EVALUATION OF DESTRUCTIVE SPONDYLOARTHROPATHIES IN HEMODIALYSIS BY COMPUTERIZED TOMOGRAPHIC SCAN AND MAGNETIC-RESONANCE-IMAGING

Objective. The incidence of destructive spondyloarthropathies (SA) in hemodialysis can reach 50% after 10 years of treatment. Few studies ha ve analyzed the magnetic resonance (MR) appearance of destructive SpA and data are controversial. Our objective was to evaluate the computer ized tomographic (CT) scan and MR appearance of destructive SpA in com parison to infectious spondylodiscitis. Methods. 23 destructive SpA we re observed in 11 patients who had undergone hemodialysis [mean durati on of treatment 12 years (89-228 mo)]: 17 SpA of the cervical spine, o ne of the dorsal, and 5 of the lumbar spine. CT scans at all levels de monstrating narrowing and discovertebral erosions were performed witho ut injection. MRI was performed with T1 and T2 weighted spin echo seq uences (0.5 T) without gadolinium injection. Radiographs were analyzed by 2 independent examiners. The data concerning MRI of infectious spo ndylodiscitis were based on a study of 57 personal cases and literatur e reports. Results, CT scan appearance was similar in all cases, espec ially showing multiple small well defined lucencies of the vertebral e ndplates. In 9 patients, MRI showed low signal intensity of the disk a nd the adjacent vertebral endplates on T1 and T2 sequences. In no cas e was discal or vertebral high signal intensity on T2 sequence noted. No periodontoidal pseudotumor was observed. Conclusion. CT scans and MRI of destructive SpA, even nonspecific, are different from those obs erved in infectious spondylodiscitis, particularly due to the absence of discal and vertebral hyper-signal on T2 sequences.