Magnetic resonance imaging grading system for active and chronic spondylarthritis changes in the sacroiliac joint

Abstract

Objective. To develop a new grading method to quantify activity and chronic spondylarthritis (SpA) changes in the sacroiliac (SI) joints identified by magnetic resonance imaging (MRI), taking into account the complex joint anatomy, and to compare the findings with radiographic changes. Methods. A total of 37 patients (15 men, 22 women) fulfilling the European Spondylarthropathy Study Group criteria for SpA were examined by MRI of the SI joint using a semicoronal T1-weighted and T1-weighted fat-saturated (T1FS) sequence, a semiaxial STIR sequence, and postcontrast semicoronal and semiaxial T1FS sequences. The images were assessed independently by 2 radiologists for presence of bone marrow edema and enhancement, fatty marrow deposition, and joint erosion at both the cartilaginous and the ligamentous joint portion. Conventional radiographs were scored in accordance with the modified New York criteria. Results. Inter-and intraobserver agreements for grading activity and chronic changes were good, with kappa values between 0.72 and 0.86 and between 0.83 and 0.90, respectively. Nearly half of the disease activity changes were due to inflammation in the ligamentous joint portion, which was significantly related to ankylosing spondylitis (AS). Patients with AS had significantly higher erosion and fatty marrow deposition scores than patients with nonprimary AS forms of SpA. The degree of erosion by MRI was significantly related to radiographic stages. Conclusion. Separate assessment of the ligamentous joint portion by MRI may be valuable for differentiating AS from nonprimary AS forms of SpA. Erosive changes on MRI were significantly related to radiographic changes, implying a possibility for substituting radiography with MRI.

Increased plasma levels of IL-21 and IL-23 in spondyloarthritis are not associated with clinical and MRI findings

“…All patients contacted the clinic because of a knee joint effusion, none received biological treatment, but all received standard disease-modifying antirheumatic drugs (DMARD). [16,17]. The methods have proven a reliable inter-and intra-observer agreement with kappa values in the range of 0.62-1.0.…”

“…The clinical scorings comprise Bath Ankylosing Spondylitis Metrology Index (BASMI), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), physicians' global score on a 100-mm visual analog scale (VAS), and C-reactive protein (CRP). The radiological examinations included radiography and MRI of the SIJ and spine [16,17]. Plasma from age-and gender-matched healthy volunteers (HV) (n = 35) served as controls (Table 1).…”

The impact of MRI on the clinical management of inflammatory arthritides

“…Erosions are identified as high or intermediate signal defects in the hypointense cortical bone on these sequences. One study used both T1W and T1FS to identify erosions in the SIJ and showed good reliability for an erosion score based on the extent of involvement of the joint surface, although this study did not directly compare these two sequences as regards reliability of detection or diagnostic utility [32]. A recent report compared T1W FS with spin-echo, threedimensional-fast low angle shot (3D-FLASH), and threedimensional-double excitation in the steady-state (3D-DESS) sequences in a retrospective analysis of scans from 30 patients with suspected sacroiliitis and 9 healthy controls [33].…”

“…Erosion Bone erosion has been defined as full-thickness loss of the dark appearance of either iliac or sacral cortical bone of the SIJ with loss of the adjacent marrow signal on T1SE images [32].…”

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

“…However, these have generally focused on global assessment either of the joint or of joint quadrants as a whole 7,8 , not on separate scoring of individual slices. The new SSS method 3 potentially provides a higher sensitivity to change and additionally allows a detailed assessment of the temporal and spatial relation between the individual pathologies.…”