THU0492 MAGNETIC RESONANCE IMAGING OF THE SACROILIAC JOINTS IN PATIENTS WITH HYPERMOBILITY: A RETROSPECTIVE COHORT STUDY

Background:The incidence of inflammatory and structural lesions on magnetic resonance imaging of sacroiliac joints (MRI SIJs) in patients with hypermobility related disorders has not been fully investigated. Hypermobile patients are more susceptible to pelvic instability and biomechanical stress of the SIJs, leading to MRI SIJ changes similar to those occurring in spondyloarthritis (SpA). Patients with hypermobility and suspected SpA pose a unique challenge owing to the high prevalence of back pain in the hypermobility cohort and the absence of spinal restriction on clinical examination.Objectives:In this study, we aim to investigate the incidence of MRI SIJ lesions in patients with hypermobility.Methods:We performed a retrospective study of all patients with a confirmed diagnosis of hypermobility related disorders (including hypermobility syndrome, hypermobility spectrum disorders and Ehlers-Danlos Syndromes) referred for an MRI lumbar spine and SIJ between 2011 and 2019 to investigate long-standing back pain. MRIs were examined by a musculoskeletal (MSK) radiologist with more than 25 years of experience, who was blinded to the clinical outcome of the patients. MRI SIJs were assessed for the presence of bone marrow oedema, subchondral sclerosis, erosion, fatty change, enthesitis, ankylosis, joint fluid and capsulitis.Results:51 patients with confirmed hypermobility related disorders were referred for MRI SIJ and lumbar spine between 2011 and 2019. 3 patients demonstrated clinical features in keeping with a diagnosis of SpA and were excluded from the study. 15/48 (31.3%) of patients with hypermobility and back pain (but no clinical picture of SpA) were found to have inflammatory and/or structural lesions on MRI SIJ. The most frequent lesions were small foci of bone marrow oedema (16.6%) followed by subchondral sclerosis (12.5%) and fatty change (10.4%). The incidence of erosions was 4.2%.Conclusion:There is a relatively high incidence of inflammatory and structural lesions on MRI SIJ of patients with hypermobility. The presence of hypermobility should be taken into consideration when interpreting MRI changes in patients with suspected SpA. Further research into long-term outcomes of MRI SIJs in patients with hypermobility and back pain is required to establish the clinical significance of these findings.Disclosure of Interests: :Alexis Jones: None declared, Coziana Ciurtin Grant/research support from: Pfizer, Consultant of: Roche, Modern Biosciences, Hanadi Kazkaz: None declared, Margaret Hall-Craggs: None declared

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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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Natural course of bone marrow oedema on magnetic resonance imaging of the sacroiliac joints in patients with early inflammatory back pain: a 2-year follow-up study

Scandinavian Journal of Rheumatology ◽

10.3109/03009742.2014.933247 ◽

2014 ◽

Vol 44 (2) ◽

pp. 129-134 ◽

Cited By ~ 9

Author(s):

M van Onna ◽

A van Tubergen ◽

AG Jurik ◽

D van der Heijde ◽

R Landewé

Keyword(s):

Magnetic Resonance Imaging ◽

Bone Marrow ◽

Back Pain ◽

Magnetic Resonance ◽

Natural Course ◽

Inflammatory Back Pain ◽

Resonance Imaging ◽

Sacroiliac Joints ◽

Follow Up Study

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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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Magnetic resonance imaging of the lumbar spine in adult: Evaluation of spinal incidental findings in patients with low back pain

Annals of Medical Research ◽

10.5455/annalsmedres.2019.02.075 ◽

2019 ◽

pp. 1

Author(s):

Hilal Altas ◽

Ali Yilmaz

Keyword(s):

Magnetic Resonance Imaging ◽

Low Back Pain ◽

Back Pain ◽

Lumbar Spine ◽

Magnetic Resonance ◽

Incidental Findings ◽

Low Back ◽

Resonance Imaging

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Magnetic Resonance Imaging Compared to Conventional Radiographs for Detection of Chronic Structural Changes in Sacroiliac Joints in Axial Spondyloarthritis

The Journal of Rheumatology ◽

10.3899/jrheum.130141 ◽

2013 ◽

Vol 40 (9) ◽

pp. 1557-1565 ◽

Cited By ~ 27

Author(s):

Denis Poddubnyy ◽

Inna Gaydukova ◽

Kay-Geert Hermann ◽

In-Ho Song ◽

Hildrun Haibel ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

New York ◽

Magnetic Resonance ◽

Structural Changes ◽

Axial Spondyloarthritis ◽

Joint Space ◽

Resonance Imaging ◽

Sacroiliac Joints ◽

Overall Performance ◽

Subchondral Sclerosis

Objective.We investigated the performance of magnetic resonance imaging (MRI) compared to conventional radiographs for detection of chronic structural changes in the sacroiliac joints (SIJ) in patients with axial spondyloarthritis (SpA).Methods.We included 112 patients with definite axial SpA (68 with ankylosing spondylitis and 44 with nonradiographic axial SpA), for whom radiographs and MRI scans of the SIJ performed at the same time were available. Radiographs and MRI of the SIJ were scored for subchondral sclerosis (score 0–2), erosions (score 0–3), and joint space changes (score 0–5) in each SIJ. Readers provided an overall impression of the extent of damage according to the scoring system of the modified New York criteria.Results.In total, 224 SIJ from 112 patients were available for analysis. There was rather low agreement between MRI and radiographs concerning definite erosions of SIJ (κ = 0.11), moderate agreement for definite subchondral sclerosis (κ = 0.46) and definite joint space abnormalities (κ = 0.41), and almost perfect agreement for joint ankylosis (κ = 0.85). MRI demonstrated a good overall performance in detection of definite “chronic” sacroiliitis, with a sensitivity of 84% and a specificity of 61%. For sacroiliitis fulfilling the modified New York criteria, MRI had a sensitivity of 81% and a specificity of 64% using radiographs as the reference method.Conclusion.MRI demonstrated good overall performance for detection of chronic structural changes in the SIJ as compared to radiographs.

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