Magnetic resonance imaging of the sacroiliac joints in SpA: with or without intravenous contrast media? A preliminary report
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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.
KeywordsSacroiliitis Spondyloarthritis Magnetic resonance imaging Treatment effects
The authors thank Miss Julia Hassall for reviewing the language.
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.
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 was obtained from all individual participants included in the study.
- 5.Puhakka KB, Jurik AG, Egund N, Schiottz-Christensen B, Stengaard-Pedersen K, van Overeem Hansen G, Christiansen JV (2003) Imaging of sacroiliitis in early seronegative spondylarthropathy. Assessment of abnormalities by MR in comparison with radiography and CT. Acta Radiol 44(2):218–229CrossRefGoogle Scholar
- 6.de Hooge M, van den Berg R, Navarro-Compán V, van Gaalen F, van der Heijde D, Huizinga T, Reijnierse M (2013) Magnetic resonance imaging of the sacroiliac joints in the early detection of spondyloarthritis: no added value of gadolinium compared with short tau inversion recovery sequence. Rheumatology (Oxford) 52(7):1220–1224CrossRefGoogle Scholar
- 10.Pascual-Salcedo D, Plasencia C, Jurado T, Del Valle L, Prado S et al (2015) Dose-tapering Of TNF inhibitors in daily rheumatology practice enables the maintenance of clinical efficacy while improving cost-effectiveness. J Pharmacovigilance 3:172Google Scholar
- 13.Marchesoni A, D’Angelo S, Anzidei M, Bortolotti R, Cantini F, Caramella D et al. SHARE Study Group (2018) Radiologist-rheumatologist multidisciplinary approach in the management of axial spondyloarthritis: a Delphi consensus statement. Clin Exp Rheumatol. Nov 16. PubMed PMID: 30557127Google Scholar
- 14.Biondi M, Vanzi E, De Otto G, Banci Buonamici F, Belmonte GM, Mazzoni LN et al (2016) Water/cortical bone decomposition: a new approach in dual energy CT imaging for bone marrow oedema detection. A Feasibility Study 32(12):1712–1716Google Scholar
- 16.De Hooge M, van den Berg R, Navarro-Compán V, van Gaalen F, van der Heijde D, Huizinga T, Reijnierse M (2013) Magnetic resonance imaging of the sacroiliac joints in the early detection of spondyloarthritis: no added value of gadolinium compared with short tau inversion recovery sequence. Rheumatology (Oxford) 52(7):1220–1224CrossRefGoogle Scholar
- 17.Maksymowicz H, Kowalewski K, Lubkowska K, Zołud W, Sąsiadek M (2010) Diagnostic value of gadolinium-enhanced MR imaging of active sacroiliitis in seronegative spondyloarthropathy. Pol J Radiol 75(2):58–65Google Scholar
- 29.Maksymowych WP (2000) Ankylosing spondylitis–at the interface of bone and cartilage. J Rheumatol 27:2295–2301Google Scholar
- 31.Volterrani L, Mazzei MA, Giordano N, Nuti R, Galeazzi M, Fioravanti A (2008) Magnetic resonance imaging in Tietze’s syndrome. Clin Exp Rheumatol 26(5):848–853Google Scholar
- 33.Pedersen SJ, Sørensen IJ, Garnero P, Johansen JS, Madsen OR, Tvede N et al (2011) ASDAS, BASDAI and different treatment responses and their relation to biomarkers of inflammation, cartilage and bone turnover in patients with axial spondyloarthritis treated with TNFα inhibitors. Ann Rheum Dis 70(8):1375–1381CrossRefGoogle Scholar
- 34.Boers M, Brooks P, Strand CV, Tugwell P (1998) The OMERACT filter for outcome measures in rheumatology. J Rheumatol 25(2):198–199Google Scholar
- 35.Pedersen SJ, Sørensen IJ, Hermann KG, Madsen OR, Tvede N, Hansen MS et al (2010) Responsiveness of the Ankylosing Spondylitis Disease Activity Score (ASDAS) and clinical and MRI measures of disease activity in a 1-year follow-up study of patients with axial spondyloarthritis treated with tumour necrosis factor alpha inhibitors. Ann Rheum Dis 69(6):1065–1071CrossRefGoogle Scholar