Computed tomography (CT) has been shown to be useful in evaluation of the intracranial lesion. But now, computed tomography has been appealing as a new radiologic modality applicable to diagnosis and treatment in orthopaedic surgery. The two-dimentional picture, in one tomographic cut of any part under investigation, was able to increase the sensitivity or resolution of detection of lesion and able to overcome the disadvanages of conventional roentgenography. Eighteen patients who injuried pelvic fracture were examined by computed tomography after evaluated by plain radiography and occasionally by standard tomography. In six cases, we get a new additional diagnosis which are not found in conventional radiography. We have found that CT was more sensitive than plain radiography in detecting the sacroiliac joint injury and its around structure injury and hip joint integrity. Of more importance, clinical sign and symptom are valuable in diagnostic process.
Diagnosis ; Hip Joint ; Humans ; Radiography ; Sacroiliac Joint

BACKGROUNDS: Due to the low sensitivity of plain radiography, the diagnosis of early stage ankylosing spondylitis (AS) is often difficult since many patients do not meet the radiographic criteria. The objective of our study was to investigate the diagnostic value of performing multidetector computed tomography (MDCT) of the sacroiliac (SI) joint in the evaluation of AS patients. METHODS: Thirty seven patients with definite or probable AS were evaluated. Plain radiography and MDCT imaging of the pelvis were performed for evaluating the SI joints. Two radiologists analyzed the images, and they graded the sacroiliitis on a scale of 0-4 according to the modified NY criteria. The clinical variables we analyzed included the disease duration, the treatment duration, the prescribed drugs, peripheral joint involvement, enthesopathy, the functional limitations and the BASDAI.. RESULTS: MDCT detected more bilateral sacroiliitis as compared to the plain radiography (86.5% vs. 75.7%, respectively), and MDCT yielded a higher grade of disease in 32.4% (right SI joint) and 24.3% (left SI joint) of the patients. More patients satisfied the modified NY criteria with using MDCT as compared with that when using the plain radiography (81.1% vs. 54.1%, respectively, p=0.002). CONCLUSIONS: Visualization of the sacroiliac joint by MDCT provided a better diagnosis of AS, and especially during the early stage of the disease.
Adolescent ; Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Sacroiliac Joint/*radiography ; Sacrum/*radiography ; Sensitivity and Specificity ; Severity of Illness Index ; Spondylitis, Ankylosing/*radiography ; Tomography, X-Ray Computed/methods

The spine and sacroiliac joint are involved in most cases of axial spondyloarthritis. Several pathologic findings from a radiography involving the spine and sacroiliac joint are the diagnostic hallmarks of axial spondyloarthritis. However, these radiographic changes reflect structural damage rather than active inflammation, which may delay diagnosis by several years. Nowadays, the Assessment of SpondyloArthritis international Society (ASAS) has focused on the reassessment of existing classification criteria and the development and validation of diagnostic tools to facilitate early diagnosis and assessment of treatment response. Magnetic resonance (MR) findings are the most remarkable changes with respect to the previously established classification criteria. Familiarity with typical MRI findings of axial spondyloarthritis and differential diseases is important in order to correctly interpret the findings and avoid misdiagnosis.
Classification ; Diagnosis ; Diagnosis, Differential* ; Diagnostic Errors ; Early Diagnosis ; Inflammation ; Magnetic Resonance Imaging* ; Radiography ; Recognition (Psychology) ; Sacroiliac Joint* ; Spine*

OBJECTIVETo study the X-ray characteristics of sacroiliac joint disorders and its clinical significance,so as to provide clinical diagnosis basis for Tuina treatment of sacroiliac joint disorder.

METHODSFrom July 2009 to March 2011,104 patients with sacroiliac joint disorder were reviewed,including 64 males and 40 females,ranging in age from 18 to 81 years, with an average of (45.39 +/- 1.30) years. The duration of the disease ranged from 1 to 144 months,with an average of (12.64 +/- 2.19) months. One hundred and four pelvic plain films and 97 lumbar spine lateral films of the patients with sacroiliac joint disorder were taken. On the lateral X-ray of lumbar,the sacral horizontal angles (lumbosacral angle) were measured; and on the X-ray of pelvis,the vertical distance of two side iliac crest (iliac crest difference), the distance from lateral border to medial margin of two hips (hip width),the clip angle between sacral spin connection and vertical axis were measured,and then the data were analyzed.

RESULTSThe mean difference of iliac crest was (10.34+/-0.73) mm; the mean width difference of hip'was (6.73+/-1.01) mm; and the mean difference of the iliac crest was larger than that of mean difference of hip (P<0.01). The occurrence rate of inequal width of hip was higher(P<0.01). The mean abnormal lumbosacral angle was (7.29 +/- 1.86) degrees,and the mean angle of sacral crest tilting to left or right was (3.18 +/- 0.47) degrees; the mean abnormal lumbosacral angle was larger than that of angle of sacral crest tilting to left or right (P<0.01), and the occurrence rate of sacral crest tilting to left or right was higher

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Biomechanical Phenomena ; Female ; Humans ; Joint Diseases ; diagnostic imaging ; Male ; Middle Aged ; Radiography ; Rotation ; Sacroiliac Joint ; diagnostic imaging ; X-Rays

Low back pain and gait disturbance began at 6 months of pregnancy in a twenty-eight years old female patient. She could not walk by herself after delivery because of severe pain and limitation of motion on pelvis. Irregular bony destruction on right sacroiliac joint and rotation of pelvis demonstrated on plain radiography. Tuberculosis was confirmed by CT guided needle biopsy. Back pain developing during pregnancy and after delivery can by overlooked as osteitis condensans ilii or nonspecific back pain. Tuberculous sacroilitis should be suspected for the patient with severe pelvic pain and bony destruction on sacroiliac joint, and with rotation of pelvis after delivery. Early diagnosis and proper treatment by anti-tuberculous medication could obtain satisfactory functional outcome. We have described an unusual case of tuberculous sacroiliitis associated with pregnancy in a 28 years old female patient and her clinical presentation, radiological features and outcome of medical treatment are discussed.
Adult ; Back Pain ; Biopsy, Needle ; Early Diagnosis ; Female ; Gait ; Humans ; Low Back Pain ; Osteitis ; Pelvic Pain ; Pelvis ; Pregnancy* ; Radiography ; Sacroiliac Joint ; Sacroiliitis ; Tuberculosis

OBJECTIVE: To diagnoze active ankylosing spondylitis (AAS) by magnetic resonance imaging (MRI). METHODS: MRI of the sacroiliac joint (SIJ) was performed on 48 patients who were clinically diagnosed as probable AS without radiologic evidence of sacroiliitis. Among them 21 were diagnozed as active sacroiliitis with MRI, whose examination was terminated; 27 whose MRI of SIJ did not diagnoze as active sacroiliitis were performed MRI in the thoracic spine. The diagnostic criteria of MRI for AAS of SIJ and/or the thoracic spine were fomulated by consulting documents. The definite diagnosis of AAS was finally made after follow-up for half a year. The sensitivity and specificity of the MRI of SIJ and/or MRI of thoracic spine were assessed. RESULTS: In the 48 patients without radiologic evidence of sacroiliitis, 38 were finally diagnosed as AAS, with established consensus criteria as reference standard. The sensitivity and specificity of the MRI of SIJ were 52.6% and 90.0%, and for the MRI of SIJ and/or the MRI of the thoracic spine 76.3% and 90.0%, respectively. CONCLUSION Clinically probable AS without MRI evidence of sacroiliitis, MRI of the thoracic spine can increase the sensitivity of AAS diagnosis.
Adolescent ; Adult ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Radiography ; Sacroiliac Joint ; diagnostic imaging ; pathology ; Spondylitis, Ankylosing ; diagnosis ; Thoracic Vertebrae ; pathology ; Young Adult

Sacroiliac joint infection is relatively rare and difficult in differential diagnosis with other spinal disorders. Delay in diagnosis is frequent which causes an increased morbidity. The authors reviewed clinical courses of the patients who were treated for pyogenic sacroiliac joint infection from January 1985 to April 1997. Investigation included physical examination, bone scan, biopsy, ESR, plain radiography, CT scan, and MRI. The diagnosis was made on clinical findings and a positive results of the above investigation. There were 17 pyogenic arthritis. Six patients had all symptoms of triad(fever, unilateral buttock pain, limping gait) and fifteen patients had typical buttock pain. Increased ESR(>20mm/hr) was noticed in fourteen patients. In all seventeen cases, skeletal scintigraphy and Gaenslen test were positive. Also CT scan and MRI study were helpful in diagnosis of the sacroiliac joint infection. Pus culture could be done in twelve cases and staphylococcus aureus was found in seven cases. Conservative treatment was performed in eleven cases, and operation in six cases. Fifteen cases were recovered and two cases relieved.
Arthritis ; Biopsy ; Buttocks ; Diagnosis ; Diagnosis, Differential ; Humans ; Magnetic Resonance Imaging ; Physical Examination ; Radiography ; Radionuclide Imaging ; Sacroiliac Joint* ; Staphylococcus aureus ; Suppuration ; Tomography, X-Ray Computed

Objective: To summarize the clinical, radiological characteristics, and prognosis of infectious sacroiliitis in children. Methods: A case-control study was conducted, including 12 cases of infectious sacroiliitis diagnosed in the Rheumatology and Immunology Department of the Children's Hospital affiliated with the Capital Institute of Pediatrics from June 2018 to June 2023. These cases comprised the case group. Concurrently, 28 cases of pediatric idiopathic arthritis involving the sacroiliac joint in the same department served as the control group. Basic patient information, clinical features, laboratory parameters, and clinical treatment outcomes for both groups were collected and analyzed. Independent sample t-tests and chi-squared tests were used for inter-group comparisons. Results: Among the 12 cases in the case group, there were 5 males and 7 females, with a disease duration of 0.8 (0.5, 1.2) months. Nine patients presented with fever, and 1 patient had limping gait. Human leukocyte antigen (HLA)-B27 positivity was observed in 1 case, and there was no family history of ankylosing spondylitis. In the control group of 28 cases, there were 19 males and 9 females, with a disease duration of 7.0 (3.0, 17.0) months. One patient (4%) had fever, and 14 cases (50%) exhibited limping gait. HLA-B27 positivity was found in 18 cases (64%), and 18 cases (64%) had a family history of ankylosing spondylitis. The case group had higher white blood cell count (WBC), neutrophil ratio, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) levels, as well as a higher proportion of unilateral involvement on magnetic resonance imaging and bone destruction on CT compared to the control group ((11.1±6.2)×10⁹ vs. (7.3±2.3)×10⁹/L, 0.64±0.10 vs. 0.55±0.12, 72 (34, 86) vs. 18 (5, 41) mm/1 h, 24.6 (10.1, 67.3) mg/L vs. 3.6 (0.8, 15.0) mg/L, 11/12 vs. 36% (10/28), 9/12 vs. 11% (3/28), t=2.90, 3.07, Z=-2.94, -3.28, χ²=10.55, 16.53, all P<0.05). Conclusions: Pediatric infectious sacroiliitis often presents as unilateral involvement with a short disease history. Elevated WBC, CRP, and ESR, as well as a high rate of bone destruction, are also common characteristics.
Male ; Female ; Humans ; Child ; Sacroiliitis/diagnostic imaging* ; Spondylitis, Ankylosing/diagnosis* ; Case-Control Studies ; Sacroiliac Joint/diagnostic imaging* ; Radiography ; Magnetic Resonance Imaging ; Fever

BACKGROUND/AIMS: The course of ankylosing spondylitis (AS) is rather variable, and the factors that predict radiographic progression remain largely obscure. In this study, we tried to determine the clinical factors and laboratory measures that are useful in predicting the radiographic progression of patients with AS. METHODS: In 64 consecutive patients with AS, we collected radiographic and laboratory data over 3 years. Radiographic data included images of the sacroiliac (SI) and hip joints and laboratory data included areas under the curve (AUC) of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), alkaline phosphatase (ALP), and hemoglobin (Hb). We investigated associations among changes in radiographic scores, initial clinical manifestations and laboratory measurements. RESULTS: Changes in scores for the SI joint and lumbar spine did not correlate with AUC for ESR, CRP, or ALP. AUC for Hb did not significantly correlate with radiographic progression in any joint. Patients with hip arthritis at the initial visit showed significantly higher radiographic score changes after 3 years in the SI and hip joint compared to those without hip arthritis. Patients who had shoulder arthritis as the initial manifestation had significantly increased AUCs for ESR and CRP compared to those without shoulder arthritis. However, at 3 years, the change of the lumbar spine score was significantly higher in patients without shoulder arthritis. CONCLUSIONS: These results indicate that hip arthritis at presentation is a useful clinical marker for predicting the structural damage to the SI and hip joint, and suggest that initial shoulder arthritis correlates with slower radiographic progression of the lumbar spine.
Adolescent ; Adult ; Alkaline Phosphatase/blood ; Biomarkers/blood ; Blood Sedimentation ; C-Reactive Protein/metabolism ; Disease Progression ; Female ; Hemoglobins/metabolism ; Hip Joint/*radiography ; Humans ; Male ; Osteoarthritis, Hip/blood/*radiography ; Predictive Value of Tests ; Retrospective Studies ; Risk Factors ; Sacroiliac Joint/*radiography ; Severity of Illness Index ; Spondylitis, Ankylosing/blood/*radiography ; Time Factors ; Young Adult

OBJECTIVETo construct a three-dimensional model to demonstrate the relation between the anterior branches of lumbosacral 4,5, lumbosacral trunk, and the pelvis.

METHODSAn formaldehyde-fixed adult cadaver was dissected to expose the anterior branches of the lumbar nerves 4 and 5, lumbosacral trunk and the sacroiliac. The mixture of titanium powder and adhesive was smeared on the surface of the major branches of L4 and L5 nerves, lumbosacral trunk, femoral nerves and obturator nerves. As soon as the mixture solidified, the specimen was scanned by spiral CT at 3 mm intervals to obtain 159 two-dimensional sectional images for three-dimensional model reconstruction on a personal computer using the software 3-D DOCTOR.

RESULTS AND CONCLUSIONThe reconstructed model can well demonstrate the spatial relation between the nerves and the pelvis, and allows rotation in every direction, which at the same time can be conveniently applied for purpose of clinical teaching.

Adult ; Cadaver ; Humans ; Imaging, Three-Dimensional ; Lumbosacral Plexus ; diagnostic imaging ; Lumbosacral Region ; diagnostic imaging ; Male ; Pelvic Bones ; diagnostic imaging ; Pelvis ; diagnostic imaging ; Radiography ; Sacroiliac Joint ; diagnostic imaging ; Spinal Nerves ; diagnostic imaging