Influence of pregnancy/childbirth on long-term bone marrow edema and subchondral sclerosis of sacroiliac joints

Abstract Objective To investigate long-term effects of pregnancy/childbirth on bone marrow edema (BME) and subchondral sclerosis of sacroiliac joints (SIJ) in comparison to MRI changes caused by spondyloarthritis (SpA) and assess the influence of birth method and number of children on SIJ-MRI changes. Materials and methods This is a retrospective cohort study with 349 women (mean age 47 ± 14 years) suffering low back pain. Four subgroups were formed based on SpA diagnosis and childbirth (CB) history. Two musculoskeletal radiologists scored the presence of BME and sclerosis on SIJ-MRI using the Berlin method. Further, an 11-point “global assessment score” representing the overall confidence of SpA diagnosis based on MRI was evaluated in addition to the ASAS (Assessment of Spondyloarthritis International Society) criterion of “positive MRI” for sacroiliitis. Results CB did not correlate with BME score (p = 0.38), whereas SpA diagnosis was associated with a higher BME score (r = 0.31, p < 0.001). Both CB (r = 0.21, p < 0.001) and SpA diagnosis (r = 0.33, p < 0.001) were correlated with a higher sclerosis score. CB was not associated with a higher confidence level in diagnosing SpA based on MRI (p = 0.07), whereas SpA diagnosis was associated with a higher score (r = 0.61, p < 0.001). Both CB (phi = 0.13, p = 0.02) and SpA diagnosis (phi = 0.23, p < 0.001) were significantly associated with a positive ASAS criterion for sacroiliitis. In non-SpA patients with CB, number of children (p = 0.001) was an independent predictor of sclerosis score, while birth method yielded no significant effect (p = 0.75). Conclusion Pregnancy/CB has no impact on long-term BME on SIJ, however, may cause long-term subchondral sclerosis—similar to SpA-associated sclerosis. Number of children is positively correlated with SIJ sclerosis. Birth method yields no effect on SIJ sclerosis.

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Method for Diagnosing the Bone Marrow Edema of Sacroiliac Joint in Patients with Axial Spondyloarthritis Using Magnetic Resonance Image Analysis Based on Deep Learning

Diagnostics ◽

10.3390/diagnostics11071156 ◽

2021 ◽

Vol 11 (7) ◽

pp. 1156

Author(s):

Kang Hee Lee ◽

Sang Tae Choi ◽

Guen Young Lee ◽

You Jung Ha ◽

Sang-Il Choi

Keyword(s):

Bone Marrow ◽

Deep Learning ◽

Bone Marrow Edema ◽

Axial Spondyloarthritis ◽

Mr Images ◽

Sacroiliac Joints ◽

Learning Network ◽

Active Sacroiliitis ◽

Deep Learning Network ◽

Marrow Edema

Axial spondyloarthritis (axSpA) is a chronic inflammatory disease of the sacroiliac joints. In this study, we develop a method for detecting bone marrow edema by magnetic resonance (MR) imaging of the sacroiliac joints and a deep-learning network. A total of 815 MR images of the sacroiliac joints were obtained from 60 patients diagnosed with axSpA and 19 healthy subjects. Gadolinium-enhanced fat-suppressed T1-weighted oblique coronal images were used for deep learning. Active sacroiliitis was defined as bone marrow edema, and the following processes were performed: setting the region of interest (ROI) and normalizing it to a size suitable for input to a deep-learning network, determining bone marrow edema using a convolutional-neural-network-based deep-learning network for individual MR images, and determining sacroiliac arthritis in subject examinations based on the classification results of individual MR images. About 70% of the patients and normal subjects were randomly selected for the training dataset, and the remaining 30% formed the test dataset. This process was repeated five times to calculate the average classification rate of the five-fold sets. The gradient-weighted class activation mapping method was used to validate the classification results. In the performance analysis of the ResNet18-based classification network for individual MR images, use of the ROI showed excellent detection performance of bone marrow edema with 93.55 ± 2.19% accuracy, 92.87 ± 1.27% recall, and 94.69 ± 3.03% precision. The overall performance was additionally improved using a median filter to reflect the context information. Finally, active sacroiliitis was diagnosed in individual subjects with 96.06 ± 2.83% accuracy, 100% recall, and 94.84 ± 3.73% precision. This is a pilot study to diagnose bone marrow edema by deep learning based on MR images, and the results suggest that MR analysis using deep learning can be a useful complementary means for clinicians to diagnose bone marrow edema.

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AB1100 PERFORMANCE OF MAGNETIC RESONANCE IMAGING FOR DETECTING SACROILIITIS IN EARLY STAGES OF SPONDYLOARTHRITIS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.5137 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1839.1-1839

Author(s):

F. Ladeb ◽

D. Ben Nessib ◽

M. Bouaziz ◽

W. Hamdi ◽

E. Labbene ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Bone Marrow ◽

Magnetic Resonance ◽

Positive Predictive Value ◽

Bone Marrow Edema ◽

Resonance Imaging ◽

Sacroiliac Joints ◽

Early Stages ◽

The Mean ◽

Marrow Edema

Background:In view of the limited accuracy of clinical evaluation to recognize sacroiliitis, several imaging techniques such as conventional radiographs, scintigraphy, ultrasound (US), computed tomography (CT) and magnetic resonance imaging (MRI) have been used to examine the sacroiliac joints (SIJ).Objectives:The aim of this study was to assess the performance of MRI for detecting sacroiliitis in early stages of spondyloarthritis (SpA).Methods:This cross-sectional prospective monocentric double-blind study included 57 patients consulting for symptoms suggestive of SpA during more than 3 months between February 2014 and February 2017. Patients with conventional radiograph showing a confirmed sacroiliitis (grade 3 or 4) were not included. After clinical examination and blood sampling, eligible patients underwent MRI of SIJ. MR images were interpreted by 2 experimented musculoskeletal radiologists blinded to clinical and laboratory data. Two professors in rheumatology blinded to radiologists’ conclusions, analyzed clinical data, laboratory tests, HLA typing, X-rays and MRI images and divided the patients into 2 groups: confirmed non radiographic SpA (nr-SpA) or no SpA. This classification was considered as the gold standard when analyzing the results.Results:Fifteen men and 42 women were enrolled. The mean age at inclusion was 39.75 ± 11 years [17-59]. The mean duration from the first symptom was 47 ± 39 months [6.6-180]. Forty-three patients were assessed as nr-SpA (75.4%) and 14 patients as no SpA (24.6%). Thirty-three percent of patients were HLA B27 positive. Totally 22 patients had sacroiliitis at MRI, all of them classified as confirmed nr-SpA. Among the nr-SpA group, MRI showed bone marrow edema (BME) in 34.9% of patients and erosions in 44.2% of patients. Among the patients in whom the diagnosis of SpA was excluded, MRI showed bone marrow edema (BME) in 7% of patients and erosions in 7% of patients. A statistically significant association was observed between the presence of sacroiliitis at MRI and rheumatologists’ diagnosis of SpA (p=0.001). The diagnostic value of MRI lesions is presented in the following table:Sensitivity (%)Specificity (%)Positive Predictive Value (%)Positive Predictive Value (%)BME34.992.993.731.7Erosions44.292.99535.1MRI conclusion: sacroiliitis51.210010040Conclusion:SIJ MRI had an excellent specificity for the diagnosis of SpA but a moderate sensitivity. Consequently, some patients in early stages of SpA might be missed by MRI. In addition, we found that diagnostic based solely on BME lacked sensitivity. Detection of erosions in addition to BME enhanced sensitivity (from 34.9% to 44.9%) without changing specificity. Indeed, many recent studies have pointed out the importance of considering structural lesions of SIJ in addition to inflammatory lesions [1, 2].References:[1]Weber U, Lambert RGW, Pedersen SJ, et al (2010) Assessment of structural lesions in sacroiliac joints enhances diagnostic utility of magnetic resonance imaging in early spondylarthritis. Arthritis Care Res 62:1763–1771.https://doi.org/10.1002/acr.20312[2]Weber U, Jurik AG, Lambert RGW, Maksymowych WP (2016) Imaging in Spondyloarthritis: Controversies in Recognition of Early Disease. Curr Rheumatol Rep 18:58.https://doi.org/10.1007/s11926-016-0607-7Disclosure of Interests:None declared

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Bone Marrow Edema and Ankylosis of the Sacroiliac Joints—Spondyloarthritis, They Said

Arthritis & Rheumatology ◽

10.1002/art.41045 ◽

2019 ◽

Vol 71 (11) ◽

pp. 1942-1942

Author(s):

Frank Verhoeven ◽

Maxime Sondag ◽

Clément Prati ◽

Daniel Wendling

Keyword(s):

Bone Marrow ◽

Bone Marrow Edema ◽

Sacroiliac Joints ◽

Marrow Edema

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Dual-Energy CT in the Detection of Bone Marrow Edema in the Sacroiliac Joints: Is There a Case for Axial Spondyloarthritis?

Radiology ◽

10.1148/radiol.2018182224 ◽

2019 ◽

Vol 290 (1) ◽

pp. 165-166 ◽

Cited By ~ 1

Author(s):

Roman Guggenberger

Keyword(s):

Bone Marrow ◽

Bone Marrow Edema ◽

Axial Spondyloarthritis ◽

Dual Energy ◽

Dual Energy Ct ◽

Sacroiliac Joints ◽

Marrow Edema

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Bone Marrow Edema on Magnetic Resonance Imaging (MRI) of the Sacroiliac Joints Is Associated with Development of Fatty Lesions on MRI over a 1-year Interval in Patients with Early Inflammatory Low Back Pain: A 2-year Followup Study

The Journal of Rheumatology ◽

10.3899/jrheum.131022 ◽

2014 ◽

Vol 41 (6) ◽

pp. 1088-1094 ◽

Cited By ~ 6

Author(s):

Marloes van Onna ◽

Astrid van Tubergen ◽

Désirée M. van der Heijde ◽

Anne Grethe Jurik ◽

Robert Landewé

Keyword(s):

Magnetic Resonance Imaging ◽

Bone Marrow ◽

Back Pain ◽

Magnetic Resonance ◽

Structural Changes ◽

Bone Marrow Edema ◽

Resonance Imaging ◽

Sacroiliac Joints ◽

Magnetic Resonance Imaging Mri ◽

Marrow Edema

Objective.To assess whether bone marrow edema (BME) detected on magnetic resonance imaging (MRI) of the sacroiliac joints (MRI-SIJ) is associated with development of structural changes on both MRI and pelvic radiographs in patients with early inflammatory back pain (IBP).Methods.Patients with IBP ≤ 2 years were followed for 2 years with annual MRI-SIJ. MRI were scored for BME and structural changes (erosions and fatty lesions). Pelvic radiographs were graded according to the modified New York (mNY) criteria. With generalized estimated equation analysis, a time trend in the structural change scores was investigated.Results.Sixty-eight patients [38% male; mean (SD) age 34.9 (10.3) yrs] were included. During the 2-year followup, pelvic radiograph grading remained constant. On MRI, the number of erosions per patient increased significantly (mean score 2.5 at baseline and 3.5 at 2-yr followup; p = 0.05). A trend was found for an increase in the number of fatty lesions per patient (mean score 5.4 at baseline and 8.5 at 2-yr followup; p = 0.06). Overall, BME was associated with the development of fatty lesions (right SIJ: OR 3.13, 95% CI 1.06–9.20; left SIJ: OR 22.13, 95% CI 1.27–384.50), preferentially in quadrants showing resolution of BME. In contrast, BME (or the resolution thereof) was not associated with the development of erosions.Conclusion.BME at baseline, especially when it disappears over time, results in the development of fatty lesions, but an association with erosions could not be demonstrated.

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