Imaging in Axial Spondyloarthritis: What is Relevant for Diagnosis in Daily Practice?

Weber, Ulrich; Jurik, Anne Grethe; Lambert, Robert G.; Maksymowych, Walter P.

doi:10.1007/s11926-021-01030-w

Cited by 12 publications

(1 citation statement)

References 106 publications

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“…However, SIJ BME is not specific nor pathognomonic for inflammatory sacroiliitis and can be seen in other SIJ conditions such as in the SIJs of peripartum females, osteitis condensans, and in marathon runners [45][46][47]. Along with the growing understanding of the nonspecific nature of BME came an awareness of the additive value of structural lesions on MRI for the diagnosis of sacroiliitis [48,49]. In addition to the lesions seen on radiography and CT -erosions, sclerosis and ankylosis -there are other structural lesions, namely periarticular fat metaplasia, or fatty Although CT is still regarded as the standard of reference for the detection of bone erosions, T1weighted (T1-w) MRI was shown to be superior to pelvic radiographs in detecting erosions (see Fig.…”

Section: Mri Of the Sacroiliac Joints: A Potential One-stop Shop For ...mentioning

confidence: 99%

Is it time to move on from pelvic radiography as the first-line imaging modality for suspected sacroiliitis?

Eshed

Diekhoff

Hermann

2022

Current Opinion in Rheumatology

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Purpose of reviewPelvic radiography in which structural lesions characteristic of sacroiliitis can be detected, is recommended as the first imaging modality when axial spondyloarthritis (axSpA) is suspected clinically. However, crosssectional modalities like computed tomography (CT) and magnetic resonance imaging (MRI) are superior to radiographs for diagnosing sacroiliitis. Thus, we currently debate the role of radiography as first imaging modality in the diagnostic workup of axSpA. Recent findingsDiagnosing sacroiliitis on pelvic radiographs is challenging with large interobserver and intraobserver variation. Low-dose CT (ldCT) of the sacroiliac joints (SIJs) was proved to be more sensitive and reliable than radiographs with comparable ionizing radiation exposure. MRI is the preferred modality for detecting early SIJ inflammation, well before structural lesions evolve. New, promising MRI sequences sensitive to cortical bone improve erosion detection, making MRI a one-stop shop for the diagnosis of sacroiliitis. SummaryGiven the debatable additive value of pelvic radiographs for the detection of sacroiliitis, and the presence of excellent alternatives for imaging the bony cortex of the SIJs such as ldCT and MRI with state-of-the-art sequences sensitive to cortical bone, it is high time to discuss the use of these more accurate modalities instead of radiographs.

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Section: Mri Of the Sacroiliac Joints: A Potential One-stop Shop For ...mentioning

confidence: 99%

Is it time to move on from pelvic radiography as the first-line imaging modality for suspected sacroiliitis?

Eshed

Diekhoff

Hermann

2022

Current Opinion in Rheumatology

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Detection of structural lesions of the sacroiliac joints in patients with spondyloarthritis: A comparison of T1-weighted 3D spoiled gradient echo MRI and MRI-based synthetic CT versus T1-weighted turbo spin echo MRI

Krabbe,

Møller,

Hadsbjerg

et al. 2024

Skeletal Radiol

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Objectives To investigate the detection of erosion, sclerosis and ankylosis using 1 mm 3D T1-weighted spoiled gradient echo (T1w-GRE) MRI and 1 mm MRI-based synthetic CT (sCT), compared with conventional 4 mm T1w-TSE. Materials and methods Prospective, cross-sectional study. Semi-coronal 4 mm T1w-TSE and axial T1w-GRE with 1.6 mm slice thickness and 0.8 mm spacing between overlapping slices were performed. The T1w-GRE images were processed into sCT images using a commercial deep learning algorithm, BoneMRI. Both were reconstructed into 1 mm semi-coronal images. T1w-TSE, T1w-GRE and sCT images were assessed independently by 3 expert and 4 non-expert readers for erosion, sclerosis and ankylosis. Cohen’s kappa for inter-reader agreement, exact McNemar test for lesion frequencies and Wilcoxon signed-rank test for confidence in lesion detection were used. Results Nineteen patients with axial spondyloarthritis were evaluated. T1w-GRE increased inter-reader agreement for detecting erosion (kappa 0.42 vs 0.21 in non-experts), increased detection of erosion (57 vs 43 of 152 joint quadrants) and sclerosis (26 vs 17 of 152 joint quadrants) among experts, and increased reader confidence for scoring erosion and sclerosis. sCT increased inter-reader agreement for detecting sclerosis (kappa 0.69 vs 0.37 in experts) and ankylosis (0.71 vs 0.52 in non-experts), increased detection of sclerosis (34 vs 17 of 152 joint quadrants) and ankylosis (20 vs 13 of 76 joint halves) among experts, and increased reader confidence for scoring erosion, sclerosis and ankylosis. Conclusion T1w-GRE and sCT increase sensitivity and reader confidence for the detection of erosion, sclerosis and ankylosis, compared with T1w-TSE. Clinical relevance statement These methods improve the detection of sacroiliac joint structural lesions and might be a useful addition to SIJ MRI protocols both in routine clinical care and as structural outcome measures in clinical trials.

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Diagnostic features of osteitis condensans ilii by MRI—a systematic literature review

Jurik,

Linauskas,

Kiil

2024

Skeletal Radiol

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Imaging in Axial Spondyloarthritis: What is Relevant for Diagnosis in Daily Practice?

Cited by 12 publications

References 106 publications

Is it time to move on from pelvic radiography as the first-line imaging modality for suspected sacroiliitis?

Is it time to move on from pelvic radiography as the first-line imaging modality for suspected sacroiliitis?

Detection of structural lesions of the sacroiliac joints in patients with spondyloarthritis: A comparison of T1-weighted 3D spoiled gradient echo MRI and MRI-based synthetic CT versus T1-weighted turbo spin echo MRI

Diagnostic features of osteitis condensans ilii by MRI—a systematic literature review

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