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  • 1
    Electronic Resource
    Electronic Resource
    Springer
    Skeletal radiology 29 (2000), S. 439-446 
    ISSN: 1432-2161
    Keywords: Key words Magnetic resonance (MR) imaging ; Sacroiliac joint ; Septic sacroiliitis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Objective. To investigate the diagnostic value of magnetic resonance (MR) imaging in detecting septic sacroiliitis and to determine whether the MR characteristics allow this entity to be differentiated from sacroiliitis in spondylarthropathy (SpA). Patients and design. The imaging findings of 11 patients with septic sacroiliitis were retrospectively analyzed by two experienced radiologists. Radiographic surveys of the pelvis as well as computed tomography (CT) and MR images of the sacroiliac joints were available in all cases. Seven of the patients additionally underwent a follow-up MR examination. The MR imaging protocol comprised combinations of coronal and transverse T1-weighted spin-echo (SE) or fast SE sequences, T2-weighted gradient-echo (GE) sequences and short tau inversion recovery sequence (STIR) sequences as well as dynamic contrast- enhanced T1-weighted acquisitions. Results. Three patients with a short disease history showed anterior and/or posterior subperiosteal infiltrations (”lava cleft phenomenon”), transcapsular infiltrations of juxta-articular muscle layers, which obscured the fasciae, and periarticular bone marrow edema. The eight patients with more advanced stages of sacroiliitis additionally showed abscess formation, sequestration, and erosion. At follow-up MR examination (n=7) under systemic antibiotic treatment, the morphologic characteristics showed progression (n=1), regression (n=4), unchanged findings (n=1), or a mixed response (n=1). Clinical improvement precedes resolution of the MR findings. Conclusions. Anterior and/or posterior subperiosteal infiltrations and transcapsular infiltrations of juxta-articular muscle layers were depicted in all patients. These MR imaging findings are characteristic of septic sacroiliitis and may be used to differentiate this entity from sacroiliitis in SpA.
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  • 2
    ISSN: 0340-1855
    Keywords: Schlüsselwörter Sakroiliitis ; Spondylarthropathie ; Magnetresonanztomographie ; Strahlenexposition ; Kosteneffektivität ; Key words Sacroiliitis ; Spondyloarthropathy ; magnetic resonance imaging ; radiation ; exposure ; cost effectiveness
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Involvement of the sacroiliac joints is a hallmark of the spondyloarthropathies, especially in ankylosing spondylitis. The conventional diagnostic imaging of sacroiliitis in early stages might cause problems, because sensitivity of conventional radiographic methods is known to be too low in early stages of the disease. Magnetic resonance imaging of the sacroiliac joints certainly enables one to detect acute as well as chronic inflammatory changes in all stages of the disease. The potential disadvantages of this method are the dependency on the examiner, the lack of standardization, and the relatively high costs. Therefore, the „Workgroup of Diagnostic Imaging in Rheumatology of the Regional Center of Rheumatology of Berlin“ including experienced rheumatologists, skeletal radiologists, and orthopedists acquired an imaging graduation for detection of sacroiliitis in consideration of the clinical background, the technical details of the methods, questions of ionizing radiation exposure, and cost effectiveness.
    Notes: Zusammenfassung Die entzündliche Beteiligung der Sakroiliakalgelenke ist das Schlüsselsymptom der Spondylarthropathien, vor allem bei der ankylosierenden Spondylitis. Die konventionelle bildgebende Diagnostik der Sakroiliitis gilt in den Frühstadien als problematisch, da die Sensitivität konventioneller Röntgenaufnahmen hier sehr gering ist. Die Magnetresonanztomographie der Sakroiliakalgelenke ist in der Lage, sowohl akut entzündliche als auch chronische Veränderungen in allen Stadien zu erfassen. Mögliche Nachteile dieser Methode sind Untersucherabhängigkeit, bislang fehlende Standardisierung sowie die noch relativ hohen Kosten. Deshalb hat der „Arbeitskreis bildgebende Diagnostik in der Rheumatologie des Regionalen Rheumazentrums Berlin“, welcher sich aus erfahrenen Rheumatologen, Skelettradiologen und Orthopäden zusammensetzt, eine Übersicht der bildgebenden Diagnostik der Sakroiliitis erarbeitet, in welcher neben dem klinischen Hintergrund auch technische Details ausgeführt und Strahlenexposition und Kosteneffektivität berücksichtigt werden.
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  • 3
    ISSN: 1432-1084
    Keywords: Key words: MR imaging ; Contrast agent Gd-EOB-DTPA ; Bile ducts ; Gallbladder
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. The purpose of this study was to investigate the time course of contrast enhancement in bile ducts and the gallbladder (GB) after injection of gadolinium-ethoxybenzyl-DTPA (Gd-EOB-DTPA). In a clinical phase-I study, MR imaging at 1.5T was performed in 16 healthy volunteers with four different doses of Gd-EOB-DTPA (10, 25, 50, and 100 μmol/kg b. w., four volunteers per dosage). The study protocol comprised a heavily T1-weighted fast multiplanar gradient-echo (GE) sequence before and at increasing intervals for up to 360 min after injection of Gd-EOB-DTPA. The signal enhancement was evaluated in extra- and intrahepatic bile ducts as well as in the GB. In all 16 volunteers the common bile duct showed intense signal enhancement beginning 5–16 min after injection (mean 10 min) and persisting for at least 120 min in 4 subjects and for 360 min in 12 subjects. The duration of signal enhancement was significantly (p 〈 0.05) longer for higher doses (50, 100 μmol/kg) than for lower doses (10, 25 μmol/kg). Intrahepatic bile ducts were hyperintense as compared with liver parenchyma in all subjects receiving 10 μmol/kg from approximately 50–120 min after contrast agent application. Intrahepatic bile ducts were not displayed using the higher doses, probably because of the strong enhancement of the liver parenchyma. Gallbladder contrasting was achieved in all cases beginning 7–33 min after injection (mean 19 min) and remained visible for up to 360 min in 94 %. Hyperintense visualization of normal extrahepatic bile ducts as well as the GB is regularly achieved with the hepatobiliary contrast agent Gd-EOB-DTPA. The dosage for hyperintense visualization of intrahepatic bile ducts is 10 μmol/kg.
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  • 4
    ISSN: 1432-2161
    Keywords: Key words Joints ; sacroiliac ; Children ; skeletal system ; MR contrast enhancement ; Arthritis ; in infants and children
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Objective. To determine in a prospective study the normal MRI morphology of the sacroiliac joints (SIJs) in relation to age and sex during adolescence. Design and patients. A total of 98 children (63 boys, mean age 12.7±2.8 years; 35 girls, mean age 13.7±2.3 years), ranging in age from 8 to 17 years, with juvenile chronic arthritis (JCA) but without signs of sacroiliitis fulfilled the study prerequisites (no back pain and no pathologic changes of the SIJs on physical examination before MRI in a 1.5-year follow-up). An additional eight HLA-B27-negative boys and eight HLA-B27-negative girls without arthritis served as controls. The MRI protocol comprised a T1-weighted SE sequence, an opposed-phase T2*-weighted GE sequence, and a dynamic contrast-enhanced study in single-section technique. Results. Noncontrast MRI permitted differentiation of “open” from ossified segmental and lateral apophyses of the sacral wings, with a significant difference in age (P 〈0.05) between children with open and ossified apophyses. Ossification of the apophyses of the sacral wings was seen significantly earlier (P 〈0.05) in girls than in boys. Girls also had a significantly higher incidence of transitional lumbosacral vertebrae, pelvic asymmetries, and accessory joints. In the contrast-enhanced opposed-phase MRI study, normal cartilage of the SIJs showed no contrast enhancement whereas the joint capsule showed a moderate enhancement. Conclusion. There are significant age- and sex-related differences in the normal MRI morphology of juvenile SIJs. Our findings might serve as a standard of comparison for the evaluation of pathologic changes – in particular for the early identification of juvenile sacroiliitis.
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  • 5
    ISSN: 1432-2161
    Keywords: Key words MR imaging ; Sacroiliitis ; Spondyloarthropathy ; Arthritis ; in infants and children
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Purpose. To verify the diagnostic value of contrast-enhanced MR imaging compared with conventional radiography in the diagnosis of sacroiliitis in children. Design and patients. Radiography and MR imaging of the sacroiliac joints were performed in 185 children subdivided into the following groups according to the modified European Spondyloarthropathy (SpA) Study Group (ESSG) criteria: group 1, undifferentiated spondyloarthropathy (uSpA) (n=53, 94.5% HLA-B27+); group 2, differentiated SpA (n=45, 93.3% HLA-B27+); group 3, patients with no signs of SpA other than oligoarthritis (n=39, 92.3% HLA-B27+); group 4, HLA-B27+ controls with various other non-SpA diagnoses (n=22); and group 5, HLA-B27– controls with various other non-SpA diagnoses (n=26). Radiographs were evaluated on the basis of the modified New York criteria independently by three experienced radiologists masked to the clinical data. In a second step, the same radiologists independently evaluated the MR images without knowledge of the clinical data and radiographic findings using the recently published criteria developed by our group. These criteria allow differentiation of acute and chronic inflammatory changes. Results. Radiography demonstrated sacroiliitis in 18 patients: 4 of 53 in group 1 (7.5%), 14 of 45 in group 2 (31%), but none in groups 3, 4 and 5. In contrast, MR imaging demonstrated acute and/or chronic sacroiliitis in 44 patients: 18 of 53 in group 1 (34%), 21 of 45 in group 2 (46.7%) and 5 of 39 in group 3 (12.8%), but none in groups 4 and 5. The percentage of sacroiliitis detected by MR imaging was significantly higher than that detected by radiography (P〈0.001). Conclusion. Contrast-enhanced MR imaging is a useful method for detecting sacroiliitis in children. Advantages of contrast-enhanced MR imaging compared with conventional radiography are a higher sensitivity due to the ability to document early and acute changes and the absence of radiation exposure.
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  • 6
    Electronic Resource
    Electronic Resource
    Springer
    Naturwissenschaften 42 (1955), S. 389-390 
    ISSN: 1432-1904
    Source: Springer Online Journal Archives 1860-2000
    Topics: Biology , Chemistry and Pharmacology , Natural Sciences in General
    Type of Medium: Electronic Resource
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  • 7
    Electronic Resource
    Electronic Resource
    Springer
    Clinical rheumatology 19 (2000), S. 51-57 
    ISSN: 1434-9949
    Keywords: Key words:Magnetic resonance imaging – Sacroiliitis – Spondyloarthropathies
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract: Inflammation of one or both sacroiliac joints is a characteristic feature of patients with spondyloarthropathies (SpA). Sacroiliitis often leads to inflammatory back pain (IBP). IBP and asymmetric peripheral arthritis of the lower limbs are the main clinical symptoms and criteria for classification and diagnosis of SpA in which sacroiliac joints are uni- or bilaterally affected with an intensity ranging from mild to very severe inflammation resulting in partial or complete ankylosis Sacroiliitis is a very frequent feature of undifferntiated SpA. In ankylosing spondylitis (AS) inflammation in the axial skeleton occurs rarely in the absence of sacroiliitis. Objective evidence of sacroiliitis obtained by imaging procedures, especially x-rays, has always been part of diagnostic and classification criteria for AS. This is in contrast to spinal radiography which, however, has been recently included in a core set of outcome items to be assessed in clinical studies. In early and acute stages of sacroiliitis the diagnosis can be difficult because conventional radiographs - which are known to have considerable intra- and interobserver variability - may be normal. Since IBP is not a specific indicator of sacroiliitis there is need for valuable imaging techniques. Scintigraphy lacks specificity. Computed tomography (CT) is a very good method to demonstrate already established bony changes and magnetic resonance imaging (MRI) has the advantage of combining a good visualisation of the complicated anatomy of the sacroiliac joint with the ability to localise different degrees of inflammation and oedema and prove a possible spread to muscles as it occurs in septic sacroiliitis, an important differential diagnosis.
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