MRI of the sacroiliac joints in spondyloarthritis: the added value of intra-articular signal changes for a ‘positive MRI’
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To determine if intra-articular signal changes at the sacroiliac joint space on MRI have added diagnostic value for spondyloarthritis, when compared to bone marrow edema (BME).
Materials and methods
A retrospective study was performed on the MRIs of sacroiliac joints of 363 patients, aged 16–45 years, clinically suspected of sacroiliitis. BME of the sacroiliac joints was correlated to intra-articular sacroiliac joint MR signal changes: high T1 signal, fluid signal, ankylosis and vacuum phenomenon (VP). These MRI findings were correlated with final clinical diagnosis. Sensitivity (SN), specificity (SP), likelihood ratios (LR), predictive values and post-test probabilities were calculated.
BME had SN of 68.9%, SP of 74.0% and LR+ of 2.6 for diagnosis of spondyloarthritis. BME in absence of intra-articular signal changes had a lower SN and LR+ for spondyloarthritis (SN = 20.5%, LR+ 1.4). Concomitant BME and high T1 signal (SP = 97.2%, LR + = 10.5), BME and fluid signal (SP = 98.6%, LR + = 10.3) or BME and ankylosis (SP = 100%) had higher SP and LR+ for spondyloarthritis. Concomitant BME and VP had low LR+ for spondyloarthritis (SP = 91%, LR + =0.9). When BME was absent, intra-articular signal changes were less prevalent, but remained highly specific for spondyloarthritis.
Our results suggest that both periarticular and intra-articular MR signal of the sacroiliac joint should be examined to determine whether an MRI is ‘positive’ or ‘not positive’ for sacroiliitis associated with spondyloarthritis.
KeywordsMRI Spondyloarthritis Sacroiliac joint Sacroiliitis Ankylosis
Compliance with ethical standards
Conflicts of interest
The authors declare that they have no conflicts of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 2.Ward MM, Deodhar A, Akl EA, American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network, et al. Recommendations for the treatment of ankylosing spondylitis and nonradiographic axial spondyloarthritis. Arthritis Rheumatol. 2015;2016(68):282–98.Google Scholar
- 19.Van den Berg R, Lenczner G, Thévenin F, et al. Classification of axial SpA based on positive imaging (radiographs and/or MRI of the sacroiliac joints) by local rheumatologists or radiologists versus central trained readers in the DESIR cohort. Ann Rheum Dis. 2015;74:2016–21.CrossRefPubMedGoogle Scholar
- 20.Heuft-Dorenbosch L, Weijers R, Landewé R, van der Linden S, van der Heijde D. Magnetic resonance imaging changes of sacroiliac joints in patients with recent-onset inflammatory back pain: inter-reader reliability and prevalence of abnormalities. Arthritis Res Ther. 2006;8:R11.CrossRefPubMedGoogle Scholar
- 21.Van den Berg R, de Hooge M, van Gaalen F, Reijnierse M, Huizinga T, van der Heijde D. Percentage of patients with spondyloarthritis in patients referred because of chronic back pain and performance of classification criteria: experience from the spondyloarthritis caught early (SPACE) cohort. Rheumatology (Oxford). 2013;52:1492–9.CrossRefGoogle Scholar