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Ziegeler K, Ulas ST, Poddubnyy D, Proft F, Rios Rodriguez V, Rademacher J, Hermann KGA, Diekhoff T. Anatomical variation of the sacroiliac joint carries an increased risk for erosion and bone marrow oedema in axial spondyloarthritis. Rheumatology (Oxford) 2023; 62:1117-1123. [PMID: 35532084 DOI: 10.1093/rheumatology/keac282] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 04/24/2022] [Accepted: 04/24/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To assess the impact of joint shape variations on inflammatory lesions on SI joint MRIs in patients with axial spondyloarthritis (axSpA). METHODS A total of 1194 patients from four different prospective cohorts were evaluated, with 684 (57.3%) having sufficient imaging data for inclusion (379 axSpA, 305 controls). All images were evaluated for joint form, erosion, sclerosis, fat metaplasia and bone marrow oedema (BMO) by two independent readers. Logistic regression analyses were used to assess the association of joint form and lesions on imaging for axSpA patients and controls. RESULTS Atypical joint forms were common in both axSpA (43.5% [154/354]) and control patients (44.2% [134/303]); both intra-articular variants and a crescent joint shape were significantly more common in axSpA patients (18.4% vs 11.6% and 11.0% vs 5.3.%, respectively; P < 0.001). The axSpA patients with intra-articular joint form variants had 2-fold higher odds of exhibiting erosions [odds ratio (OR) 2.09 (95% CI 1.18, 3.69)] and BMO [OR 1.79 (95% CI 1.13, 2.82)]; this association was not observed in controls. Accessory joints increased the odds for sclerosis in axSpA patients [OR 2.54 (95% CI 1.10, 5.84)] and for sclerosis [OR 17.91 (95% CI 6.92, 46.37)] and BMO [OR 2.05 (95% CI 1.03, 4.07)] in controls. CONCLUSIONS Joint form variations are associated with the presence of inflammatory lesions on SI joint MRIs of axSpA patients. This should be taken into consideration in future research on the interplay of mechanical strain and inflammation in axSpA.
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Affiliation(s)
| | | | - Denis Poddubnyy
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin
| | - Fabian Proft
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin
| | - Valeria Rios Rodriguez
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin
| | - Judith Rademacher
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin.,Berlin Institute of Health, Berlin, Germany
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Hahn S, Song JS, Choi EJ, Cha JG, Choi Y, Ju Song Y, Kim I, Park EH. Can Bone Erosion in Axial Spondyloarthropathy be Detected by Ultrashort Echo Time Imaging? A Comparison With Computed Tomography in the Sacroiliac Joint. J Magn Reson Imaging 2022; 56:1580-1590. [PMID: 35247216 DOI: 10.1002/jmri.28110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 02/01/2022] [Accepted: 02/02/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Structural lesion evaluation in axial spondyloarthropathy (SpA) can improve accuracy of diagnosis. However, structural lesions (bone erosions) are difficult to be assessed using conventional MRI compared to computed tomography (CT). PURPOSE To evaluate the diagnostic performance of ultrashort echo time (UTE) for detecting bone erosion in axial SpA compared to T1WI and three-dimensional double-echo steady-state (3D DESS) imaging using CT as the reference standard. STUDY TYPE Retrospective. POPULATION Fourteen patients (eight females, 57.1%) and 14 healthy controls (seven females, 50.0%) who underwent sacroiliac (SI) joint MRI and CT. FIELD STRENGTH/SEQUENCE 3 T; TSE T1WI, 3D DESS, 2D UTE. ASSESSMENT The bilateral SI joints were assessed for bone erosion. Three observers scored bone erosion for all three sequences of MRI. CT was used as the gold standard. Diagnostic confidence in axial SpA was measured based on a four-point confidence score. STATISTICAL TESTS Correlation of erosion scores between CT and MRI were evaluated using Spearman's correlation test. Sensitivity, specificity, and positive-negative predictive values were calculated. Confidence scores were compared using the Wilcoxon sum rank test. Statistical significance was set at P < 0.05. RESULTS Compared with erosion scores of CT, the correlation coefficients for each MRI sequence showed significant low-to-high positive correlations (0.39-0.72). UTE imaging showed the highest correlation coefficients for all observers (0.70, 0.72, and 0.67, respectively). The specificity of UTE imaging was equal or higher than those of T1WI and 3D DESS for all observers (0.86 vs. 0.71 vs. 0.57; 0.93 vs. 0.71 vs. 0.57; 0.79 vs. 0.79 vs. 0.43). All observers had the highest confidence in interpreting UTE imaging for detecting bone erosion among the three sequences (3.5, 3.4, and 3.3 for UTE; 3.1, 3.0, and 2.6 for T1WI; and 3.2, 2.7, and 2.4 for DESS). DATA CONCLUSION UTE imaging can detect bone erosions in patients with axial SpA and show higher specificity than conventional T1WI and 3D DESS. EVIDENCE LEVEL 4 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Seok Hahn
- Department of Radiology, Inje University Haeundae Paik Hospital, Busan, Republic of Korea
| | - Ji Soo Song
- Department of Radiology, Jeonbuk National University Hospital, Jeonju, Republic of Korea.,Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Eun Jung Choi
- Department of Radiology, Jeonbuk National University Hospital, Jeonju, Republic of Korea.,Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Jang Gyu Cha
- Department of Radiology, Soonchunhyang University Bucheon Hospital, Bucheon-si, Republic of Korea
| | - Yunjung Choi
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea.,Division of Rheumatology, Department of Internal Medicine, Jeonbuk National University Medical School, Jeonju, Republic of Korea
| | - Young Ju Song
- Department of Radiology, Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - InSeong Kim
- Siemens Healthineers Ltd., Seoul, Republic of Korea
| | - Eun Hae Park
- Department of Radiology, Jeonbuk National University Hospital, Jeonju, Republic of Korea.,Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
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Protopopov M, Proft F, Wichuk S, Machado PM, Lambert RG, Weber U, Juhl Pedersen S, Østergaard M, Sieper J, Rudwaleit M, Baraliakos X, Maksymowych WP, Poddubnyy D. Comparing MRI and conventional radiography for the detection of structural changes indicative of axial spondyloarthritis in the ASAS cohort. Rheumatology (Oxford) 2022; 62:1631-1635. [PMID: 35951746 DOI: 10.1093/rheumatology/keac432] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 06/10/2022] [Accepted: 07/02/2022] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To compare magnetic resonance imaging (MRI) and conventional radiography of sacroiliac joints (SIJs) for detection of structural lesions typical for axial spondyloarthritis (axSpA). METHODS Adult patients from the Assessment of SpondyloArthritis international Society (ASAS) cohort with symptoms suggestive of axSpA and both SIJ MRIs and radiographs available for central reading were included. Radiographs were evaluated by three readers according to the modified New York (mNY) criteria grading system. The presence of structural damage on radiographs was defined as 1) fulfilment of the radiographic mNY criterion and 2) additionally, a lower threshold for sacroiliitis of at least grade 2 unilaterally. MRI scans were assessed for the presence of structural changes indicative of axSpA by 7 readers. Diagnostic performance (sensitivity-Se, specificity-Sp, positive and negative predictive values-PPV and NPV-and positive and negative likelihood ratios-LR+ and LR-) of MRI and radiographs (vs rheumatologist's diagnosis of axSpA) were calculated. RESULTS Overall, 183 patients were included, 135 (73.7%) were diagnosed with axSpA. Structural lesions indicative of axSpA on MRI had Se 38.5%, Sp 91.7%, PPV 92.9%, NPV 34.6%, LR + 4.62, LR- 0.67. Sacroiliitis according to the mNY criteria had Se 54.8%, Sp 70.8%, PPV 84.1%, NPV 35.8%, positive LR + 1.88, LR- 0.64. Radiographic sacroiliitis of at least grade 2 unilaterally had Sn 65.2%, Sp 50.0%, PPV 78.6%, NPV 33.8%, LR + 1.30, LR- 0.69. CONCLUSION Structural lesions of SIJ detected by MRI demonstrated better diagnostic performance and better inter-reader reliability compared with conventional radiography.
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Affiliation(s)
| | - Fabian Proft
- Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Stephanie Wichuk
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Pedro M Machado
- Centre for Rheumatology & MRC Centre for Neuromuscular Diseases, University College London, London, UK
| | - Robert G Lambert
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
| | - Ulrich Weber
- 6Practice Buchsbaum, Rheumatology, Schaffhausen, Switzerland
| | - Susanne Juhl Pedersen
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Martin Rudwaleit
- Rheumazentrum Ruhrgebiet, Ruhr-University Bochum, Herne, Germany
| | | | | | - Denis Poddubnyy
- Charité Universitätsmedizin Berlin, Berlin, Germany.,German Rheumatism Research Centre, Berlin, Germany
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Hermann KGA, Ziegeler K, Kreutzinger V, Poddubnyy D, Proft F, Deppe D, Greese J, Sieper J, Diekhoff T. What amount of structural damage defines sacroiliitis: a CT study. RMD Open 2022; 8:rmdopen-2021-001939. [PMID: 35064092 PMCID: PMC8785200 DOI: 10.1136/rmdopen-2021-001939] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 11/25/2021] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To propose a data-driven definition for structural changes of sacroiliac (SI) joints in the context of axial spondyloarthritis (axSpA) imaging on a large collective of CT datasets. METHODS 546 individuals (102 axSpA, 80 non-axSpA low back pain and 364 controls without back pain) with SI joint CTs were evaluated for erosions, sclerosis and ankylosis using a structured scoring system. Lesion frequencies and spatial distribution were compared between groups. Diagnostic performance (sensitivity (SE), specificity (SP), positive predictive values, negative predictive values and positive and negative likelihood ratios) was calculated for different combinations of imaging findings. Clinical diagnosis served as standard of reference. RESULTS Ankylosis and/or erosions of the middle and dorsal joint portions yielded the best diagnostic performance with SE 67.6% and SP 96.3%. Inclusion of ventral erosions and sclerosis resulted in lower diagnostic performance with SE 71.2%/SP 92.5% and SE 70.6%/SP 90.0%, respectively. CONCLUSIONS Sclerosis and ventrally located erosions of SI joints have lower specificity on CT of the SI joint in the context of axSpA imaging. Ankylosis and/or erosions of the middle and dorsal joint portions show a strong diagnostic performance and are appropriate markers of a positive SI joint by CT.
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Affiliation(s)
- Kay Geert A Hermann
- Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Katharina Ziegeler
- Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | - Denis Poddubnyy
- Division of Gastroenterology, Infectious Diseases and Rheumatology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Fabian Proft
- Division of Gastroenterology, Infectious Diseases and Rheumatology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Dominik Deppe
- Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Juliane Greese
- Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Joachim Sieper
- Division of Gastroenterology, Infectious Diseases and Rheumatology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Torsten Diekhoff
- Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany
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