Role of Diffusion-Weighted MRI in the Detection of Early Active Sacroiliitis

Bozgeyik, Zülkif; Özgöçmen, Salih; Kocakoç, Ercan

doi:10.2214/ajr.07.3865

Cited by 117 publications

(93 citation statements)

References 27 publications

(24 reference statements)

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“…In some studies, contrastenhanced T 1 -weighted sequences were found to be more sensitive than STIR and fat-suppressed T 2 -weighted images. 4 Up to date, many studies have been performed on detection of sacroiliitis with DWI. Bozgeyik et al 4 studied 42 patients with chronic low back pain (suspected spondyloarthropathy).…”

Section: Discussionmentioning

confidence: 99%

“…3,4 Musculoskeletal abnormalities assessed by DWI are muscle, cartilage and soft tissue diseases, several spinal abnormalities, and bone marrow edema. 4 Acute osteoporotic and metastatic fractures of vertebra, spinal infection and malignancy can be discriminated by the help of DWI. Detection of skull metastasis and traumatic bone marrow edema are also possible with DWI.…”

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confidence: 99%

“…Detection of skull metastasis and traumatic bone marrow edema are also possible with DWI. 3,4 Seronegative spondyloarthropathies (SpA) are a group of diseases composed of ankylosing spondylitis (AS), Reiter syndrome, enteropathic arthritis, psoriatic arthritis, and undifferentiated SpA. 5 There is no relationship between the rheumatoid factor and the disease group, and the presence of class I human histocompatibility leukocyte antigen-B27 has been shown to increase 20 times the risk of developing a SpA as compared to general population.…”

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confidence: 99%

“…6,7 Sacroiliac joints are primarily affected in SpAs and sacroiliitis is an important diagnostic criterion in the disease group. 4,6 Inflammatory back pain is the primary symptom of sacroiliitis that is aggravated by rest and improved by physical activity. 8 Because of difficulty in differentiating mechanical back pain and inflammatory back pain, imaging is important in the diagnosis of sacroiliitis.…”

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confidence: 99%

“…4 The ability of earlier diagnosis with advanced magnetic resonance imaging (MRI) techniques like dynamic contrast-enhanced MRI or DWI even in the lack of positive laboratory findings for SpA make the method accessible as compared to plain radiographs or computed tomography especially in the active stage of disease. 4,6 The diffusivity of an individual tissue may be affected by many in vivo (like patients' age and body temperature) and ex vivo (like different MRI devices, area of region of interest [ROI], b value) factors. To eliminate these variations, use of normalized ADC, also named as relative ADC (r-ADC) is suggested which is calculated by the formula ADC lesion/ADC reference site.…”

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confidence: 99%

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Application of Diffusion-Weighted Imaging in the Detection of Active Sacroiliitis and the Comparison of Apparent Diffusion Coefficient and Relative Apparent Diffusion Coefficient Values

et al. 2016

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Objectives: This study aims to evaluate the role of diffusion-weighted imaging in detection of active sacroiliitis and compare the apparent diffusion coefficient (ADC) and normalized relative ADC (r-ADC) values by using vertebra and iliac wings as reference organs. Patients and methods:The study included 56 patients (26 males, 30 females; mean age 37.7±10.1 years; range 18 to 66 years) with chronic back pain and without history of sacroiliitis who underwent magnetic resonance imaging. T2-weighted spectral presaturation with inversion recovery, contrast-enhanced T1-weighted spectral presaturation with inversion recovery, and diffusion-weighted (b values: 0 and 600 s/mm 2 ) images were obtained. All images were evaluated by two different radiologists for interobserver variability. All individuals were grouped in either mechanical low back pain (control group) or active sacroilitis (disease group) groups according to the presence or absence of MRI findings of active sacroilitis. ADC values of both surfaces were measured from normal and affected areas of joints. Also, ADC values of L5 vertebra and iliac wings were measured as reference organs to calculate r-ADC values. Results: Mean ADC and r-ADC values measured from lesions were significantly higher than that of normal appearing bone marrow areas in both patients with mechanical low back pain (n=17) and active sacroiliitis (n=39). Both ADC values and r-ADC values could differentiate active lesions from normal appearing bone marrow areas as well as contrast-enhanced T1-weighted images. According to r-ADC values calculated with the L5 vertebra, unaffected portions of bone marrow areas in patients with sacroiliitis were normalized whereas r-ADC remained higher than normal in affected portions of the bones. Conclusion: Diffusion-weighted imaging is a fast, sensitive magnetic resonance imaging sequence in detection of active sacroiliitis. It does not require contrast agent and can be safely used as an adjunct to conventional magnetic resonance images. r-ADC is also highly sensitive in detecting active sacroiliitis and may be used as an alternative to standard ADC measurements for the demonstration of inflammation. It helps eliminate individual bone marrow differences by using patients' own normal bone marrow measurements and increases diagnostic accuracy.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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confidence: 99%

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confidence: 99%

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Application of Diffusion-Weighted Imaging in the Detection of Active Sacroiliitis and the Comparison of Apparent Diffusion Coefficient and Relative Apparent Diffusion Coefficient Values

et al. 2016

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

Madsen¹,

Jurik²

2009

Arthritis Care & Research

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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.

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Association of the apparent diffusion coefficient with maturity in adolescent sacroiliac joints

Bray

Vendhan²,

Roberts³

et al. 2016

Magnetic Resonance Imaging

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PurposeTo determine the extent to which apparent diffusion coefficient (ADC) values vary with skeletal maturity in adolescent joints.Materials and MethodsA retrospective study was performed with Institutional Review Board (IRB) approval. We used a picture archiving and communication system (PACS) search to identify and recruit all adolescents who had undergone 1.5T magnetic resonance imaging (MRI) of the sacroiliac joints (SIJs) between January 2010 and June 2015, and had no evidence of sacroiliitis and normal inflammatory markers. In all, 55 individuals were assessed. For each patient, coronal and sagittal images of the sacrum were visually analyzed to determine sacral maturity. Patients were divided into three groups depending on the degree of fusion of the sacral segmental apophyses: “Fused,” “Partial,” and “Unfused.” For each group, SIJ ADC was measured using a linear region‐of‐interest technique.ResultsMean ADC values were 690 × 10−6 mm2/s in the fused group, 720 × 10−6 mm2/s in the partial group, and 842 × 10−6 mm2/s in the unfused group. ADC values were significantly higher in the unfused group than in the fused group (P = 0.046). ADC values were also higher in unfused subjects than partially fused subjects (P = 0.074).ConclusionJoint ADC values are higher in skeletally immature (unfused) patients than in skeletally more mature (fused) patients. ADC values measured in the unfused group overlap with those previously reported in sacroiliitis. These results suggest that ADC measurements in adolescent joints must be interpreted in light of joint maturity. Joint immaturity may lead to misdiagnosis of sacroiliitis, since immature juxta‐articular bone may appear similar to inflammation. J. Magn. Reson. Imaging 2016. J. Magn. Reson. Imaging 2016;44:556–564.

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Role of Diffusion-Weighted MRI in the Detection of Early Active Sacroiliitis

Cited by 117 publications

References 27 publications

Application of Diffusion-Weighted Imaging in the Detection of Active Sacroiliitis and the Comparison of Apparent Diffusion Coefficient and Relative Apparent Diffusion Coefficient Values

Application of Diffusion-Weighted Imaging in the Detection of Active Sacroiliitis and the Comparison of Apparent Diffusion Coefficient and Relative Apparent Diffusion Coefficient Values

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

Association of the apparent diffusion coefficient with maturity in adolescent sacroiliac joints

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