SPARTAN is a research and treatment network organization that includes expert clinicians and researchers who care for patients with spondyloarthritis. At this 15th Annual meeting research was presented that increases our understanding of these disorders that affect the spine.
The general notion would be that our knowledge of ancient disorders that are recognized in mummies from Egypt would be complete but that is not correct. We continue to gain greater understanding of exactly how these disorders affect human beings. One example is the determination of the best radiographic technique to follow change in the spine. Is it x-rays, magnetic resonance imaging (MRI), or computed tomography (CT).
Michael Ward, MD of the National Institutes of Health presented his 2 year study of measuring syndesmophytes in ankylosing spondylitis (AS) patients that is reported in the medical literature. Syndesmophytes are the vertically-oriented thin wafers of bone that fuse the spine, preventing motion. Growth of syndesmophytes is indicative of progression of disease. Ward performed lumbar spine CT scans on 33 AS patients at baseline, 1 year and 2 years. The heights and volumes of syndesmophytes were measured at 4 levels of the spine. The CT volume and height changes were associated with physician visual ratings of change more frequently than either MRI or Xray.
CT is a more sensitive means of quantifying bone growth in that spine than other radiographic techniques. The limiting factor for CT is the amount of radiation used for this technique compared to Xrays (less) and MRI (none). Dr. Ward and his group are investigating low radiation dose CT scans as a means of using this technique over time.
Currently, xray remains the primary way patients with AS are identified. MRI is a method to identify early inflammatory lesions in the sacroiliac joints. CT scan is the means to measure response to therapy with an inhibition of syndesmophyte formation. At this time, quantitative CT scanning remains a research technique.
- Ward M. Session on Quantification of syndesmophyte growth by CT. Proceedings from the 2017 Annual Spartan meeting
- Tan S et al. Quantitative syndesmophyte measurement in ankylosing spondylitis using CT: longitudinal validity and sensitivity to change over 2 years. Ann Rheum Dis 2015;74:437-443