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

  • Francesco GentiliEmail author
  • Luca Cantarini
  • Marta Fabbroni
  • Aandrea Nigri
  • Francesco Giuseppe Mazzei
  • Bruno Frediani
  • Mauro Galeazzi
  • Luca Volterrani
  • Maria Antonietta Mazzei



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.


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).


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.


Sacroiliitis Spondyloarthritis Magnetic resonance imaging Treatment effects 



The authors thank Miss Julia Hassall for reviewing the language.

Author’s contribution

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.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict 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.

Informed consent

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


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Copyright information

© Italian Society of Medical Radiology 2019

Authors and Affiliations

  • Francesco Gentili
    • 1
    Email author
  • Luca Cantarini
    • 2
  • Marta Fabbroni
    • 2
  • Aandrea Nigri
    • 3
  • Francesco Giuseppe Mazzei
    • 4
  • Bruno Frediani
    • 2
  • Mauro Galeazzi
    • 2
  • Luca Volterrani
    • 1
  • Maria Antonietta Mazzei
    • 1
  1. 1.Department of MedicalSurgical and Neuro Sciences, Diagnostic Imaging, University of Siena, Azienda Ospedaliera Universitaria SeneseSienaItaly
  2. 2.Rheumatology UnitResearch Center of Systemic Autoimmune and Autoinflammatory Diseases, University of Siena, Azienda Ospedaliera Universitaria SeneseSienaItaly
  3. 3.Faculty of StatisticsSapienza University of RomeRomeItaly
  4. 4.Diagnostic Imaging, Azienda Ospedaliera Universitaria SeneseSienaItaly

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