European Radiology

, Volume 28, Issue 10, pp 4163–4173 | Cite as

Whole body MRI in spondyloarthritis (SpA): Preliminary results suggest that DWI outperforms STIR for lesion detection

  • Frederic E. LecouvetEmail author
  • Nicolas Vander Maren
  • Laurence Collette
  • Nicolas Michoux
  • Perrine Triqueneaux
  • Maria Stoenoiu
  • Frederic Houssiau
  • Jacques Malghem
  • Marie-Laurence Denis
  • Ahmed Larbi
  • Adrien Nzeusseu Toukap



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.

Key Points

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.


Spondylarthritis 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


C-reactive protein


Disease-modifying anti-rheumatic drugs


Diffusion-weighted imaging




Human leucocyte antigen –B27


Inflammatory back pain


Modified New-York


Non-steroidal anti-inflammatory drugs


Sacro-iliac joints


Axial spondyloarthritis


Short tau (τ) inversion recovery


Tumour necrosis factor alpha




Visual analogue scale


Whole body



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.

Informed consent

The institution’s ethics committee did not require informed consent for the retrospective review of prospectively acquired data.

Ethical approval

Institutional Review Board approval was obtained.


• retrospective

• case-control study

• performed at one institution

Supplementary material

330_2018_5377_MOESM1_ESM.doc (580 kb)
ESM 1 (DOC 580 kb)


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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  • Frederic E. Lecouvet
    • 1
    Email author
  • Nicolas Vander Maren
    • 1
  • Laurence Collette
    • 2
  • Nicolas Michoux
    • 1
  • Perrine Triqueneaux
    • 1
  • Maria Stoenoiu
    • 3
  • Frederic Houssiau
    • 3
  • Jacques Malghem
    • 1
  • Marie-Laurence Denis
    • 1
  • Ahmed Larbi
    • 1
  • Adrien Nzeusseu Toukap
    • 3
  1. 1.Department of Radiology and Medical ImagingInstitut de Recherche Expérimentale et Clinique (IREC),Université Catholique de Louvain (UCL), Cliniques Universitaires Saint LucBrusselsBelgium
  2. 2.EORTC, Head of the Statistics UnitEORTC HeadquartersBrusselsBelgium
  3. 3.Department of RheumatologyCliniques Universitaires Saint-LucBrusselsBelgium

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