
PET-CT
Inflammation tracersglucose analogue F-18 FDG
macrophage tracer C-11 PK11195
Bone tracerF-18 Fluoride