Radiomics for the Detection of Active Sacroiliitis Using MR Imaging

Abstract

Detecting active inflammatory sacroiliitis at an early stage is vital for prescribing medications that can modulate disease progression and significantly delay or prevent debilitating forms of axial spondyloarthropathy. Conventional radiography and computed tomography offer limited sensitivity in detecting acute inflammatory findings as these methods primarily identify chronic structural lesions. Conversely, Magnetic Resonance Imaging (MRI) is the preferred technique for detecting bone marrow edema, although it is a complex process requiring extensive expertise. Additionally, ascertaining the origin of lesions can be challenging, even for experienced medical professionals. Machine learning (ML) has showcased its proficiency in various fields by uncovering patterns that are not easily perceived from multi-dimensional datasets derived from medical imaging. The aim of this study is to develop a radiomic signature to aid clinicians in diagnosing active sacroiliitis. A total of 354 sacroiliac joints were segmented from axial fluid-sensitive MRI images, and their radiomic features were extracted. After selecting the most informative features, a number of ML algorithms were utilized to identify the optimal method for detecting active sacroiliitis, leading to the selection of an Extreme Gradient Boosting (XGBoost) model that accomplished an Area Under the Receiver-Operating Characteristic curve (AUC-ROC) of 0.71, thus further showcasing the potential of radiomics in the field.

Radiological Insights into Sacroiliitis: A Narrative Review

“…MRI is considered the gold standard for the diagnosis of sacroiliitis, especially in early and inflammatory stages [5]. It provides valuable information for diagnosing and monitoring the condition, assessing disease activity, and guiding treatment decisions [5] As demonstrated in Figure 4, MRI is particularly sensitive in detecting activ inflammation [44].…”

“…MRI is considered the gold standard for the diagnosis of sacroiliitis, especially in early and inflammatory stages [5]. It provides valuable information for diagnosing and monitoring the condition, assessing disease activity, and guiding treatment decisions [5] As demonstrated in Figure 4, MRI is particularly sensitive in detecting activ inflammation [44]. In sacroiliitis, MRI often reveals edema (swelling) and increased signa intensity on T2-weighted images within and around the SIJ [13].…”

“…Concerns have arisen due to its limitation of being a two-dimensional technique to evaluate three-dimensional structures. Therefore, other modalities have been considered such as Computed Tomography (CT) scans, Magnetic Resonance Imaging (MRI), and nuclear medicine scans (bone scans) [ 4 , 5 , 6 , 7 ].…”

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“…In addition, X-rays cannot detect the early stages of the disease, where inflammation occurs and irreversible structural changes have not yet happened. The early stages of the disease can be diagnosed through magnetic resonance imaging (MRI) [ 7 , 8 , 9 ]. MRI can detect early sacroiliitis symptoms such as subchondral bone marrow edema.…”