Age- and Sex-dependent Frequency of Fat Metaplasia and Other Structural Changes of the Sacroiliac Joints in Patients without Axial Spondyloarthritis: A Retrospective, Cross-sectional MRI Study

Ziegeler, Katharina; Eshkal, Hamama; Schorr, Claudia; Sieper, Joachim; Diekhoff, Torsten; Makowski, Marcus R.; Hamm, Bernd; Hermann, Kay-Geert A.

doi:10.3899/jrheum.170904

Cited by 44 publications

(26 citation statements)

References 35 publications

(49 reference statements)

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“…A recent retrospective, cross‐sectional study of pelvic MRI in a large population of subjects without a rheumatic disease diagnosis found that, although fat lesions were common and increased with age (50.6% of subjects age <45 years versus 94.4% of subjects age ≥75 years), erosions were uncommon (0.6% of subjects age <45 years and 2.6% of subjects in the entire study population) and had no age‐dependent increase . In our study, we found fat lesions in all of the participant groups, although to a much lower extent.…”

Section: Discussioncontrasting

confidence: 52%

Magnetic Resonance Imaging of Lesions in the Sacroiliac Joints for Differentiation of Patients With Axial Spondyloarthritis From Control Subjects With or Without Pelvic or Buttock Pain: A Prospective, Cross‐Sectional Study of 204 Participants

Seven

Østergaard

Morsel‐Carlsen

et al. 2019

Arthritis & Rheumatology

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Objective. To evaluate whether different types of sacroiliac (SI) joint lesions identified by magnetic resonance imaging (MRI) could differentiate axial spondyloarthritis (SpA) from conditions with buttock or pelvic pain attributable to other reasons, including postpartum women and healthy subjects.Methods. The study was designed as a prospective, cross-sectional study involving 204 participants, comprising patients with axial SpA (n = 41) and control groups of subjects with or without SI joint pain, including patients with lumbar disc herniation (n = 25), women with (n = 46) or without (n = 14) postpartum buttock/pelvic pain (having given birth within the preceding 4-16 months), hospital cleaning staff (n = 26), long-distance runners (n = 23), and healthy men (n = 29). Participants underwent clinical examination and MRI, and MRIs were evaluated in a blinded manner by 2 readers according to the Spondyloarthritis Research Consortium of Canada (SPARCC) SI joint inflammation and structural lesion scores. SPARCC score cutoff levels were defined as scores above a certain threshold. Primary analyses were based on reader agreement with regard to the presence of SI joint pathologic features on MRI ("concordant reads"). Sensitivity, specificity, and positive and negative predictive values were calculated.Results. SI joint ankylosis and backfill were detected by MRI only in patients with axial SpA (32% and 37%, respectively), while bone marrow edema (BME) and fat lesions were seen in all non-axial SpA control groups (3-39% with BME and 4-14% with fat lesions). SI joint erosion was present only in patients with axial SpA and in women with postpartum buttock/pelvic pain (at erosion score cutoffs of >1 and >4, 61% and 34%, respectively, in patients with axial SpA, and 9% and 2%, respectively, in women with postpartum buttock/pelvic pain). A SPARCC BME score of ≥5 was present only in patients with axial SpA (56%) and in women with postpartum buttock/pelvic pain (24%), while fat lesions were present, albeit rarely, at high SPARCC cutoff scores in nearly all groups. Of the 38 women from the non-postpartum control groups who had given birth (mean time since birth 9.7 years), 2 (5%) had BME, whereas none had SI joint erosion or fat lesions, and none had a BME score of ≥4.Conclusion. BME and fat lesions were most pronounced in patients with axial SpA, but also occurred in other groups, particularly women with postpartum buttock/pelvic pain. Erosion above a certain SPARCC score threshold as well as backfill and ankylosis were highly specific for axial SpA.

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Section: Discussioncontrasting

confidence: 52%

Magnetic Resonance Imaging of Lesions in the Sacroiliac Joints for Differentiation of Patients With Axial Spondyloarthritis From Control Subjects With or Without Pelvic or Buttock Pain: A Prospective, Cross‐Sectional Study of 204 Participants

Seven

Østergaard

Morsel‐Carlsen

et al. 2019

Arthritis & Rheumatology

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“…It is now well established that resolution of subchondral BME in the SIJ may be associated with the appearance of bright tissue on a T1W scan indicating the expression of fatty acids although the histopathology of this tissue is unknown 16–18. While the appearance of fat in the bone marrow may also be physiological,19 20 previous reports have shown that the appearance of post-inflammatory fat metaplasia has characteristic features defined by a distinct border, homogeneous increase in T1W signal and proximity to subchondral bone 21. This lesion has previously been shown to be reliably detected and to be highly specific for SpA,21 22 although questionable to what degree it enhances diagnosis because of the concomitant presence of lesions such as BME and erosion.…”

Section: Discussionmentioning

confidence: 92%

MRI lesions in the sacroiliac joints of patients with spondyloarthritis: an update of definitions and validation by the ASAS MRI working group

et al. 2019

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ObjectivesThe Assessment of SpondyloArthritis international Society (ASAS) MRI working group (WG) was convened to generate a consensus update on standardised definitions for MRI lesions in the sacroiliac joint (SIJ) of patients with spondyloarthritis (SpA), and to conduct preliminary validation.MethodsThe literature pertaining to these MRI lesion definitions was discussed at three meetings of the group. 25 investigators (20 rheumatologists, 5 radiologists) determined which definitions should be retained or required revision, and which required a new definition. Lesion definitions were assessed in a multi-reader validation exercise using 278 MRI scans from the ASAS classification cohort by global assessment (lesion present/absent) and detailed scoring (inflammation and structural). Reliability of detection of lesions was analysed using kappa statistics and the intraclass correlation coefficient (ICC).ResultsNo revisions were made to the current ASAS definition of a positive SIJ MRI or definitions for subchondral inflammation and sclerosis. The following definitions were revised: capsulitis, enthesitis, fat lesion and erosion. New definitions were developed for joint space enhancement, joint space fluid, fat metaplasia in an erosion cavity, ankylosis and bone bud. The most frequently detected structural lesion, erosion, was detected almost as reliably as subchondral inflammation (κappa/ICC:0.61/0.54 and 0.60/0.83) . Fat metaplasia in an erosion cavity and ankylosis were also reliably detected despite their low frequency (κappa/ICC:0.50/0.37 and 0.58/0.97).ConclusionThe ASAS-MRI WG concluded that several definitions required revision and some new definitions were necessary. Multi-reader validation demonstrated substantial reliability for the most frequently detected lesions and comparable reliability between active and structural lesions.

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“…Although not required in ASAS definitions of SpA on MRI, the presence of concomitant structural lesions may contribute to diagnosing axial SpA (2). Several studies have examined the presence of inflammatory (4–8,10–13) and structural (4,5,7–14) SI joint features on MRI, such as erosion, fat lesions, sclerosis, backfill, and ankylosis, either individually or in various combinations (14,15), in axial SpA and/or in different conditions. In a recent publication (9), we investigated the diagnostic utility of BME and different structural lesions (i.e., fat lesions, erosion, backfill, and ankylosis) in SI joints identified by MRI according to the Spondyloarthritis Research Consortium of Canada (SPARCC) method (16,17) for differentiating patients with axial SpA from control subjects with or without buttock or pelvic pain.…”

Section: Introductionmentioning

confidence: 99%

Anatomic Distribution of Sacroiliac Joint Lesions on Magnetic Resonance Imaging in Patients With Axial Spondyloarthritis and Control Subjects: A Prospective Cross‐Sectional Study, Including Postpartum Women, Patients With Disc Herniation, Cleaning Staff, Runners, and Healthy Individuals

Seven

Østergaard

Morsel‐Carlsen

et al. 2021

Arthritis Care & Research

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Objective To investigate the anatomic location and distribution of lesions on magnetic resonance imaging (MRI) in the sacroiliac (SI) joints in patients with axial spondyloarthritis (SpA), women with and without postpartum pain (childbirth within 4–16 months), patients with disc herniation, cleaning staff, runners, and healthy persons. Methods In a prospective cross‐sectional study of 204 participants, MRI of the entire cartilaginous compartment of the SI joint was scored blindly by 2 independent, experienced readers, according to Spondyloarthritis Research Consortium of Canada definitions of SI joint inflammation and structural lesions in each SI joint quadrant or half and in each of 9 slices. The locations of the lesions (unilateral/bilateral, upper/lower, sacral/iliac, and anterior/central/posterior slices) were analyzed based on concordant reads. Results Bone marrow edema (BME) occurred in all quadrants in nearly all participant groups, but rarely bilaterally, except in patients with axial SpA and women with postpartum pain. Fat lesions were mainly found in axial SpA and occurred in all quadrants, but mostly bilaterally in sacral quadrants. Erosion was rare, except in axial SpA, where it was mainly iliac and often bilateral. Sclerosis was exclusively iliac and most frequent in women with postpartum pain. Conclusion The location and distribution of common SI joint lesions in axial SpA and non–axial SpA were reported, and group‐specific patterns were revealed. BME distributed bilaterally or unilaterally, both locally and more widespread in the SI joint, is common in both postpartum women with pain and axial SpA patients, which limits the use of BME to differentiate these groups. This study indicates that the presence of fat lesions, especially when widespread, and/or erosion, particularly when located centrally or posteriorly, are diagnostically important and should be investigated further.

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Age- and Sex-dependent Frequency of Fat Metaplasia and Other Structural Changes of the Sacroiliac Joints in Patients without Axial Spondyloarthritis: A Retrospective, Cross-sectional MRI Study

Abstract: Our study shows a very high prevalence of fat metaplasia adjacent to the sacroiliac joint in asymptomatic patients, while erosions are extremely uncommon.

Cited by 44 publications

References 35 publications

Magnetic Resonance Imaging of Lesions in the Sacroiliac Joints for Differentiation of Patients With Axial Spondyloarthritis From Control Subjects With or Without Pelvic or Buttock Pain: A Prospective, Cross‐Sectional Study of 204 Participants

Magnetic Resonance Imaging of Lesions in the Sacroiliac Joints for Differentiation of Patients With Axial Spondyloarthritis From Control Subjects With or Without Pelvic or Buttock Pain: A Prospective, Cross‐Sectional Study of 204 Participants

MRI lesions in the sacroiliac joints of patients with spondyloarthritis: an update of definitions and validation by the ASAS MRI working group

Anatomic Distribution of Sacroiliac Joint Lesions on Magnetic Resonance Imaging in Patients With Axial Spondyloarthritis and Control Subjects: A Prospective Cross‐Sectional Study, Including Postpartum Women, Patients With Disc Herniation, Cleaning Staff, Runners, and Healthy Individuals

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