Normal subchondral high T2 signal on MRI mimicking sacroiliitis in children: frequency, age distribution, and relationship to skeletal maturity

Herregods, Nele; Jans, Lennart; Chen, Min; Paschke, Joel; Buyser, Stefanie De; Renson, Thomas; Dehoorne, Joke; Joos, Rik; Lambert, Robert G.; Jaremko, Jacob L.

doi:10.1007/s00330-020-07328-0

Cited by 23 publications

(25 citation statements)

References 26 publications

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“…The pelvis was the most common location for focal bone marrow hyperintensities. Bone marrow heterogeneity due to residual red marrow is a normal finding in the pelvis at all ages and is typically symmetrical [15][16][17][18][19]. Symmetry was not frequently registered in our study, but findings with a symmetrical appearance were mainly located in the pelvis.…”

Section: Discussioncontrasting

confidence: 55%

“…To date, no such definition exists for children [23,24]. In a recent study, Herregods et al assessed the MRI appearance of the sacroiliac joints in a cohort of 251 individuals aged 6-18 years with or without low back pain [15]. The authors concluded that asymmetrical subchondral T2W signal, especially when more intense on the iliac side, "is unlikely to be normal and should be considered suspicious for pathologic bone marrow edema".…”

Section: Discussionmentioning

confidence: 99%

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Whole body magnetic resonance imaging in healthy children and adolescents. Bone marrow appearances of the axial skeleton

Brandis¹,

Zadig²,

Avenarius³

et al. 2022

European Journal of Radiology

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Section: Discussioncontrasting

confidence: 55%

Section: Discussionmentioning

confidence: 99%

Whole body magnetic resonance imaging in healthy children and adolescents. Bone marrow appearances of the axial skeleton

Brandis¹,

Zadig²,

Avenarius³

et al. 2022

European Journal of Radiology

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“…The application of MRI in children with suspected sacroiliitis remains the gold standard for evaluation of early disease, but it can encounter some difficulties in clinical routine because of the necessity of sedation for younger children, long waiting lists for dedicated sessions, and variability in MRI interpretation of pediatric SIJs due to the changes that occur with skeletal maturation [3,4,6].…”

Section: Discussionmentioning

confidence: 99%

“…The routine application of MRI in children with suspected sacroiliitis can encounter some difficulties as variability in MRI interpretation of pediatric sacroiliac joints (SIJs) due to the changes that occur with skeletal maturation (metaphyseal equivalent signal intensity and red bone marrow spots mimicking bone marrow edema) and the necessity of sedation for younger children, with dedicated MRI session [3,4]. Moreover, the role of contrast-enhanced sequences and the applicability of ASAS criteria in pediatric sacroiliitis are still debated [5,6].…”

Section: Introductionmentioning

confidence: 99%

Doppler and Spectral Ultrasound of Sacroiliac Joints in Pediatric Patients with Suspected Juvenile Spondyloarthritis

et al. 2022

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Background: Power Doppler ultrasound (PDUS) with spectral wave analysis (SWA) has been compared with magnetic resonance imaging (MRI) in documenting active sacroiliitis in early spondyloarthritis (SpA) but, to date, PDUS/SWA has not been yet applied to the study of sacroiliac joints (SIJs) in children. Methods: A group of 20 children (13 F/7 M, mean age 14.2 y) with suspected juvenile SpA (jSpA) underwent PDUS/SWA and, subsequently, MRI of the SIJs. SIJs PDUS scoring and resistance index (RI) of the SIJs flows were recorded. The accuracy of PDUS/SWA for the diagnosis of active sacroiliitis was evaluated, with MRI as the gold standard. Results: PDUS signals were detected in 19 patients and 30 SIJs. Bone marrow edema (BME) lesions on MRI were detected in 12 patients (diagnosed as jSpA) and 22 SIJs. PDUS scoring on SIJs were higher in patients with a final diagnosis of jSpA (p = 0.003). On SWA, the mean RIs in patients with or without final diagnosis of active sacroiliitis were, respectively, 0.604 and 0.767 (p = 0.005) at joint level. A RI < 0.55 and PDUS > 1 showed the higher specificity for sacroiliitis (AUROC curve 0.854 for PDUS and 0.920 for RI). SIJs PDUS/SWA showed an overall concordance of 82.35%, with substantial agreement (k = 0.627) with MRI on the diagnosis of sacroiliitis. Conclusions: In children with sacroiliitis, PDUS demonstrates a rich vascularization into SIJs and low RIs (<0.55) have high specificity for this condition. SIJs PDUS/SWA could be useful as a screening method in children with suspected jSpA.

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“…Furthermore, the spectrum of BME abnormalities available in this study may have been limited, which facilitated the decision making of raters during the exercise. Note should be made, however, that the normal spectrum of SIJ signals varies according to the degree of skeletal maturation of children and adolescents [ 27 , 28 ]. As a result, atlases should be developed to address physiologic variation of bone marrow signals across age groups of children and adolescents in future exercises that involve bone marrow scoring in growing joints.…”

Section: Discussionmentioning

confidence: 99%

Reliability of the Preliminary OMERACT Juvenile Idiopathic Arthritis MRI Score (OMERACT JAMRIS-SIJ)

Otobo

Herregods

Jaremko

et al. 2021

JCM

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This study reports the reliability of the juvenile idiopathic arthritis magnetic resonance imaging scoring system (JAMRIS-SIJ). The study comprised of eight raters—two rheumatologists and six radiologists—and 30 coronal T1 and Short-Tau Inversion Recovery (STIR) MRI scans of patients with enthesitis-related juvenile spondylarthritis. The median age of patients was 15 years with a mean disease duration of 5 years and 22 (73.3%) of the sample were boys. The inter-rater agreement of scores for each of the JAMRIS-SIJ items was calculated using a two-way random effect, absolute agreement, and single rater intraclass correlation coefficient (ICC 2.1). The ICC was interpreted together with kurtosis, since the ICC is also affected by the distribution of scores in the sample. The eight-rater, single measure inter-rater ICC (and kurtosis) values for JAMRIS-SIJ inflammation and damage components were the following: bone marrow edema (BME), 0.76 (1.2); joint space inflammation, 0.60 (1.8); capsulitis, 0.58 (9.2); enthesitis, 0.20 (0.1); ankylosis, 0.89 (35); sclerosis, 0.53 (4.6); erosion, 0.50 (6.5); fat lesion, 0.40 (21); backfill, 0.38 (38). The inter-rater reliability for BME and ankylosis scores was good and met the a priori set ICC threshold, whereas for the other items it was variable and below the selected threshold. Future directives should focus on refinement of the scores, definitions, and methods of interpretation prior to validation of the JAMRIS-SIJ through the assessment of its measurement properties.

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Normal subchondral high T2 signal on MRI mimicking sacroiliitis in children: frequency, age distribution, and relationship to skeletal maturity

Cited by 23 publications

References 26 publications

Whole body magnetic resonance imaging in healthy children and adolescents. Bone marrow appearances of the axial skeleton

Whole body magnetic resonance imaging in healthy children and adolescents. Bone marrow appearances of the axial skeleton

Doppler and Spectral Ultrasound of Sacroiliac Joints in Pediatric Patients with Suspected Juvenile Spondyloarthritis

Reliability of the Preliminary OMERACT Juvenile Idiopathic Arthritis MRI Score (OMERACT JAMRIS-SIJ)

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