scholarly journals The evaluation of bone marrow edema in sacroiliac joint in patients with ankylosing spondylitis using magnetic resonance imaging Dixon sequence

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Ming-Shan Du ◽  
Xuan-Qi Xiong ◽  
He Liu ◽  
Xin Qin ◽  
Xiao-Fei Hu ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Ankylosing Spondylitis ◽  
Magnetic Resonance ◽  
Sacroiliac Joint ◽  
Bone Marrow Edema ◽  
Control Group ◽  
Case Group ◽  
Resonance Imaging ◽  
Sacroiliac Joints ◽  
Marrow Edema

Abstract Background Bone marrow edema of the sacroiliac joint is the early imaging manifestation, an indicator of inflammatory activity of ankylosing spondylitis (AS) (Yang R, et. al. Medicine (Baltimore) 98:e14620, 2019). Objective The aim of the study was to investigate the value of magnetic resonance imaging (MRI) Dixon sequence in the diagnosis of marrow edema of the sacroiliac joint in patients with AS. Methods Forty-five patients with AS admitted in our hospital between November 2016 and February 2019 were selected retrospectively as the case group. Forty-five healthy subjects recruited between November 2016 and February 2019 served as the control group. Bath ankylosing spondylitis disease activity index (BASDAI), Bath ankylosing spondylitis functional index (BASFI), C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were recorded after admission to the hospital. The Dixon sequence water-fat ratio of the iliac and sacral surfaces of the bilateral sacroiliac joints in the study group were compared with indicators above in order to find the correlation. Results The water-fat ratio under the bilateral sacroiliac joints on Dixon sequence images in the case group was significantly higher than that in the healthy control group (P<0.05). The Dixon sequence water-fat ratio of the iliac and sacral surfaces of the bilateral sacroiliac joints in the study group were positively correlated with spinal arthritis research (SPARCC), BASFI and BASDAI score (all P < 0.05), but did not correlate with ESR and CRP. Conclusion The water-fat ratio of magnetic resonance Dixon sequence can be used as a reference index to evaluate the degree of bone marrow edema in active stage of sacroiliac arthritis.

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

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

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

2014 ◽  
Vol 41 (6) ◽  
pp. 1088-1094 ◽  
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.

Erosions Are the Most Relevant Magnetic Resonance Imaging Features in Quantification of Sacroiliac Joints in Ankylosing Spondylitis

2010 ◽  
Vol 37 (3) ◽  
pp. 622-627 ◽  
Author(s):  
MARIUS C. WICK ◽  
RÜDIGER J. WEISS ◽  
WERNER JASCHKE ◽  
ANDREA S. KLAUSER
Keyword(s):  
Magnetic Resonance Imaging ◽  
Bone Marrow ◽  
Ankylosing Spondylitis ◽  
Magnetic Resonance ◽  
Contrast Medium ◽  
Rheumatic Diseases ◽  
Bone Marrow Edema ◽  
Imaging Features ◽  
Resonance Imaging ◽  
Marrow Edema

Objective.To determine the most relevant radiological features in quantitative magnetic resonance imaging (MRI) of sacroiliac (SI) joints in patients with recent-onset ankylosing spondylitis (AS) versus patients with SI involvement due to other rheumatic diseases, or to degenerative SI pain.Methods.We retrospectively analyzed laboratory values, clinical data, and MRI of the SI joints of 179 patients admitted for evaluation of AS-suspicious SI pain. Standardized MRI sequences were performed at time of first presentation, then archived, and retrospectively quantitatively assessed using a modified SPARCC method for formal statistical comparisons.Results.Of all patients, 27 (15%) were diagnosed with definite AS. The remainder had SI involvement in other rheumatic diseases, HLA-B27– spondyloarthropathy, or nonspecific degenerative changes. While joint space irregularities, bone marrow edema, subcortical cysts, and contrast medium enhancement were found in MRI of all patients, these features were inconsistent, and only erosions were statistically significantly (p < 0.02) in patients diagnosed with AS. Only in AS, the presence of erosions and the quantitative SPARCC erosion subscore correlated to a statistically significant degree (p < 0.02) with laboratory levels of inflammation.Conclusion.Erosions alone, not bone marrow edema or contrast medium enhancement, are the most disease-specific measurable imaging findings in SI MRI of patients with AS.

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