AXIAL AND PERIPHERAL MANIFESTATION IN SPONDYLOARTHRITIS: A WHOLE BODY MRI APPROACH

Background: Spondyloarthritis (SpA) is a group of similar diseases with distinct clinical features and a common genetic predisposition, its best known representative being ankylosing spondylitis. Patients predominantly suffer from axial disease (spine and sacroiliac joints). Peripheral arthritis and enthesitis are common findings and important features in some subtypes of SpA and may need additional imaging depending on clinical presentation. The latest generation of MRI scanners is capable to employ sophisticated computational techniques (reconstruction algorithms) and arrays of coils wherein each coil would independently and simultaneously image a given volume (parallel imaging). These techniques can be used to generate images of the whole body from head to toe with a total scan range of up to 205 cm.Objectives: The aim of the current study was to evaluate whole body MRI (WB-MRI) as a comprehensive imaging procedure in SpA patients.Methods: Thirty nine patients with known SpA and at least one painful joint region/spinal segment underwent MRI using a whole body scanner (Siemens Avanto 1.5 Tesla). Coronal and sagittal T1-weighted fast spin echo and short tau inversion recovery (STIR) sequences were acquired using parallel imaging techniques and special coil devices. Total scan times were between 55 to 70 minutes. Images of the spine, thorax, pelvis and upper and lower extremities were read by two experienced musculoskeletal radiologists. Global joint pain was recorded on a 0-10 visual analogue scale (VAS).Results: Patients included in the study were considerably active with a mean VAS pain value of 6.5±1.8. Thirty five patients (90%) showed axial inflammatory lesions while 28 patients (72%) showed a peripheral involvement (mean of 1.6 inflamed peripheral joints per patient). Four patients (10%) did not show any inflammatory changes. At the axial skeleton, findings were spondylitis (74%), sacroiliitis (72%), diskitis (38%), costovertebral arthritis (28%), arthritis of the facet joints (23%), and enthesitis of spinal ligaments (18%). Most frequent peripheral findings were arthritis of the ankle (38%), the knee (23%), the sternoclavicular joint (21%), the hip (13%), and the shoulder (13%). Peripheral enthesitis was found at the Achilles tendon (28%) and the plantar fascia (8%).Conclusion: WB-MRI enables comprehensive imaging of patients with SpA within acceptable scanning times using parallel imaging techniques and demonstrates inflammatory regions of both the axial and peripheral skeleton. Based on our data, peripheral manifestations are considerably more frequent than reported in the literature. Thus, WB-MRI has the potential to serve as "one stop shop" in patients with active SpA.Citation: Ann Rheum Dis, volume 65, supplement II, year 2006, page 692Session: Diagnostics and imaging procedures