Magnetic resonance imaging grading system for active and chronic spondylarthritis changes in the sacroiliac joint

Abstract

Objective. To develop a new grading method to quantify activity and chronic spondylarthritis (SpA) changes in the sacroiliac (SI) joints identified by magnetic resonance imaging (MRI), taking into account the complex joint anatomy, and to compare the findings with radiographic changes. Methods. A total of 37 patients (15 men, 22 women) fulfilling the European Spondylarthropathy Study Group criteria for SpA were examined by MRI of the SI joint using a semicoronal T1-weighted and T1-weighted fat-saturated (T1FS) sequence, a semiaxial STIR sequence, and postcontrast semicoronal and semiaxial T1FS sequences. The images were assessed independently by 2 radiologists for presence of bone marrow edema and enhancement, fatty marrow deposition, and joint erosion at both the cartilaginous and the ligamentous joint portion. Conventional radiographs were scored in accordance with the modified New York criteria. Results. Inter-and intraobserver agreements for grading activity and chronic changes were good, with kappa values between 0.72 and 0.86 and between 0.83 and 0.90, respectively. Nearly half of the disease activity changes were due to inflammation in the ligamentous joint portion, which was significantly related to ankylosing spondylitis (AS). Patients with AS had significantly higher erosion and fatty marrow deposition scores than patients with nonprimary AS forms of SpA. The degree of erosion by MRI was significantly related to radiographic stages. Conclusion. Separate assessment of the ligamentous joint portion by MRI may be valuable for differentiating AS from nonprimary AS forms of SpA. Erosive changes on MRI were significantly related to radiographic changes, implying a possibility for substituting radiography with MRI.

Does evaluation of the ligamentous compartment enhance diagnostic utility of sacroiliac joint MRI in axial spondyloarthritis?

“…There was virtually no isolated inflammation in the ligamentous SIJ compartment alone without associated lesions in the cartilaginous compartment. This observation is in line with the results of a previous report in which only 1 of 37 patients fulfilling the ESSG criteria showed isolated inflammation of just the ligamentous SIJ compartment [ 21 ]. However, in our study, concomitant BME lesions both in the cartilaginous and ligamentous compartment showed more frequently in nr-axSpA (12–42 %) than in NSBP patients (2 %).…”

What is the reliability of non-trained investigators in recognising structural MRI lesions of sacroiliac joints in patients with recent inflammatory back pain? Results of the DESIR cohort

“…This suggests that the fairly low agreement may be rather due to the general difficulty in distinguishing structural lesions from physiological abnormalities and not (only) to the calibration and reading methods. Moreover, global agreement for structural lesions (including erosions, fatty lesions and ankylosis) seems better in studies including a high proportion of patients with AS (κ=0.84),14 or when the median symptoms duration is longer (κ=0.76–0.80) 29. Puhakka et al 23 included patients with a short symptom duration (median disease duration=19 months) excluding patients with AS, and found an agreement similar to our study (κ=0.42).…”

Increased plasma levels of IL-21 and IL-23 in spondyloarthritis are not associated with clinical and MRI findings

“…We also report increased levels of IL-23, whereas we were unable to detect IL-17A in plasma from SpA patients. We did not observe association with cytokine levels and disease activity clinically nor with disease activity and chronicity measured by MRI, despite a detailed MR scoring of the SIJ and the entire spine [16,17].…”

“…Rudwaleit et al have shown that signs of active inflammation by MRI in SpA do not correlate to clinical measurements, using the Berlin MRI spine score method [21]. The present and previous results showed that the use of a more extensive scoring system did not associate MRI findings to the clinical parameters [17,22]. Adding to this, we did not find an association between MRI and IL-17A, IL-21, and IL-23 plasma levels.…”