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.

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

2013 ◽  
Vol 40 (9) ◽  
pp. 1557-1565 ◽  
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.

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.

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

Prognostic Significance of Magnetic Resonance Imaging Changes of the Sacroiliac Joints in Spondyloarthritis – A Followup Study

2010 ◽  
Vol 37 (8) ◽  
pp. 1718-1727 ◽  
Author(s):  
KAREN BERENTH MADSEN ◽  
BERIT SCHIØTTZ-CHRISTENSEN ◽  
ANNE GRETHE JURIK
Keyword(s):  
Magnetic Resonance Imaging ◽  
New York ◽  
Magnetic Resonance ◽  
Axial Spondyloarthritis ◽  
Prognostic Significance ◽  
Activity Score ◽  
Resonance Imaging ◽  
Sacroiliac Joints ◽  
Scoring Method ◽  
Magnetic Resonance Imaging Mri

Objective.To evaluate the prognostic significance of sacroiliac joint (SIJ) changes by magnetic resonance imaging (MRI) based on 2–7 years of followup of patients with axial spondyloarthritis (SpA).Methods.Ninety-four patients (50 women, 44 men) with axial SpA obtained MRI of the SIJ from 1998–2004. They were examined at followup after 25–95 months (mean 51), including MRI and radiography of the SIJ and the spine. The Danish scoring method was used to quantify the activity and chronic SIJ changes by MRI. The activity score included subchondral edema and/or enhancement, while chronic changes encompassed erosions and subchondral fatty marrow deposition (FMD).Results.The MR score values for chronic SIJ changes increased significantly during followup, and were most pronounced in HLA-B27-positive patients and patients fulfilling the modified New York criteria for ankylosing spondylitis (AS) at followup. SIJ activity scores ≥ 2, total chronic scores ≥ 1, erosion scores ≥ 1, and FMD scores ≥ 4 at baseline were significantly related to progression of chronic SIJ changes. Activity score values ≥ 3 at baseline had a sensitivity of 0.83, specificity of 0.75, and accuracy of 0.80 in relation to the presence of AS at followup. The similar values for total chronic SIJ scores ≥ 4 at baseline were 0.86, 0.75, and 0.82, respectively, and for erosion scores ≥ 2 they were 0.88, 0.75, and 0.83.Conclusion.The occurrence of manifest SIJ activity by MRI or chronic changes at baseline was related to progression of chronic changes and the presence of AS at followup.

scholarly journals Magnetic Resonance Imaging (MRI) Utilization in a Ghanaian Teaching Hospital: Trend and Policy Implications

2020 ◽  
Vol 54 (1) ◽  
pp. 3-9
Author(s):  
Yaw B. Mensah ◽  
Kwadwo Mensah ◽  
Hafisatu Gbadamosi ◽  
Naa A. Mensah
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Teaching Hospital ◽  
Linear Regression Analysis ◽  
Policy Implications ◽  
Body Parts ◽  
Resonance Imaging ◽  
Mri Studies ◽  
Magnetic Resonance Imaging Mri ◽  
Clinical Conditions

Background: The use of Magnetic Resonance Imaging (MRI) is new in Ghana compared with some Western countries.A number of studies have observed increased MRI utilization due to increased sensitivity to diagnosis, and the paradigm shift to modalities that do not use radiation. Challenges with MRI use include high cost of the examination and inappropriate requests by referring clinicians. Objective: To determine the MRI utilisation trend in Korle Bu Teaching Hospital (KBTH), Ghana and its policy implications. Materials and Methods: A retrospective study undertaken in the Radiology Department, KBTH, from February to March, 2017. Eight hundred and forty request forms for MRI studies between January, 2013 and December 2016 were reviewed. Information on patient’s age and sex, number of MRI studies done, body parts and clinical conditions evaluated, appropriateness of clinical requests and existing policies on MRI in Ghana was gathered. Measures of central tendency and spread were obtained. Chi square, Pearson’s correlation and linear regression analysis were also used in the analysis. Results: The top three body parts requested were Spine (55 %), Brain (19%) and Joints (6 %); degenerative disease was the most common clinical condition evaluated.Significant association and correlation were obtained between of the number of body parts evaluated and examination year as well as the variety of clinical conditions requested and examination year. Conclusion: A progressive increase was noted in MRI utilisation both in number and diversity but no policy guiding MRI use in Ghana exists.

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