Ulrich Weber1,2,3, Anne Grethe Jurik4,5, Anna Zejden4, Ejnar Larsen6, Steen Hylgaard Jørgensen7, Kaspar Rufibach8,9, Christian Schioldan10, Søren Schmidt-Olsen11. 1. Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg. 2. Hospital of Southern Jutland, University Hospital of the Region of Southern Denmark, Aabenraa. 3. Department of Regional Health Research, University of Southern Denmark, Odense. 4. Department of Radiology, Aarhus University Hospital, Aarhus. 5. Department of Clinical Medicine, Health, Aarhus University, Aarhus. 6. Department of Radiology, Hjørring, Denmark. 7. Department of Clinical Medicine, Center for Clinical Research, North Denmark Regional Hospital, Hjørring, Denmark. 8. Rufibach rePROstat EF, Biostatistical Consulting and Training, Meiringen. 9. Division of Biostatistics, F. Hoffmann-La Roche, Basel, Switzerland. 10. Department of Physiotherapy, Clinic Benefit, Frederikshavn, Denmark. 11. Department of Rheumatology and Sports Medicine, North Denmark Regional Hospital, Hjørring, Denmark.
Abstract
OBJECTIVE: Assessment of combined semi-axial and semi-coronal SI joint MRI in two cohorts of young athletes to explore frequency and topography of non-specific bone marrow oedema (BMO), its association with four constitutional SI joint features, and potential restriction of false-positive assignments of Assessment of SpondyloArthritis International Society-defined sacroiliitis on standard semi-coronal scans alone. METHODS: Combined semi-axial and semi-coronal SI joint MRI scans of 20 recreational runners before/after running and 22 elite ice-hockey players were evaluated by three blinded readers for BMO and its association with four constitutional SI joint features: vascular partial volume effect, deep iliac ligament insertion, fluid-filled bone cyst and lumbosacral transitional anomaly. Scans of TNF-treated spondyloarthritis patients served to mask readers. We analysed distribution and topography of BMO and SI joint features across eight anatomical SI joint regions (upper/lower ilium/sacrum, subdivided in anterior/posterior slices) descriptively, as concordantly recorded by ⩾2/3 readers on both MRI planes. BMO confirmed on both scans was compared with previous evaluation of semi-coronal MRI alone, which met the Assessment of SpondyloArthritis International Society definition for active sacroiliitis. RESULTS: Perpendicular semi-axial and semi-coronal MRI scans confirmed BMO in the SI joint of every fourth young athlete, preferentially in the anterior upper sacrum. BMO associated with four constitutional SI joint features was observed in 20-36% of athletes, clustering in the posterior lower ilium. The proportion of Assessment of SpondyloArthritis International Society-positive sacroiliitis recorded on the semi-coronal plane alone decreased by 33-56% upon amending semi-axial scans. CONCLUSION: Semi-axial combined with standard semi-coronal scans in MRI protocols for sacroiliitis facilitated recognition of non-specific BMO, which clustered in posterior lower ilium/anterior upper sacrum.
OBJECTIVE: Assessment of combined semi-axial and semi-coronal SI joint MRI in two cohorts of young athletes to explore frequency and topography of non-specific bone marrow oedema (BMO), its association with four constitutional SI joint features, and potential restriction of false-positive assignments of Assessment of SpondyloArthritis International Society-defined sacroiliitis on standard semi-coronal scans alone. METHODS: Combined semi-axial and semi-coronal SI joint MRI scans of 20 recreational runners before/after running and 22 elite ice-hockey players were evaluated by three blinded readers for BMO and its association with four constitutional SI joint features: vascular partial volume effect, deep iliac ligament insertion, fluid-filled bone cyst and lumbosacral transitional anomaly. Scans of TNF-treated spondyloarthritispatients served to mask readers. We analysed distribution and topography of BMO and SI joint features across eight anatomical SI joint regions (upper/lower ilium/sacrum, subdivided in anterior/posterior slices) descriptively, as concordantly recorded by ⩾2/3 readers on both MRI planes. BMO confirmed on both scans was compared with previous evaluation of semi-coronal MRI alone, which met the Assessment of SpondyloArthritis International Society definition for active sacroiliitis. RESULTS:Perpendicular semi-axial and semi-coronal MRI scans confirmed BMO in the SI joint of every fourth young athlete, preferentially in the anterior upper sacrum. BMO associated with four constitutional SI joint features was observed in 20-36% of athletes, clustering in the posterior lower ilium. The proportion of Assessment of SpondyloArthritis International Society-positive sacroiliitis recorded on the semi-coronal plane alone decreased by 33-56% upon amending semi-axial scans. CONCLUSION: Semi-axial combined with standard semi-coronal scans in MRI protocols for sacroiliitis facilitated recognition of non-specific BMO, which clustered in posterior lower ilium/anterior upper sacrum.
Authors: Rosa Marie Kiil; Clara E Mistegaard; Anne Gitte Loft; Anna Zejden; Oliver Hendricks; Anne Grethe Jurik Journal: Arthritis Res Ther Date: 2022-03-24 Impact factor: 5.156