Dra. Rosa Alvarez Malagón Radióloga Músculo- Esquelética u Osteoarticular

Transcripción

1 Dra. Rosa Alvarez Malagón Radióloga Músculo- Esquelética u Osteoarticular

2 Usualmente Reportamos para el neurocirujano, cirujano ortopeda, rehabilitador, médico deportivo. Qué pasa con el Reumatólogo? No buscamos estas patologías..spa

3 Diseases classified as spondyloarthropathies. 1. Ankylosing spondylitis 2. Arthritis associated with inflammatory bowel diseases (ulcerative colitis UC, Crohn s disease CD) 3. Reactive arthritis 4. Undifferentiated spondyloarthropathies 5. Psoriatic arthritis 6. Juvenile spondyloarthropathies Pol J Radiol Apr-Jun; 78(2):

4 ASAS criteria classification para el eje axial ASAS (Assessment in SpondyloArthritis international Society) * Diagnosis of sacroilitis in the course of SpA is supported by presence of active inflammatory lesions in MR examination or x-ray changes defined according to modified New York criteria from ** Symptoms of SpA: inflammatory back pain, arthritis, enthesitis, iritis, dactylitis, psoriasis, C or UC, good response to non-steroidal antiinflammatory drugs, family history of SpA, presence of HLA-B27, elevated serum CRP level. Inflammatory back pain in clinical examination (def.: back pain lasting 3 months that first occurred before the age of 45, with insidious, chronic onset, improving after exercise, without improvement after rest, nocturnal pain improving on getting up from bed) Sacroiliitis in imaging studies HLA-B27 antigen present sign of spondyloarthrop athy or 2 signs of spondyloarthrop athy Pol J Radiol Apr-Jun; 78(2):

5 ASAS criteria classification periféricas para SPA Arthritis (usually non-symmetrical arthritis of lower limb joints), enthesitis (inflammation of tendon, ligament and capsule insertions), dactylitis (so-called sausage fingers) plus 1 symptom of SpA or 2 other symptoms of SpA 1 sign of spondyloarthropathy psoriasis CD or UC preceding infection positive HLA-B27 uveitis sacroilitis in x-ray or MR 2 other signs of spondyloarthropathy arthritis enthesitis dactylitis/sausage fingers inflammatory back pain family history of SpA

6 Radiological classification of sacroilitis according to New York criteria. Grade 0 Grade 1 No changes/sacroiliac joint normal Suspected changes (blurry margins of sacroiliac joint gap) Grade 2 Minimal changes (single erosions and periarticular sclerosis involving small area of iliac or sacral bone) Grade 3 Grade 4 Advanced changes (distinct periarticular sclerosis, numerous erosions with widening of articular gap, possible partial ankylosis) Total ankylosis Pol J Radiol Apr-Jun; 78(2): 43 49

7 Criterio radiológico para SPA según los criterios modificados de NY (1984) Pol J Radiol Apr-Jun; 78(2): 43 49

8 Barato y fácil acceso Varía entre observadores Retarda el dx Poco sensible en etapas iniciales Cx y hallazgos (1-9 años)

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10 Rx normal en atleta de 21 años con dolor lumbar. Vistas de Ferguson oblícuas AP Oblique views

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12 Bilateral Grade 2 SACROILIITIS Note subtle erosions inferior Sacroiliitis aspect grado II bilateral Bilateral Grade 2 SI joints. of both SI joints (arrows) Note sclerosis on iliac side Tercio medio e inferior (sinovial) of joints (arrows) Posterior y superior (ligamentosa)

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17 Grade 4 sacroiliitis. Ankylosis of SI joints. Note ossification of ilio-lumbar ligaments (arrows). SI Grado IV Lig. Ilio-lumbares

18 SI: derecha grado I. // La izquierda es grado I/II

19 Mismo pt anterior : SI bilateral Ax STIR

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21 Grado II derecha y grado I izquierda

22 Masc de 24 y.o en emergencia por dolor lumbar. Erosiones lado ilíaco inicial por cartílago más fino Escleroris Ankilosis (cambios estructurales)

23 Sensible al edema o inflamación Y las efusiones. STIR / T2 Fat Sat / DP fat sat No radiación Menos detecta oscificación, calcificaciones y cambios corticales.

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25 SI activa vs Inactiva

26 Fat metaplasia

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34 Esquinas Anteriores vertebrales (anterior corners) Unión Costo Vertebral y Costo Transversa Erosiones de los Platillos Vertebrales.

35 IVE AND INACTIVE INACTIVE ACTIVE Sag T1 Sag STIR

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43 Protrusio deformity Bilateral fused hip and SI joints ENTHESITIS T2 Cor STIR Cor STIR

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