[Optimized use of cross-sectional imaging for the early diagnosis and management of ankylosing spondyloarthropathy].
It is becoming increasingly desirable to diagnose ankylosing spondyloarthropathy (AS) at its pre-radiographic stage (prior to the presence of sacro-iliitis on radiographs). MRI plays a key role for early diagnosis of AS, as illustrated by recently proposed international diagnostic criteria (ASAS). MRI of the SI joints is most helpful for early diagnosis; sequences using fat suppression and/or Gadolinium administration are necessary for the detection of inflammatory changes. However, the rate of false positive and false negative results of MR imaging of the SI joints, especially early in the course of the disease, is unknown and requires prudent interpretation of imaging findings. In patients with normal MRI examination of the SI joints and/or if symptoms are limited to the spine, MRI of the lumbar spine with STIR and/or Gadolinium administration may be helpful; again the positive and negative predictive values are unknown, especially early in the course of the disease. The demonstration of inflammatory changes on MRI, at the axial level, could be an indication for anti-TNF treatment, outside of WMA (national and international recommendations). The role of Doppler US, especially for peripheral entheses, remains hypothetical for early diagnosis. The role of MRI for structural evaluation is also being assessed even though radiographs remain the standard of reference. To date, no treatment, conventional or other, has been shown to have a structural effect (aside from limitations related to the methodology of available studies).
Kemta Lekpa
F
F
Service de Rhumatologie, CHU Albert Chenevier-Henri Mondor, APHP, UFR Médecine Paris XII, 94010 Créteil cedex, France.
Lenczner
G
G
Farrenq
V
V
Claudepierre
P
P
D000328:Adult; D018501:Antirheumatic Agents / Q000627:therapeutic use; D003287:Contrast Media / Q000008:administration & dosage; D003937:Diagnosis, Differential; D018450:Disease Progression; D042241:Early Diagnosis; D019786:Gadolinium DTPA; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D007596:Joints / Q000473:pathology*; D008159:Lumbar Vertebrae / Q000473:pathology; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D012446:Sacroiliac Joint / Q000473:pathology; D012680:Sensitivity and Specificity; D013167:Spondylitis, Ankylosing / Q000145:classification / Q000175:diagnosis*; D013904:Thoracic Vertebrae / Q000473:pathology; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors; D014463:Ultrasonography / Q000379:methods*
D018501:Antirheumatic Agents; D003287:Contrast Media; D014409:Tumor Necrosis Factor-alpha; D019786:Gadolinium DTPA