Effect of mechanical stress on magnetic resonance imaging of the sacroiliac joints: assessment of military recruits by magnetic resonance imaging study

Varkas, Gaëlle; Hooge, M. de; Renson, Thomas; Mits, Sophie De; Carron, Philippe; Jacques, Peggy; Moris, Muriel; Souverijns, Geert; Jans, Lennart; Elewaut, Dirk; Bosch, Filip Van den

doi:10.1093/rheumatology/kex491

Cited by 81 publications

(45 citation statements)

References 29 publications

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“…This suggests a good performance of the existing definitions of a ‘positive spinal MRI’ (cut-off≥5 lesions11) related to specificity. Furthermore, these results are also in line with previously published data on SIJ MRIs only or in groups with smaller patient numbers7 from different samples, such as athletes14 and military recruits 15. There, the relative frequency of BME lesions ranged largely between 6% and 60%.…”

Section: Discussionsupporting

confidence: 90%

Frequency of MRI changes suggestive of axial spondyloarthritis in the axial skeleton in a large population-based cohort of individuals aged <45 years

et al. 2019

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ObjectiveTo investigate the frequency of bone marrow oedema (BME) and fatty lesions (FL) suggestive of axial spondyloarthritis (axSpA) on MRI of the spine and sacroiliac joints (SIJ) in a general population sample.MethodsAs part of a community-based cohort project (Study of Health in Pomerania), volunteers underwent spinal (sagittal T1/T2) and SIJ (semicoronal short tau inversion recovery) MRI examinations. Two calibrated readers evaluated the images to detect BME in SIJ and vertebral corners (VC) and FL in VC suggestive of axSpA using Assessment of SpondyloArthritis international Society definitions.ResultsMRIs of 793 volunteers (49.4% males, mean age 37.3±6.3 years, 8.4% human leucocyte antigen-B27+) aged <45 years were evaluated. SIJ BME was seen in 136 (17.2%), VC BME in 218 (27.5%) and FL in 645 (81.4%) volunteers. SIJ BME in ≥1, ≥3 and ≥5 SIJ quadrants was seen in 136 (17.2%), 7 (0.9%) and 1 (0.1%) volunteers, respectively. In VC, BME≥1, ≥3 and ≥5 lesions were seen in 218 (27.5%), 38 (4.8%) and 6 (0.8%) volunteers, respectively, while FL≥1, ≥3 and ≥5 were seen in 645 (81.3%), 351 (44.3%) and 185 (23.3%) volunteers, respectively. Logistic regression analysis showed that BME and FL in VC were related to increasing age: OR 1.33, 95% CI 1.02 to 1.72, and OR 1.73, 95% CI 1.32 to 2.27, per decade increase, respectively.ConclusionsIn this large population-based study, a high frequency of inflammatory and fatty MRI lesions suggestive of axSpA was found, especially in the spine. This indicates a limited value of such MRI findings for diagnosis and classification of axSpA. The increasing frequency with age suggests that mechanical factors could play a role.

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Section: Discussionsupporting

confidence: 90%

Frequency of MRI changes suggestive of axial spondyloarthritis in the axial skeleton in a large population-based cohort of individuals aged <45 years

et al. 2019

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“…However, these abnormalities are seen equally in patients with nonspecific low back pain and asymptomatic patients . In a sample of healthy asymptomatic military recruits, SIJ abnormalities visualized on magnetic resonance iaging (MRI) were present in 40.9% of participants, suggesting low specificity of such findings . MRI findings have not been studied in the context of SIJ pain confirmed by intra‐articular diagnostic SIJ injection.…”

Section: Diagnostic Imagingmentioning

confidence: 99%

Challenges in Diagnosing Sacroiliac Joint Pain: A Narrative Review

Schneider

Rosati

Zheng

et al. 2019

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Accurate diagnosis of sacroiliac joint (SIJ) pain is challenging. Diagnosis can be aided by pain referral patterns, historical features, physical examination maneuvers, and imaging. However, all of these diagnostic tools have limitations. The most reliable clinical tools may be a combination of three or more positive physical exam maneuvers, although the evidence is inconsistent even for this strategy. Intra‐articular diagnostic SIJ injections are often used as the reference standard for “true” sacroiliac pain. However, such injections do not consider extra‐articular sources of pain that may also exist as part of the sacroiliac joint complex. Research has established the posterior sacral ligaments as a possible source of pain, and the innervation of these ligaments has been anatomically defined. It is possible that by expanding our focus from the articular portion of the sacroiliac complex structure to both the joint and extra‐capsular ligaments, advancements in clinical diagnosis and treatment will be possible.

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“…Currently, ASAS axSpA classification criteria consider bone marrow oedema as the only lesion which fulfils the definition of positive MRI [2] and this was the reason why we decided to design an algorithm detecting this kind of active inflammatory changes. However, next limitation of our method is that the presence of bone marrow oedema within the sacroiliac joints is not pathognomonic for axSpA and it could be visible in patients with non-specific back pain (up to 23% of cases), women in the postpartum period (21-41%), athletes (30-41%), soldiers (36%) and healthy volunteers (up to 7%) [15][16][17][18][19]. For this reason, investigators are searching for the perfect combination of changes within the sacroiliac joints, which will increase the specificity of axSpA diagnosis with the use of MRI.…”

Section: Discussionmentioning

confidence: 99%

The semi-automated algorithm for the detection of bone marrow oedema lesions in patients with axial spondyloarthritis

et al. 2020

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The aim of the study was to create the efficient tool for semi-automated detection of bone marrow oedema lesions in patients with axial spondyloarthritis (axSpA). MRI examinations of 22 sacroiliac joints of patients with confirmed axSpA-related sacroiliitis (median SPARCC score: 14 points) were included into the study. Design of our algorithm is based on Maksymowych et al. evaluation method and consists of the following steps: manual segmentation of bones (T1W sequence), automated detection of reference signal region, sacroiliac joint central lines and ROIs, a division of ROIs into quadrants, automated detection of inflammatory changes (STIR sequence). As a gold standard, two sets of manual lesion delineations were created. Two approaches to the performance assessment of lesion detection were considered: pixel-wise (detections compared pixel by pixel) and quadrant-wise (quadrant to quadrant). Statistical analysis was performed using Spearman's correlation coefficient. Correlation coefficient obtained for pixel-wise comparison of semi-automated and manual detections was 0.87 (p = 0.001), while for quadrant-wise analysis was 0.83 (p = 0.001). The correlation between two sets of manual detections was 0.91 for pixel-wise comparison (p = 0.001) and 0.88 (p = 0.001) for quadrant-wise approach. Spearman's correlation between two manual assessments was not statistically different from the correlation between semi-automated and manual evaluations, both for pixel-(p = 0.14) and quadrant-wise (p = 0.17) analysis. Average single slice processing time: 0.64 ± 0.30 s. Our method allows for objective detection of bone marrow oedema lesions in patients with axSpA. The quantification of affected pixels and quadrants has comparable reliability to manual assessment.

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Effect of mechanical stress on magnetic resonance imaging of the sacroiliac joints: assessment of military recruits by magnetic resonance imaging study

Cited by 81 publications

References 29 publications

Frequency of MRI changes suggestive of axial spondyloarthritis in the axial skeleton in a large population-based cohort of individuals aged <45 years

Frequency of MRI changes suggestive of axial spondyloarthritis in the axial skeleton in a large population-based cohort of individuals aged <45 years

Challenges in Diagnosing Sacroiliac Joint Pain: A Narrative Review

The semi-automated algorithm for the detection of bone marrow oedema lesions in patients with axial spondyloarthritis

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