title: Enthesitis of lumbar spinal ligaments in clinically suspected spondyloarthritis: value of gadolinium-enhanced MR images in comparison to STIR.
abstract: OBJECTIVE
  To compare detection of spinal ligament enthesitis between gadolinium-enhanced fat-saturated T1-weighted gadolinium-enhanced fat-saturated T1-weighted (T1+Gd) and STIR sequences in patients with suspected spondyloarthritis.
  
  
  METHODS
  Sixty-eight patients (37 males, 42 ± 14 years) with a sacroiliac-joint (SIJ) and lumbar spine MRI for suspected spondyloarthritis were prospectively included. Sagittal T1+Gd and STIR images of the lumbar spine were assessed by two readers for enthesitis of interspinous/supraspinous ligaments, and for capsulitis of facet-joints between T12-S1. Patients' MRI were grouped according to ASAS (Assessment of SpondyloArthritis international Society) criteria in positive (group A) or negative (group B) SIJs. Enthesitis/capsulitis were compared between groups. Interreader agreement was assessed.
  
  
  RESULTS
  Enthesitis/capsulitis per patient was statistically significantly more frequent with T1+Gd compared to STIR (p ≤ 0.007), except for interspinous ligaments for reader 1 (p = 0.455). Interspinous enthesitis, supraspinous enthesitis, and capsulitis were present with T1+Gd(STIR) in 64.7 %(72.1 %), 60.3 %(17.7 %), and 61.8 %(29.4 %) for reader 1, and 51.5 %(41.2 %), 45.6 %(7.4 %), and 91.2 %(45.5 %) for reader 2. There were 76.5 %(52/68) patients in group A and 23.5 %(16/68) in group B. Total number of enthesitis/capsulitis on T1+Gd was statistically significantly higher in group A than B (4.96 vs. 2.94, p = 0.026; 8.12 vs. 5.25, p = 0.041 for reader 1 and 2, respectively). Interreader agreement showed mixed results for interspinous/supraspinous/capsulitis but was higher on T1+Gd (ICC = 0.838/0.783/0.367; p ≤ 0.001) compared to STIR (ICC = 0.652/0.298/0.224; p ≤ 0.032).
  
  
  CONCLUSIONS
  In patients with suspected spondyloarthritis, enthesitis/capsulitis in the lumbar spine are common findings and more frequently/reliably detected with T1+Gd than STIR. In patients with positive SIJ-MRI, the total number of enthesitis/capsulitis in T1+Gd was higher compared to patients with negative SIJ-MRI.
authors.affiliation: Radiology, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland. christoph.agten@balgrist.ch.|Faculty of Medicine, University of Zurich, Zurich, Switzerland. christoph.agten@balgrist.ch.
authors.forename: Christoph A
authors.initials: CA
authors.lastname: Agten
authors.affiliation: Radiology, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland. veronika.zubler@balgrist.ch.|Faculty of Medicine, University of Zurich, Zurich, Switzerland. veronika.zubler@balgrist.ch.
authors.forename: Veronika
authors.initials: V
authors.lastname: Zubler
authors.affiliation: Radiology, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland. andrea.rosskopf@balgrist.ch.|Faculty of Medicine, University of Zurich, Zurich, Switzerland. andrea.rosskopf@balgrist.ch.
authors.forename: Andrea B
authors.initials: AB
authors.lastname: Rosskopf
authors.affiliation: Rheumatology, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland. bettina.weiss@balgrist.ch.|Faculty of Medicine, University of Zurich, Zurich, Switzerland. bettina.weiss@balgrist.ch.
authors.forename: Bettina
authors.initials: B
authors.lastname: Weiss
authors.affiliation: Radiology, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland. christian.pfirrmann@balgrist.ch.|Faculty of Medicine, University of Zurich, Zurich, Switzerland. christian.pfirrmann@balgrist.ch.
authors.forename: Christian W A
authors.initials: CW
authors.lastname: Pfirrmann
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003287:Contrast Media; D005260:Female; D005682:Gadolinium; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D008159:Lumbar Vertebrae / Q000473:pathology; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D025241:Spondylarthritis / Q000473:pathology*; D055815:Young Adult
chemical_list: D003287:Contrast Media; D005682:Gadolinium
keywords: Enthesitis; Gadolinium; MRI; Spinal ligaments; Spondyloarthritis