Whole body MRI in spondyloarthritis (SpA): Preliminary results suggest that DWI outperforms STIR for lesion detection
To compare the diagnostic accuracy of DWI and STIR sequences in Whole body (WB) MRI of SpA patients.
Materials and methods
Twenty consecutive patients with confirmed active SpA and 20 controls were investigated with identical WB MRI protocols, including DWI and STIR images. Two observers recorded ‘lesions’ (high signal intensity foci on STIR and high b-value DWI) in 17 anatomical areas, making a 17-point ‘area score’ and a 40-point ‘lesion score’. ROC performance, inter-observer agreement, correlation with clinical parameters and spine and sacro-iliac joints (SIJ) MRI scores were assessed.
SpA patients had significantly higher lesion scores on DWI than on STIR (p<0.025). The lesion score area under the curve was significantly higher with DWI (99.9) than with STIR (95.8, p=0.02). DWI lesion score ≥5 had both sensitivity and specificity ≥85 %. With STIR the best threshold ≥3 yielded sensitivity ≥85 % and specificity ≥60 %. DWI area score ≥3 yielded sensitivity ≥85 % and specificity ≥80 %. With STIR the best threshold ≥4 yielded sensitivity ≥70 % and specificity ≥80 %. Inter-observer agreement was strong for both sequences. In patients, the lesion score was positively correlated with ASDAS-CRP, log(CRP), and local MRI scores.
DWI is a promising alternative to STIR in WB MRI to detect active SpA lesions.
• DWI is a robust alternative to STIR in WBMRI in SpA.
• DWI might be superior in discriminating relevant inflammatory and degenerative changes.
• Positive correlations exist between WB MRI, clinical, biological, local MRI data.
• Distribution and frequency of abnormal MRI findings in SpA are highlighted.
KeywordsSpondylarthritis Spine Whole body imaging Diffusion, magnetic resonance imaging Magnetic resonance imaging
Average diffusion coefficient
Assessment of SpondyloArthritis International Society
Ankylosing Spondylitis Disease Activity Score
Bath Ankylosing Spondylitis Disease Activity Index
Bath Ankylosing Spondylitis Functional Index
Disease-modifying anti-rheumatic drugs
Human leucocyte antigen –B27
Inflammatory back pain
Non-steroidal anti-inflammatory drugs
Short tau (τ) inversion recovery
Tumour necrosis factor alpha
Visual analogue scale
The authors state that this work has not received any funding.
Compliance with ethical standards
The scientific guarantor of this publication is F.E. Lecouvet.
Conflict of interest
The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.
Statistics and biometry
No complex statistical methods were necessary for this paper.
The institution’s ethics committee did not require informed consent for the retrospective review of prospectively acquired data.
Institutional Review Board approval was obtained.
• case-control study
• performed at one institution
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