title: Limited role of gadolinium to detect active sacroiliitis on MRI in juvenile spondyloarthritis.
abstract: OBJECTIVE
  The aim of this study is to determine the added diagnostic value of contrast-enhanced (CE) magnetic resonance imaging (MRI) compared to routine non contrast-enhanced MRI to detect active sacroiliitis in clinically juvenile spondyloarthritis (JSpA).
  
  
  METHODS
  A total of 80 children clinically suspected for sacroiliitis prospectively underwent MRI of the sacroiliac (SI) joints. Axial and coronal T1-weighted (T1), Short-tau inversion recovery (STIR) and fat-saturated T1-weighted gadolinium-DTPA (Gd) contrast-enhanced (T1/Gd) sequences were obtained. The presence of bone marrow edema (BME), capsulitis, enthesitis, high intra-articular STIR signal, synovial enhancement and a global diagnostic impression of the MRI for diagnosis of sacroiliitis was recorded.
  
  
  RESULTS
  STIR and T1/Gd sequences had 100% agreement for depiction of BME, capsulitis and enthesitis. High intra-articular STIR signal was seen in 18/80 (22.5%) patients, 15 (83%) of whom also showed synovial enhancement in the T1/Gd sequence. Sensitivity (SN) and specificity (SP) for a clinical diagnosis of JSpA were similar for high STIR signal (SN = 33%, SP = 85%) and T1/Gd synovial enhancement (SN = 36%, SP = 92%). Positive likelihood ratio (LR+) for JSpA was twice as high for synovial enhancement than high STIR signal (4.5 compared to 2.2). Global diagnostic impression was similar (STIR: SN = 55%, SP = 87%, LR + =4 .2; T1/Gd: SN = 55%, SP = 92%, LR + = 6.9).
  
  
  CONCLUSIONS
  MRI without contrast administration is sufficient to identify bone marrow edema, capsulitis and retroarticular enthesitis as features of active sacroiliitis in juvenile spondyloarthritis. In selected cases when high STIR signal in the joint is the only finding, gadolinium-enhanced images may help to confirm the presence of synovitis.
authors.affiliation: Department of Radiology and Medical Imaging, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium. Nele.Herregods@uzgent.be.
authors.forename: N
authors.initials: N
authors.lastname: Herregods
authors.affiliation: Department of Radiology & Diagnostic Imaging, University of Alberta Hospital, 8440-112 Street, Edmonton, T6G 2B7, AB, Canada.
authors.forename: J L
authors.initials: JL
authors.lastname: Jaremko
authors.affiliation: Rheumazentrum Ruhrgebiet, Ruhr-University Bochum, Claudiusstr. 45, 44649, Herne, Germany.
authors.forename: X
authors.initials: X
authors.lastname: Baraliakos
authors.affiliation: Department of Pediatric Rheumatology, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium.
authors.forename: J
authors.initials: J
authors.lastname: Dehoorne
authors.affiliation: Department of Radiology and Medical Imaging, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium.
authors.forename: A
authors.initials: A
authors.lastname: Leus
authors.affiliation: Department of Radiology and Medical Imaging, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium.
authors.forename: K
authors.initials: K
authors.lastname: Verstraete
authors.affiliation: Department of Radiology and Medical Imaging, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium.
authors.forename: L
authors.initials: L
authors.lastname: Jans
mesh_terms: D000293:Adolescent; D002648:Child; D003287:Contrast Media; D003937:Diagnosis, Differential; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D007089:Image Enhancement; D008279:Magnetic Resonance Imaging; D008297:Male; D011446:Prospective Studies; D015203:Reproducibility of Results; D012446:Sacroiliac Joint / Q000473:pathology; D058566:Sacroiliitis / Q000150:complications / Q000473:pathology*; D012680:Sensitivity and Specificity; D025241:Spondylarthritis / Q000150:complications / Q000473:pathology*
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA
keywords: Diagnostic value; Gadolinium; Juvenile spondyloarthritis; Magnetic resonance imaging; Sacroiliitis