ABSTRACT
BACKGROUND: SERONEGATIVE SPONDYLOARTHROPATHY (SPA) IS A GROUP OF DISEASES INCLUDING: ankylosing spondylitis, psoriatic spondyloarthrithis, reactive arthritis, spondyloarthrithis associated with inflammatory bowel disease, and undifferentiated spondyloarthritis. One of the diagnostic criteria of SpA is the presence of sacroiliitis. Periarticular bone marrow oedema (histologically corresponding to osteitis) is a primary symptom of the active stage of inflammation, which can be identified by MR using T2-weighted images. Its presence is essential for the therapeutic decision. The aims of this study were: 1. to compare the diagnostic value of T2-weighted images with T1 gadolinium-enhanced fat saturation (FS) images. 2. to establish if T1 gadolinium-enhanced images increase the diagnostic value of the MRI examination. MATERIAL/METHODS: With the use of a 1.5T MRI scanner, 35 patients aged 19-67 years were examined. They were classified as having SpA or suspicious of SpA. The following findings were assessed: bone marrow oedema, synovitis, capsulitis/enthesistis. They were evaluated and compared on T2 and T1 gadolinium-enhanced FS images. RESULTS: Active sacroiliitis was identified in 21 patients, chronic in 1 patient. Two patients had signs of synovitis without any features of bone marrow oedema. One patient had fracture of the sacral bone. Ten patients had no signs of sacroiliitis. There was no significant difference in the diagnostic value between FSE T2 images and T1 gadolinium-enhanced images with FS in the evaluation of bone marrow oedema and capsulitis/enthesitis. However, T1 gadolinium-enhanced images were more sensitive than FSE T2 images in visualising synovitis. CONCLUSIONS: MRI is a very sensitive method to identify active sacroiliitis in SpA. MRI without contrast administration is sufficient to identify bone marrow oedema as a crucial finding in active sacroiliitis. The gadolinium-enhanced images make the diagnosis easier, especially in patients with minimal bone marrow oedema because they reveal or better depict synovitis, while they do not improve visualisation of capsulitis/enthesitis.
ABSTRACT
BACKGROUND: CT-angiography is a non-invasive method, alternative to cerebral angiography in the diagnosis of intracranial aneurysms. The aim of the study was the assessment of the efficiency of CT-angiography in a large material, which has been mostly verified with angiography and/or surgery. MATERIAL/METHODS: CT-angiography was performed in 196 patients with intracranial bleeding. Seventy-three (73) patients underwent also cerebral angiography (CA), 121 were operated on, 74 of them solely on the basis of CT-angiography. A spiral CT scanning (2 mm slices, 1-1.5 pitch, 1 mm-gap reconstruction) combined with an injection of 120 mL of contrast medium (5 mL/sec) was used. Subsequently three-dimensional MIP reconstructions were received, supplemented in some cases with SSD, VRT and MPR. RESULTS: CT-angiography revealed 128 aneurysms in 106 patients, located mostly in anterior communicating, middle cerebral and internal carotid arteries. The size of most aneurysms was 6-10 mm, but nearly one-third of them did not exceed 5 mm. In the group of patients who underwent CA, there was only 1 false negative CT-angiography result, while in 7 patients CT-angiography allowed for the diagnosis of small aneurysms which were not clearly visible on CA. CT-angiography was superior to CA in assessment of aneurysm morphology by 3 independent radiologists in 17 out of 22 cases. CT-angiography findings were confirmed during surgery in all 74 patients. CONCLUSIONS: CT-angiography is highly effective in the diagnosis of intracranial aneurysms and the evaluation of their morphology. In our opinion, in most cases, CT-angiography is precise enough to plan a surgical or endovascular procedure.
