Magnetic Resonance Imaging of the Axial Skeleton in Patients With Spondyloarthritis: Distribution Pattern of Inflammatory and Structural Lesions

Abstract

Purpose:Spondyloarthritis is a chronic inflammatory disorder of the musculoskeletal system driven by systemic enthesitis and typically involving the axial skeleton, ie, the spine and the sacroiliac joints. The purpose of this study was to assess the distribution pattern of inflammatory and structural magnetic resonance imaging (MRI) findings in spondyloarthritis.Methods:Retrospective study of 193 patients with axial spondyloarthritis who received MRI of the spine and the sacroiliac joints. We quantitatively assessed inflammatory and structural lesions using established MRI-based scoring methods. The significance of the differences between gender, HLA-B27 status, and spine and sacroiliac involvement was determined.Results:In total, 174 patients (90.2%) showed a sacroiliac involvement and 120 patients (62.2%) a combined involvement of the sacroiliac joints and the spine. An isolated sacroiliac involvement was found in 54 patients (28.0%) and an isolated spine involvement in 19 patients (9.8%). The sacroiliac joint was significantly more involved in men than in women (P < .01), and men had significantly higher scores for structural lesions (P < .001). The subgroup of HLA-B27–positive patients showed a significantly higher percentage of sacroiliac involvement compared with HLA-B27–negative patients (P < .05).Conclusions:Spondyloarthritis is a systemic disorder predominantly involving the sacroiliac joints. However, the entire axial skeleton may be affected. In particular, HLA-B27–negative women show atypical manifestations without sacroiliac involvement. Magnetic resonance imaging in spondyloarthritis should cover the entire axial skeleton, ie, sacroiliac joints and the spine to meet the pathophysiology of this disorder and capture the true extent of inflammatory and structural lesions.

Application and preliminary validation of the hip inflammation MRI scoring system (HIMRISS) in spondyloarthritis

“…In recent decades, magnetic resonance imaging (MRI) has emerged as an important and sensitive tool for diagnosing early inflammation, including edema, fat deposition, and synovitis in SpA; the best estimated sensitivity achieved up to 90% in previous studies . Soft tissue inflammation and active inflammation, including sacroiliitis, bone marrow edema, and peripheral arthritis, which are undetectable by the traditional radiological modality, are sensitive by MRI . MRI can detect hip involvement earlier than X‐rays in SpA patients, and early diagnosis and treatment can lead to better prognosis and reversible disease changes .…”

Reliability and Accuracy of MRI in Orthopedics: A Survey of Its Use and Perceived Limitations

“…Two studies have demonstrated superiority of MRI over radiography in early diagnosis of both HLA-positive and HLA-negative spondyloarthropathies. 17,18 Orthopedic surgeons must therefore emphasize an up to date understanding of indications to use MRI effectively. Additional value in MRI may be created from the possibility of creating patient anatomical reconstructions for additional modeling.…”

Chiropractic Care in the Management of Inactive Ankylosing Spondylitis: A Case Series

“…6,8 Hoffstetter et al found that lesions revealed on MRI were most likely to occur in the SI joints and spine (62%) and least likely to occur in the spine alone (10%). 26 However, the specificity of bone marrow abnormalities on MRI is controversial. 9 Additionally, a recent systematic review indicated that bone marrow lesions seen in AS may also be seen in degenerative disease and normal populations.…”