دانلود رایگان ترجمه مقاله تصویربرداری از بیمار با درد ساکرولیاک (نشریه الزویر ۲۰۱۶)

تصویربرداری از بیمار با درد ساکرولیاک

Imaging the Patient With Sacroiliac Pain

Abstract

Sacroiliac (SI) region pain is a common clinical presentation and is often due to pathology involving the SI joints, usually of inflammatory, infective, neoplastic, or post-traumatic etiology. The SI joints have a unique anatomic layout and composition and can be imaged with a variety of techniques including conventional radiographs, computed tomography, isotope bone scintigraphy, and magnetic resonance imaging. This article reviews a range of common SI joint conditions, illustrated by multimodality imaging findings. We also discuss strategies for choosing the optimal imaging modality, pearls, and pitfalls of imaging and discuss an algorithm for approaching the patient with suspected inflammatory back pain.

۱ Introduction

Low back pain not uncommonly arises secondary to pathology in the sacroiliac (SI) joints, which can include inflammatory, infective, neoplastic, and post-traumatic conditions. Many patients with lower back or SI region pain will present to their primary care physician, specialist rheumatologist, or orthopaedic surgeon. The initial challenge for the physician is to confirm origin of symptoms from the SI joint. The criterion standard for confirmation of SI pain is relief of symptoms after image guided SI joint injection [1]. Clinical evaluation of the SI joint should include the posterior superior iliac spine distraction test, pelvic compression and distraction, Gaenslen’s test and the flexion, abduction, and external rotation test [2]. SI joint pain can be differentiated from discogenic lower back pain by the lack of neurological features and a normal straight leg raising test. Piriformis syndrome can also cause similar posterior thigh and buttock pain but can be differentiated by application of the passive flexion, adduction, and internal rotation test. Following a thorough clinical assessment and appropriate laboratory investigations, imaging forms the next major step in the investigation of patients with suspected inflammatory back pain (IBP) or SI joint pathology and various imaging modalities are available to the clinician [3,4]. Increasingly, advanced imaging modalities such as magnetic resonance imaging (MRI) are being used to detect early changes of sacroiliitis and expedite diagnosis in patients with IBP, allowing prompt commencement of disease modifying therapy [3,5,6].