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MRI of the sacroiliac joints in spondyloarthritis: the added value of intra-articular signal changes for a ‘positive MRI’

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Abstract

Objective

To determine if intra-articular signal changes at the sacroiliac joint space on MRI have added diagnostic value for spondyloarthritis, when compared to bone marrow edema (BME).

Materials and methods

A retrospective study was performed on the MRIs of sacroiliac joints of 363 patients, aged 16–45 years, clinically suspected of sacroiliitis. BME of the sacroiliac joints was correlated to intra-articular sacroiliac joint MR signal changes: high T1 signal, fluid signal, ankylosis and vacuum phenomenon (VP). These MRI findings were correlated with final clinical diagnosis. Sensitivity (SN), specificity (SP), likelihood ratios (LR), predictive values and post-test probabilities were calculated.

Results

BME had SN of 68.9%, SP of 74.0% and LR+ of 2.6 for diagnosis of spondyloarthritis. BME in absence of intra-articular signal changes had a lower SN and LR+ for spondyloarthritis (SN = 20.5%, LR+ 1.4). Concomitant BME and high T1 signal (SP = 97.2%, LR + = 10.5), BME and fluid signal (SP = 98.6%, LR + = 10.3) or BME and ankylosis (SP = 100%) had higher SP and LR+ for spondyloarthritis. Concomitant BME and VP had low LR+ for spondyloarthritis (SP = 91%, LR + =0.9). When BME was absent, intra-articular signal changes were less prevalent, but remained highly specific for spondyloarthritis.

Conclusion

Our results suggest that both periarticular and intra-articular MR signal of the sacroiliac joint should be examined to determine whether an MRI is ‘positive’ or ‘not positive’ for sacroiliitis associated with spondyloarthritis.

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Authors and Affiliations

  1. Department of Radiology and Medical Imaging, Ghent University Hospital, De Pintelaan 185, B-9000, Ghent, Belgium

    Frederiek Laloo, N. Herregods, K. Verstraete & L. Jans

  2. Department of Radiology & Diagnostic Imaging, University of Alberta Hospital, 8440-112 Street, Edmonton, AB, T6G 2B7, Canada

    J. L. Jaremko

Authors
  1. Frederiek Laloo
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  2. N. Herregods
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  3. J. L. Jaremko
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  4. K. Verstraete
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  5. L. Jans
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Corresponding author

Correspondence to Frederiek Laloo.

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The authors declare that they have no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Laloo, F., Herregods, N., Jaremko, J.L. et al. MRI of the sacroiliac joints in spondyloarthritis: the added value of intra-articular signal changes for a ‘positive MRI’. Skeletal Radiol 47, 683–693 (2018). https://doi.org/10.1007/s00256-017-2830-3

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  • DOI: https://doi.org/10.1007/s00256-017-2830-3

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