Psöriazisli hastalarda sakroileitin manyetik rezonans görüntüleme bulguları
Amaç: Bu çalışmanın amacı, psöriazisli hastalardaki sakroileit sıklığını ve sakroileite ait karakteristik manyetikrezonans (MR) görüntüleme bulgularını belirlemektir.Yöntemler: Çalışmamıza hastanemiz Dermatoloji polikliniğinde, Şubat 2012-Şubat 2013 tarihleri arasında klinik ve histopatolojik olarak psöriazis tanısı konulan toplam 68 hasta dâhil edildi. Tüm hastalara bilateral sakroiliak MR inceleme yapıldı. MR görüntüleme, 1,5 T sistemde, koronal planda T1-ağırlıklı turbo spin-echo, T2-ağırlıklı ve yağ-baskılı short tau inversion recovery (STIR) sekansları ile uygulandı. Subkondral kemikteki değişiklikler MR sinyal özelliklerine göre sınıflandırıldı. Bulgular: Çalışmaya dâhil edilen hastaların 37’si (%54,4) erkek, 31’i (% 45,6) kadın idi. Yaşları 16-60 yıl arasında değişen hastaların yaş ortalaması 32,3±7,8 yıl olarak bulundu. Hastaların ortalama hastalık süresi 12,4±8,6 yıl (dağılım 2-24 yıl) idi. Toplam 68 psöriazis hastasının 52’sinde (%76,5) sakroileit lehine herhangi bir bulgu saptanmazken, 16 hastada (%23,5) sakroileit ile uyumlu sinyal değişiklikleri izlendi. Sakroileit saptanan 16 hastaya ait toplam 22 sakroiliak eklemde bir ya da birden çok radyolojik lezyonu saptadık. Manyetik rezonans incelemedeki patolojik bulgulara göre sınıflandırıldığında 6 (%27,3) eklemde Tip-1, 8 (%36,4) eklemde Tip-2, 10 (%45,5) eklemde Tip-3 değişiklik bulguları, 9 (%40,9) eklemde erezyon, 6 (%27,3) eklemde eklem mesafesinde daralma ve 5 (%22,7) eklemde ankiloz bulguları izlendi. Sonuç: Psöriazisli hastalarda sakroileit önemli bir problem teşkil etmektedir. MR görüntüleme psöriazisli hastalardaki sakroileit tanısında, sakroiliak eklem anatomisini ve sakroileit lezyonlarını ayrıntılı olarak gösterebilen veradyasyon maruziyeti olmayan non-invaziv yararlı bir görüntüleme yöntemidir.
Magnetic resonance imaging findings of sacroiliitis in patients with psoriasis
Objective: The aim of this study was to determine the frequency and characteristic magnetic resonance (MR) imaging features of sacroiliitis in patients with psoriasis disease. Methods: A total of 68 patients who diagnosed with psoriasis in Dermatology department of our hospital between February-2012 and February-2013 were included to our study. All patients were underwent bilateral sacroiliac MR. MR study were performed with the sequences of the coronal T1 weighted turbo spin-echo, T2 weighted and STIR images using a 1,5-T MR device for all patients. Changes in the subchondral bone were classified according to MR signal features. Results: Of these patients, 37 (54.4 %) were male and 31 (45.6 %) were female. The mean age was 32.3±7.8 years, ranging from 16 to 60 years. Mean disease duration was 12.4±8.6 years (2-24 years). While MR imaging findings were normal in 52 (76,5%) patients, signal changes consisted with sacroiliitis were observed in 16 (23.5%) patients. One or more MR lesion consisted with sacroiliitis were observed in a total of 22 sacroiliac joint of 16 patients. The signal abnormalities detected by MR imaging were as follows, Type-1 changes in 6 (27.3%) joints, Type-2 changes in 8 (36.4%) joints, Type-3 changes in 10 (45.5%) joints, erosions in 9 (40.9%) joints, narrowing the joints space in 6 (27.3%) joints and ankylosis in 5 (22.7%) joints. Conclusion: Sacroiliitis in psoriatic patients is an important clinical problem. MR imaging is a useful diagnostic modality in the diagnosis of psoriatic sacroiliitis which can demonstrate detailed anatomy of the sacroiliac joint and the changes of sacroiliitis without radiation exposure.
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- 1. Gelfand JM, Gladman DD, Mease PJ, et al. Epidemiology of psoriatic arthritis in the population of the United States. J Am Acad Dermatol 2005;53:573.
- 2. Shbeeb M, Uramoto KM, Gibson LE, et al. The epidemiology of psoriatic arthritis in Olmsted County, Minnesota, USA, 1982-1991. J Rheumatol 2000;27:1247- 1250.
- 3. Tuncer S. Psoriatic Arthritis Türkiye Klinikleri J Int Med Sci 2005;1:32-38.
- 4. Camp RDR. Psoriasis. In: Champion RH, Burton JL, Burns DA, Breathnach SM, eds. Textbook of Dermatology, Sixth edition. Oxford, Blackwell Science Publ., 1998:1589-1649.
- 5. Ahlström H, Felteius N, Nyman R, Hallgren R. Magnetic resonance imaging of sacroiliac joint inflammation. Arthritis Rheum 1990;33:1763-1769.
- 6. Muche B, Bollow M, Francois RJ, et al. Anatomic structures involved in early- and late-stage sacroiliitis in spon-dylarthritis: a detailed analysis by contrast-en- hanced magnetic resonance imaging. Arthritis Rheum 2003;48:1374-1384.
- 7. Dougados M, Van der Linden S, Juhlin R, et al. The European Spondyloarthropathy Study Group preliminary criteria for the classification of spondyloarthropathy. Arthritis Rheum 1991;34:1218-1227.
- 8. Helliwell PS, Taylor WJ. Classification and diagnostic criteria for psoriatic arthritis. Ann Rheum Dis 2005, Suppl II:ii3-ii7.
- 9. Gladman DD. Psoriatic Arthritis. Rheum. Dis Clin North Am 1998;24:829-844.
- 10. Marsal S, Armadans-Gil L, Martinez M, et al. Clinical, radiographic and HLA assosiations as markers for different patterns of psoriatic arthritis. Rheumatology 1999;38:332-337.
- 11. Braun J, Bollow M, Seper J. Radiology and pathology of the spondyloarthropathies. Rheum Dis Clin N Am 1998;24:697-735.
- 12. Murphy MD, Wetzel LH, Brable JM, et al. Sacroiliitis: MR imaging findings. Radiology 1991;180:239-244.
- 13. Braun J, Bollow M, Seper J. Radiology and pathology of the spondyloarthropathies. Rheum Dis Clin N Am 1998;24:697-735.
- 14. Yu W, Feng F, Dion E, et al. Comparison of radiography, computed tomography and magnetic resonance imag-ing in the detection of sacroiliitis accompanying ankylosing spondylitis. Skeletal Radiol 1998;27:311- 320.
- 15. Blum U, Buitrago-Tellez C, Mudinger A, et al. Magnetic resonance imaging (MRI) for detection of active sacroiliitis: a prospective study comparing conventional radiography, sintigraphy and contrast-enhanced MRI. J Rheumatol 1996;23:2107-2115.
- 16. Battafarano DF, West SG, Rak KM, et al. Comparision of bone scan, computed tomography and magnetic resonance imaging in the diagnosis of active sacroiliitis. Semin Arthritis Rheum 1993;23:161-176.
- 17. Ahlström H, Felteius N, Nyman R, Hallgren R. Magnetic resonance imaging of sacroiliac joint inflammation. Arthritis Rheum 1990;33:1763-1769.
- 18. Docherty P, Mitchell MJ, MacMillan L, et al. Magnetic resonance imaging in the detection of sacroiliitis. J Rheumatol 1992;19:393-401.
- 19. Wittram C, Whitehouse CH. Normal variation in the magnetic resonance imaging appearances of the sacroiliac joints: pitfalls in the diagnosis of sacroiliitis. Clin Radiol 1995;50:371-376.
- 20. Ricci C, Cova M, Kang YS, et al. Normal age related patterns of cellular and fatty bone marrow distribution in the axial skeleton: MR imaging study. Radiology 1990;177:83-88.
- 21. Dawson KL, Moore SG, Rowland CM. Age related marrow changes in the pelvis: MR and anatomical findings. Radiology 1992;183:47-51.