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Magnetic resonance imaging of the sacroiliac joints in SpA: with or without intravenous contrast media? A preliminary report

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Abstract

Object

Active sacroiliitis based on magnetic resonance imaging (MRI) without intravenous (I.V.) contrast material injection is considered sufficient for the diagnosis of spondyloarthritis (SpA), according to the Assessment of SpondyloArthritis International Society (ASAS) criteria. This work shows the added value of administering I.V. contrast material when evaluating the response to tumor necrosis factor (TNF) antagonists therapy, on the extension of bone marrow oedema (BMO) and pathological enhancement (osteitis/synovitis) in the sacroiliac joints (SIJs) on MRI.

Materials and methods

Forty-three patients (25 females and 18 males, mean age of 54 ± 16.60 years, range 22–75 years) with a clinical diagnosis of SpA and active sacroiliitis at MRI with I.V. contrast material, were considered for a follow-up MRI after 6 months of TNF antagonists therapy. Disease activity was monitored by a Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) questionnaire. Descriptive statistics, Student’s t test and Cohen’s kappa were used. P < 0.05 was considered statistically significant.

Results

Thirty-eight patients were finally included in the study; 36 of them showed an improvement on clinical assessment after therapy. Score’s difference (improvement) after treatment was calculated in the MRI sequences both with and without contrast agent (respectively, mean value and range 3.18, 0–12 with contrast and 1.63, 0–7 without contrast). This improvement was statistically significant in each group (P value of 7.097e−08 with contrast and 6.741e−06 without contrast), and there was a significant difference between the two group too (P-value of 8.598e−07). Cohen’s kappa for dichotomous variables showed a better agreement between the post-contrast MRI findings and BASDAI (K = 0.53, agreement = 92.11%, P = 0.0001) than MRI without contrast and BASDAI (K = 0.11, agreement = 57.89%, P = 0.06).

Conclusions

The evaluation of enhancement is a reliable tool for the assessment of the response to therapy in SIJs involvement in SpA, better than BMO; hence, it should be advised in the MRI of these patients.

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Acknowledgements

The authors thank Miss Julia Hassall for reviewing the language.

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Authors and Affiliations

  1. Department of Medical, Surgical and Neuro Sciences, Diagnostic Imaging, University of Siena, Azienda Ospedaliera Universitaria Senese, Viale Bracci 10, 53100, Siena, Italy

    Francesco Gentili, Luca Volterrani & Maria Antonietta Mazzei

  2. Rheumatology Unit, Research Center of Systemic Autoimmune and Autoinflammatory Diseases, University of Siena, Azienda Ospedaliera Universitaria Senese, Viale Bracci 10, 53100, Siena, Italy

    Luca Cantarini, Marta Fabbroni, Bruno Frediani & Mauro Galeazzi

  3. Faculty of Statistics, Sapienza University of Rome, Viale Regina Elena 295, 00161, Rome, Italy

    Aandrea Nigri

  4. Diagnostic Imaging, Azienda Ospedaliera Universitaria Senese, Viale Bracci 10, 53100, Siena, Italy

    Francesco Giuseppe Mazzei

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  1. Francesco Gentili
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  2. Luca Cantarini
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  5. Francesco Giuseppe Mazzei
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Contributions

Gentili F, Mazzei MA, Mazzei FG, Galeazzi M and Volterrani L were involved in protocol/project development; Gentili F, Mazzei FG, Cantarini L, Fabbroni M and Frediani B contributed to data collection or management; Mazzei MA, Gentili F, Nigri A, Cantarini L and Fabbroni M were involved in data analysis.

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Correspondence to Francesco Gentili.

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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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Gentili, F., Cantarini, L., Fabbroni, M. et al. Magnetic resonance imaging of the sacroiliac joints in SpA: with or without intravenous contrast media? A preliminary report. Radiol med 124, 1142–1150 (2019). https://doi.org/10.1007/s11547-019-01016-w

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  • DOI: https://doi.org/10.1007/s11547-019-01016-w

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