Sakroiliitis in der MRT – welche Informationen benötigen Radiologinnen und Radiologen und Rheumatologinnen und Rheumatologen?

Zusammenfassung

Bildgebung spielt bei der der axialen Spondyloarthritis (axSpA) eine Schlüsselrolle. Um eine präzise Diagnostik und der damit verbundenen Therapie zu ermöglichen ist hier eine effektive interdisziplinäre Kommunikation zwischen der Radiologie und Rheumatologie entscheidend. Dabei ist die Bereitstellung wichtiger Informationen zur Patientendemographie (Alter, Geschlecht), zur Anamnese (u. a. klinische axSpA-Features, Verdachtsdiagnose, Grund der Bildgebung), zur Klinik (Schmerzanamnese inklusive entzündlicher Charakter) und Labordaten (Entzündungsparameter, HLA-B27 Status) sowie eventuelle Kontraindikationen für Bildgebung (beispielsweise Klaustrophobie) für die Radiologie entscheidend, um eine gezielte Einordnung der Bildgebungsbefunde zu ermöglichen und damit letztendlich einen für die Rheumatologie wertvollen radiologischen Befund zu erstellen. Auf der anderen Seite soll der radiologische Befund alle wichtigen Informationen enthalten die für die Diagnose entscheidend sind. Dazu gehören die von der Rheumatologie bereitgestellten Patienteninformationen, technische Details der Untersuchung sowie die bedeutsamsten Bildgebungsbefunden. Zu diesen gehören das Knochenmarködem (Osteitis), Erosionen und Fettmetaplasien. Daneben sollen auch weitere Läsionen, die für oder gegen eine axSpA sprechen aufgeführt werden. Letztendlich sollen die wichtigsten Befunde in einer zusammenfassenden Beurteilung gebündelt werden und eine Einschätzung der bildgebenden Diagnose gegeben werden unter Angabe der diagnostischen Sicherheit. So trägt eine effektive interdisziplinäre Kommunikation zur optimalen Diagnosestellung und der damit verbunden Therapie bei.

Abstract

Imaging plays a key role in the diagnosis of axial spondyloarthritis (axSpA). Effective interdisciplinary communication between radiologists and rheumatologists is crucial for an accurate diagnosis and subsequent treatment. The radiologist requires essential information, including patient demographics (age, sex), medical history (e. g., clinical axSpA features, suspected diagnosis, reason for imaging), clinical details (pain history including inflammatory characteristics) and laboratory data (inflammatory markers, HLA-B27 status), as well as any contraindications for imaging (e. g., claustrophobia). This allows for an accurate interpretation of imaging findings and the provision of valuable radiological reports for the rheumatologist. On the other hand, radiological reports must include all important diagnostic information such as patient details provided by the rheumatologist, technical aspects of the examination and key imaging findings, including bone marrow edema (osteitis), erosions and fat metaplasia. In addition, other relevant imaging findings should be noted. Ultimately, a summary report should consolidate the most important findings and offer a diagnostic interpretation, including an indication of diagnostic confidence. Effective interdisciplinary communication is essential for achieving an accurate diagnosis and guiding appropriate treatment.

Schlüsselwörter

axiale Spondyloarthritis - Sakroiliitis - Bildgebung

Keywords

axialspondyloarthritis - sacroiliitis - imaging

Publikationsverlauf

Eingereicht: 16. September 2024

Angenommen: 01. November 2024

Artikel online veröffentlicht:
10. Dezember 2024

• Literatur

• 1 Reveille JD, Witter JP, Weisman MH. Prevalence of axial spondylarthritis in the United States: estimates from a cross-sectional survey. Arthritis Care Res (Hoboken) 2012; 64: 905-910
• 2 Braun J, Bollow M, Remlinger G. et al. Prevalence of spondylarthropathies in HLA-B27 positive and negative blood donors. Arthritis Rheum 1998; 41: 58-67
• 3 Pamukcu M, Duran TI. Could C-Reactive Protein/Albumin Ratio be an Indicator of Activation in Axial Spondyloarthritis?. J Coll Physicians Surg Pak 2021; 30: 537-541
• 4 Mandl P, Navarro-Compan V, Terslev L. et al. EULAR recommendations for the use of imaging in the diagnosis and management of spondyloarthritis in clinical practice. Ann Rheum Dis 2015; 74: 1327-1339
• 5 Hollingsworth PN, Cheah PS, Dawkins RL. et al. Observer variation in grading sacroiliac radiographs in HLA-B27 positive individuals. J Rheumatol 1983; 10: 247-254
• 6 van Tubergen A, Heuft-Dorenbosch L, Schulpen G. et al. Radiographic assessment of sacroiliitis by radiologists and rheumatologists: does training improve quality?. Ann Rheum Dis 2003; 62: 519-525
• 7 Mandl P, Navarro-Compán V, Terslev L. et al. EULAR recommendations for the use of imaging in the diagnosis and management of spondyloarthritis in clinical practice. Ann Rheum Dis 2015; 74: 1327-1339
• 8 Diekhoff T, Hermann KG, Greese J. et al. Comparison of MRI with radiography for detecting structural lesions of the sacroiliac joint using CT as standard of reference: results from the SIMACT study. Ann Rheum Dis 2017; 76: 1502-1508
• 9 Sieper J, Rudwaleit M, Baraliakos X. et al. The Assessment of SpondyloArthritis international Society (ASAS) handbook: a guide to assess spondyloarthritis. Ann Rheum Dis 2009; 68: ii1-ii44
• 10 Maksymowych WP, Lambert RG, Ostergaard M. et al. MRI lesions in the sacroiliac joints of patients with spondyloarthritis: an update of definitions and validation by the ASAS MRI working group. Ann Rheum Dis 2019; 78: 1550-1558
• 11 Stal R, van Gaalen F, Sepriano A. et al. Facet joint ankylosis in r-axSpA: detection and 2-year progression on whole spine low-dose CT and comparison with syndesmophyte progression. Rheumatology (Oxford) 2020;
• 12 Diekhoff T, Giraudo C, Machado PM. et al. Clinical information on imaging referrals for suspected or known axial spondyloarthritis: recommendations from the Assessment of Spondyloarthritis International Society (ASAS). Ann Rheum Dis 2024;
• 13 Diekhoff T, Eshed I, Giraudo C. et al. Reporting Sacroiliac Joint Imaging Performed for Known or Suspected Axial Spondyloarthritis: Assessment of SpondyloArthritis International Society Recommendations. Radiology 2024; 311: e231786
• 14 Almodóvar R, Bueno Á, Batlle E. et al. Magnetic resonance imaging assessment in patients with axial spondyloarthritis: development of checklists for use in clinical practice. Rheumatol Int 2019; 39: 2119-2127
• 15 Bennett AN, Marzo-Ortega H, Kaur-Papadakis D. et al. The Use of Magnetic Resonance Imaging in Axial Spondyloarthritis: Time to Bridge the Gap Between Radiologists and Rheumatologists. J Rheumatol 2017; 44: 780-785
• 16 Vereecke E, Diekhoff T, Eshed I. et al. ESR Essentials: Imaging of sacroiliitis-practice recommendations by ESSR. Eur Radiol 2024;
• 17 [Anonym] Good practice for radiological reporting. Guidelines from the European Society of Radiology (ESR). Insights Imaging 2011; 2: 93-96
• 18 Pohlner T, Deppe D, Ziegeler K. et al. Diagnostic accuracy in axial spondyloarthritis: a systematic evaluation of the role of clinical information in the interpretation of sacroiliac joint imaging. RMD Open 2024; 10
• 19 Calin A, Porta J, Fries JF. et al. Clinical history as a screening test for ankylosing spondylitis. Jama 1977; 237: 2613-2614
• 20 Rudwaleit M, Metter A, Listing J. et al. Inflammatory back pain in ankylosing spondylitis: a reassessment of the clinical history for application as classification and diagnostic criteria. Arthritis Rheum 2006; 54: 569-578
• 21 Garrett S, Jenkinson T, Kennedy LG. et al. A new approach to defining disease status in ankylosing spondylitis: the Bath Ankylosing Spondylitis Disease Activity Index. J Rheumatol 1994; 21: 2286-2291
• 22 Diekhoff T, Lambert R, Hermann KG. MRI in axial spondyloarthritis: understanding an 'ASAS-positive MRI' and the ASAS classification criteria. Skeletal Radiol 2022; 51: 1721-1730
• 23 Poddubnyy D, Weineck H, Diekhoff T. et al. Clinical and imaging characteristics of osteitis condensans ilii as compared with axial spondyloarthritis. Rheumatology (Oxford) 2020;
• 24 Munn Z, Jordan Z. Interventions to reduce anxiety, distress and the need for sedation in adult patients undergoing magnetic resonance imaging: a systematic review. Int J Evid Based Healthc 2013; 11: 265-274
• 25 Dewey M, Schink T, Dewey CF. Claustrophobia during magnetic resonance imaging: cohort study in over 55,000 patients. J Magn Reson Imaging 2007; 26: 1322-1327
• 26 Napp AE, Diekhoff T, Stoiber O. et al. Audio-guided self-hypnosis for reduction of claustrophobia during MR imaging: results of an observational 2-group study. Eur Radiol 2021; 31: 4483-4491
• 27 Ji XJ, Sun K, Hu ZY. et al. Comparison of clinical manifestations according to HLA-B(27) genotype in ankylosing spondylitis patients: real-world evidence from smart management system for spondyloarthritis. Zhonghua Nei Ke Za Zhi 2018; 57: 179-184
• 28 Lambert RGW, Baraliakos X, Bernard SA. et al. Development of international consensus on a standardised image acquisition protocol for diagnostic evaluation of the sacroiliac joints by MRI: an ASAS-SPARTAN collaboration. Ann Rheum Dis 2024;
• 29 Diekhoff T, Greese J, Sieper J. et al. Improved detection of erosions in the sacroiliac joints on MRI with volumetric interpolated breath-hold examination (VIBE): results from the SIMACT study. Ann Rheum Dis 2018; 77: 1585-1589
• 30 Deppe D, Hermann KG, Proft F. et al. CT-like images of the sacroiliac joint generated from MRI using susceptibility-weighted imaging (SWI) in patients with axial spondyloarthritis. RMD Open 2021; 7
• 31 Di Dier K, Deppe D, Diekhoff T. et al. Clash of the titans: Current CT and CT-like imaging modalities in sacroiliitis in spondyloarthritis. Best Pract Res Clin Rheumatol 2023; 37: 101876
• 32 Bray TJP, Jones A, Bennett AN. et al. Recommendations for acquisition and interpretation of MRI of the spine and sacroiliac joints in the diagnosis of axial spondyloarthritis in the UK. Rheumatology (Oxford) 2019; 58: 1831-1838
• 33 Poddubnyy D, Weineck H, Diekhoff T. et al. Clinical and imaging characteristics of osteitis condensans ilii as compared with axial spondyloarthritis. Rheumatology (Oxford) 2020; 59: 3798-3806
• 34 Hermann KGA, Ziegeler K, Kreutzinger V. et al. What amount of structural damage defines sacroiliitis: a CT study. RMD Open 2022; 8
• 35 Song IH, Hermann KG, Haibel H. et al. Inflammatory and fatty lesions in the spine and sacroiliac joints on whole-body MRI in early axial spondyloarthritis--3-Year data of the ESTHER trial. Semin Arthritis Rheum 2016; 45: 404-410
• 36 Maksymowych WP, Wichuk S, Chiowchanwisawakit P. et al. Fat metaplasia and backfill are key intermediaries in the development of sacroiliac joint ankylosis in patients with ankylosing spondylitis. Arthritis Rheumatol 2014; 66: 2958-2967
• 37 Oei MW, Evens AL, Bhatt AA. et al. Imaging of the Aging Spine. Radiol Clin North Am 2022; 60: 629-640
• 38 Gohil I, Vilensky JA, Weber EC. Vacuum phenomenon: Clinical relevance. Clin Anat 2014; 27: 455-462
• 39 Ziegeler K, Kreutzinger V, Diekhoff T. et al. Impact of age, sex, and joint form on degenerative lesions of the sacroiliac joints on CT in the normal population. Sci Rep 2021; 11: 5903
• 40 Illeez OG, Atıcı A, Ulger EB. et al. The transitional vertebra and sacroiliac joint dysfunction association. Eur Spine J 2018; 27: 187-193
• 41 Ziegeler K, Ulas ST, Poddubnyy D. et al. Anatomical variation of the sacroiliac joint carries an increased risk for erosion and bone marrow oedema in axial spondyloarthritis. Rheumatology (Oxford) 2023; 62: 1117-1123
• 42 Ziegeler K, Kreutzinger V, Proft F. et al. Joint anatomy in axial spondyloarthritis: strong associations between sacroiliac joint form variation and symptomatic disease. Rheumatology (Oxford) 2021; 61: 388-393
• 43 Šarčević Z, Tepavčević A. Association between adolescent idiopathic scoliosis and sacroiliac joint dysfunction in young athletes: A case control study. Medicine (Baltimore) 2019; 98: e15161
• 44 Johnson AJ, Ying J, Swan JS. et al. Improving the quality of radiology reporting: a physician survey to define the target. J Am Coll Radiol 2004; 1: 497-505
• 45 Ulas ST, Radny F, Ziegeler K. et al. Self-reported diagnostic confidence predicts diagnostic accuracy in axial spondyloarthritis imaging. Rheumatology (Oxford) 2024; 63: 2199-2204