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Sacroiliac joint beyond sacroiliitis—further insights and old concepts on magnetic resonance imaging

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Abstract

The sacroiliac joint (SIJ) is an amphiarthrosis composed of a posterior syndesmosis and an anterior cartilaginous portion, with limited yet present mobility. Its main function is to transmit the load from the axial skeleton to the lower limbs and vice-versa; it is susceptible to early mechanical and degenerative changes which are much more common than inflammatory sacroiliitis. Magnetic resonance imaging (MRI) has increasingly been used to evaluate these changes, and while subchondral bone marrow edema (BME) is a common finding related to both, care must be taken when applying the ASAS research MRI definition for sacroiliitis without considering lesion BME topography, size and depth, concomitant structural damage and, of course, the clinical picture. In this review, we will discuss the anatomy and biomechanics of the SIJ, the noninflammatory causes of SIJ subchondral BME, and how these concepts combined can be used to increase our diagnostic confidence.

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Abbreviations

ASAS:

Assessment of Spondyloarthritis International Society

AS:

Ankylosing spondylitis

BME:

Bone marrow edema

MRI:

Magnetic resonance imaging

OCI:

Osteitis condensans Ilii

SIJ:

Sacroiliac joint

RCP:

Reactive C-protein

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  1. Department of Musculoskeletal Radiology, Fleury Medicina e Saúde, Rua Mato Grosso 306, 1st Floor, Higienópolis, SP, 01239-040, São Paulo, Brazil

    Bruno Cerretti Carneiro, Thiago Astil Rizzetto, Flávio Duarte Silva, Isabela Azevedo Nicodemos da Cruz, Júlio Brandão Guimarães, Alípio Gomes Ormond Filho & Marcelo Astolfi Caetano Nico

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Carneiro, B.C., Rizzetto, T.A., Silva, F.D. et al. Sacroiliac joint beyond sacroiliitis—further insights and old concepts on magnetic resonance imaging. Skeletal Radiol 51, 1923–1935 (2022). https://doi.org/10.1007/s00256-022-04067-9

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