Development and Preliminary Validation of the Spondyloarthritis Research Consortium of Canada Magnetic Resonance Imaging Sacroiliac Joint Structural Score

Maksymowych, Walter P.; Wichuk, Stephanie; Chiowchanwisawakit, Praveena; Lambert, Robert G.; Pedersen, Susanne Juhl

doi:10.3899/jrheum.140519

Cited by 127 publications

(126 citation statements)

References 21 publications

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“…The SSS method incorporates scoring principles similar to those of the SPARCC SI joint inflammation score, which is based on assessment of consecutive slices through the SI joints, division of each SI joint into quadrants, and dichotomous scoring (present/absent) of lesions in each quadrant (11). The presence/absence of lesions is scored in SI joint quadrants (for fat metaplasia and erosion) or halves (for backfill and ankylosis), using a direct online dataentry system based on a schematic diagram of the SI joints.…”

Section: Methodsmentioning

confidence: 99%

“…They are evaluated systematically every 6 months according to a standardized protocol that includes clinical and laboratory parameters. Imaging parameters include SPARCC MRI SI joint inflammation scores that are recorded for each patient in the cohort (by readers unconnected with this study) at baseline, at 3-6 months for patients starting anti-tumor necrosis factor ␣ (anti-TNF␣) therapy, and annually for all patients, as described previously (11). A total of 147 patients had available baseline and 2-year followup MRI scans.…”

Section: Methodsmentioning

confidence: 99%

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Fat Metaplasia and Backfill Are Key Intermediaries in the Development of Sacroiliac Joint Ankylosis in Patients With Ankylosing Spondylitis

Maksymowych

Wichuk

Chiowchanwisawakit

et al. 2014

Arthritis & Rheumatology

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129

108

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Objective. Fat metaplasia in bone marrow on T1-weighted magnetic resonance imaging (MRI) scans may develop after resolution of inflammation in patients with ankylosing spondylitis (AS) and may predict new bone formation in the spine. Similar tissue, termed backfill, may also fill areas of excavated bone in the sacroiliac (SI) joints and may reflect resolution of inflammation and tissue repair at sites of erosions. The purpose of this study was to test our hypothesis that SI joint ankylosis develops following repair of erosions and that tissue characterized by fat metaplasia is a key intermediary step in this pathway.Methods. We used the Spondyloarthritis Research Consortium of Canada (SPARCC) SI structural lesion score (SSS) method to assess fat metaplasia, erosions, backfill, and ankylosis on MRIs of the SI joints in 147 patients with AS monitored for 2 years. Univariate and multivariate regression analyses focused first on identifying significant MRI predictors of new backfill and fat metaplasia. We then assessed the role of backfill and fat metaplasia in the development of new ankylosis. All analyses were adjusted for demographic features, treatment, and baseline and 2-year change in SSS values for parameters of inflammation and MRI structural lesions.Results. Resolution of inflammation and reduction of erosions were each independently associated with the development of new backfill and fat metaplasia at 2 years on multivariate analyses. Multivariate regression analysis that included demographic features, baseline and 2-year change in parameters of inflammation and MRI structural lesion showed that reduction in erosions (P ‫؍‬ 0.0005) and increase in fat metaplasia (P ‫؍‬ 0.002) at 2 years was each independently associated with the development of new ankylosis.Conclusion. Our data support a disease model whereby ankylosis develops following repair of erosions, and fat metaplasia and backfill are key intermediary steps in this pathway.Spondyloarthritis (SpA) is an inflammatory disorder primarily of the axial spine that typically begins with sacroiliitis. The first sign of disease on radiography is the appearance of erosion of the subchondral bone of the ilium, which is seen as a blurred cortical outline. Progression results in more extensive erosion involving the sacral bone and the appearance of pseudowidening. Subsequent features include bone sclerosis and, finally, ankylosis across the joint. Magnetic resonance imaging (MRI) constitutes a major advance in the field through its ability to demonstrate active inflammation on fatsuppressed sequences, such as short tau inversion recovery (STIR), and structural lesions, such as fat metaplasia, erosions, and ankylosis, on T1-weighed sequences (1).

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Fat Metaplasia and Backfill Are Key Intermediaries in the Development of Sacroiliac Joint Ankylosis in Patients With Ankylosing Spondylitis

Maksymowych

Wichuk

Chiowchanwisawakit

et al. 2014

Arthritis & Rheumatology

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129

108

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“…The SSS is described in detail and the interreader reliability determined. It demonstrated overall moderate to good reliability for both status scores and change scores over 1-2 years of followup 3 . Further validation in additional longitudinal cohorts with different disease durations, degrees of inflammation and damage, and therapeutic regimens are obviously needed.…”

mentioning

confidence: 99%

“…Preferably, different aspects of progression should be measurable, particularly if there is an interest in understanding details of the disease process. In this issue of The Journal, Maksymowych, et al describe the development and validation of a magnetic resonance imaging (MRI) scoring method for several aspects of structural damage in the sacroiliac joints (SIJ) 3 . This is an important step in clarification of the development of these structural changes.…”

mentioning

confidence: 99%

“…This is an important step in clarification of the development of these structural changes. Building on definitions of individual SIJ pathologies (erosion, backfill, fat infiltration, ankylosis) described in the MORPHO study by Weber, et al 4,5 , Maksymowych, et al describe and apply a newly developed scoring system by which the presence/absence of lesions is systematically scored in SIJ quadrants (fat, erosion) or halves (backfill, ankylosis) separately in each of 5 consecutive semicoronal slices through the cartilaginous part of the joint 3 . The quadratic per-slice scoring system follows the same principles as the Spondyloarthritis Research Consortium of Canada (SPARCC) scoring method for SIJ inflammation 6 .…”

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confidence: 99%

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Magnetic Resonance Imaging — Key to Understanding and Monitoring Disease Progression in Spondyloarthritis?

Østergaard

Sørensen

2015

J Rheumatol

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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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Development and Preliminary Validation of the Spondyloarthritis Research Consortium of Canada Magnetic Resonance Imaging Sacroiliac Joint Structural Score

Abstract: The new SPARCC MRI SSS method can detect structural changes in the SIJ with acceptable reliability over a 1-2-year timeframe, and should be further validated in patients with SpA.

Cited by 127 publications

References 21 publications

Fat Metaplasia and Backfill Are Key Intermediaries in the Development of Sacroiliac Joint Ankylosis in Patients With Ankylosing Spondylitis

Fat Metaplasia and Backfill Are Key Intermediaries in the Development of Sacroiliac Joint Ankylosis in Patients With Ankylosing Spondylitis

Magnetic Resonance Imaging — Key to Understanding and Monitoring Disease Progression in Spondyloarthritis?

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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