RADIOLOGICAL FEATURES IN PEDIATRIC IMAGING

Juvenilni idiopatski artritis (JIA) autoimunosna je bolest koja se javlja u dječjoj dobi prije navršene 16. godine života i najčešća je reumatska bolest u pedijatrijskoj populaciji s procijenjenom prevalencijom od 2 do 20, a incidencijom od 16 do 150 na 100.000 djece. Defi nira se kao upala jednog ili više zglobova koja traje najmanje 6 tjedana u kontinuitetu. JIA je ponajprije klinička dijagnoza koja se nadopunjuje nalazima laboratorijske i radiološke obrade radi što ranijeg postavljanja dijagnoze, procjene proširenosti bolesti, praćenja tijeka bolesti i odgovora na primijenjenu terapiju. Vrijedeća ILAR-ova (iz engl. International League of Associations for Rheumatology) klasifi kacija defi nira osam različitih tipova bolesti.Juvenile idiopathic arthritis (JIA) is an autoimmune disease usually occurring in children before the age of 16. As one of the most prevalent rheumatic diseases in the pediatric population, with an estimated prevalence of 2 to 20 and an incidence of 16 to 150 per 100,000 children, it is defi ned as an infl ammation of one or more joints, with a duration of 6 weeks minimum. JIA is primarily diagnosed clinically, confi rmed by laboratory and radiological fi ndings, with the goal of early detection and assessment of the spread and progress of the disease as well as the response to medication. Th e current International League of Associations for Rheumatology (ILAR) classifi cation defi nes eight types of arthritis

Application of radiological imaging in rheumatoid arthritis

Tehnološki napredak i razvoj radioloških uređaja pruža veće mogućnosti u dijagnostičkom postupku. Dijagnosticiranu bolest potrebno je stupnjevati da bismo promjene pojedinih zglobova lakše pratili, bilo da su uvjetovane progresijom bolesti ili regresijom zbog terapije. Opisane su mogućnosti slikovne obrade koštano-mišićnog sustava. U dijagnostičkom postupku koristimo standardnu radiološku obradu, kompjuteriziranu tomografiju, magnetsku rezonanciju, ultrazvuk, te kolor-dopler. Važan je podatak i koštana mineralna gustoća pa rutinski snimamo i denzitometriju kostiju.Advancement in technology and development in the field of radiological equipment provides us with a variety of diagnostic possibilities. Once diagnosed, further grading of pathologic condition is needed in order to monitor the changes of affected joints, either progression due to the course of the disease or remission due to the applied therapy. Different methods used in imaging of musculoskeletal system are discussed, including use of standard radiography, computed tomography, magnetic resonance, ultrasound and Color Doppler imaging. Bone mineral density results add much additional data so densitometry scanning is performed routinely

Cardiovascular Drugs Consumption - Comparison between Two Croatian Regions, City of Zagreb and Lika-Senj County

The aim of this paper is to determine the differences in the outpatient consumption of cardiovascular drugs between Croatian regions: the City of Zagreb and Lika-Senj County. The data on the number of packages and the purchase price for each drug have been obtained from all pharmacies in Lika-Senj County and all pharmacies in the City of Zagreb. Defined daily doses/1000 inhabitants/day (DDD/1000/day) was calculated for every drug in accordance with its code name and Anatomical Therapeutic Chemical/Defined Daily Dose (ATC/DDD) index of the World Health Organization (WHO) for 2007. For drug combinations without defined daily doses, equivalent doses (ED) were used. The quality of drug prescribing within the group of cardiovascular drugs was assessed using the Drug Utilization (DU90%) method and the adherence of the DU90% segment to the guidelines for prescribing individual drug groups. The statistical significance of differences in results between the City of Zagreb and Lika-Senj County was tested using the chi-square test at the level of statistical significance p<0.05. The comparison of the share of the five most often prescribed drug groups in Lika-Senj County has shown statistically significant differences when compared to the City of Zagreb (χ2=28.93, df=4, p<0.001). The total outpatient consumption of cardiovascular drugs in the City of Zagreb and Lika-Senj County differs significantly. The consumption, quality of prescribing drugs and cost/DDD in the City of Zagreb is higher than in Lika-Senj County; in the City of Zagreb, newer and more expensive drugs are prescribed to a higher extent

EARLY VS. ADVANCED OSTEOARTHRITIS FROM A RADIOLOGICAL ASPECT

Osteoartritis (OA) je najčešći oblik artritisa koji znatno utječe na život pojedinca i općenito na zdravlje populacije. Napredak slikovne obrade i napredak u tehnici snimanja omogućio je prikaz zglobne hrskavice i mekih tkiva oko zgloba i u zglobu. Upotrebom tih tehnika moguć je prikaz morfologije hrskavice te procjena njezinoga biokemijskog sastava. Magnetska rezonancija (MR) je najvažniji u slikovnom prikazu hrskavice u OA iako se grublje promjene hrskavice mogu vidjeti i UZ-om koji se smatra komplementarnom metodom. Očekuje se porast prevalencije OA s rastućom epidemijom debljine i povećanja prosječne životne dobi, odnosno sve veće starosti populacije. Rizični čimbenici za nastanak OA uključuju: dob, debljinu, prethodnu povredu zgloba ili ekstremiteta, genetsku podlogu sa znatnom familijarnom anamnezom, smanjenu razinu spolnih hormona, mišićnu slabost ili ponavljanu upotrebu zgloba. Također čimbenici koji pospješuju razvitak OA su infekcija, odlaganje kristala, akromegalija, prethodna upalna bolest ili metabolička bolest poput alkaptonurije, hemokromatoze i Wilsonove bolesti, te hemoglobinopatija, kao što je anemija srpastih stanica, talasemija, neuroartropatija koje vode Charcotovoj artropatiji ili siringomijeliji, tabesu i dijabetesu. Unatoč svim terapijskim dostignućima nema efikasnog lijeka za OA, što se odražava u nedostatku potpunog shvaćanja patofiziologije i prirodnog procesa. Upalne promjene u OA vjerojatno su sekundarne; prvo nastanu promjene u hrskavici i subhondralnoj kosti, zato se i smatra da to nije pasivna degenerativna bolest, nego aktivan proces koji pokreće mehanički čimbenik. Primarni i sekundarni OA imaju istu patohistološku osnovu. Bilateralna i simetrična afekcija nađe se uvijek u primarnom OA, posebice kada su zahvaćene šake. U OA prve promjene se nađu na artikulacijskoj hrskavici sinovijalnih zglobova, a promjene nastanu i na sinovijskoj tekućini, kao i na subhondralnoj kosti, na kapsuli zgloba i ostalom zglobnom staničju.Osteoarthritis (OA) is the most common form of arthritis. It has a significant impact on the life of an individual as well as on the general health of the population. The progress achieved in image processing and acquisition techniques has made it possible to visualize the articular cartilage as well as the soft tissues around and inside the joint. By using these techniques, it is possible to depict the morphology of cartilage and assess its biochemical composition. MRI is the most important imaging method for visualization of the cartilage in OA, although certain larger cartilage lesions can also be seen by US, which is considered a complementary imaging method. With the growing epidemic of obesity and longer life expectancy in the general population, the prevalence of OA is expected to rise in the future. Risk factors for OA include: older age, obesity, previous injury, genetic predisposition with a significant family history for certain diseases, reduced levels of sex hormones, muscle weakness, and repeated overuse of a joint. Factors that can also contribute to the development of OA include: infection, crystal deposition disease, acromegaly, inflammatory bowel disease, metabolic diseases such as alkaptonuria, hemochromatosis, and Wilson’s disease, or hemoglobinopathies such as sickle cell anemia and thalassemia, as well as neuroarthropathies that lead to Charcot arthropathy or syringomyelia, tabes, and diabetes. Despite all recent advances in therapy, there is still no effective treatment for OA, which results from the still incomplete understanding of the pathophysiology and natural processes of OA. The inflammatory changes that occur in OA are probably secondary, with changes in cartilage and subchondral bone occurring first. This is the reason why OA is not considered to be a passive degenerative disease but an active process caused by mechanical factors. Primary and secondary OA have the same pathohistological basis. Bilateral and symmetrically affected joints are typically encountered in primary OA, especially when wrists are involved. Initial changes in OA are usually found on the articular cartilage of synovial joints, but they also occur in the synovial fluid, subchondral bone, joint capsule, and other articular tissue

Radiologic imaging of crystalline arthritides

Giht je skupina bolesti karakterizirana artritisom, a nastaje zbog promjene u metabolizmu urata te dolazi do odlaganja mononatrijskih kristala urične kiseline u zglobove i meka tkiva. Klinički nalazimo akutni i kronični artritis, nakupine tofa, intersticijsku renalnu bolest i nefrolitijazu kristalima urične kiseline. Definitivna dijagnoza postavlja se dokazom kristala urične kiseline u zglobu ili tjelesnim tekućinama.Gout is a group of diseases characterized by arthritis and is a result of urate metabolism disturbance with the deposition of monosodium urate crystals in the joint and soft tissues. Clinical manifestations include acute and chronic arthritis, tophaceous deposits, interstitial renal disease and uric acid nephrolithiasis. The diagnosis is based on the identification of uric acid crystals in joint or body fluids

Chronic Recurrent Multifocal Osteomyelitis (CRMO) and Synovitis Acne Pustulosis Hyperostosis Osteitis (SAPHO) Syndrome – Two Presentations of the Same Disease?

The two most common entities among generally rare but under-diagnosed autoinflammatory bone disorders are chronic recurrent multifocal osteomyelitis (CRMO) and synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome. Due to their similarities, many authors consider CRMO to be a subtype of SAPHO syndrome. The aim of this study was to compare clinical, laboratory, and imaging features and outcomes of patients with CRMO and SAPHO. The analysis of the data from 6 children with CRMO (four girls and two boys, age 3.5-14 years) and of 6 children (6 boys, age 13.5-17.5 years) with SAPHO syndrome was performed. The initiating symptoms in all patients with CRMO were bone pain with multifocal bone lesions. There were no skin manifestations. Five out of six patients achieved control with nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids, while one patient required disease-modifying antirheumatic drugs (DMARDs). The initiating symptom in five patients with SAPHO syndrome were severe acne, while in one patient acne occurred two years after the disease onset. Two patients typically developed inflamed sternoclavicular joints and sternum, while the others showed changes affecting other skeletal regions. Three patients achieved control with NSAIDs and corticosteroids, the others required DMARDs and TNFα inhibitors. In comparison with patients with CRMO, patients with SAPHO suffered more frequent and longer lasting exacerbations. In conclusion, CRMO and SAPHO syndrome have an array of common characteristics, but also a number of differences. Nevertheless, further investigation into the etiopathogenesis is required to establish a definite relationship between CRMO and SAPHO. </p

Chronic Recurrent Multifocal Osteomyelitis (CRMO) and Synovitis Acne Pustulosis Hyperostosis Osteitis (SAPHO) Syndrome – Two Presentations of the Same Disease?

The two most common entities among generally rare but under-diagnosed autoinflammatory bone disorders are chronic recurrent multifocal osteomyelitis (CRMO) and synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome. Due to their similarities, many authors consider CRMO to be a subtype of SAPHO syndrome. The aim of this study was to compare clinical, laboratory, and imaging features and outcomes of patients with CRMO and SAPHO. The analysis of the data from 6 children with CRMO (four girls and two boys, age 3.5-14 years) and of 6 children (6 boys, age 13.5-17.5 years) with SAPHO syndrome was performed. The initiating symptoms in all patients with CRMO were bone pain with multifocal bone lesions. There were no skin manifestations. Five out of six patients achieved control with nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids, while one patient required disease-modifying antirheumatic drugs (DMARDs). The initiating symptom in five patients with SAPHO syndrome were severe acne, while in one patient acne occurred two years after the disease onset. Two patients typically developed inflamed sternoclavicular joints and sternum, while the others showed changes affecting other skeletal regions. Three patients achieved control with NSAIDs and corticosteroids, the others required DMARDs and TNFα inhibitors. In comparison with patients with CRMO, patients with SAPHO suffered more frequent and longer lasting exacerbations. In conclusion, CRMO and SAPHO syndrome have an array of common characteristics, but also a number of differences. Nevertheless, further investigation into the etiopathogenesis is required to establish a definite relationship between CRMO and SAPHO. </p

DISCONTINUATION OF BIOLOGICS IN PATIENTS WITH JUVENILE IDIOPATHIC ARTHRITIS AFTER ACHIEVING CLINICAL REMISSION: EXPERIENCE OF THE REPUBLIC OF CROATIA REFERRAL CENTER FOR PEDIATRIC AND ADOLESCENT RHEUMATOLOGY

Cilj: Utvrditi trajanje kliničke remisije tijekom terapije biološkim lijekovima te rizik od relapsa nakon prekida njihove primjene u bolesnika s juvenilnim idiopatskim artritisom (JIA). Ispitanici i metode: Retrospektivna analiza podataka bolesnika s JIA, liječenih biološkim lijekovima u Referentnom centru za pedijatrijsku i adolescentnu reumatologiju Ministarstva zdravstva RH, u razdoblju od 2010. do 2015. godine, kojima je nakon postizanja kliničke remisije ukinuta biološka terapija. Rezultati: Biološkim lijekovima (blokatorima TNF-α, IL-1 i IL-6) liječen je 71 bolesnik s JIA. U 17 bolesnika (23,9%) biološka je terapija prekinuta zbog postizanja kliničke remisije u prosječnom trajanju od 27 mjeseci (1 – 60). Prosječno vrijeme praćenja nakon prekida biološke terapije iznosilo je 24 mjeseca (12 – 59). Rani relaps, tijekom prvih 6 mjeseci nakon prekida terapije, zabilježen je u 5/17 bolesnika (29,4%), u 1 bolesnika (5,8%) zabilježen je relaps u periodu od 6. do 12. mjeseca praćenja. Jedanaest bolesnika (64,7%) ostalo je u remisiji tijekom cijelog razdoblja praćenja.Aim: To determine the duration of clinical remission under biologics and the risk of relapse aft er discontinuation of their application in patients with JIA. Patients and methods: Retrospective collection of medical records of JIA patients treated with biologics at the Referral Center for Pediatric and Adolescent Rheumatology of the Republic of Croatia Ministry of Health during the period from 2010 to 2015, in whom biological therapy was discontinued aft er achieving clinical remission. Results: Th e biologics (anti TNF, anti IL-6, anti IL-1) were used in 71 patients with JIA. In 17 patients (23.9%) the biologics were discontinued aft er achieving clinical remission aft er an average treatment duration of 27 months (1–60). The average monitoring time aft er the discontinuation of biologics was 24 months (12–59). Early relapses were observed in 5/17 patients (29.4%) during the first 6 months of therapy discontinuation, while in one patient (5.8%) there was a relapse in the 6- to 12-month monitoring period. Eleven patients (64.7%) remained in remission throughout the monitoring period. Conclusion: Th e introduction of biologics into the therapy is clearly defined in recent guidelines for JIA treatment. On the other hand, discontinuing their use aft er achieving clinical remission is still based on the experience and judgment of pediatric rheumatologists. Therefore, the development of appropriate guidelines with defined time and mode of discontinuation of biological therapy is one of the essential goals in the treatment and monitoring of JIA patients

Color Doppler of sacroiliac joints in patients with juvenile idiopathic arthritis

Juvenilni idiopatski artritis (JIA) jedna je od najčešćih kroničnih bolesti dječje dobi. U bolesnika koji boluju od entezitisu pridruženoga artritisa (ERA), jednog od sedam podtipova JIA, česta je upalna zahvaćenost aksijalnog skeleta pa je za rano postavljanje dijagnoze i primjenu terapije te izbjegavanje teških komplikacija bolesti potrebna rana i adekvatna radiološka obrada. ----- Ciljevi istraživanja: Utvrditi valjanost obojenoga doplera u otkrivanju i praćenju sakroiliitisa u bolesnika s JIA-ERA u usporedbi s magnetskom rezonancijom. Ustanoviti prevalenciju zahvaćenosti SI zglobova u ovih bolesnika te analizirati povezanost radioloških s kliničkim i laboratorijskim nalazima. Utvrditi potrebu intravenske primjene paramagnetskog kontrastnog sredstva za MR detekciju akutnog sakroiliitisa. ----- Materijali i metode: U istraživanju je sudjelovalo 85 ispitanika, 57 djevojčica i 28 dječaka prosječne starosti 14,25 godina. Svim ispitanicima dva neovisna ispitivača učinila su UZV pregled SI zglobova primjenom obojenoga i pulsirajućeg doplera uz izračun vrijednosti RI indeksa te MR pregled prema standardiziranom protokolu. Prikupljeni su anamnestički i klinički podaci te rezultati laboratorijske obrade. ----- Rezultati: Od 85 bolesnika UZV pregledom utvrđena je pozitivna vaskularizacija u 15 (ispitivač 1), odnosno 9 (ispitivač 2) analiziranih SI zglobova desno te u 19, odnosno 11 SI zglobova lijevo. Povećanjem broja detektiranih doplerskih signala protoka (1 DSP/više DSP u manje od polovine analiziranog područja/više DSP u više od polovine analiziranog područja) došlo je do pada vrijednosti RI indeksa (0,72-0,63-0,58 desno i 0,70-0,65-0,54 lijevo za ispitivača 1 i 0,70-0,65 desno i 0,70-0,67 lijevo za ispitivača 2). Nakon kondenzacije čestica mjernih instrumenata (ispitivač 1/ispitivač 2) na zajedničku aritmetičku sredinu statistički značajna korelacija utvrđena je između pozitivnog UZV nalaza vaskularizacije, stupnja vaskularizacije i vrijednosti RI indeksa i nalaza akutne upale na MR pregledu (0,26, 0,27 i 0,24 desno te 0,26, 0,24, 0,25 lijevo, sve s pogreškom zaključivanja manjom od 5%). Koeficijent dobivene korelacije nije visok, no upućuje na statistički značajnu povezanost između nalaza UZV i MR pregleda. Izračunata osjetljivost ultrazvuka ovisno o ispitivaču varira između 0,26 i 0,39, a specifičnost je za oba ispitivača veća od 0,80. Korelacija ispitivača za UZV pregled umjerena je (0,64 desno i 0,47 lijevo), a za MR pregled visoka (0,91 desno i 0,85 lijevo). Statistički značajna razlika između ispitanika s urednim MR nalazom i nalazom sakroiliitisa utvrđena je za varijable anamneze upalne bolesti u obitelji, sedimentacije eritrocita i vrijednosti skora JADAS-10. Vrlo visoka korelacija utvrđena je za detekciju upalnih promjena između nativnog MR pregleda i pregleda s intravenskom primjenom kontrastnog sredstva. ----- Zaključak: Obojeni dopler može detektirati akutne upalne promjene SI zgloba, korelacija s MR pregledom statistički je značajna, ali niskog koeficijenta uz osjetljivost metode do 39%. Najbolja korelacija postiže se kada je ultrazvučno detektirano 3 ili više DSP uz RI vrijednost <0,60. Zbog visoke specifičnosti (80-95%) moguća je upotreba ultrazvuka kao probirne metode. Nije potrebna intravenska primjena kontrastnog sredstva za MR detekciju akutnog sakroiliitisa.Introduction: Juvenile idiopathic arthritis (JIA) is one of the most common chronic diseases in pediatric population. In the course of their disease, patients with enthesitis-related arthritis (ERA), one of seven subtypes of JIA, often develop inflammatory involvement of axial skeleton. Therefore, performing an adequate diagnostic procedure in time is essential for early diagnosis, introduction of therapy and avoiding joint damage and functional disability. Aims of the study: To determine the value of Color Doppler in detection and monitoring of sacroiliitis in patients with jSpA/ERA in comparison with MRI. To investigate the prevalence of acute and/or chronic sacroiliitis in these patients and analyse the correlation between radiological and clinical and laboratory findings. Moreover, to further explore the necessity of intravenous contrast application for detection of SI joints acute inflammatory changes on MRI. Materials and methods: 85 consecutive patients were included in this study, 57 girls and 28 boys with mean age of 14.25 years. Color Doppler ultrasound (CDUS) of sacroiliac joints was performed for each patient by two investigators and RI index was calculated. SI joints were also evaluated with an MRI exam by the same two investigators using standardized protocol. Medical history for each patient, relevant clinical data, and laboratory findings were collected. Results: Out of 85 patients, SI joint vascularization was determined with CDUS in 15 right and 19 left SI joints respectively by investigator 1 and in 9 (right) and 11 (left) SI joints by investigator 2. An increased number of doppler flow signals (1 DFS, >1 DFS in 1 DFS in >50% of analyzed area) resulted in a decrease of RI index for both investigators (right: 0.72-0.63-0.58, left: 0.70-0.65-0.54 - investigator 1; right: 0.70-0.65, left 0.70-0.67 - investigator 2). After data condensation for both investigators on arithmetic mean, a statistically significant correlation was determined for CDUS findings of joint vascularization, grade of vascularization and RI index, and MRI findings of acute sacroiliitis as a gold standard (right: 0.26, 0.27, 0.24, left: 0.26, 0.24, 0.25, p<0.05). Correlation coefficient is not high but suggests a statistically significant link between CDUS and MRI findings. CDUS sensitivity in detection of acute sacroiliitis varies between 0.26 and 0.39 depending on investigator, specificity is higher than 0.80 for both investigators. CDUS interobserver agreement is modest (0.64 right and 0.47 left) but very high for MRI (0.91 right, 0.85 left). Between patients with normal MRI findings and those with acute and/or chronic sacroiliitis, statistically significant differences were present for these variables: positive family history for inflammatory disease, erythrocyte sedimentation rate, and JADAS-10 score (both higher in patients with sacroiliitis). An extremely high correlation was established for detection of acute sacroiliitis on MRI when using both unenhanced and contrast enhanced MRI sequences. Conclusion: CDUS can detect acute sacroiliitis, correlation with MRI findings is statistically significant, but has a low coefficient giving it a sensitivity of 39%. The best correlation is achieved when 3 or more doppler flow signals are detected with CDUS and RI index is <0.60. A high specificity of 80-95% makes it possible to use CDUS as a screening method. Administration of contrast agent is not necessary for detection of acute sacroiliitis on MRI

Color Doppler of sacroiliac joints in patients with juvenile idiopathic arthritis

Juvenilni idiopatski artritis (JIA) jedna je od najčešćih kroničnih bolesti dječje dobi. U bolesnika koji boluju od entezitisu pridruženoga artritisa (ERA), jednog od sedam podtipova JIA, česta je upalna zahvaćenost aksijalnog skeleta pa je za rano postavljanje dijagnoze i primjenu terapije te izbjegavanje teških komplikacija bolesti potrebna rana i adekvatna radiološka obrada. ----- Ciljevi istraživanja: Utvrditi valjanost obojenoga doplera u otkrivanju i praćenju sakroiliitisa u bolesnika s JIA-ERA u usporedbi s magnetskom rezonancijom. Ustanoviti prevalenciju zahvaćenosti SI zglobova u ovih bolesnika te analizirati povezanost radioloških s kliničkim i laboratorijskim nalazima. Utvrditi potrebu intravenske primjene paramagnetskog kontrastnog sredstva za MR detekciju akutnog sakroiliitisa. ----- Materijali i metode: U istraživanju je sudjelovalo 85 ispitanika, 57 djevojčica i 28 dječaka prosječne starosti 14,25 godina. Svim ispitanicima dva neovisna ispitivača učinila su UZV pregled SI zglobova primjenom obojenoga i pulsirajućeg doplera uz izračun vrijednosti RI indeksa te MR pregled prema standardiziranom protokolu. Prikupljeni su anamnestički i klinički podaci te rezultati laboratorijske obrade. ----- Rezultati: Od 85 bolesnika UZV pregledom utvrđena je pozitivna vaskularizacija u 15 (ispitivač 1), odnosno 9 (ispitivač 2) analiziranih SI zglobova desno te u 19, odnosno 11 SI zglobova lijevo. Povećanjem broja detektiranih doplerskih signala protoka (1 DSP/više DSP u manje od polovine analiziranog područja/više DSP u više od polovine analiziranog područja) došlo je do pada vrijednosti RI indeksa (0,72-0,63-0,58 desno i 0,70-0,65-0,54 lijevo za ispitivača 1 i 0,70-0,65 desno i 0,70-0,67 lijevo za ispitivača 2). Nakon kondenzacije čestica mjernih instrumenata (ispitivač 1/ispitivač 2) na zajedničku aritmetičku sredinu statistički značajna korelacija utvrđena je između pozitivnog UZV nalaza vaskularizacije, stupnja vaskularizacije i vrijednosti RI indeksa i nalaza akutne upale na MR pregledu (0,26, 0,27 i 0,24 desno te 0,26, 0,24, 0,25 lijevo, sve s pogreškom zaključivanja manjom od 5%). Koeficijent dobivene korelacije nije visok, no upućuje na statistički značajnu povezanost između nalaza UZV i MR pregleda. Izračunata osjetljivost ultrazvuka ovisno o ispitivaču varira između 0,26 i 0,39, a specifičnost je za oba ispitivača veća od 0,80. Korelacija ispitivača za UZV pregled umjerena je (0,64 desno i 0,47 lijevo), a za MR pregled visoka (0,91 desno i 0,85 lijevo). Statistički značajna razlika između ispitanika s urednim MR nalazom i nalazom sakroiliitisa utvrđena je za varijable anamneze upalne bolesti u obitelji, sedimentacije eritrocita i vrijednosti skora JADAS-10. Vrlo visoka korelacija utvrđena je za detekciju upalnih promjena između nativnog MR pregleda i pregleda s intravenskom primjenom kontrastnog sredstva. ----- Zaključak: Obojeni dopler može detektirati akutne upalne promjene SI zgloba, korelacija s MR pregledom statistički je značajna, ali niskog koeficijenta uz osjetljivost metode do 39%. Najbolja korelacija postiže se kada je ultrazvučno detektirano 3 ili više DSP uz RI vrijednost <0,60. Zbog visoke specifičnosti (80-95%) moguća je upotreba ultrazvuka kao probirne metode. Nije potrebna intravenska primjena kontrastnog sredstva za MR detekciju akutnog sakroiliitisa.Introduction: Juvenile idiopathic arthritis (JIA) is one of the most common chronic diseases in pediatric population. In the course of their disease, patients with enthesitis-related arthritis (ERA), one of seven subtypes of JIA, often develop inflammatory involvement of axial skeleton. Therefore, performing an adequate diagnostic procedure in time is essential for early diagnosis, introduction of therapy and avoiding joint damage and functional disability. Aims of the study: To determine the value of Color Doppler in detection and monitoring of sacroiliitis in patients with jSpA/ERA in comparison with MRI. To investigate the prevalence of acute and/or chronic sacroiliitis in these patients and analyse the correlation between radiological and clinical and laboratory findings. Moreover, to further explore the necessity of intravenous contrast application for detection of SI joints acute inflammatory changes on MRI. Materials and methods: 85 consecutive patients were included in this study, 57 girls and 28 boys with mean age of 14.25 years. Color Doppler ultrasound (CDUS) of sacroiliac joints was performed for each patient by two investigators and RI index was calculated. SI joints were also evaluated with an MRI exam by the same two investigators using standardized protocol. Medical history for each patient, relevant clinical data, and laboratory findings were collected. Results: Out of 85 patients, SI joint vascularization was determined with CDUS in 15 right and 19 left SI joints respectively by investigator 1 and in 9 (right) and 11 (left) SI joints by investigator 2. An increased number of doppler flow signals (1 DFS, >1 DFS in 1 DFS in >50% of analyzed area) resulted in a decrease of RI index for both investigators (right: 0.72-0.63-0.58, left: 0.70-0.65-0.54 - investigator 1; right: 0.70-0.65, left 0.70-0.67 - investigator 2). After data condensation for both investigators on arithmetic mean, a statistically significant correlation was determined for CDUS findings of joint vascularization, grade of vascularization and RI index, and MRI findings of acute sacroiliitis as a gold standard (right: 0.26, 0.27, 0.24, left: 0.26, 0.24, 0.25, p<0.05). Correlation coefficient is not high but suggests a statistically significant link between CDUS and MRI findings. CDUS sensitivity in detection of acute sacroiliitis varies between 0.26 and 0.39 depending on investigator, specificity is higher than 0.80 for both investigators. CDUS interobserver agreement is modest (0.64 right and 0.47 left) but very high for MRI (0.91 right, 0.85 left). Between patients with normal MRI findings and those with acute and/or chronic sacroiliitis, statistically significant differences were present for these variables: positive family history for inflammatory disease, erythrocyte sedimentation rate, and JADAS-10 score (both higher in patients with sacroiliitis). An extremely high correlation was established for detection of acute sacroiliitis on MRI when using both unenhanced and contrast enhanced MRI sequences. Conclusion: CDUS can detect acute sacroiliitis, correlation with MRI findings is statistically significant, but has a low coefficient giving it a sensitivity of 39%. The best correlation is achieved when 3 or more doppler flow signals are detected with CDUS and RI index is <0.60. A high specificity of 80-95% makes it possible to use CDUS as a screening method. Administration of contrast agent is not necessary for detection of acute sacroiliitis on MRI