Abstract
Objective
The microscopic study of the various components of joints provide a proper basis for understanding the nature of pathologic lesions to which they are subject and their imaging appearances. This study was designed to correlate MR imaging with a systematic histological study of the normal sacroiliac joint (SIJ), which to our knowledge is not available in the literature.
Design and patients
Five male cadavers, aged 20 to 45 years, and seven male and seven female volunteers, aged 23 to 44 years, were investigated with oblique transaxial and coronal MR imaging of the SIJs. A variety of sequences including pre- and post-contrast T1 fat-saturated studies in the volunteers were used. Cryosectioning was performed in six SIJs of the five cadavers and compared with the MR images for the microscopic joint anatomy and assessed for the presence of abnormalities resembling those associated with sacroiliitis.
Results
Throughout the SIJ, the hyaline cartilage of the sacral bone and the proximal third of the hyaline iliac cartilage was strongly attached to the surrounding stabilizing ligaments, forming wide margins of fibrocartilage. In the distal one-third of the joint only, the margins of the iliac joint facet resemble that of a synovial joint, which include an inner capsule with synovial cells. The MR anatomy of the ventral and dorsal aspects of the SIJ was only adequately visualized at oblique transaxial MR imaging. No contrast enhancement occurred in the synovial tissue or in the cartilaginous joint space. The dorsal transition between the proximal 2/3 and distal 1/3 of the cartilaginous joint was at microscopy rich in anatomical and histological variants, including osseous clefts, cartilage and subchondral defects, and vascular connective tissue in the bone marrow. These were all recognized at oblique transaxial MR imaging and in coronal MR sectioning may resemble abnormalities. Otherwise, no erosions, bone marrow abnormalities, bone sclerosis or abnormal contrast enhancement occurred in the normal joints.
Conclusions
The SIJ should be classified anatomically as a symphysis with some characteristics of a synovial joint being confined to the distal cartilaginous portion at the iliac side. Coronal MR imaging does not allow assessment of normal anatomy, variants or abnormalities of the ventral and dorsal margins of the cartilaginous SIJ.
Similar content being viewed by others
References
Dougados M, van der Linden S, Juhlin R et al. The European Spondylarthropathy Study Group preliminary criteria for the classification of spondylarthropathy. Arthritis Rheum 1991; 34:1218–1227.
Ahlström H, Feltelius N, Nyman R, Hällgren R. Magnetic resonance imaging of sacroiliac joint inflammation. Arthritis Rheum 1990; 33:1763–1769.
Murphey MD, Wetzel LH, Bramble JM, Levine E, Simpson KM, Lindsley HB. Sacroiliitis: MR imaging findings. Radiology 1991; 180:239–244.
Bollow M, Braun J, Hamm B, Eggens U et al. Early sacroiliitis in patients with sponyloarthopathy: evaluation with dynamic gadolinium-enhanced MR imaging. Radiology 1995; 194:529–536.
Blum U, Buitrago-Tellez C, Mundinger A et al. Magnetic resonance imaging (MRI) for detection of active sacroiliitis—a prospective study comparing conventional radiography, scintigraphy, and contrast enhanced MRI. J Rheumatol 1996; 23:2107–2115.
Yu W, Feng F, Dion E, Yang H, Jiang M, Genant HK. Comparison of radiography, computed tomography and magnetic resonance imaging in the detection of sacroiliitis accompanying ankylosing spondylitis. Skeletal Radiol 1998; 27:311–320.
Puhakka KB, Jurik AG, Egund N, Schiøttz-Christensen B et al. MR imaging of early seronegative spondylarthropathy. Abnormalities associated to clinical and laboratory findings. Rheumatology (In press).
Schunke BB. The anatomy and development of the sacroiliac joint in man. Anat Rec 1938; 72:313–331.
MacDonald GR, Hunt TE. Sacroiliac joint: Observations on the gross and histological changes in various age groups. Can Med Assoc J 1952; 66:157–163.
Solonen K. The sacroiliac joint in the light of anatomical, roentgenological and clinical studies. Acta Orthop Scand Suppl 27 1957:1–115.
Albee FH. A study of the anatomy and clinical importance of the sacroiliac joint. JAMA 1909; 53:1273–1275.
Brooke R. The sacro-iliac joint. J Anat 1924; 59:299–305.
Puhakka KB, Jurik AG, Egund N, Schiottz-Christensen B et al. Imaging of sacroiliitis in early seronegative spondylarthropathy. Assessment of abnormalities by MR in comparison with radiography and CT. Acta Radiol 2003; 44:218–229.
Warwick R, Williams PL. Arthrology. In: Gray’s anatomy, 35th British edn. Philadelphia: WB Saunders, 1973:388–412.
Ham AW. Joints. In: Ham AW, ed. Histology, 5th edn. Philadelphia: J.P. Lippincott, 1965:358–475.
Resnick D. Rheumatoid arthritis and the seronegative spondyloarthropaties: radiographic and pathologic concepts. In: Resnick D ed. Diagnosis of bone and joint disorders, 4th edn. Philadelphia: W.B. Saunders, 2002:837–890.
Resnick D. Articular anatomy and histology. In: Resnick D, ed. Diagnosis of bone and joint disorders. Philadelphia: W.B. Saunders, 2002:688–707.
Resnick D. Inflammatory disorders of the vertebral column: seronegative spondyloarthropathies, adult-onset rheumatoid arthritis, and juvenile chronic arthritis. Clin Imaging 1989; 13:253–268.
Sashin D. A critical analysis of the anatomy and the pathologic changes of the sacro-iliac joints. J Bone Joint Surg 1930; 12:891–910.
Bowen V, Cassidy JD. Macroscopic and microscopic anatomy of the sacroiliac joint from embryonic life until the eighth decade. Spine 1981; 6:620–628.
Paquin JD, van der Rest M, Marie PJ et al. Biochemical and morphologic studies of cartilage from the adult human sacroiliac joint. Arthritis Rheum 1983; 26:887–895.
Kampen WU, Tillmann B. Age-related changes in the articular cartilage of human sacroiliac joint. Anat Embryol (Berl) 1998; 198:505–513.
Lynch FW. The pelvic articulation during pregnancy, labor and puerperium: An X-ray study. Surg Gynecol Obstet 1920; 12:891–910.
Carter ME, Loewi G. Anatomical changes in normal sacroiliac joints during childhood and comparison with the changes in Still’s disease. Ann Rheum Dis 1962; 21:121–134.
Egund N, Olsson TH, Schmid H et al. Movements in the sacroiliac joints demonstrated with roentgen stereophotogrammetry. Acta Radiol [Diagn] (Stockh) 1978; 19:833–846.
Weisl H. The movements of the sacroiliac joint. Acta Anat 1955; 10:608–621.
Resnick D, Niwayama G, Goergen TG. Degenerative disease of the sacroiliac joint. Invest Radiol 1975; 10:608–621.
Prassopoulos PK, Faflia CP, Voloudaki AE et al. Sacroiliac joints: anatomical variants on CT. J Comput Assist Tomogr 1999; 23:323–327
Bollow M, Braun J, Biedermann T et al. Use of contrast-enhanced MR imaging to detect sacroiliitis in children. Skeletal Radiol 1998; 27:606–616.
Braun J, Bollow M, Eggens U et al. Use of dynamic magnetic resonance imaging with fast imaging in the detection of early and advanced sacroiliitis in spondylarthropathy patients. Arthritis Rheum 1994; 37:1039–1045.
Braun J, Khan MA, Sieper J. Enthesitis and ankylosis in spondylarthropathy: What is the target of the immune response? Ann Rheum Dis 2000; 59:985–994.
Wittram C, Whitehouse GH. Normal variation in the magnetic resonance imaging appearances of the sacroiliac joints: pitfalls in the diagnosis of sacroiliitis. Clin Radiol 1995; 50:371–376.
Ball J. Enthesopathy of rheumatoid and ankylosing spondylitis. Ann Rheum Dis 1971; 30:213–223.
Francois RJ, Gardner DL, Degrave EJ, Bywaters EG. Histopathologic evidence that sacroiliitis in ankylosing spondylitis is not merely enthesitis. Arthritis Rheum 2000; 43:2011–2024.
Wittram C, Whitehouse GH, Bucknall RC. Fat suppressed contrast enhanced MR imaging in the assessment of sacroiliitis. Clin Radiol 1996; 51:554–558.
Duda SH, Laniado M, Schick F et al. Normal bone marrow in the sacrum of young adults: differences between the sexes seen on chemical-shift MR imaging. Am J Roentgenol 1995; 164:935–940.
Levine CD, Schweitzer ME, Ehrlich SM. Pelvic marrow in adults. Skeletal Radiol 1994; 23:343–347.
Walker JM. The sacroiliac joint: a critical review. Phys Ther 1992; 72:903–916.
Rauschning W. Computed tomography and cryomicrotomy of lumbar spine specimens. A new technique for multiplanar anatomic correlation. Spine 1983; 8:170–180.
Acknowledgements
We kindly acknowledge the Danish Rheumatism Association and A.P. Møller og Hustru Chastine Mc-Kinney Møllers Fond til almene Formaal for financial support. We thank Nycomed Denmark A/S for providing the contrast agent and the engineer, Ph.D. Peter Vestergaard Poulsen, for technical assistance in providing the MRI sequences.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Puhakka, K.B., Melsen, F., Jurik, A.G. et al. MR imaging of the normal sacroiliac joint with correlation to histology. Skeletal Radiol 33, 15–28 (2004). https://doi.org/10.1007/s00256-003-0691-4
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00256-003-0691-4