The role of multi-parametric MR imaging in the detection of early inflammatory sacroiliitis according to ASAS criteria.
OBJECTIVE
To retrospectively evaluate the accuracy of multi-parametric magnetic resonance (MR) imaging including fat saturated (FS) T2-weighted, short-tau inversion recovery (STIR), diffusion-weighted (DW-MR), and dynamic-contrast-enhanced MR (DCE-MR) imaging techniques in the diagnosis of early inflammatory sacroiliitis and determine the additional value of DW-MR and DCE-MR images according to recently defined 'Assessment in SpondyloArthritis international Society' criteria.


METHODS
The study included 45 patients with back pain. Two radiologists estimated the likelihood of osteitis in 4 independent viewing sessions including FS T2-weighted, STIR, DW-MR and DCE-MR images. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the receiver operating characteristic (ROC) curve (AUC) were calculated.


RESULTS
Of the 45 patients, 31 had inflammatory back pain. Of 31, 28 (90.3%) patients had inflammatory sacroiliitis diagnosed by clinical and laboratory analysis. FS T2-weighted MR images had the highest sensitivity (42.8% for both radiologists) for detecting osteitis in patients with inflammaory sacroiliitis when compared to other imaging sequences. For specificity, PPV, NPV, accuracy, and AUC levels there were no statistically significant difference between image viewing settings. However, adding STIR, DW-MR and DCE-MR images to the FS T2-weighted MR images did not improve the above stated indices.


CONCLUSIONS
FS T2-weighted MR imaging had the highest sensitivity when compared to other imaging sequences. The addition of DW-MR and DCE-MR images did not significantly improve the diagnostic value of MR imaging in the diagnosis of osteitis for both experienced and less experienced radiologists.
Department of Radiology, Fatih Sultan Mehmet Training and Research Hospital, E-5 Karayolu Uzeri, 34752 Atasehir, Istanbul, Turkey. Electronic address: nursoylu@yahoo.com.
Fatma Nur
FN
Boy
Health Services Vocational School, Esenyurt University, Dogan Arasli Bulvari No 120, Esenyurt, Istanbul, Turkey. Electronic address: arda_kayhan@yahoo.com.
Arda
A
Kayhan
Department of Radiology, Fatih Sultan Mehmet Training and Research Hospital, E-5 Karayolu Uzeri, 34752 Atasehir, Istanbul, Turkey. Electronic address: hakki.karakas@gmail.com.
Hakki Muammer
HM
Karakas
Department of Physical Therapy and Rehabilitation, Fatih Sultan Mehmet Training and Research Hospital, E-5 Karayolu Uzeri, 34752 Atasehir, Istanbul, Turkey. Electronic address: feyzamd@yahoo.com.
Feyza
F
Unlu-Ozkan
Department of Physical Therapy and Rehabilitation, Fatih Sultan Mehmet Training and Research Hospital, E-5 Karayolu Uzeri, 34752 Atasehir, Istanbul, Turkey. Electronic address: drduygusilte@hotmail.com.
Duygu
D
Silte
Department of Physical Therapy and Rehabilitation, Fatih Sultan Mehmet Training and Research Hospital, E-5 Karayolu Uzeri, 34752 Atasehir, Istanbul, Turkey. Electronic address: iaktas@hotmail.com.
İlknur
İ
Aktas
D000293:Adolescent; D000328:Adult; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D007090:Image Interpretation, Computer-Assisted / Q000379:methods* / Q000592:standards*; D038622:Internationality; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods* / Q000592:standards*; D015588:Observer Variation; D017410:Practice Guidelines as Topic; D015203:Reproducibility of Results; D058566:Sacroiliitis / Q000473:pathology*; D012680:Sensitivity and Specificity; D055815:Young Adult
Diffusion-weighted MRI; Dynamic contrast-enhanced MRI; Inflammatory sacroiliitis; Magnetic resonance imaging