articulatii sacroiliace.pdf
TRANSCRIPT
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Rezonanta Magnetica
Articulatii sacroiiliace
Nicolae Bolog, MD
Clinica Diagnostic Phoenix
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Cuprins
• Tehnica de examinare
• Diagnostic faza acuta / faza activa
• Evaluarea tratamentului
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Tehnica
• Pacient in decubit dorsal
• In aceeasi examinare : sacroiliace si coloana
• Platforma tehnica: 1.5 T (whole-spine)
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Tehnica
• Rapida
• SI : 5 minute
• Coloana: 11 minute
• Nu necesita contrast i.v.
One-stop shopping Saturday, May 8, 2010
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Diagnostic sacroileita / spondilita
• Radiografia:
• Utilizata pentru cuantificarea leziunilor din SA
• Scoruri:
• Stokes AS spinal score (SASSS)
• Bath Ankylosing Spondylitis Radiological Index
(BASRI)
• Avantaje: reproductibila
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Diagnostic sacroileita / spondilita
• Radiografia: dezavantaje
• Sensibilitate mica la evolutie
• Evaluare partiala a unor segmente:
• SASSS – col lombara
• SASSS m – col lombara si cervicala
• BASRI – col lombara, cervicala si sacroiliace
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Diagnostic sacroileita / spondilita
• Radiografia: dezavantaje
• Nu evidentiaza edemul in fazele incipiente ale bolii
• Nu evidentiaza sinovita in fazele incipiente ale bolii
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Diagnostic sacroileita / spondilitaFaza incipienta sau acuta
• Rezonanta magnetica:
Permite diagnosticul tuturor modificarilor
patologice din SI / SA:
• Edem intraosos (sacroiliace, corpi vertebrali)
• Sinovita
• Modificari inflamatorii: disc, art costo-vertebrale, artinterfatetare
• Entezite ligamente spinale
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Edemul intraosos
• Articulatiisacroiliace:
• Edemul poate sa aparafara sa evidentiem sinovita
• Indicatie de contrast i.v.
• Morfopatologic = osteita
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Edemul intraosos
• Corpi vertebrali
• Leziune Romanus
incipienta
• Indicatie de contrast i.v.
• Morfopatologic = osteita
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Edemul intraosos
“Sacroiliac joint biopsies in early sacroiliitis” Marzo-Ortega H et al. Rheumatology 2007;46(7):1210
“Correlation of histopathological findings and MRI in thespine of patients with ankylosing spondilitis”
Appel H et al. Arthritis research & Therapy 2006;8:R143
• Exista o buna corelatie intre RM si morfopatologie
• Toate cazurile cu edem RM au fost confirmate
• Edemul care ocupa > 60% din maduva! apare RM
• Edem < 30% din maduva! nu apare RM
• Celularitate: limfocite CD 3, CD 4, CD 8
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Leziunea Romanus
• Edem intraosos – nu RX
– Leziune activa / florida
• Degenerare adipoasa
– Leziune inactiva
– Apare pe Rx – “shiny corners”
– Apare tarziu in evolutie
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Spondilodiscita
Leziunea Andersson (1973)
• Modificari inflamatorii discale
• Afecteaza si platourile
• 8% din pacientii cu SA
• Examinarea de electie RM
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Scorul RM la pacientii cu SAASspiMRI
• Scor activitate
– 0 = Normal 1 = edem minor cu captare 25% 2 = edem moderat cucaptare 50% 3 = edem accentuat cu captare>50% 4 = eroziune minora(25%) cu edem si captare 5 = eroziune moderata(>25% but 50%), cu
edem si captare 6 = eroziune majora (>50%) cu edem si captare
• Scor cronicitate
– 0 = Normal 1 = scleroza minora 2 = scleroza/vertebra patrata/posibilsindesmofit 3 = 1-2 sindesmofiti/mici eroziuni 4 = >2 sindesmofiti/spondilodiscita/eroziuni severe 5 = punte vertebrala 6 = fuziunevertebrala
Braun J et al. Arthritis Rheumat 2003;48(4):1126-1136
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Scorul RM la pacientii cu SAASspiMRI
Braun J et al. Arthritis Rheumat 2003;48(4):1126-1136 Saturday, May 8, 2010
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Rolul RM in tratament
• Introducerea anti-TNF a crescut si necesitatea unuidiagnostic de acuratete in faza incipienta
• O metoda de diagnostic sensibila la modificarile subterapie
• Un scor reproductibil
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Rolul RM in tratament
“Magnetic resonance imaging examinations of the spine inpatients with ankylosing spondylitis, before and after
successful therapy with infliximab: Evaluation of a newscoring system”
Braun J et al. Arthritis Rheumat 2003;48(4):1126-1136
• 20 pacienti
• Examinare RM: 0, 2 si 6 saptamani
• 9 pacienti infliximab (5mg/kgc)
• 11 pacienti placebo
• 2 scoruri RM: de activitate si de cronicitate ASspiMRI
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Rolul RM in tratament
• Gd-DTPA si STIRreflecta scorul deactivitate
• T1 reflecta scorul de
cronicitate
0.039 0.001 0.55
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Rolul RM in tratament
“Clinical and MRI findings in ankylosing spondylitis patientseligible for anti-TNF therapy. Response to short-term
etoricoxib therapy”
Jarrett SJ et al. Ann Rheum Dis published online 24Oct 2008
• 22 pacienti
• Examinare RM: 0 si 6 saptamani
• etoricoxib (90mg/zi)
• Scorul Leeds pentru RM pentru sacroiliace si collombara (nr de leziuni)
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Rolul RM in tratament
• O activitate marcata evidentiabila RM la momentuldiagnosticului sugereaza un raspuns terapeuticmajor la terapie biologica
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Concluzii
• Rezonanta magnetica permite evaluarea tuturormodificarilor patologice din SA
• Rezonanta magnetica este capabila sa identifice
modificarile in stadiul incipient
• Utilizand rezonanta magnetica putem diferentia leziunileactive de cele cronice
• Scorul ASspiMRI este reproductibil si poate fi utilizat inmonitorizarea terapiei
Saturday, May 8, 2010