Anterior Chest Wall in Axial Spondyloarthritis: Imaging, Interpretation, and Differential Diagnosis

Winston J. Rennie; Lennart Jans; Anne Grethe Jurik; Iwona Sudoł-Szopińska; Claudia Schueller-Weidekamm; Iris Eshed

doi:10.1055/s-0038-1639472

Seminars in Musculoskeletal Radiology, Table of Contents

Semin Musculoskelet Radiol 2018; 22(02): 197-206
DOI: 10.1055/s-0038-1639472

Review Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Anterior Chest Wall in Axial Spondyloarthritis: Imaging, Interpretation, and Differential Diagnosis

Winston J. Rennie

¹Department of Radiology, Leicester Royal Infirmary, University Hospitals of Leicester, Leicester, United Kingdom

,

Lennart Jans

²Department of Radiology, Ghent University Hospital, Ghent, Belgium

,

Anne Grethe Jurik

³Division of Radiology, Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark

,

Iwona Sudoł-Szopińska

⁴Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland

,

Claudia Schueller-Weidekamm

⁵Division of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging und Image-guided Therapy, Medical University of Vienna/Vienna General Hospital, Vienna, Austria

,

Iris Eshed

⁶Department of Radiology, Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

› Author Affiliations

Abstract

Anterior chest wall (ACW) inflammation is not an uncommon finding in patients with axial spondyloarthritis (ax-SpA) and reportedly occurs in 26% of these patients. Radiologists may only be familiar with spinal and peripheral joint imaging, possibly due to the inherent challenges of ACW imaging on some cross-sectional imaging modalities. Knowledge of relevant joint anatomy and the location of sites of inflammation allows the interpreting radiologist to better plan appropriate imaging tests and imaging planes. Accurate assessment of disease burden, sometimes in the absence of clinical findings, may alert the treating rheumatologist, allowing a better estimation of disease burden, increased accuracy of potential imaging scoring systems, and optimize assessment and response to treatment. This article reviews salient anatomy and various imaging modalities to optimize diagnosis, important differential diagnoses, and the interpretation of ACW imaging findings in ax-SpA.

Keywords

spondyloarthritis - anterior chest wall - magnetic resonance imaging - ultrasound - radionuclide imaging

Full Text

References

References
1 Weber U, Lambert RG, Rufibach K. , et al. Anterior chest wall inflammation by whole-body magnetic resonance imaging in patients with spondyloarthritis: lack of association between clinical and imaging findings in a cross-sectional study. Arthritis Res Ther 2012; 14 (01) R3
2 Dawes PT, Sheeran TP, Hothersall TE. Chest pain—a common feature of ankylosing spondylitis. Postgrad Med J 1988; 64 (747) 27-29
3 Fournié B, Boutes A, Dromer C. , et al. Prospective study of anterior chest wall involvement in ankylosing spondylitis and psoriatic arthritis. Rev Rhum Engl Ed 1997; 64 (01) 22-25
4 Elhai M, Paternotte S, Burki V. , et al. Clinical characteristics of anterior chest wall pain in spondyloarthritis: an analysis of 275 patients. Joint Bone Spine 2012; 79 (05) 476-481
5 Jurik AG. Anterior chest wall involvement in seronegative arthritides. A study of the frequency of changes at radiography. Rheumatol Int 1992; 12 (01) 7-11
6 Becker NJ, de Smet AA, Cathcart-Rake W, Stechschulte DJ. Psoriatic arthritis affecting the manubriosternal joint. Arthritis Rheum 1986; 29 (08) 1029-1031
7 Ramonda R, Lorenzin M, Lo Nigro A. , et al. Anterior chest wall involvement in early stages of spondyloarthritis: advanced diagnostic tools. J Rheumatol 2012; 39 (09) 1844-1849
8 Verhoeven F, Guillot X, Godfrin-Valnet M, Prati C, Wendling D. Ultrasonographic evaluation of the anterior chest wall in spondyloarthritis: a prospective and controlled study. J Rheumatol 2015; 42 (01) 87-92
9 Wendling D, Prati C, Demattei C, Loeuille D, Richette P, Dougados M. Anterior chest wall pain in recent inflammatory back pain suggestive of spondyloarthritis. data from the DESIR cohort. J Rheumatol 2013; 40 (07) 1148-1152
10 Rennie WJ. Clinical examination or whole-body magnetic resonance imaging: the Holy Grail of spondyloarthritis imaging. Arthritis Res Ther 2012; 14 (01) 110
11 Guglielmi G, Cascavilla A, Scalzo G, Salaffi F, Grassi W. Imaging of sternocostoclavicular joint in spondyloarthropathies and other rheumatic conditions. Clin Exp Rheumatol 2009; 27 (03) 402-408
12 Schils JP, Resnick D, Haghighi P, Trudell D, Sartoris DJ. Sternocostal joints. Anatomic, radiographic and pathologic features in adult cadavers. Invest Radiol 1989; 24 (08) 596-603
13 Sebes JI, Salazar JE. The manubriosternal joint in rheumatoid disease. AJR Am J Roentgenol 1983; 140 (01) 117-121
14 Johnston TB, Whillis J. Gray's Anatomy. Philadelphia, PA: Lea & Febiger; 1976: 309-310
15 Robinson CM, Jenkins PJ, Markham PE, Beggs I. Disorders of the sternoclavicular joint. J Bone Joint Surg Br 2008; 90 (06) 685-696
16 Lee JT, Campbell KJ, Michalski MP. , et al. Surgical anatomy of the sternoclavicular joint: a qualitative and quantitative anatomical study. J Bone Joint Surg Am 2014; 96 (19) e166
17 Kier R, Wain SL, Apple J, Martinez S. Osteoarthritis of the sternoclavicular joint. Radiographic features and pathologic correlation. Invest Radiol 1986; 21 (03) 227-233
18 Taccari E, Spadaro A, Riccieri V, Guerrisi R, Guerrisi V, Zoppini A. Sternoclavicular joint disease in psoriatic arthritis. Ann Rheum Dis 1992; 51 (03) 372-374
19 Emery RJ, Ho EK, Leong JC. The shoulder girdle in ankylosing spondylitis. J Bone Joint Surg Am 1991; 73 (10) 1526-1531
20 Louvel JP, Duvey A, Da Silva F. , et al. Computed tomography of sternoclavicular joint lesions in spondyloarthropathies. Skeletal Radiol 1997; 26 (07) 419-423
21 Haydl H, Petershofer H, Ellegast HH, Prohaska E. Diagnosis of psoriatic osteoarthropathy: comparison of clinical, radiologic and scintigraphic findings [in German]. Wien Klin Wochenschr 1984; 96 (09) 337-343
22 Jurik AG. Seronegative arthritis and sternocostoclavicular syndromes. In: Jurik AG. , ed. Imaging of the Sternocostoclavicular Region. New York, NY: Springer; 2007: 113-141
23 Lentle BC, Russell AS, Percy JS, Jackson FI. Scintigraphic findings in ankylosing spondylitis. J Nucl Med 1977; 18 (06) 524-528
24 Collie DA, Smith GW, Merrick MV. 99mTc-MDP scintigraphy in ankylosing spondylitis. Clin Radiol 1993; 48 (06) 392-397
25 Gheita TA, Azkalany GS, Kenawy SA, Kandeel AA. Bone scintigraphy in axial seronegative spondyloarthritis patients: role in detection of subclinical peripheral arthritis and disease activity. Int J Rheum Dis 2015; 18 (05) 553-559
26 Yamashita H, Kubota K, Takahashi Y. , et al. Similarities and differences in fluorodeoxyglucose positron emission tomography/computed tomography findings in spondyloarthropathy, polymyalgia rheumatica and rheumatoid arthritis. Joint Bone Spine 2013; 80 (02) 171-177
27 Idolazzi L, Salgarello M, Gatti D. , et al. 18F-fluoride PET/CT for detection of axial involvement in ankylosing spondylitis: correlation with disease activity. Ann Nucl Med 2016; 30 (06) 430-434
28 Healy PJ, Helliwell PS. Measuring clinical enthesitis in psoriatic arthritis: assessment of existing measures and development of an instrument specific to psoriatic arthritis. Arthritis Rheum 2008; 59 (05) 686-691
29 Plagou A, Teh J, Grainger AJ. , et al. Recommendations of the ESSR Arthritis Subcommittee on Ultrasonography in Inflammatory Joint Disease. Semin Musculoskelet Radiol 2016; 20 (05) 496-506
30 Sudoł-Szopińska I, Jans L, Teh J. Rheumatoid arthritis: what do MRI and ultrasound show. J Ultrason 2017; 17 (68) 5-16
31 D. R. MJ K. Rheumatoid arthritis and related diseases. In: Resnick D, Kransdorf MJ. , eds. Bone and Joint Imaging. Philadelphia, PA: Saunders Elsevier; 2005: 267-278
32 Sudoł-Szopińska I, Kwiatkowska B, Prochorec-Sobieszek M, Pracoń G, Walentowska-Janowicz M, Maśliński W. Enthesopathies and enthesitis. Part 2: Imaging studies. J Ultrason 2015; 15 (61) 196-207
33 Restrepo CS, Martinez S, Lemos DF. , et al. Imaging appearances of the sternum and sternoclavicular joints. Radiographics 2009; 29 (03) 839-859
34 Rubenstein J. Seronegative spondyloarthropathies and SAPHO syndrome. In: Weissman B. , ed. Imaging of Arthritis and Metabolic Bone Disease. Philadelphia, PA: Saunders Elsevier; 2009: 410-427
35 Freyschmidt J, Sternberg A. The bullhead sign: scintigraphic pattern of sternocostoclavicular hyperostosis and pustulotic arthroosteitis. Eur Radiol 1998; 8 (05) 807-812
36 Schaub S, Sirkis HM, Kay J. Imaging for synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome. Rheum Dis Clin North Am 2016; 42 (04) 695-710
37 Sant GR, Dias E. Primary gout affecting the sternoclavicular joint. BMJ 1976; 1 (6004): 262