Objective To investigate the clinical value of diffusion-weighted imaging (DWI) for evaluating the activity of sacroiliitis in ankylosing spondylitis (AS).Methods Totally 73 AS patients were prospectively enrolled and divided into active group (n=43) and chronic group (n=30) according to Bath ankylosing spondylitis disease activity index (BASDAI) scores and laboratory findings. Conventional magnetic resonance imaging (MRI) and DWI were performed in all subjects. Apparent diffusion coefficient (ADC) values of subchondral lesions in sacroiliac joint were independently measured by two radiologists,and the relative ADC (rADC) values were calculated. ADC and rADC values were compared between active and chronic groups. The efficiencies of ADC and rADC values for differentiating the activity of sacroiliitis were analyzed. In addition,the correlation coefficients of ADC values,rADC values,and BASDAI scores were calculated.Results The ADC and rADC values in the active group were (0.667±0.122)×10 mm /s and (1.715±0.343)×10 mm /s,respectively,which were significantly higher than those of the chronic group [(0.492±0.0651)×10 mm /s and (1.289±0.209)×10 mm /s,respectively)] (P<0.0001). The agreement of measurement results between two radiologists was good,and all the interclass correlation coefficients were >0.81. The correlation coefficients of ADC value and rADC value with BASDAI scores were 0.82 and 0.80,respectively (P<0.0001). The optimal cutoff values of ADC value and rADC value for differentiating AS activity were 0.545×10 mm /s and 1.467×10 mm /s,respectively,The specificity was 81.8% for both indicators,and the sensitivity was 92.0% and 88.0%,respectively.Conclusion DWI is helpful in the quantitative assessment of the activity of sacroiliitis in AS patients.
Diffusion Magnetic Resonance Imaging ; Humans ; Sacroiliitis ; complications ; diagnostic imaging ; Sensitivity and Specificity ; Spondylitis, Ankylosing ; complications ; diagnostic imaging

BACKGROUND: Andersson lesions (ALs) are not uncommon in ankylosing spondylitis (AS). Plain radiography (PR) is widely used for the diagnosis of ALs. However, in our practice, there were some ALs in AS patients that could not be detected on plain radiographs. This study aimed to propose the concept of occult ALs and evaluate the prevalence and radiographic characteristics of the occult ALs in AS patients. METHODS: A total of 496 consecutive AS patients were admitted in the Affiliated Drum Tower Hospital, Medical School of Nanjing University between April 2003 and November 2019 and they were retrospectively reviewed. The AS patients with ALs who met the following criteria were included for the investigation of occult ALs: (1) with pre-operative plain radiographs of the whole-spine and (2) availability of pre-operative computed tomography (CT) and/or magnetic resonance imaging (MRI) of the whole-spine. The occult ALs were defined as the ALs which were undetectable on plain radiographs but could be detected by CT and/or MRI. The extensive ALs involved the whole discovertebral junction or manifested as destructive lesions throughout the vertebral body. Independent-samples t test was used to compare the age between the patients with only occult ALs and those with only detectable ALs. Chi-square or Fisher exact test was applied to compare the types, distribution, and radiographic characteristics between detectable and occult ALs as appropriate. RESULTS: Ninety-two AS patients with a mean age of 44.4 ± 10.1 years were included for the investigation of occult ALs. Twenty-three patients had occult ALs and the incidence was 25% (23/92). Fifteen extensive ALs were occult, and the proportion of extensive ALs was significantly higher in detectable ALs (97% vs. 44%, χ2 = 43.66, P < 0.001). As assessed by PR, the proportions of osteolytic destruction with reactive sclerosis (0 vs. 100%, χ2 = 111.00, P < 0.001), angular kyphosis of the affected discovertebral units or vertebral body (0 vs. 22%, χ2 = 8.86, P = 0.003), formation of an osseous bridge at the intervertebral space adjacent to ALs caused by the ossification of the anterior longitudinal ligament (38% vs. 86%, χ2 = 25.91, P < 0.001), and an abnormal height of the affected intervertebral space were all significantly lower in occult ALs (9% vs. 84%, χ2 = 60.41, P < 0.001). CONCLUSIONS Occult ALs presented with more subtle radiographic changes. Occult ALs should not be neglected, especially in the case of extensive occult ALs, because the stability of the spine might be severely impaired by these lesions.
Adult ; Humans ; Kyphosis/diagnostic imaging* ; Magnetic Resonance Imaging ; Middle Aged ; Radiography ; Retrospective Studies ; Spine/diagnostic imaging* ; Spondylitis, Ankylosing/diagnostic imaging*

To compare the differences in apparent diffusion coefficient (ADC) and fractional anisotropy (FA) between brucella spondylitis (BS) groups at different stages before treatment and the normal control group and to evaluate the change trend of ADC value and FA value at different time points before and after treatment. Totally 53 patients suspected of BS by conventional magnetic resonance imaging (MRI) and later confirmed as BS patients by serological tests were enrolled in this study. These patients underwent conventional MRI and diffusion tensor imaging scans,and the ADC value and FA value were measured. Independent sample test was used to compare the ADC value and FA value between the BS group and the control group,the ADC value and FA value between the BS group at each stage. Repeated measurement ANOV was used to compare the ADC values and FA values at different time points before and after treatment. FA imaging showed that the color code of BS was different from that of the normal control group,and the color code of FA imaging showed increased singal. The ADC values of BS in the acute,subacute,and chronic stages [(1.45±0.02)×10 mm /s,(1.35±0.03)×10 mm /s,(1.26±0.05)×10 mm /s,respectively] were significantly higher than those in the control group [(1.06±0.09) ×10 mm /s](=2.538,=0.009;=1.998,=0.032;=1.575,=0.004),and the FA value (0.55±0.02,0.65±0.03,0.71±0.04,respectively) were significantly lower than those of the control group (0.78±0.02) (=2.440,=0.012; =1.847,=0.041;=2.102,=0.003). Repeated measurement analysis showed that there were statistically significant differences in ADC values and FA values at different time points before and after treatment in the acute,subacute,and chronic stages (ADC:=12.100,<0.001;=8.439,=0.005;=9.704,=0.004,respectively;FA:=7.080,=0.002;=6.607;=0.003;=8.868,=0.001,respectively). The ADC values at different time points after treatment were significantly lower than those before treatment or at a previous time point after treatment (=332.14,<0.001),and the FA values were significantly higher than those before treatment or at a previous time point after treatment (=134.26,<0.001). FA color code can intuitively display differences in BS and normal vertebral bodies and show change of color code before and after treatment. Also,the ADC values and FA values can quantitatively reveal differences between BS and normal vertebral body in different time points and quantify BS vertebral lesion changes before and after treatment. In particular,in BS patients who are recovering from treatment,it can quantify microscopic edema. Therefore,diffusion tensor imaging may be useful objective indicator in evaluating the effectiveness of a specific treatment for BS.
Anisotropy ; Brucella ; Brucellosis ; diagnostic imaging ; Diffusion Magnetic Resonance Imaging ; Diffusion Tensor Imaging ; Humans ; Spondylitis ; diagnostic imaging ; microbiology

Brucella ; Brucellosis/diagnosis* ; Cervical Vertebrae/diagnostic imaging* ; Epidural Abscess ; Humans ; Magnetic Resonance Imaging ; Quadriplegia ; Spondylitis/diagnostic imaging*

OBJECTIVETo discuss surgical procedures and curative effect of ankylosing spondylitis with cervical spine fracture.

METHODSFrom January 2003 to October 2011, 8 patients with ankylosing spondylitis with cervical spine fracture were respectively treated by surgical treatment (7 cases) and conservative treatment (1 case), 8 cases were male with an average of age 41 years old (ranged, 27 to 49). All patients were confirmed by CT and MRI,and 6 cases combined with spinal cord injury. One case was treated with skull-neck-thorax model, 7 cases were treated by surgery. The procedures included anterior approach (5 cases), posterior approach (1 case), and combined anteroposterior approach (1 case). Fracture fusion condition were evaluated according to CT at the final following up, improvement of spinal cord injury were assessed according to Frankel classification.

RESULTSEight patients were followed up from 4 to 38 months with an average of 34 months. Seven cases obtained bone healing, 3 patients without spinal cord injury remained intact after operation, 5 patients with spinal cord injury improved at different degree after operation. Frankel classification of 7 patients were improved 1 degree, and 1 case delayed union for following up.

CONCLUSIONAnkylosing spondylitis with cervical spine fracture is a special kind of trauma, which have a high rate of neurological deficits. Surgery should be performed as early as possible, and procedures were chosen depending on particular case.

Adult ; Cervical Vertebrae ; diagnostic imaging ; injuries ; surgery ; Female ; Fracture Fixation, Internal ; Humans ; Male ; Middle Aged ; Radiography ; Retrospective Studies ; Spinal Fractures ; diagnostic imaging ; surgery ; Spondylitis, Ankylosing ; diagnostic imaging ; surgery

Humans ; Uric Acid ; Cross-Sectional Studies ; Spondylarthritis/diagnostic imaging* ; C-Reactive Protein ; Spondylitis, Ankylosing

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

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

OBJECTIVE: To investigate the effect of interventional therapy in the treatment of intervertebral space infection. METHODS: The needle was punctured into the infected intervertebral space from the post-lateral side of the spine monitored by X-rays. The pus was drained, the degenerative disc tissues and necrosis tissues were excised and taken out, and at the end a drainaging catheter was put into the space through the needle. The patient should lie in bed absolutely. The antibiotics was injected into the space through the silicon catheter every day. Three to four weeks later, the catheter was removed. RESULTS: All the 8 patients got good results after the therapy. The low back pain was dramatically alleviated instantly at the day of operation. Erythrocyte sedimental rate gradually descended. After 3 approximately 4 weeks of treatment,the catheter was removed. CONCLUSION Interventional therapy of the intervertebral space infection has notable advantage over the open operation.
Adolescent ; Adult ; Aged ; Anti-Bacterial Agents ; administration & dosage ; Blood Sedimentation ; Female ; Humans ; Intervertebral Disc ; diagnostic imaging ; microbiology ; Male ; Middle Aged ; Punctures ; methods ; Radiography, Interventional ; methods ; Spondylitis ; diagnostic imaging ; microbiology ; therapy ; Staphylococcal Infections ; blood ; therapy ; Treatment Outcome

BACKGROUNDPrevious studies showed that combining apparent diffusion coefficient (ADC) value with the Spondyloarthritis Research Consortium of Canada (SPARCC) index value might provide a reliable evaluation of the activity of ankylosing spondylitis (AS), and that contrast-enhanced (CE) magnetic resonance imaging (MRI) is unnecessary. However, the results were based on confirming only a small random sample. This study aimed to assess the role of CE-MRI in differentiating the disease activity of AS by comparing ADC value with a large sample.

METHODSA total of 115 patients with AS were enrolled in accordance with Bath AS Disease Activity Index and laboratory indices, and 115 patients were divided into two groups, including active group (n = 69) and inactive group (n = 46). SPARCC, ΔSI, and ADC values were obtained from the short tau inversion recovery (STIR), diffusion-weighted imaging (DWI), and CE-MRI, respectively. One-way analysis of variance and receiver operating characteristic analysis were performed for all parameters.

RESULTSThe optimal cutoff values (with sensitivity, specificity, respective area under the curve, positive likelihood ratio, and negative likelihood ratio) for the differentiation between active and inactive groups are as follows: SPARCC = 6 (72.06%, 82.61%, 0.836, 4.14, 0.34); ΔSI (%) = 153 (80.6%, 84.78%, 0.819, 5.3, 0.23); ADC value = 1.15 × 10-3 mm2/s (72.73%, 81.82%, 0.786, 4, 0.33). No statistical differences were found among the predictive values of SPARCC, ΔSI, and ADC. Multivariate analysis showed no significant difference between the combination of SPARCC and ADC values with and without ΔSI.

CONCLUSIONSUsing large sample, we concluded that the combination of STIR and DWI would play significant roles in assessing the disease activity, and CE-MRI sequence is not routinely used in imaging of AS to avoid renal fibrosis and aggravation of kidney disease.

Adolescent ; Adult ; Contrast Media ; Diagnosis, Differential ; Diffusion Magnetic Resonance Imaging ; methods ; Female ; Humans ; Image Enhancement ; methods ; Magnetic Resonance Imaging ; methods ; Male ; Middle Aged ; ROC Curve ; Sensitivity and Specificity ; Spondylitis, Ankylosing ; diagnostic imaging ; physiopathology ; Young Adult