Differences in topographical location of sacroiliac joint MRI lesions in patients with early axial spondyloarthritis and mechanical back pain

Kiil, Rosa Marie; Mistegaard, Clara Elbæk; Loft, Anne Gitte; Zejden, Anna; Hendricks, Oliver; Jurik, Anne Grethe

doi:10.1186/s13075-022-02760-7

Cited by 17 publications

(9 citation statements)

References 36 publications

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“…MRI changes, such as subchondral BME ( Figure 4 ), might be expected in both PsA patients and healthy people, especially recreational runners, professional ice hockey players, or women in the postpartum period (who present mechanic SIJ modification), leading to significant “false positive” diagnoses of PsA. However, sacroiliac joint inflammation does not exceed three quadrants in these cases, unlike in the SpA group [ 13 , 22 , 23 , 43 , 75 , 76 ].…”

Section: Resultsmentioning

confidence: 99%

“…BME or sclerosis noted on the proximal/distal third of the posterior quadrant of the joint along with structural lesions, such as bone erosions or backfill, are strongly suggestive of sacroiliitis. [ 13 , 22 , 76 , 78 ]. The incidence of 30–41% of physically active individuals [ 78 ] that meet the ASAS criteria for axSpA advocates the importance of contextual MRI interpretation with a patient’s clinical and serological profile.…”

Section: Resultsmentioning

confidence: 99%

“…In a genetically predisposed individual, factors such as obesity, infections, articular trauma (sprain or dislocation), or skin trauma (triggering the Koebner phenomenon) can lead to a self-sustained immune response and clinical manifestations [ 12 ]. The spondyloarthropathies are characterized by articular and periarticular inflammatory modifications, with a destructive evolution, different from mechanical changes in non-inflammatory conditions [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

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MRI Findings in Axial Psoriatic Spondylarthritis

et al. 2023

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Psoriatic arthritis is a significant medical condition with a high prevalence, a wide variety of non-specific symptoms, and a high degree of overlap with other spondylarthritis disorders, particularly ankylosing spondylitis. Hence, knowledge of the magnetic resonance imaging (MRI) manifestations and a multidisciplinary strategy are required for the better management of these patients. We searched publications from the last 10 years and focused on the most relevant ones which discussed the classification criteria, the MRI characteristics of axial psoriatic arthritis, the importance of MRI for follow up, and the reliability of skin and synovial biopsy. Axial spondylarthritis can be diagnosed and followed up on using the well-established MRI technique and, additionally, a biopsy. The analysis and concordance between them can provide new directions for future studies.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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MRI Findings in Axial Psoriatic Spondylarthritis

et al. 2023

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“…These results align with the findings in the only previous study of postpartum women to assess the location of BME in the axial/semi‐axial scan plane, showing BME to cluster in the middle cartilaginous joint portion (13). This unique BME topography pattern might indicate strain‐related changes, which may add to the differentiation from BME related to sacroiliitis, where a widespread lesion distribution has been observed, including presence of BME in the ligamentous joint portion (6,17,29).…”

Section: Discussionmentioning

confidence: 99%

“…Apart from the standard SPARCC evaluation module, BME was also assessed using a recently introduced 2-plane assessment method designed for a refined topographical evaluation of SI joint BME (17). Briefly, the assessment was based on simultaneous evaluation of the semi-axial and semi-coronal STIR images.…”

Section: Methodsmentioning

confidence: 99%

Evolution of Magnetic Resonance Imaging Lesions at the Sacroiliac Joints During and After Pregnancy by Serial Magnetic Resonance Imaging From Gestational Week Twenty to Twelve Months Postpartum

Kiil

Weber

Loft

et al. 2023

Arthritis & Rheumatology

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Objective. Sacroiliac (SI) joint magnetic resonance imaging (MRI) findings simulating sacroiliitis related to axial spondyloarthritis (SpA) may occur in women before and after birth. This study was undertaken to explore the prevalence, evolution, and topography of SI joint MRI lesions in pregnant and postpartum women.Methods. A prospective cohort study included 103 first-time mothers who underwent up to 5 serial SI joint MRI between gestational week 20 and 12 months postpartum. After calibration, 3 assessors independently evaluated bone marrow edema (BME), including sacroiliitis according to the Assessment of SpondyloArthritis international Society (ASAS), as well as structural lesions, using the Spondyloarthritis Research Consortium of Canada (SPARCC) and a novel 2-plane assessment method.Results. BME was frequent both during pregnancy and the postpartum period, peaking at 3 months postpartum with a prevalence of 69% (SPARCC) and 80% (2-plane method), but still present in 54% (SPARCC) and 58% (2-plane method) of subjects at 12 months postpartum. At 12 months postpartum, sacroiliitis according to the current ASAS definition was met in 41%, while 21% and 14% of women fulfilled the newly proposed ASAS MRI thresholds for active and structural SI joint lesions, respectively. BME clustered in the anterior middle joint portions at all time points, and ligamentous BME was rare. At 12 months postpartum, SPARCC erosion scores ≥3 (ASAS threshold) were observed in only 2.8% of women.Conclusion. At 12 months postpartum, 41% of women met the current ASAS sacroiliitis definition, which may result in false-positive assignments of axial SpA diagnosis in postpartum women with back pain. The topographical BME distribution and virtually absent erosions (ASAS threshold) at 12 months postpartum may help discriminate postpartum strain-related conditions from axial SpA-related sacroiliitis.

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Magnetic Resonance Imaging Topography of Bone Marrow Edema in the Sacroiliac Joint of Postpartum Women

Kiil,

Weber,

Jurik

2024

ACR Open Rheumatology

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ObjectiveA traditional monoplanar semicoronal and a biplanar magnetic resonance imaging (MRI) assessment method were used to compare the topographical distribution of postpartum strain‐related bone marrow edema (BME) at the sacroiliac joint (SIJ).MethodsThe presence and topographical location of SIJ BME were assessed independently by three readers in 71 women 12 months postpartum. A traditional monoplanar semicoronal and a biplanar BME evaluation by 8 (upper and lower) and 12 joint (upper, middle, and lower) regions, respectively, was performed with >4 weeks between the two assessments. Descriptive results were reported as mean ± SD and ranges, and interreader agreement by intraclass correlation coefficient (ICC).ResultsBy semicoronal assessment, 38 (53.5%) women had BME with a mean ± SD SPARCC score of 2.3 ± 4.0 (range 0–22; ICC 0.93, 95% confidence interval [CI] 0.92–0.94). Forty‐one (57.8%) had BME by biplanar assessment with a mean ± SD sum score of 2.9 ± 5.8 (range 0–32.7; ICC 0.89, 95% CI 0.88–0.91). By semicoronal assessment, the highest frequency and mean SPARCC scores were in the anterior upper regions of ilium (24%, mean 0.6) and sacrum (21%, mean 0.3) followed by the posterior upper sacral (20%, mean 0.4) and posterior lower iliac (20%, mean 0.3) regions. By biplanar assessment, the anterior middle joint regions had highest BME frequency and sum scores, sacral side (32%, mean 1.9) and iliac side (27%, mean 2.0), respectively; frequencies and sum scores were generally higher in the anterior compared to the posterior joint regions.ConclusionThe 12‐region biplanar assessment revealed a predominantly anterior middle location of postpartum SIJ BME whereas the 8‐region monoplanar approach did not demarcate distinct strain‐prone SIJ regions. Complementing traditional monoplanar semicoronal SIJ MRI evaluation by a semiaxial assessment may facilitate discrimination of strain‐related conditions from early axial spondyloarthritis.

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Differences in topographical location of sacroiliac joint MRI lesions in patients with early axial spondyloarthritis and mechanical back pain

Cited by 17 publications

References 36 publications

MRI Findings in Axial Psoriatic Spondylarthritis

MRI Findings in Axial Psoriatic Spondylarthritis

Evolution of Magnetic Resonance Imaging Lesions at the Sacroiliac Joints During and After Pregnancy by Serial Magnetic Resonance Imaging From Gestational Week Twenty to Twelve Months Postpartum

Magnetic Resonance Imaging Topography of Bone Marrow Edema in the Sacroiliac Joint of Postpartum Women

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