Wertigkeit der MR-Tomografie bei der Diagnostik der abakteriellen Sakroiliitis
BACKGROUND: Back pain has many causes. These includes destruction of tumors, changes due to metabolism dysfunction, degenerative illnesses and post infection arthritis. Another one is seronegative spondylarthopathy. Ankylosing spondylitis, reactive arthrits at Reiter disease, psoriatic arthritis, arthritis at chronic inflammatory intestinal disease and undifferentiated spondylarthopathy are amoung seronegative Spondylarthopathy. Diagnostic gold standard of these rheumatoid illnesses was a combination of anamnesis, examination and x-ray. In the last years Magnetic resonance imaging (MRI) became more important in the early diagnostic procedure of radiologists and rheumatologists. METHODS: The aim of our work was to verify the diagnostic value of MRI of the sacroiliac joint at inflammatory low back pain especially under daily routine. To do so all patients were seen at least for four years to verify the first MRI diagnosis. Furthermore we analysed the depandancy of this method from the experience of the physican with a interobserver reliability test. Therefore we analysed the MRI pictures of 65 patients in our department of radiology and neuroradiology in Augsburg (Germany). These patients had to fulfil following criterias: - clinical suspicion of inflammatory lower back pain accourding to the criteria of Calin et al. (1985) - examination and diagnosis by a rheumatologist - MRI in our department (July 95 to September 1998) - second examination and final diagnosis by a rheumatologist at least four years after the MRI. RESULTS: To evaluate the quality of routine MRI we compared the results of our radiology diagnosis with the final diagnosis of rheumatologists. Our analysis showed a sensitivity of 95%, a specificity of 98% for early MRI diagnosis of sacroiliitis. To evaluate the depandance of MRI from the physicans experience we analysed the MRI of 58 patients (=116 sacroiliac joints). Three radiologists with different experience in MRI stated these 56 MRI pictures without knowledge of medical history, primary and final diagnosis. On a given report they had to find sacroiliitis and different medical findings of each sacroiliac joint. This analysis of the results of the three radiologists without kwowledge of patients information showed sensitivity of 63%, a specificity of 80% for early MRI diagnosis of sacroiliitis. This data indicates a moderate level of agreement by kappa statistic analysis (kappa =0,71). On the other hand there are no single MRI finding to allow the diagnosis sacroiliitis. CONCLUSION: In conclusion to quality of MRI in the early sacroiliitis we came up with the following: MRI is capable for early diagnosis of sacroiliitis even in stadium 2 or below in x-ray. To diagnose sacroiliitis you need more than just a single MRI finding but a sum of all these MRI findings. A single MRI finding does not allow to diagnose sacroiliits. The accurancy arises with the experience of the physican. Clinical data like anamnesis and laboratory findings improve the sensitivity and specificity for early MRI diagnosis of sacroiliitis
info:eu-repo/classification/ddc/610, Medizin
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