Investigation of Different Bone Scintigraphy Methods in the Determination of Sacroileitis with Spondyloarthritis Patients

Abstract

The diagnostic value of scintigraphy in the detection of sacroiliitis in patients with spondyloarthritis is unclear. Our aim is to evaluate the diagnostic value of bone scintigraphy that is done by different methods in detecting sacroiliitis in patients with clinically possible spondyloarthritis. Thirty-four patients with clinically sacroiliac disease underwent scintigraphic, laboratory and radiographic examinations. Eighty-one subjects were also included as a control group for quantitative analysis of the bone scan. 99mTc-MDP bone scintigraphy was performed using a planar imaging and single photon emission computed tomography (SPECT). In the planar images, the ratios between the whole and partial sacroiliac joint and the sacrum were measured, in addition, the sacroiliac joint and ilium ratio was calculated in the SPECT images. Using the clinical signs as the reference criterion, the diagnostic accuracy of the scintigraphic parameters was assessed. The sensitivity and specificity of planar imaging were 53% and 64%. When we used the ratio of the lower part of the joint, sensitivity and specificity were slightly increased. The sensitivity and specificity values (77% and 86%) of SPECT were higher than that found in planar methods. The sacroiliac joint / sacrum ratio (SI/S) in the control group did not differ between the right-left joints and between both sexes, however, there was a marked decrease with age in both sexes. As a result of the study, it was found that sacroiliac joint quantitative bone scintigraphy has a limited value for the diagnosis of sacroiliitis. In additon, SPECT shows better sensitivity and specificity than planar bone scintigraphy in the diagnosis of sacroiliitis.

Keywords

• Sacroiliitis
• Sacroiliac scintigraphy
• SPECT

Spondiloartrit Hastalarında Sakroileit Tespitinde Farklı Kemik Sintigrafisi Yöntemlerinin İncelenmesi

Abstract

Spondiloartritli hastalarda sakroilietin saptanmasında sintigrafinin tanısal değeri net değildir. Amacımız klinik olarak olası spondiloartritli hastalarda sakroilietin saptanmasında farklı yöntemlerle yapılan kemik sintigrafisinin tanısal değerini değerlendirmektir. Klinik olarak sakroiliak hastalığı olan 37 hastaya sintigrafik, laboratuvar ve radyografik inceleme yapıldı. Kontrol grubu olarak 81 olgunun kemik taramasının kantitatif analizi dahil edildi. Kemik sintigrafisi 99mTc-MDP düzlemsel görüntüleme ve tek foton emisyonlu bilgisayarlı tomografi (SPECT) kullanılarak yapıldı. Düzlemsel görüntülerde tüm ve kısmi sakroiliak eklem ile sakrum arasındaki oranlar ölçüldü, ek olarak SPECT görüntülerinde sakroiliak eklem ve ilium oranı hesaplandı. Klinik bulgular referans kriter olarak kullanılarak sintigrafik parametrelerin tanısal doğruluğu değerlendirildi. Düzlemsel görüntülemenin duyarlılığı ve özgüllüğü % 53 ve % 64 olarak tespit edildi. Eklemin alt kısmına ait oran kullanıldığında duyarlılık ve özgüllüğün az miktarda arttığı saptandı. SPECT ile bulunan duyarlılık ve özgüllük değerleri (% 77 ve % 86), düzlemsel yöntemlerde bulunanlardan daha yüksek olarak bulundu. Kontrol grubundaki sakroiliak eklem / sakrum oranı (Sİ/S) oranları hem sağ-sol eklemler arasında hem de her iki cins arasında farklılık göstermedi, ancak her iki cinste yaşla birlikte belirgin azalma saptandı. Çalışmanın sonucunda sakroiliak eklem kantitatif kemik sintigrafisinin sakroileit tanısı için sınırlı bir değerinin olduğu bulunmuştur. Ayrıca, SECT sakroileit tanısında düzlemsel kemik sintigrafisinden daha iyi duyarlılık ve özgüllük göstermektedir.

Keywords

• Sakroileit
• sakroiliak sintigrafi
• SPECT

References

1. Slobodin G, Hussein H, Rosner I, Eshed I. Sacroiliitis - early diagnosis is key. J Inflamm Res. 2018; 11: 339-344.
2. van Tubergen A, Weber U. Diagnosis and classification in spondyloarthritis: identifying a chameleon. Nat Rev Rheumatol. 2012; 8(5): 253-261.
3. Slobodin G, Rimar D, Boulman N, Kaly L, Rozenbaum M, Rosner I, et al. Acute sacroiliitis. Clin Rheumatol. 2016; 35: 851-6
4. Bernard SA, Kransdorf MJ, Beaman FD, Adler SR, Amini B, Appel M et al. ACR Appropriateness Criteria® Chronic Back Pain Suspected Sacroiliitis-Spondyloarthropathy. J Am Coll Radiol. 2017; 14(5): 62-70.
5. Song IH, Carrasco-Fernández J, Rudwaleit M, et al. The diagnostic value of scintigraphy in assessing sacroiliitis in ankylosing spondylitis: a systematic literature research. Ann Rheum Dis. 2008; 67(11): 1535-40.
6. Gheita TA, Azkalany GS, Kenawy SA, Kandeel AA. Bone scintigraphy in axial seronegative spondyloarthritis patients: role in detection of subclinical peripheral arthritis and disease activity. Int J Rheum Dis 2015; 18: 553-9.
7. Tofuku K, Koga H, Komiya S. The diagnostic value of single-photon emission computed tomography/computed tomography for severe sacroiliac joint dysfunction. Eur Spine J. 2015; 24: 859-63.
8. Parghane RV, Singh B, Sharma A, Singh H, Singh P, Bhattacharya A. Role of (99m)Tc-Methylene Diphosphonate SPECT/CT in the Detection of Sacroiliitis in Patients with Spondyloarthropathy: Comparison with Clinical Markers and MRI. J Nucl Med Technol. 2017; 45(4): 280-284.

9. Rudwaleit M, van der Heijde D, Landewé R, et al. The Assessment of SpondyloArthritis International Society classification criteria for peripheral spondyloarthritis and for spondyloarthritis in general. Ann Rheum Dis. 2011;70: 25-31.
10. Inanc N, Atagündüz P, Sen F, Biren T, Turoğlu HT, Direskeneli H. The investigation of sacroiliitis with different imaging techniques in spondyloarthropathies. Rheumatol Int. 2005; 25(8): 591-4.
11. Kaçar G, Kaçar C, Karayalçin B, Güngör F, Tuncer T, Erkiliç M. Quantitative sacroiliac joint scintigraphy in normal subjects and patients with sacroiliitis. Ann Nucl Med. 1998; 12(3): 169-73.
12. Akdeniz O, Alayli G, Tosun FC, Diren B, Cengiz K, Selçuk MB, et al. Early spondyloarthropathy: scintigraphic, biological, and clinical findings in MRI-positive patients. Clin Rheumatol. 2008; 27(4): 469-74.
13. Pınar Koç Z, Kin Cengiz A, Aydın F, et al. Sacroiliac Indicis Increase the Specificity of Bone Scintigraphy in the Diagnosis of Sacroiliitis. Mol Imaging Radionucl Ther. 2015; 24(1): 8-14.
14. Yildiz A, Gungor F, Tuncer T, Karayalcin B. The evaluation of sacroiliitis using 99mTc-nanocolloid and 99mTc-MDP scintigraphy. Nucl Med Commun. 2001; 22(7): 785-94.
15. Davis MC, Turner DA, Charters JR et al. Quantitative sacroiliac scintigraphy. The effect of method of selection of region of interest. Clin Nucl Med. 1984; 9: 334–340
16. Bozkurt MF, Kiratli P. Quantitative sacroiliac scintigraphy for pediatric patients: comparison of two methods. Ann Nucl Med. 2014; 28(3): 227-31.
17. Tiwari BP, Basu S. Estimation of sacroiliac joint index in normal subjects of various age groups: comparative evaluation of four different methods of quantification in skeletal scintigraphy. Nucl Med Rev Cent East Eur. 2013; 16(1): 26-30.
18. Lin WY, Wang SJ. Influence of age and gender on quantitative sacroiliac joint scintigraphy. J Nucl Med. 1998; 39(7): 1269-72.