Detection of Sacroiliitis by Short-tau Inversion Recovery and T2-weighted Turbo Spin Echo Sequences: Results from the SIMACT Study

Abstract

Objective.To compare proton density–weighted short-tau inversion recovery (PD-STIR) and T2-weighted fat-suppressed turbo spin echo (T2-FS) sequences for detecting osteitis lesions of the sacroiliac joints (SIJ) in patients with chronic low back pain (CLBP).Methods.This prospective study included 110 patients with CLBP and suspected spondyloarthritis and 18 healthy controls. All 128 participants (age range: 19–57 yrs) underwent 3.0 Tesla magnetic resonance imaging (MRI) of the SIJ including PD-STIR and T2-FS. Two readers independently scored PD-STIR and T2-FS images for osteitis in separate sessions. Sum scores and signal-to-noise (SNR) and contrast-to-noise (CNR) ratios were calculated. Images were further analyzed as to whether they fulfilled the Assessment of SpondyloArthritis international Society (ASAS) criterion of a positive MRI (MRI+). Interreader agreement was calculated using intraclass correlation coefficients.Results.Average osteitis sum scores were higher for T2-FS images (mean sum score of 4.10 in T2-FS vs 2.55 in PD-STIR, p = 0.017). Mean SNR was 16.54 for PD-STIR and 37.30 for T2-FS (p = 0.0289). Mean CNR was 4.14 for PD-STIR and 20.20 for T2-FS (p = 0.0212). For both readers, the ASAS MRI+ definition was more often fulfilled by T2-FS than by PD-STIR images, resulting in more patients being classified as having axial spondyloarthritis (axSpA): 68 patients using T2-FS versus 58 patients using PD-STIR. Interreader intraclass correlation coefficients were very good for both PD-STIR (0.91) and T2-FS (0.86).Conclusion.T2-FS sequences improve image quality and hence the detection of osteitis compared to the PD-STIR sequence. More patients were classified as axSpA based on a positive MRI by T2-FS.

Comparison between STIR and T2-weighted SPAIR sequences in the evaluation of inflammatory sacroiliitis: diagnostic performance and signal-to-noise ratio

“…Our findings support those reported recently in the literature, suggesting that there is no superiority of the STIR sequence over other fluid-sensitive sequences for the evaluation of subchondral bone edema of the sacroiliac joints in patients with spondyloarthritis (5,6,10) . We found no difference between the STIR and T2 SPAIR sequences in terms of their diagnostic performance in identifying active inflammation of the subchondral bone tissue of the sacroiliac joints.…”

“…Dalto et al (5) also assessed interobserver agreement among specialists in radiology and rheumatology, whereas our readers were musculoskeletal radiologists. Greese et al (10) conducted a study comparing T2-weighted fat-saturated turbo spin-echo sequences with proton-density STIR sequences in a 3.0-T scanner and found that the former had a better SNR and was better able to identify bone edema. Although those authors reported results similar to ours for SNR, they studied the SNR in images of the sacroiliac joints acquired in 3.0-T scanners, whereas the images evaluated in our study were acquired in 1.5-T scanners.…”

Anatomic Distribution of Sacroiliac Joint Lesions on Magnetic Resonance Imaging in Patients With Axial Spondyloarthritis and Control Subjects: A Prospective Cross‐Sectional Study, Including Postpartum Women, Patients With Disc Herniation, Cleaning Staff, Runners, and Healthy Individuals

“…Other possible contributors to the differences between studies could be differences in study population, i.e., the intensity of training and/or the type and amount of pelvic strain in the groups of athletes. Finally, the MRI acquisition parameters differed between studies because we applied a TE for STIR images of 37 msec, versus 68 msec in the study by Weber et al (10), which may have slightly reduced the detectability of BME lesions (23) in our study.…”

How I do it – MRT der Sakroiliakalgelenke

“…Für die Differenzialdiagnose muss man neben den klinischen Angaben die exakte Lokalisation der Läsionen an der kompliziert geformten Gelenkfläche nutzen. Für die genaue Beschreibung der Lokalisation und das bessere Verständnis für die dreidimensionale Lage der Befunde hat sich die 24-Regionen-Methode bewährt [13,24]: Schon immer wurden Befunde im gesamten Gelenk bewertet und beschrieben. Für wissenschaftliche Auswertungen teilte man jedes Gelenk oft in 4 Quadranten ein, also 8 pro Patient*in [25].…”