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. 2010 Apr;75(2):58-65.

Diagnostic value of gadolinium-enhanced MR imaging of active sacroiliitis in seronegative spondyloarthropathy

Hanna Maksymowicz  1 , Krzysztof Kowalewski, Katarzyna Lubkowska, Wojciech Zołud, Marek Sąsiadek
Affiliations

Diagnostic value of gadolinium-enhanced MR imaging of active sacroiliitis in seronegative spondyloarthropathy

Hanna Maksymowicz et al. Pol J Radiol. 2010 Apr.

Abstract

Background: SERONEGATIVE SPONDYLOARTHROPATHY (SPA) IS A GROUP OF DISEASES INCLUDING: ankylosing spondylitis, psoriatic spondyloarthrithis, reactive arthritis, spondyloarthrithis associated with inflammatory bowel disease, and undifferentiated spondyloarthritis. One of the diagnostic criteria of SpA is the presence of sacroiliitis. Periarticular bone marrow oedema (histologically corresponding to osteitis) is a primary symptom of the active stage of inflammation, which can be identified by MR using T2-weighted images. Its presence is essential for the therapeutic decision. The aims of this study were: 1. to compare the diagnostic value of T2-weighted images with T1 gadolinium-enhanced fat saturation (FS) images. 2. to establish if T1 gadolinium-enhanced images increase the diagnostic value of the MRI examination.

Material/methods: With the use of a 1.5T MRI scanner, 35 patients aged 19-67 years were examined. They were classified as having SpA or suspicious of SpA. The following findings were assessed: bone marrow oedema, synovitis, capsulitis/enthesistis. They were evaluated and compared on T2 and T1 gadolinium-enhanced FS images.

Results: Active sacroiliitis was identified in 21 patients, chronic in 1 patient. Two patients had signs of synovitis without any features of bone marrow oedema. One patient had fracture of the sacral bone. Ten patients had no signs of sacroiliitis. There was no significant difference in the diagnostic value between FSE T2 images and T1 gadolinium-enhanced images with FS in the evaluation of bone marrow oedema and capsulitis/enthesitis. However, T1 gadolinium-enhanced images were more sensitive than FSE T2 images in visualising synovitis.

Conclusions: MRI is a very sensitive method to identify active sacroiliitis in SpA. MRI without contrast administration is sufficient to identify bone marrow oedema as a crucial finding in active sacroiliitis. The gadolinium-enhanced images make the diagnosis easier, especially in patients with minimal bone marrow oedema because they reveal or better depict synovitis, while they do not improve visualisation of capsulitis/enthesitis.

Keywords: magnetic resonance; sacroiliitis; seronegative spondyloarthropathies.

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Figures

Figure 1.
Figure 1.
(A) T2 FS image, transverse plane. (B) T1 FS+C image, transverse plane. Regional oedema (A)/contrast enhancement (osteitis, (B)) of the bone marrow, on the iliac side, erosion on the sacral side of the right sacroiliac joint.
Figure 2.
Figure 2.
(A) T2 FS image, frontal-oblique plane. (B) T1 FS+C image, frontal-oblique plane. Generalised oedema of the bone marrow/osteitis in both sacroiliac joints.
Figure 3.
Figure 3.
(A) T2 FS image, transverse plane. (B) T1 FS+C image, transverse plane. Linear enhancement of the synovial membrane in the left sacroiliac joint.
Figure 4.
Figure 4.
(A) T2 FS image, transverse plane. (B) T1 FS+C image, transverse plane. (C) T1-weighted image, frontal-oblique plane. (D) TSFS+C weighted image, frontal-oblique plane. Generalised inflammation of the synovial membrane with concomitant periarticular fatty conversion of the bone marrow.
Figure 5.
Figure 5.
(A) T1 image, transverse plane. (B) T2 FS image, transverse plane. (C) T1S+C image, transverse plane. Multiple bilateral erosions, segmental enhancement of the synovial membrane and concomitant regions of osteitis and of fatty conversion.
Figure 6.
Figure 6.
(A) T1 image, frontal-oblique plane. (B) T1 FS+C image, frontal plane. Partial bone union and persisting features of active synovitis.
Figure 7.
Figure 7.
(A) T2FS image, transverse plane. (B) T1FS+C image, transverse plane. Inflammatory lesions of the synovial membrane and of the insertions of paravertebral muscle ligaments and tendons (enthesopathy).
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