Herregods Nele, Dehoorne Joke, Jaremko Jacob, Joos Rik, Baraliakos Xenofon, Verstraete Koenraad, Jans Lennart
Ghent University Hospital, BE.
University of Alberta Hospital, CA.
J Belg Soc Radiol. 2016 Nov 19;100(1):95. doi: 10.5334/jbr-btr.1198.
Early diagnosis of spondyloarthritis (SpA) is becoming more important as new medical treatment options have become available to treat inflammation and delay progression of the disease. Increasingly, magnetic resonance imaging (MRI) of the sacroiliac joints is obtained for early detection of inflammatory changes, as it shows active inflammatory and structural lesions of sacroiliitis long before radiographic changes become evident. MRI of the sacroiliac joints in children is a useful tool for suspected juvenile spondyloarthritis (JSpA), even though it is not yet included in the current pediatric classification systems. Recognizing MRI features of pediatric sacroiliitis is a challenge. As most radiologists are not familiar with the normal MRI appearance of the pediatric sacroiliac joint, clear definitions are mandatory. Actually, the adult Assessment of Spondyloarthritis International Society (ASAS) definition for sacroiliitis needs some adaptations for children. A proposal for a possible pediatric-specific definition for active sacroiliitis on MRI is presented in this review. Furthermore, MRI without contrast administration is sufficient to identify bone marrow edema (BME), capsulitis, and retroarticular enthesitis as features of active sacroiliitis in JSpA. In selected cases, when high short tau inversion recovery (STIR) signal in the joint is the only finding, gadolinium-enhanced images may help to confirm the presence of synovitis. Lastly, we found a high correlation between pelvic enthesitis and sacroiliitis on MRI of the sacroiliac joints in children. As pelvic enthesitis indicates active inflammation, it may play a role in assessment of the inflammatory status. Therefore, it should be carefully sought and noted when examining MRI of the sacroiliac joints in children.
随着可用于治疗炎症和延缓疾病进展的新医疗选择不断出现，脊柱关节炎（SpA）的早期诊断变得愈发重要。越来越多地，骶髂关节的磁共振成像（MRI）被用于早期检测炎症变化，因为它能在放射学改变明显之前很久就显示出骶髂关节炎的活动性炎症和结构性病变。儿童骶髂关节的MRI对于疑似幼年脊柱关节炎（JSpA）是一种有用的工具，尽管它尚未被纳入当前的儿科分类系统。识别儿童骶髂关节炎的MRI特征是一项挑战。由于大多数放射科医生不熟悉儿童骶髂关节的正常MRI表现，明确的定义是必不可少的。实际上，成人脊柱关节炎国际协会（ASAS）对骶髂关节炎的定义需要针对儿童进行一些调整。本综述提出了一个可能的针对儿童的MRI上活动性骶髂关节炎的特定定义建议。此外，不使用造影剂的MRI足以识别骨髓水肿（BME）、关节囊炎和关节后附着点炎，这些是JSpA中活动性骶髂关节炎的特征。在某些选定的病例中，当关节内高短tau反转恢复（STIR）信号是唯一发现时，钆增强图像可能有助于确认滑膜炎的存在。最后，我们发现儿童骶髂关节MRI上盆腔附着点炎与骶髂关节炎之间存在高度相关性。由于盆腔附着点炎表明存在活动性炎症，它可能在评估炎症状态中发挥作用。因此，在检查儿童骶髂关节MRI时应仔细寻找并记录。
