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Imaging in dialysis spondyloarthropathy
Daphne J Theodorou1, Stavroula J Theodorou, Donald Resnick
1Department of Radiology, School of Medicine, University of California, San Diego Medical Center, USA. daphne_theodorou@hotmail.com
Seminars in Dialysis
|August 23, 2002
Summary
Destructive spondyloarthropathy, linked to hemodialysis-associated amyloidosis, affects the cervical spine in chronic kidney disease patients. Imaging mimics infection, but MRI T2-weighted signals can help differentiate, with potential for spinal instability and cord compromise.
Area of Science:
- Nephrology
- Orthopedic Surgery
- Radiology
Background:
- Destructive spondyloarthropathy is a recently described condition in patients undergoing maintenance hemodialysis.
- It primarily affects the cervical spine and is associated with chronic renal disease.
- The pathogenesis is unclear but linked to hemodialysis-associated amyloidosis.
Purpose of the Study:
- To describe the clinical and radiographic features of destructive spondyloarthropathy in patients with chronic renal disease.
- To differentiate this condition from infectious spondylodiskitis using imaging modalities.
- To highlight potential complications and management strategies.
Main Methods:
- Review of radiographic features including plain radiography, computed tomography (CT), and magnetic resonance imaging (MRI).
- Correlation of imaging findings with clinical presentation and duration of hemodialysis.
- Differential diagnosis considerations, particularly distinguishing from infectious processes.
Main Results:
- The condition frequently involves the lower cervical spine and craniocervical junction.
- Radiographic findings include osteolytic lesions, vertebral endplate sclerosis, narrowed intervertebral spaces, and minimal osteophytosis.
- MRI may mimic spondylodiskitis, but the absence of high T2-weighted signal intensity aids in excluding infection.
Conclusions:
- Destructive spondyloarthropathy in dialysis patients presents with imaging features that can simulate infection.
- Duration of hemodialysis appears to be a correlating factor.
- Potential complications include vertebral collapse, spinal instability, and spinal cord compromise, possibly requiring surgical intervention.