PurposeTo evaluate the potential of etanercept versus sulfasalazine to reduce active inflammatory lesions on whole-body MRI in active axial spondyloarthritis with a symptom duration of less than 5 years.MethodsPatients were randomly assigned to etanercept (n=40) or sulfasalazine (n=36) treatment over 48 weeks. All patients showed active inflammatory lesions (bone marrow oedema) on MRI in either the sacroiliac joints or the spine. MRI was performed at weeks 0, 24 and 48 and was scored for active inflammatory lesions in sacroiliac joints and the spine including posterior segments and peripheral enthesitis by two radiologists, blinded for treatment arm and MRI time point.ResultsIn the etanercept group, the reduction of the sacroiliac joint score from 7.7 at baseline to 2.0 at week 48 was significantly (p=0.02) larger compared with the sulfasalazine group from 5.4 at baseline to 3.5 at week 48. A similar difference in the reduction of inflammation was found in the spine from 2.2 to 1.0 in the etanercept group versus from 1.4 to 1.3 in the sulfasalazine group between baseline and week 48, respectively (p=0.01). The number of enthesitic sites also improved significantly from 26 to 11 in the etanercept group versus 24 to 26 in the sulfasalazine group (p=0.04 for difference). 50% of patients reached clinical remission in the etanercept group versus 19% in the sulfasalazine group at week 48.ConclusionIn patients with early axial spondyloarthritis active inflammatory lesions detected by whole-body MRI improved significantly more in etanercept versus sulfasalazine-treated patients. This effect correlated with a good clinical response in the etanercept group.

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Purpose:To evaluate the incidence of MRI-related claustrophobia and prematurely terminated MRI (ptMRI) examinations due to claustrophobia in a large-scale cohort study. Materials and Methods:The hospital's computerized radiology information system (RIS) was retrospectively analyzed for all 1.5-Tesla MRI examinations and reports during the year 2004. Data collected included demographic information, body part examined, known claustrophobia, and whether the examination was prematurely terminated. All information available on the MRI examinations and the patient-based data (i.e., excluding any additional examinations per patient) were analyzed.Results: A total of 5798 MRI reports of 4821 patients were evaluated. A total of 95 patients (1.97%) suffered from claustrophobia and 59 (1.22%) prematurely terminated the examination due to claustrophobia. The incidence of ptMRI was higher in women than men (no statistical significance). The majority of patients with ptMRI were between 20 and 80 years old. Patients undergoing head MRI showed the highest incidence of ptMRI and those undergoing extremity, breast, or pelvic MRI had the lowest. Prone compared to supine positioning results in the lowest ptMRI incidence (P Ͻ 0.05). Conclusion:Claustrophobic reactions cause a relatively low incidence of ptMRI and are influenced by sex, body part examined, and positioning within the MR scanner. Sedation and prone positioning might help overcome these reactions. SINCE ITS INTRODUCTION in the 1980s, MRI has become a popular diagnostic procedure. MRI evaluation usually involves the patient being inserted head-first into a relatively narrow tunnel and remaining motionless for up to and beyond one hour. Anxiety-related reactions during MRI have been extensively reported and researched, with a reported incidence of up to 37% (1-4). Claustrophobia is an anxiety disorder that involves the fear of enclosed or confined spaces (5). The reported incidence of premature termination, or failure of the MRI examination due to claustrophobic reactions ranges between 0.5% and 14.5%. The available data has mostly been obtained with relatively old MRI scanners and in small study cohorts (1,2,6 -9).The purpose of the current study was to evaluate the incidence of MRI-related claustrophobia and prematurely-terminated MRI examinations in a large-scale cohort study of patients undergoing 1.5-Tesla MRI. MATERIALS AND METHODSOur university-based department of radiology uses a computerized radiology information system (RIS). For every MRI examination performed, the patient and examination data are manually stored in the data base. Additional information (i.e., if a patient misses the MRI appointment, prematurely terminates the examination, etc.) is also coded into the RIS.An extensive computerized search of all MRI examinations and reports performed during the year 2004 was carried out. For each examination, data collected included demographic information of the patient (age, sex), body part examined, whether contrast medium or premedication was administered, ...