Descriptions of spinal MRI lesions and definition of a positive MRI of the spine in axial spondyloarthritis: a consensual approach by the ASAS/OMERACT MRI study group

Hermann, Kay-Geert A.; Baraliakos, Xenofon; Heijde, D.M.F.M. van der; Jurik, Anne-Grethe; Landewé, Robert; Marzo‐Ortega, Helena; Østergaard, Mikkel; Rudwaleit, Martín; Sieper, Joachim; Braun, Jürgen

doi:10.1136/ard.2011.150680

Cited by 227 publications

(186 citation statements)

References 43 publications

(60 reference statements)

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“…Considering this limitation, the reliability of the assessment of structural changes has been reported to be only fair to moderate (39,40). Finally, we did not assess posterolateral spinal lesions (costovertebral of facet joint arthritis), which might be more specifically involved in axial SpA than in DISH (5).…”

Section: Latourte Et Almentioning

confidence: 99%

“…Consequently, ASAS has proposed a consensual definition of an active sacroiliitis on MRI, which has been included in the ASAS classification criteria (4). More recently, ASAS also developed criteria for a spine MRI highly suggestive of axial SpA based on spinal inflammatory lesions (5). Structural changes, such as erosions or fat depositions, can also be detected by MRI and have thus been studied both at the sacroiliac (SI) joint and the spine level in this regard (6)(7)(8)(9).…”

Section: Introductionmentioning

confidence: 99%

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Imaging Findings Suggestive of Axial Spondyloarthritis in Diffuse Idiopathic Skeletal Hyperostosis

Latourte

Charlon

Etcheto

et al. 2017

Arthritis Care & Research

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Objective. To describe the magnetic resonance imaging (MRI) findings in diffuse idiopathic skeletal hyperostosis (DISH) patients and to assess the proportion of DISH patients whose MRI findings would fulfill the Assessment of Spondyloarthritis International Society (ASAS) criteria for a positive MRI of axial spondyloarthritis (SpA). Methods. This study involved all DISH patients who had a spine or sacroiliac (SI) joint MRI performed between January 2009 and December 2014. Sociodemographic and clinical data were collected. Available radiographs and MRI were analyzed and blindly scored by an experienced reader, using the Spondyloarthritis Research Consortium of Canada (SPARCC) scores for both spine and SI joint MRI. Results. A total of 53 symptomatic DISH patients was included in the analysis. The mean AE SD SPARCC score of the spine was 18.3 AE 23.4. Thirty-five patients (67.3%) had at least 1 fatty corner. Thirty patients (57.7%) met the ASAS definition of a spine MRI suggestive of axial SpA, but only 6 patients (15.8%) with an available SI joint MRI had sacroiliitis according to ASAS criteria. Only 1 patient (3.3%) had ≥3 erosions on the SI joint. Conclusion. Inflammatory lesions of the spine are common on the MRI of symptomatic DISH patients, and more than half fulfilled the ASAS criteria for a spine MRI suggestive of axial SpA. However, only a few patients met the ASAS definition of active sacroiliitis, suggesting that MRI of the SI joint but not of the spine might allow the differential diagnosis of DISH versus axial SpA in the elderly.

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Section: Latourte Et Almentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Imaging Findings Suggestive of Axial Spondyloarthritis in Diffuse Idiopathic Skeletal Hyperostosis

Latourte

Charlon

Etcheto

et al. 2017

Arthritis Care & Research

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“…Fat metaplasia is frequently observed in the bone marrow of the sacroiliac (SI) joints and spine at locations that are typical for inflammation (i.e., vertebral corners, adjacent to vertebral end plates, and facet and costovertebral joints) (2)(3)(4). Recently published MRI data suggest that resolution of inflammation (i.e., bone marrow edema) in the spine may be associated with the development of fat metaplasia in the same area and later also with the development of new syndesmophytes (5)(6)(7).…”

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confidence: 99%

Fat Metaplasia and Backfill Are Key Intermediaries in the Development of Sacroiliac Joint Ankylosis in Patients With Ankylosing Spondylitis

Maksymowych

Wichuk

Chiowchanwisawakit

et al. 2014

Arthritis & Rheumatology

125

100

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Objective. Fat metaplasia in bone marrow on T1-weighted magnetic resonance imaging (MRI) scans may develop after resolution of inflammation in patients with ankylosing spondylitis (AS) and may predict new bone formation in the spine. Similar tissue, termed backfill, may also fill areas of excavated bone in the sacroiliac (SI) joints and may reflect resolution of inflammation and tissue repair at sites of erosions. The purpose of this study was to test our hypothesis that SI joint ankylosis develops following repair of erosions and that tissue characterized by fat metaplasia is a key intermediary step in this pathway.Methods. We used the Spondyloarthritis Research Consortium of Canada (SPARCC) SI structural lesion score (SSS) method to assess fat metaplasia, erosions, backfill, and ankylosis on MRIs of the SI joints in 147 patients with AS monitored for 2 years. Univariate and multivariate regression analyses focused first on identifying significant MRI predictors of new backfill and fat metaplasia. We then assessed the role of backfill and fat metaplasia in the development of new ankylosis. All analyses were adjusted for demographic features, treatment, and baseline and 2-year change in SSS values for parameters of inflammation and MRI structural lesions.Results. Resolution of inflammation and reduction of erosions were each independently associated with the development of new backfill and fat metaplasia at 2 years on multivariate analyses. Multivariate regression analysis that included demographic features, baseline and 2-year change in parameters of inflammation and MRI structural lesion showed that reduction in erosions (P ‫؍‬ 0.0005) and increase in fat metaplasia (P ‫؍‬ 0.002) at 2 years was each independently associated with the development of new ankylosis.Conclusion. Our data support a disease model whereby ankylosis develops following repair of erosions, and fat metaplasia and backfill are key intermediary steps in this pathway.Spondyloarthritis (SpA) is an inflammatory disorder primarily of the axial spine that typically begins with sacroiliitis. The first sign of disease on radiography is the appearance of erosion of the subchondral bone of the ilium, which is seen as a blurred cortical outline. Progression results in more extensive erosion involving the sacral bone and the appearance of pseudowidening. Subsequent features include bone sclerosis and, finally, ankylosis across the joint. Magnetic resonance imaging (MRI) constitutes a major advance in the field through its ability to demonstrate active inflammation on fatsuppressed sequences, such as short tau inversion recovery (STIR), and structural lesions, such as fat metaplasia, erosions, and ankylosis, on T1-weighed sequences (1).

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“…MRI is the most sensitive for detecting early inflammatory changes in the SIJs and spine, and it is increasingly widely used for making diagnoses, monitoring disease activity, and guiding treatment of patients with aSpA. [2][3][4][5][6][7][8] In fact, the Assessment of SpondyloArthritis International Society (ASAS) has included active inflammation in the SIJs on MRI as part of its latest classification submit your manuscript | www.dovepress.com…”

Section: Introductionmentioning

confidence: 99%

Intercorrelation between MRI disease activity scores of the sacroiliac joints and the spine, and clinical disease activity indices in patients with axial spondyloarthritis

Lau¹,

Mok²,

Chan³

et al. 2017

RMI

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Objective: To analyze the correlation between the magnetic resonance imaging (MRI) disease activity scores and the clinical disease activity indices (DAI) in Chinese patients with active axial spondyloarthritis (aSpA) that required biologics therapy. The correlation between MRI disease activity scores of the sacroiliac joints (SIJs) and the spine in these patients was also assessed. Methods: This was a cross-sectional study design in which adult patients who fulfilled the Assessment of SpondyloArthritis international Society classification criteria for aSpA and had active disease (Bath Ankylosing Spondylitis Disease Activity Index score ≥4, persistent spinal pain despite nonsteroidal anti-inflammatory drugs therapy >3 months) that required biologics therapy were included. The MRI disease activities were measured using the Spondyloarthritis Research Consortium of Canada (SPARCC) scores. Correlation between the SPARCC scores of the SIJs and the spine, and clinical DAI was calculated. Results: Fifty-seven patients (47 men and 10 women; mean age 37 ± 12 years) completed the study. There was no statistically significant correlation between the SPARCC scores and clinical DAI. The SPARCC score of the SIJs showed a positive correlation with the SPARCC score of the spine (r = 0.34, p < 0.05). The thoracic discovertebral units (57%) were found to be more frequently associated with significant disease activity than the other levels of the spine. Conclusion: MRI can detect active inflammation which may not be reflected by clinical DAI. MRI should be performed in patients with aSpA to provide a more comprehensive assessment and to better reflect disease activity and severity. MRI findings of more severe sacroiliitis should prompt the radiologist to look for involvement in the entire spine, particularly in the thoracic region.

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Descriptions of spinal MRI lesions and definition of a positive MRI of the spine in axial spondyloarthritis: a consensual approach by the ASAS/OMERACT MRI study group

Cited by 227 publications

References 43 publications

Imaging Findings Suggestive of Axial Spondyloarthritis in Diffuse Idiopathic Skeletal Hyperostosis

Imaging Findings Suggestive of Axial Spondyloarthritis in Diffuse Idiopathic Skeletal Hyperostosis

Fat Metaplasia and Backfill Are Key Intermediaries in the Development of Sacroiliac Joint Ankylosis in Patients With Ankylosing Spondylitis

Intercorrelation between MRI disease activity scores of the sacroiliac joints and the spine, and clinical disease activity indices in patients with axial spondyloarthritis

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