title: 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.
abstract: OBJECTIVE
  To investigate the additional value of T1 fat-saturated after gadolinium (T1/Gd) compared with T1 and short tau inversion recovery (STIR) sequence in detecting active lesions of the SI joints typical of axial SpA (axSpA) in a prospective cohort study, the SpondyloArthritis Caught Early (SPACE) cohort, and to assess its influence on final MRI diagnosis of the SI joint (MRI-SIJ) based on the Assessment of Spondyloarthritis International Society (ASAS) definition of active sacroiliitis.
  
  
  METHODS
  Patients in the SPACE cohort received baseline and 3-month follow-up MRI-SIJ with coronal oblique T1, STIR and T1/Gd sequences. Bone marrow oedema (BME), capsulitis/enthesitis and synovitis and active sacroiliitis according to the ASAS definition were evaluated by three blinded readers.
  
  
  RESULTS
  A total of 127 patients received an MRI-SIJ at baseline and 67 patients also received an MRI-SIJ at 3 months follow-up since the Gd protocol was added some months after the start of the SPACE project. Twenty-five of the 127 patients (19.7%) with a baseline MRI-SIJ and 14 of 67 patients (20.6%) with a follow-up MRI-SIJ presented BME on the STIR sequence sufficient to fulfill the ASAS definition for a positive MRI-SIJ. In eight patients, additional synovitis and/or capsulitis/enthesitis was observed; however, no additional BME was visualized on T1/Gd. One patient, without clinical diagnosis of axSpA, showed synovitis as an isolated finding.
  
  
  CONCLUSIONS
  Synovitis and capsulitis/enthesitis are detectable with the administration of Gd. However, they are always observed in the presence of BME. Therefore T1 and STIR sequence alone are sufficient in the MRI assessment that, among others, is used for diagnosing patients with early axSpA.
authors: Rheumatology Department, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands.
authors: Manouk
authors: M
authors: de Hooge
authors: Rosaline
authors: R
authors: van den Berg
authors: Victoria
authors: V
authors: Navarro-Compán
authors: Floris
authors: F
authors: van Gaalen
authors: Désirée
authors: D
authors: van der Heijde
authors: Tom
authors: T
authors: Huizinga
authors: Monique
authors: M
authors: Reijnierse
mesh_terms: D000328:Adult; D001855:Bone Marrow Diseases / Q000175:diagnosis; D015331:Cohort Studies; D042241:Early Diagnosis; D004487:Edema / Q000175:diagnosis; D005682:Gadolinium; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D011446:Prospective Studies; D012446:Sacroiliac Joint / Q000473:pathology*; D058566:Sacroiliitis / Q000175:diagnosis; D025241:Spondylarthritis / Q000175:diagnosis* / Q000473:pathology; D013585:Synovitis / Q000175:diagnosis; D055815:Young Adult
chemical_list: D005682:Gadolinium
keywords: MRI; gadolinium; sacroiliitis; spondyloarthritis