Grading of inflammatory disease activity in the sacroiliac joints with magnetic resonance imaging: comparison between short-tau inversion recovery and gadolinium contrast-enhanced sequences.
OBJECTIVE
We investigated the potential concordance of 2 different magnetic resonance (MR) sequences - short-tau inversion recovery (STIR) and fat-saturated T1-weighted spin-echo after application of gadolinium (Gd) contrast medium to detect active bone marrow abnormalities at the sacroiliac joints (SIJ) in patients with spondyloarthritis (SpA).


METHODS
Blinded and using the Danish scoring method, we evaluated transaxial MR images of the 2 sequences in 40 patients with SpA with disease duration of 3-14 years. Both the cartilaginous and ligamentous portions of the SIJ were analyzed.


RESULTS
There was a significant positive correlation between the activity scores obtained by STIR and Gd-enhanced sequences (p < 0.0001). Agreement in the detection of bone marrow abnormalities occurred in 60 of the 80 joints, 35 with and 25 without signs of active disease. Discordance with STIR-positive marrow activity scores occurred in only 11 joints; Gd-enhanced positive scores in 9 joints. The STIR sequence detected remnants of marrow activity in the periphery of chronic fatty replacement not seen or partly obscured on the Gd sequence. Small subchondral enhancing lesions may not be scored on the STIR sequence, mostly because of reduced image resolution.


CONCLUSIONS
Active bone marrow abnormalities were detected nearly equally well with STIR and Gd-enhanced fat-suppressed T1 sequences in patients with SpA, with STIR being most sensitive to visualize active abnormalities in the periphery of chronic changes.
Madsen
Karen Berenth
KB
Department of Radiology, Aarhus University Hospital NBG, Aarhus, Denmark.
Egund
Niels
N
Jurik
Anne Grethe
AG
D000293:Adolescent; D000328:Adult; D001853:Bone Marrow / Q000473:pathology*; D005260:Female; D005682:Gadolinium; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012446:Sacroiliac Joint / Q000473:pathology*; D012720:Severity of Illness Index; D025241:Spondylarthritis / Q000473:pathology*
D005682:Gadolinium