title: Hybrid 18F-labeled Fluoride Positron Emission Tomography/Magnetic Resonance (MR) Imaging of the Sacroiliac Joints and the Spine in Patients with Axial Spondyloarthritis: A Pilot Study Exploring the Link of MR Bone Pathologies and Increased Osteoblastic Activity.
abstract: OBJECTIVE
  The biologically active molecule used in positron emission tomography (PET) for depiction of osteoblastic activity is 18F-labeled fluoride (18F-F). We examined whether inflammatory or chronic changes on magnetic resonance imaging (MRI) in the sacroiliac joints (SIJ) and the spines of patients with active ankylosing spondylitis (AS) are linked to osteoblastic activity, assessed by PET/MRI.
  
  
  METHODS
  Thirteen patients with AS (mean age 37.8 ± 11.4 yrs, Bath AS Disease Activity Index > 4, no anti-TNF treatment) underwent 3-Tesla whole-spine and SIJ PET/MRI. Two independent readers recorded pathologic changes related to vertebral (VQ) or SIJ quadrants (SQ). Final scores were based on reader agreement.
  
  
  RESULTS
  A total of 104 SQ and 1196 VQ were examined. In SIJ, bone marrow edema (BME) was seen in 44.2%, fat deposition (FD) in 42.3%, and 18F-F in 46.2% SQ. BME alone was associated with 18F-F in 78.6% and FD alone in only 7.7% SQ, while the combination BME/FD was associated with 18F-F in 72.2% SQ. Erosions, sclerosis, and ankylosis alone were rarely associated with 18F-F. In the spine, BME alone was seen in 9.9%, FD in 18.2%, and 18F-F in 5.4% VQ. BME alone was associated with 18F-F in 14.3% and FD alone in 8.7% VQ, while the combination BME/FD was associated with 18F-F in 40.6% VQ.
  
  
  CONCLUSIONS
  In this study of hybrid 18F-F PET/MRI of patients with active AS, we show that BME rather than chronic changes is associated with osteoblastic activity, while the combination of BME and FD showed the highest 18F-F uptake. The use of PET/MRI in prediction of future syndesmophyte formation in AS needs further exploration in prospective studies.
authors.affiliation: From the Department of Diagnostic and Interventional Radiology, and Department of Rheumatology, Medical Faculty, University of Dusseldorf, Dusseldorf; Department of Nuclear Medicine, and Department of Diagnostic and Interventional Radiology and Neuroradiology, Medical Faculty, University of Duisburg-Essen, Essen; Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Herne, Germany.C. Buchbender, MD, Department of Diagnostic and Interventional Radiology; B. Ostendorf, MD, Department of Rheumatology, Medical Faculty, University of Dusseldorf; V. Ruhlmann, MD, Department of Nuclear Medicine, Medical Faculty, University of Duisburg-Essen; P. Heusch, MD; F. Miese, MD, Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Dusseldorf; K. Beiderwellen, MD, Department of Diagnostic and Interventional Radiology and Neuroradiology, Medical Faculty, University of Duisburg-Essen; M. Schneider, MD, Department of Rheumatology, Medical Faculty, University of Dusseldorf; J. Braun, MD, Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum; G. Antoch, MD, Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Dusseldorf; X. Baraliakos, MD, Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum.
authors.forename: Christian
authors.initials: C
authors.lastname: Buchbender
authors.affiliation: From the Department of Diagnostic and Interventional Radiology, and Department of Rheumatology, Medical Faculty, University of Dusseldorf, Dusseldorf; Department of Nuclear Medicine, and Department of Diagnostic and Interventional Radiology and Neuroradiology, Medical Faculty, University of Duisburg-Essen, Essen; Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Herne, Germany.C. Buchbender, MD, Department of Diagnostic and Interventional Radiology; B. Ostendorf, MD, Department of Rheumatology, Medical Faculty, University of Dusseldorf; V. Ruhlmann, MD, Department of Nuclear Medicine, Medical Faculty, University of Duisburg-Essen; P. Heusch, MD; F. Miese, MD, Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Dusseldorf; K. Beiderwellen, MD, Department of Diagnostic and Interventional Radiology and Neuroradiology, Medical Faculty, University of Duisburg-Essen; M. Schneider, MD, Department of Rheumatology, Medical Faculty, University of Dusseldorf; J. Braun, MD, Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum; G. Antoch, MD, Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Dusseldorf; X. Baraliakos, MD, Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum.
authors.forename: Benedikt
authors.initials: B
authors.lastname: Ostendorf
authors.affiliation: From the Department of Diagnostic and Interventional Radiology, and Department of Rheumatology, Medical Faculty, University of Dusseldorf, Dusseldorf; Department of Nuclear Medicine, and Department of Diagnostic and Interventional Radiology and Neuroradiology, Medical Faculty, University of Duisburg-Essen, Essen; Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Herne, Germany.C. Buchbender, MD, Department of Diagnostic and Interventional Radiology; B. Ostendorf, MD, Department of Rheumatology, Medical Faculty, University of Dusseldorf; V. Ruhlmann, MD, Department of Nuclear Medicine, Medical Faculty, University of Duisburg-Essen; P. Heusch, MD; F. Miese, MD, Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Dusseldorf; K. Beiderwellen, MD, Department of Diagnostic and Interventional Radiology and Neuroradiology, Medical Faculty, University of Duisburg-Essen; M. Schneider, MD, Department of Rheumatology, Medical Faculty, University of Dusseldorf; J. Braun, MD, Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum; G. Antoch, MD, Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Dusseldorf; X. Baraliakos, MD, Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum.
authors.forename: Verena
authors.initials: V
authors.lastname: Ruhlmann
authors.affiliation: From the Department of Diagnostic and Interventional Radiology, and Department of Rheumatology, Medical Faculty, University of Dusseldorf, Dusseldorf; Department of Nuclear Medicine, and Department of Diagnostic and Interventional Radiology and Neuroradiology, Medical Faculty, University of Duisburg-Essen, Essen; Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Herne, Germany.C. Buchbender, MD, Department of Diagnostic and Interventional Radiology; B. Ostendorf, MD, Department of Rheumatology, Medical Faculty, University of Dusseldorf; V. Ruhlmann, MD, Department of Nuclear Medicine, Medical Faculty, University of Duisburg-Essen; P. Heusch, MD; F. Miese, MD, Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Dusseldorf; K. Beiderwellen, MD, Department of Diagnostic and Interventional Radiology and Neuroradiology, Medical Faculty, University of Duisburg-Essen; M. Schneider, MD, Department of Rheumatology, Medical Faculty, University of Dusseldorf; J. Braun, MD, Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum; G. Antoch, MD, Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Dusseldorf; X. Baraliakos, MD, Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum.
authors.forename: Philipp
authors.initials: P
authors.lastname: Heusch
authors.affiliation: From the Department of Diagnostic and Interventional Radiology, and Department of Rheumatology, Medical Faculty, University of Dusseldorf, Dusseldorf; Department of Nuclear Medicine, and Department of Diagnostic and Interventional Radiology and Neuroradiology, Medical Faculty, University of Duisburg-Essen, Essen; Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Herne, Germany.C. Buchbender, MD, Department of Diagnostic and Interventional Radiology; B. Ostendorf, MD, Department of Rheumatology, Medical Faculty, University of Dusseldorf; V. Ruhlmann, MD, Department of Nuclear Medicine, Medical Faculty, University of Duisburg-Essen; P. Heusch, MD; F. Miese, MD, Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Dusseldorf; K. Beiderwellen, MD, Department of Diagnostic and Interventional Radiology and Neuroradiology, Medical Faculty, University of Duisburg-Essen; M. Schneider, MD, Department of Rheumatology, Medical Faculty, University of Dusseldorf; J. Braun, MD, Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum; G. Antoch, MD, Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Dusseldorf; X. Baraliakos, MD, Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum.
authors.forename: Falk
authors.initials: F
authors.lastname: Miese
authors.affiliation: From the Department of Diagnostic and Interventional Radiology, and Department of Rheumatology, Medical Faculty, University of Dusseldorf, Dusseldorf; Department of Nuclear Medicine, and Department of Diagnostic and Interventional Radiology and Neuroradiology, Medical Faculty, University of Duisburg-Essen, Essen; Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Herne, Germany.C. Buchbender, MD, Department of Diagnostic and Interventional Radiology; B. Ostendorf, MD, Department of Rheumatology, Medical Faculty, University of Dusseldorf; V. Ruhlmann, MD, Department of Nuclear Medicine, Medical Faculty, University of Duisburg-Essen; P. Heusch, MD; F. Miese, MD, Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Dusseldorf; K. Beiderwellen, MD, Department of Diagnostic and Interventional Radiology and Neuroradiology, Medical Faculty, University of Duisburg-Essen; M. Schneider, MD, Department of Rheumatology, Medical Faculty, University of Dusseldorf; J. Braun, MD, Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum; G. Antoch, MD, Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Dusseldorf; X. Baraliakos, MD, Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum.
authors.forename: Karsten
authors.initials: K
authors.lastname: Beiderwellen
authors.affiliation: From the Department of Diagnostic and Interventional Radiology, and Department of Rheumatology, Medical Faculty, University of Dusseldorf, Dusseldorf; Department of Nuclear Medicine, and Department of Diagnostic and Interventional Radiology and Neuroradiology, Medical Faculty, University of Duisburg-Essen, Essen; Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Herne, Germany.C. Buchbender, MD, Department of Diagnostic and Interventional Radiology; B. Ostendorf, MD, Department of Rheumatology, Medical Faculty, University of Dusseldorf; V. Ruhlmann, MD, Department of Nuclear Medicine, Medical Faculty, University of Duisburg-Essen; P. Heusch, MD; F. Miese, MD, Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Dusseldorf; K. Beiderwellen, MD, Department of Diagnostic and Interventional Radiology and Neuroradiology, Medical Faculty, University of Duisburg-Essen; M. Schneider, MD, Department of Rheumatology, Medical Faculty, University of Dusseldorf; J. Braun, MD, Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum; G. Antoch, MD, Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Dusseldorf; X. Baraliakos, MD, Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum.
authors.forename: Matthias
authors.initials: M
authors.lastname: Schneider
authors.affiliation: From the Department of Diagnostic and Interventional Radiology, and Department of Rheumatology, Medical Faculty, University of Dusseldorf, Dusseldorf; Department of Nuclear Medicine, and Department of Diagnostic and Interventional Radiology and Neuroradiology, Medical Faculty, University of Duisburg-Essen, Essen; Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Herne, Germany.C. Buchbender, MD, Department of Diagnostic and Interventional Radiology; B. Ostendorf, MD, Department of Rheumatology, Medical Faculty, University of Dusseldorf; V. Ruhlmann, MD, Department of Nuclear Medicine, Medical Faculty, University of Duisburg-Essen; P. Heusch, MD; F. Miese, MD, Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Dusseldorf; K. Beiderwellen, MD, Department of Diagnostic and Interventional Radiology and Neuroradiology, Medical Faculty, University of Duisburg-Essen; M. Schneider, MD, Department of Rheumatology, Medical Faculty, University of Dusseldorf; J. Braun, MD, Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum; G. Antoch, MD, Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Dusseldorf; X. Baraliakos, MD, Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum.
authors.forename: Juergen
authors.initials: J
authors.lastname: Braun
authors.affiliation: From the Department of Diagnostic and Interventional Radiology, and Department of Rheumatology, Medical Faculty, University of Dusseldorf, Dusseldorf; Department of Nuclear Medicine, and Department of Diagnostic and Interventional Radiology and Neuroradiology, Medical Faculty, University of Duisburg-Essen, Essen; Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Herne, Germany.C. Buchbender, MD, Department of Diagnostic and Interventional Radiology; B. Ostendorf, MD, Department of Rheumatology, Medical Faculty, University of Dusseldorf; V. Ruhlmann, MD, Department of Nuclear Medicine, Medical Faculty, University of Duisburg-Essen; P. Heusch, MD; F. Miese, MD, Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Dusseldorf; K. Beiderwellen, MD, Department of Diagnostic and Interventional Radiology and Neuroradiology, Medical Faculty, University of Duisburg-Essen; M. Schneider, MD, Department of Rheumatology, Medical Faculty, University of Dusseldorf; J. Braun, MD, Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum; G. Antoch, MD, Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Dusseldorf; X. Baraliakos, MD, Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum.
authors.forename: Gerald
authors.initials: G
authors.lastname: Antoch
authors.affiliation: From the Department of Diagnostic and Interventional Radiology, and Department of Rheumatology, Medical Faculty, University of Dusseldorf, Dusseldorf; Department of Nuclear Medicine, and Department of Diagnostic and Interventional Radiology and Neuroradiology, Medical Faculty, University of Duisburg-Essen, Essen; Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Herne, Germany.C. Buchbender, MD, Department of Diagnostic and Interventional Radiology; B. Ostendorf, MD, Department of Rheumatology, Medical Faculty, University of Dusseldorf; V. Ruhlmann, MD, Department of Nuclear Medicine, Medical Faculty, University of Duisburg-Essen; P. Heusch, MD; F. Miese, MD, Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Dusseldorf; K. Beiderwellen, MD, Department of Diagnostic and Interventional Radiology and Neuroradiology, Medical Faculty, University of Duisburg-Essen; M. Schneider, MD, Department of Rheumatology, Medical Faculty, University of Dusseldorf; J. Braun, MD, Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum; G. Antoch, MD, Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Dusseldorf; X. Baraliakos, MD, Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum. baraliakos@me.com.
authors.forename: Xenofon
authors.initials: X
authors.lastname: Baraliakos
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010006:Osteoblasts / Q000000981:diagnostic imaging* / Q000473:pathology; D010865:Pilot Projects; D049268:Positron-Emission Tomography; D012446:Sacroiliac Joint / Q000000981:diagnostic imaging* / Q000473:pathology; D013131:Spine / Q000000981:diagnostic imaging* / Q000473:pathology; D025241:Spondylarthritis / Q000000981:diagnostic imaging* / Q000473:pathology
keywords: ANKYLOSING SPONDYLITIS; AXIAL SPONDYLOARTHRITIS; MR-PET; PET/MRI; SPONDYLOARTHRITIDES