title: Gadolinium contrast-enhanced MRI sequence does not have an incremental value in the assessment of sacroiliitis in patients with early inflammatory back pain by using MRI in combination with pelvic radiographs: a 2-year follow-up study.
abstract: OBJECTIVE
  To evaluate the potential incremental value in detecting sacroiliitis of the T1 post-gadolinium diethylenetriaminepenta-acetic acid (Gd-DTPA) MRI sequence of the sacroiliac joints (SIJ) compared with the combination of short tau inversion recovery (STIR) MRI sequence and pelvic radiographs in patients with inflammatory back pain (IBP) suspected for axial spondyloarthritis.
  
  
  METHODS
  A 2-year follow-up study was conducted in patients with IBP of less than 2 years duration. Annual MRI of the SIJ (MRI-SIJ) was performed and scored for bone marrow oedema (BME). Pelvic radiographs were scored according to the modified New York (mNY) criteria. Agreement on the presence of BME detected by the STIR and post-Gd-DTPA sequence and the incremental value of post-Gd-DTPA sequence over STIR plus radiographs was analysed by descriptive methods and kappa statistics.
  
  
  RESULTS
  At baseline, 20 (29%) out of 68 patients (38% male; mean (SD) age 34.9 (10.3) years) enrolled had BME both on the STIR and post-Gd-DTPA sequences; 4 patients (6%) on the STIR sequence only; none on the post-Gd-DTPA sequence only (kappa value: 0.87). Fifteen (22%) patients fulfilled the mNY criteria at baseline. Sixty-two (91%) patients had at least 1 follow-up MRI-SIJ. At 2-year follow-up, 2 patients had BME on the post-Gd-DTPA sequence without BME on the STIR sequence. These 2 patients already fulfilled the mNY criteria at baseline.
  
  
  CONCLUSIONS
  In this cohort of patients with early IBP, the post-Gd-DTPA sequence of the MRI-SIJ did not have an incremental value in the detection of sacroiliitis compared with the STIR sequence plus pelvic radiographs.
authors.affiliation: Department of Medicine, Division of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands. m.van.onna@mumc.nl.
authors.forename: M
authors.initials: M
authors.lastname: van Onna
authors.forename: A
authors.initials: A
authors.lastname: van Tubergen
authors.forename: D
authors.initials: D
authors.lastname: van der Heijde
authors.forename: A G
authors.initials: AG
authors.lastname: Jurik
authors.forename: R
authors.initials: R
authors.lastname: Landewé
mesh_terms: D000328:Adult; D001416:Back Pain / Q000175:diagnosis / Q000209:etiology; D057186:Comparative Effectiveness Research; D003287:Contrast Media; D003937:Diagnosis, Differential; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D062072:Patient Acuity; D011859:Radiography; D015203:Reproducibility of Results; D012446:Sacroiliac Joint / Q000000981:diagnostic imaging / Q000503:physiopathology; D058566:Sacroiliitis / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA