Intermediate-weighted MRI with fat suppression (IW-FS): diagnostic performance for bone marrow edema and erosion detection in axial spondyloarthritis

Abstract

Background

Bone marrow edema (BME) and erosion of the sacroiliac joint are both key lesions for diagnosing axial spondyloarthritis (axSpA) on magnetic resonance imaging (MRI).

Purpose

To qualitatively and quantitatively compare intermediate-weighted MRI with fat suppression (IW-FS) with T2-weighted short tau inversion recovery (T2-STIR) in assessment of sacroiliac BME and erosion in axSpA.

Material and Methods

Patients aged 18–60 years with axSpA were prospectively enrolled. All patients underwent a 3.0-T MRI examination of the sacroiliac joints. Para-coronal IW-FS, T2-STIR, and T1-weighted (T1W) images were acquired. BME and erosion were scored by two readers in consensus on IW-FS and STIR using a modified Spondyloarthritis Research Consortium of Canada (SPARCC) scoring system. Consensus scores on T1WI were used as the reference for erosion. Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were measured for BME.

Results

In total, 49 patients (mean age=33.4 ± 7.6 years) were included. More patients were scored as having BME on T2-STIR (36 vs. 29, P = 0.016). SPARCC-BME score on IW-FS was lower than that acquired on T2-STIR (mean, 11.5 vs. 14.7, P = 0.002). SNR and CNR of BME were both lower on IW-FS than on T2-STIR (mean SNR, 118 vs. 218, P < 0.001; mean CNR, 44 vs. 137, P < 0.001). The sensitivity of erosion detection was higher on IW-FS (83%) than on T2-STIR (54%, P = 0.006).

Conclusion

IW-FS is not sufficient for BME detection using T2-STIR as the reference standard in patients with axSpA. IW-FS has a much higher sensitivity than T2-STIR for erosion detection in the sacroiliac joint.

Keywords

Skeletal-axial MR-imaging joints marrow adults arthritides

Get full access to this article

View all access options for this article.

References

Sieper

Poddubnyy

. Axial spondyloarthritis. Lancet 2017;390:73–84.

Taurog

Chhabra

Colbert

. Ankylosing spondylitis and axial spondyloarthritis. N Engl J Med 2016;374:2563–2574.

Maksymowych

Lambert

Ostergaard

, et al. MRI lesions in the sacroiliac joints of patients with spondyloarthritis: an update of definitions and validation by the ASAS MRI working group. Ann Rheum Dis 2019;78:1550–1558.

Jans L, Coeman L, Van Praet L, et al. How sensitive and specific are Mri features of sacroiliitis for diagnosis of spondyloarthritis in patients with inflammatory back pain? Jbr-Btr 2014; 97: 202–205.

Diekhoff

Greese

Sieper

, et al. Improved detection of erosions in the sacroiliac joints on MRI with volumetric interpolated breath-hold examination (VIBE): results from the SIMACT study. Ann Rheum Dis 2018;77:1585–1589.

Baraliakos

Hoffmann

Deng

, et al. Detection of erosions in the sacroiliac joints of patients with axial spondyloarthritis using the magnetic resonance imaging VIBE technique. J Rheumatol 2019;46:1445–1449.

Schueller-Weidekamm

Mascarenhas

Sudol-Szopinska

, et al. Imaging and interpretation of axial spondylarthritis: the radiologist's perspective–consensus of the arthritis subcommittee of the ESSR. Semin Musculoskelet Radiol 2014;18:265–279.

Dalto

Assad

Crema

, et al.

MRI assessment of bone marrow oedema in the sacroiliac joints of patients with spondyloarthritis: is the SPAIR T2w technique comparable to STIR?

Eur Radiol 2017;27:3669–3676.

Del Grande

Santini

Herzka

, et al. Fat-suppression techniques for 3-T MR imaging of the musculoskeletal system. Radiographics 2014;34:217–233.

10.

Greese

Diekhoff

Sieper

, et al. Detection of sacroiliitis by short-tau inversion recovery and T2-weighted turbo spin echo sequences: results from the SIMACT study. J Rheumatol 2019;46:376–383.

11.

Ozgen

. Comparison of fat-saturated T2-weighted and contrast-enhanced fat-saturated T1-weighted sequences in MR imaging of sacroiliac joints in diagnosing active sacroiliitis. Eur J Radiol 2015;84:2593–2596.

12.

Ozgen

. The value of the T2-weighted multipoint Dixon sequence in MRI of sacroiliac joints for the diagnosis of active and chronic sacroiliitis. AJR Am J Roentgenol 2017;208:603–608.

13.

Puhakka

Melsen

Jurik

, et al. MR Imaging of the normal sacroiliac joint with correlation to histology. Skeletal Radiol 2004;33:15–28.

14.

Sammet

Thomas

, et al. Musculoskeletal MRI pulse sequences: a review for residents and fellows. Radiographics 2019;39:2038–2039.

15.

Tokuda

Harada

Ueda

, et al. MR Imaging of meniscal tears: comparison of intermediate-weighted FRFSE imaging with intermediate-weighted FSE imaging. Jpn J Radiol 2012;30:713–720.

16.

Roemer

Kwoh

Hannon

, et al. Semiquantitative assessment of focal cartilage damage at 3T MRI: a comparative study of dual echo at steady state (DESS) and intermediate-weighted (IW) fat suppressed fast spin echo sequences. Eur J Radiol 2011;80:e126–e131.

17.

Peterfy

Gold

Eckstein

, et al. MRI Protocols for whole-organ assessment of the knee in osteoarthritis. Osteoarthritis Cartilage 2006;14:A95–111.

18.

Crema

Roemer

Marra

, et al. Articular cartilage in the knee: current MR imaging techniques and applications in clinical practice and research. Radiographics 2011;31:37–61.

19.

Maksymowych

Inman

Salonen

, et al. Spondyloarthritis research consortium of Canada magnetic resonance imaging index for assessment of sacroiliac joint inflammation in ankylosing spondylitis. Arthritis Rheum 2005;53:703–709.

20.

Maksymowych

Wichuk

Chiowchanwisawakit

, et al. Development and preliminary validation of the spondyloarthritis research consortium of Canada magnetic resonance imaging sacroiliac joint structural score. J Rheumatol 2015;42:79–86.

21.

Sieper

Rudwaleit

Baraliakos

, et al. The assessment of spondyloarthritis international society (ASAS) handbook: a guide to assess spondyloarthritis. Ann Rheum Dis 2009;68:ii1–i44.

22.

Klengel

Stumpp

Klengel

, et al. Detection of traumatic bone marrow lesions after knee trauma: comparison of ADC maps derived from diffusion-weighted imaging with standard fat-saturated proton density-weighted turbo spin-echo sequences. Radiology 2017;283:469–477.

23.

Greese

Diekhoff

Sieper

, et al. Detection of sacroiliitis by short-tau inversion recovery and T2-weighted turbo spin echo sequences: results from the SIMACT study. J Rheumatol 2019;46:376–383.

24.

Giraudo

Magnaldi

Weber

, et al.

Optimizing the MRI protocol of the sacroiliac joints in spondyloarthritis: which para-axial sequence should be used?

Eur Radiol 2016;26:122–129.

25.

Baraliakos

Hermann

Landewe

, et al. Assessment of acute spinal inflammation in patients with ankylosing spondylitis by magnetic resonance imaging: a comparison between contrast enhanced T1 and short tau inversion recovery (STIR) sequences. Ann Rheum Dis 2005;64:1141–1144.

26.

Althoff

Feist

Burova

, et al.

Magnetic resonance imaging of active sacroiliitis: do we really need gadolinium?

Eur J Radiol 2009;71:232–236.

27.

Madsen

Egund

Jurik

. Grading of inflammatory disease activity in the sacroiliac joints with magnetic resonance imaging: comparison between short-tau inversion recovery and gadolinium contrast-enhanced sequences. J Rheumatol 2010;37:393–400.

28.

Jones

Unger

Granstrom

, et al. Bone marrow imaging using STIR at 0.5 and 1.5T. Magn Reson Imaging 1992;10:169–176.