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

Öz

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.

Anahtar Kelimeler

• Sacroiliitis
• Sacroiliac scintigraphy
• SPECT

Spondiloartrit Hastalarında Sakroileit Tespitinde Farklı Kemik Sintigrafisi Yöntemlerinin İncelenmesi

Öz

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.

Anahtar Kelimeler

• Sakroileit
• sakroiliak sintigrafi
• SPECT

Kaynakça

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