Improved detection of erosions in the sacroiliac joints on MRI with volumetric interpolated breath-hold examination (VIBE): results from the SIMACT study

2018 ◽  
Vol 77 (11) ◽  
pp. 1585-1589 ◽  
Author(s):  
Torsten Diekhoff ◽  
Juliane Greese ◽  
Joachim Sieper ◽  
Denis Poddubnyy ◽  
Bernd Hamm ◽  
...  
Keyword(s):  
Low Dose ◽  
Axial Spondyloarthritis ◽  
Three Dimensional ◽  
Breath Hold ◽  
Low Back ◽  
Sacroiliac Joints ◽  
Weighted Sequence ◽  
Sum Score ◽  
Mri Sequences ◽  
Higher Sensitivity

ObjectiveTo compare the performance of a new three-dimensional MRI sequence (volumetric interpolated breath-hold examination; MR-VIBE) with a conventional T1-weighted sequence (MR-T1) for the detection of erosions in the sacroiliac joints (SIJs) using low-dose CT (ldCT) as reference.MethodsldCT and T1-MRI and MR-VIBE of 110 prospectively included patients with low back pain and suspected axial spondyloarthritis (axSpA) were scored for erosions by two readers. The presence of erosions on the patients’ level, the erosion sum score, sensitivity and specificity of both MRI sequences using ldCT as a reference as well as agreement between the readers were assessed.ResultsMR-VIBE had a higher sensitivity than MR-T1 (95% vs 79%, respectively) without a decrease in specificity (93% each). MR-VIBE compared with MR-T1 identified 16% more patients with erosions (36 vs 30 of 38 patients with positive ldCT findings). The erosion sum score was also higher for MR-VIBE (8.1±9.3) than MR-T1 (6.7±8.4), p=0.003. The agreement on erosion detection was also higher for MR-VIBE (κ=0.71) compared with MRI-T1 (κ=0.56).ConclusionVIBE detected erosions in the SIJs with higher sensitivity without a loss of specificity and superior reliability compared with a standard T1-weighted sequence. Its value for the diagnosis of axSpA has still to be determined.

Detection of Erosions in Sacroiliac Joints of Patients with Axial Spondyloarthritis Using the Magnetic Resonance Imaging Volumetric Interpolated Breath-hold Examination

2019 ◽  
Vol 46 (11) ◽  
pp. 1445-1449 ◽  
Author(s):  
Xenofon Baraliakos ◽  
Florian Hoffmann ◽  
Xiaohu Deng ◽  
Yan-Yan Wang ◽  
Feng Huang ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Structural Changes ◽  
Axial Spondyloarthritis ◽  
Linear Regression Analysis ◽  
Cartilage Defects ◽  
Breath Hold ◽  
Resonance Imaging ◽  
Sacroiliac Joints ◽  
Magnetic Resonance Imaging Mri

Objective.The volumetric interpolated breath-hold examination (VIBE) magnetic resonance imaging (MRI) technique can visualize erosive cartilage defects in peripheral joints. We evaluated the ability of VIBE to detect erosions in sacroiliac joints (SIJ) of patients with axial spondyloarthritis (axSpA) compared to the established T1-weighted MRI sequence and computed tomography (CT).Methods.MRI (T1-weighted and VIBE) and CT scans of SIJ of 109 patients with axSpA were evaluated by 2 blinded readers based on SIJ quadrants (SQ). Erosions were defined according to Assessment of Spondyloarthritis international Society (ASAS) definitions. Scores were recorded if readers were in agreement.Results.Erosions were less frequently detected by CT (153 SQ) than by T1-weighted MRI (182 SQ; p = 0.008) and VIBE-MRI (199 SQ; p < 0.001 vs CT and p = 0.031 vs T1-weighted MRI). Taking CT as the gold standard, the sensitivity of VIBE-MRI (71.2%) was higher than that for T1-weighted MRI (63.4%), with similar specificity (87.3% vs 88%, respectively). In linear regression analysis, younger age was significantly associated with occurrence of erosions independently in VIBE-MRI (β = 0.384, p < 0.001) and T1-weighted MRI (β = 0.369, p < 0.001) compared to CT.Conclusion.The VIBE-MRI sequence was more sensitive than T1-weighted MRI in identifying erosive damage in the SIJ, especially in younger patients. This might be due to the ability of VIBE-MRI to identify structural changes in the cartilage that have not yet extended to the underlying bone, where CT seems to be superior.

scholarly journals OP0256 CHOOSE WISELY: IMAGING FOR DIAGNOSIS OF AXIAL SPONDYLOARTHRITIS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 156.2-157
Author(s):  
T. Diekhoff ◽  
I. Eshed ◽  
F. Radny ◽  
K. Ziegeler ◽  
F. Proft ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Computed Tomography ◽  
Bone Marrow ◽  
Magnetic Resonance ◽  
Sensitivity And Specificity ◽  
Interrater Reliability ◽  
Axial Spondyloarthritis ◽  
Breath Hold ◽  
Resonance Imaging ◽  
Sacroiliac Joints

Background:To date, the European Alliance of Associations for Rheumatology (EULAR) guidelines recommend X-ray (XR) as first line imaging in axial Spondyloarthritis (axSpA) and magnetic resonance imaging (MR) if the diagnosis cannot be established by XR and clinical features. However, much knowledge has been gained recently strengthening the applicability of MR for the detection of structural lesions and raising the question, whether XR is still necessary. Also, several publications used low-dose computed tomography (CT) as reference standard and imaging test.Objectives:In light of this complex diagnostic situation, the aim of this study was to compare the three major modalities, XR, MR and CT of SIJ, in their diagnostic performance of axSpA and differential diagnosis in a cohort of patients with low back pain using the final judgment of the rheumatologist as standard of reference.Methods:163 patients (89 with axSpA; 74 with degenerative diseases) underwent XR, CT and MR. Three blinded experts categorized the imaging into axSpA, other diseases or normal in 5 separate reading rounds (XR, CT, MR, XR+MR, CT+MR, respectively). The results were compared to the clinical diagnosis. Sensitivity and specificity values for axSpA and interrater reliability were compared.Results:XR showed lower sensitivity and specificity (66.3%/67.6% respectively) compared to MR (82.0%/86.5%) and CT (77.5%/97.3%). Sensitivity and specificity of XR+MR was similar to MR alone (77.5% / 87.8%). However, CT+MR was superior to MR alone (75.6% / 97.3%) (see Figure). CT had the best interrater reliability (kappa = 0.875) followed by MR (0.665) and XR (0.517). CR+MR reliability was similar (0.662) compared to MR alone, while CT+MR reliability (0.732) was superior.Figure 1.Frequency of positive and negative findings in radiography (XR), computed tomography (CT), magnetic resonance imaging (MR) and combinations and resulting diagnostic accuracy values. SE: Sensitivity, SP: Specificity, LR-/+: negative/positive likelihood ratio.Conclusion:In conclusion, XR is inferior to cross-sectional imaging and should be replaced by MR or CT for differential diagnosis. While MR is the most sensitive imaging technique, it lacks specificity when compared to CT. CT alone has high diagnostic accuracy, despite being insensitive to bone marrow lesions such as fatty metaplasia or osteitis. Adding CT to MR leads to an increase in specificity at a minor expense of sensitivity.References:[1]Sieper J, Rudwaleit M, Baraliakos X, et al. The Assessment of SpondyloArthritis international Society (ASAS) handbook: a guide to assess spondyloarthritis. Ann Rheum Dis. 2009;68 Suppl 2:ii1-44.[2]Mandl P, Navarro-Compán V, Terslev L, et al. EULAR recommendations for the use of imaging in the diagnosis and management of spondyloarthritis in clinical practice. Ann Rheum Dis. 2015;74(7):1327-39.[3]Diekhoff T, Hermann KA, Greese J, et al. Comparison of MRI with radiography for detecting structural lesions of the sacroiliac joint using CT as standard of reference: results from the SIMACT study. Ann Rheum Dis. 2017.[4]Diekhoff T, Greese J, Sieper J, Poddubnyy D, Hamm B, Hermann KA. Improved detection of erosions in the sacroiliac joints on MRI with volumetric interpolated breath-hold examination (VIBE): results from the SIMACT study. Ann Rheum Dis. 2018;77(11):1585-89.[5]Baraliakos X, Hoffmann F, Deng X, Wang YY, Huang F, Braun J. Detection of Erosions in Sacroiliac Joints of Patients with Axial Spondyloarthritis Using the Magnetic Resonance Imaging Volumetric Interpolated Breath-hold Examination. The Journal of rheumatology. 2019;46(11):1445-49.[6]Wu H, Zhang G, Shi L, et al. Axial Spondyloarthritis: Dual-Energy Virtual Noncalcium CT in the Detection of Bone Marrow Edema in the Sacroiliac Joints. Radiology. 2019;290(1):157-64.Disclosure of Interests:Torsten Diekhoff Speakers bureau: Canon MS, Roche, Novartis, MSD, Grant/research support from: Assessment of Spondyloarthritis International Society, Iris Eshed: None declared, Felix Radny: None declared, Katharina Ziegeler: None declared, Fabian Proft: None declared, Juliane Greese: None declared, Dominik Deppe: None declared, Robert Biesen: None declared, Kay-Geert Hermann: None declared, Denis Poddubnyy: None declared

scholarly journals Biomarkers, imaging and disease activity indices in patients with early axial spondyloarthritis: the Italian arm of the SpondyloArthritis-Caught-Early (SPACE) Study

Reumatismo ◽  
2017 ◽  
Vol 69 (2) ◽  
pp. 65 ◽  
Author(s):  
M. Lorenzin ◽  
A. Ortolan ◽  
S. Vio ◽  
M. Favero ◽  
F. Oliviero ◽  
...  
Keyword(s):  
Disease Activity ◽  
Observational Studies ◽  
Axial Spondyloarthritis ◽  
Low Back ◽  
X Rays ◽  
Sacroiliac Joints ◽  
Asas Criteria ◽  
Patient Groups ◽  
Active Sacroiliitis ◽  
Activity Indices

The study aimed to evaluate biomarkers facilitating early diagnosis of axial spondyloarthritis (axSpA) and correlations between them and disease activity parameters and imaging indexes. Patients with low back pain (LBP) (≥3 months, ≤2 years, onset ≤45 years) participating in the Italian arm of the SpondyloArthritis-Caught-Early SPACE study underwent a physical examination, questionnaires, laboratory tests, X-rays and MRI of the spine and sacroiliac joints (SIJ). An expert rheumatologist formulated axSpA diagnosis in accordance with Assessment of SpondyloArthritis International Society (ASAS) criteria. Disease activity and physical functioning were assessed using imaging, clinical and serological indices. Spine and SIJ MRI and X-rays were scored independently by 2 readers using the SPARCC, mSASSS and NY-criteria. Patients were classified as: subjects with signs of radiographic sacroiliitis (r-axSpA), subjects with signs of sacroiliitis on SIJ-MRI but not on X-rays (nr-axSpA MRI SIJ+) or subjects with no signs of sacroiliitis on MRI/X-rays but with &gt;2 SpA features and signs of bone oedema on MRI spine (nr-axSpA MRI SIJ-/undifferentiated SpA). Significant differences were found in the prevalence of radiographic sacroiliitis, active sacroiliitis on MRI and SPARCC SIJ scores. Biomarker levels were not significantly increased in any of the patient groups. The correlations between IL-17 and IL-23 and other indices were not significant; correlations were found between IL-22 and BASFI, BASG1, HAQ, VAS pain, between mSASSS and MMP3, and between the latter and hsCRP. Although not significantly higher in any of the three groups, IL-22, MMP3 and hsCRP values were correlated with some disease activity indexes and with mSASSS. Large observational studies are required to confirm these preliminary findings.

Association of lumbosacral transitional vertebra and sacroiliitis in patients with inflammatory back pain suggesting axial spondyloarthritis

Rheumatology ◽  
2019 ◽  
Vol 59 (7) ◽  
pp. 1679-1683
Author(s):  
Guillermo Carvajal Alegria ◽  
Marie Voirin-Hertz ◽  
Florent Garrigues ◽  
Marion Herbette ◽  
Lucile Deloire ◽  
...  
Keyword(s):  
New York ◽  
Back Pain ◽  
Axial Spondyloarthritis ◽  
Inflammatory Back Pain ◽  
Low Back ◽  
Sacroiliac Joints ◽  
Exact Test ◽  
Lumbosacral Transitional Vertebra ◽  
Potential Impact

Abstract Objective Lumbosacral transitional vertebras (LSTVs) are common in the general population, but their potential impact on the sacroiliac joints is unclear. We aimed to determine the prevalence of LSTVs and to assess their associations with sacroiliitis by standard radiography and MRI in a population with suspected axial spondyloarthritis. Methods The data were from the DESIR cohort of 688 patients aged 18–50 years with inflammatory low back pain for ⩾3 months but &lt;3 years suggesting axial spondyloarthritis. The baseline pelvic radiographs were read by two blinded readers for the presence and type (Castellvi classification) of LSTVs. Associations between LSTVs and other variables collected at baseline and at the diagnosis were assessed using the χ2 test (or Fisher's exact test) or the Mann–Whitney test. Results LSTV was found in 200/688 (29.1%) patients. Castellvi type was Ia in 54 (7.8%), Ib in 76 (11.0%), IIa in 20 (2.9%), IIb in 12 (1.7%), IIIa in 7 (1.0%), IIIb in 21 (3.0%) and IV in 10 (1.4%) patients. Compared with the group without LSTVs, the group with LSTVs had higher proportions of patients meeting modified New York criteria for radiographic sacroiliitis (19% vs 27%, respectively; P = 0.013) and Assessment of SpondyloArthritis international Society MRI criteria for sacroiliitis (29% vs 39%, respectively; P = 0.019). Conclusion In patients with inflammatory back pain suggesting axial spondyloarthritis, LSTVs are associated with both radiographic and MRI sacroiliitis.

High Resolution Microscopy of Multi-Layered Biological Crystals

1982 ◽  
Vol 40 ◽  
pp. 80-83
Author(s):  
H.A. Cohen ◽  
T.W. Jeng ◽  
W. Chiu
Keyword(s):  
High Resolution ◽  
Low Dose ◽  
Three Dimensional ◽  
Data Interpretation ◽  
Two Dimensional ◽  
Biological Objects ◽  
Density Maps ◽  
Density Map ◽  
Complex Crystal ◽  
High Resolution Microscopy

This tutorial will discuss the methodology of low dose electron diffraction and imaging of crystalline biological objects, the problems of data interpretation for two-dimensional projected density maps of glucose embedded protein crystals, the factors to be considered in combining tilt data from three-dimensional crystals, and finally, the prospects of achieving a high resolution three-dimensional density map of a biological crystal. This methodology will be illustrated using two proteins under investigation in our laboratory, the T4 DNA helix destabilizing protein gp32*I and the crotoxin complex crystal.

Projected Structure of the Surface Protein of Sulfolobus Spec. B12 Determined to a Resolution of 1.0 NM by Cryo-Electronmicroscopy

1990 ◽  
Vol 48 (1) ◽  
pp. 102-103
Author(s):  
G. Lembcke ◽  
F. Zemlin
Keyword(s):  
Low Dose ◽  
Maximum Dose ◽  
Three Dimensional ◽  
Surface Protein ◽  
Protein S ◽  
Radiation Sensitivity ◽  
Specimen Preparation ◽  
Molecular Architecture ◽  
High Radiation ◽  
Fritz Haber

The thermoacidophilic archaebacterium Sulfolobus spec. B12 , which is closely related to Sulfolobus solfataricus , possesses a regularly arrayed surface protein (S-layer), which is linked to the plasma membrane via spacer elements spanning a distinct interspace of approximately 18 nm. The S-layer has p3-Symmetry and a lattice constant of 21 nm; three-dimensional reconstructions of negatively stained fragments yield a layer thickness of approximately 6-7 nm.For analysing the molecular architecture of Sulfolobus surface protein in greater detail we use aurothioglucose(ATG)-embedding for specimen preparation. Like glucose, ATG, is supposed to mimic the effect of water, but has the advantage of being less volatile. ATG has advantages over glucose when working with specimens composed exclusively of protein because of its higher density of 2.92 g cm-3. Because of its high radiation sensitivity electromicrographs has to be recorded under strict low-dose conditions. We have recorded electromicrographs with a liquid helium-cooled superconducting electron microscope (the socalled SULEIKA at the Fritz-Haber-lnstitut) with a specimen temperature of 4.5 K and with a maximum dose of 2000 e nm-2 avoiding any pre-irradiation of the specimen.

Comparison of Non-radiographic Axial Spondyloarthritis and Ankylosing Spondyltis from a Single Rheumatology Hospital in Morocco

2020 ◽  
Vol 16 (3) ◽  
pp. 240-244 ◽  
Author(s):  
Nessrine Akasbi ◽  
Siar Nihad ◽  
Zoukal Sofia ◽  
El Kohen Khadija ◽  
Harzy Taoufik
Keyword(s):  
Disease Burden ◽  
Axial Spondyloarthritis ◽  
Univariate Analysis ◽  
Cross Sectional Study ◽  
Low Back ◽  
New Classification ◽  
Cross Sectional ◽  
Asas Criteria ◽  
History Of ◽  
High Level

Background: According to the new classification criteria developed by The Assessment of SpondyloArthritis International Society, patients with axial spondyloarthritis (axSpA) can be classified in 2 subgroups: Patients with radiographic axial spondyloarthritis: ankylosing spondylitis patients (AS) and those with non-radiographic axial spondyloarthritis (nr-axSpA). Objective: The aim of the present study is to describe and discuss the differences and similarities between the two subgroups. Patients and Methods: A cross-sectional study was conducted in a single rheumatology hospital in Morocco. These included patients diagnosed as having axial spondyloarthritis according to ASAS criteria 2010, during a period of 6 years. The AS and the nr-axSpA subgroups were compared for the various axSpA-related variables. Results: Of the 277 patients with a diagnosis of axial SpA who were included in this study, 160 had AS and 117 had nr-axSpA. AS and nr-ax-SpA shared a similar age at diagnosis, similar prevalence of low back pain, lumbar stiffness, extra-articular manifestations, BASDAI and BASFI. In the multivariate analysis, AS patients were mainly male with cervical stiffness, enthesitis, coxitis and high level of ESR (erythrocyte sedimentation rate). The females generally had a family history of SpA and arthritis and were associated to the nr-axSpA form in the univariate analysis. Conclusion: This was the first study to characterise patients with AS and nr-axSpA in Morocco. Consistent with other studies published, this study showed that patients with nr-axSpA and patients with AS shared a comparable degree of disease burden.

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

2021 ◽  
Author(s):  
Christoph Germann ◽  
Daniela Kroismayr ◽  
Florian Brunner ◽  
Christian W. A. Pfirrmann ◽  
Reto Sutter ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Bone Marrow Edema ◽  
Low Back ◽  
Long Term Effects ◽  
Sacroiliac Joints ◽  
Number Of Children ◽  
Mri Changes ◽  
Marrow Edema ◽  
Subchondral Sclerosis

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.

scholarly journals 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 ◽  
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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