%0 Journal Article
%T Clinical examination or whole-body magnetic resonance imaging: the Holy Grail of spondyloarthritis imaging
%A Winston J Rennie
%J Arthritis Research & Therapy
%D 2012
%I BioMed Central
%R 10.1186/ar3737
%X The Holy Grail of magnetic resonance imaging (MRI) is the acquisition of diagnostic images in the shortest scan time, leading to better patient compliance and thereby to images without artifacts. The Holy Grail of a scientific study is a standardized design and a methodological approach. The recent study by Weber and colleagues is written by experts in the field who have utilized both these unwritten commandments [1]. They have used a standardized design and methodology in their selection of whole-body MRI. This allows a good scientific analysis of the clinical parameters and imaging in the assessment of anterior chest wall findings in spondyloarthropathy (SpA).It is arguable, however, that conventional MRI at higher fields, with cardiorespiratory gating, allows a more accurate assessment of joints by providing better spatial resolution than whole-body MRI, and the selection of this modality could have led to the inclusion of false positive lesions. The poor specificity and the cost-effectiveness of whole-body MRI has led to questioning its value as a screening investigation in the past [2], and this study may help rethink that approach [1].The selection of an important yet traditionally ignored joint involved in SpA is also intriguing [3]. The morphoanatomy of the costovertebral joint, its involvement in enthesitis and the importance of standardized MRI protocols have been previously stressed [4]. It is not just the imaging of the anterior chest wall joints that needs standardization, but the methods used to clinically examine these joints by different physician groups. The clinical assessment using the Maastricht Ankylosing Spondylitis Enthesitis Score protocol relies on palpation pressure [5]. This protocol does not deal with the rules of rib motion. Ribs 1 to 5 exhibit primarily 'pump-handle motion', whereas ribs 6 to 10 exhibit 'bucket-handle motion'. Ribs 11 and 12, which do not articulate with the thoracic cage, undergo 'caliper motion'. The clinical examinat
%U http://arthritis-research.com/content/14/1/110