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  • Comparison of MRI with radiography for detecting structural lesions of the sacroiliac joint using CT as standard of reference: results from the SIMACT study

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Clinical and epidemiological research
Extended report
Comparison of MRI with radiography for detecting structural lesions of the sacroiliac joint using CT as standard of reference: results from the SIMACT study
  1. Torsten Diekhoff1,
  2. Kay-Geert A Hermann1,
  3. Juliane Greese1,
  4. Carsten Schwenke2,
  5. Denis Poddubnyy3,
  6. Bernd Hamm1,
  7. Joachim Sieper3
  1. 1 Department of Radiology, Charité—Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
  2. 2 SCO:SSiS Statistical Consulting, Berlin, Germany
  3. 3 Clinic of Rheumatology, Medical Department I, Charité—Universitätsmedizin Berlin, Campus Benjamin Franklin, Humbolt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
  1. Correspondence to Dr Kay-Geert A Hermann, Department of Radiology (CCM), Charité—Universitätsmedizin Berlin, Charitéplatz 1, Berlin  10117, Germany; kghermann{at}gmail.com

Abstract

Objective Radiographs of sacroiliac (SI) joints are used for the detection of structural damage in patients with axial spondyloarthritis (axSpA), but are often difficult to interpret. Here, we address the question how the T1-weighted MRI (T1w MRI) sequence compares with radiography for SI joints’ structural lesions using low-dose CT as the standard of reference.

Methods Radiographs, T1w MRI and low-dose CT of the SI joints from 110 patients (mean age 36.1 (19–57) years, 52% males and 48% females; 53% with axSpA, 21 non-radiographic axSpA and 32% radiographic axSpA, 47% with non-SpA) referred to the rheumatologist because of unclear chronic back pain, but possible axSpA, were scored for structural lesions (erosions, sclerosis, joint space changes and an overall impression of positivity).

Results Using low-dose CT as the standard of reference, T1w MRI showed markedly better sensitivity with significantly more correct imaging findings compared with radiography for erosions (79% vs 42%; p=0.002), joint space changes (75% vs 41%; p=0.002) and overall positivity (85% vs 48%; p=0.001), respectively, while there were no differences between X-rays and MRI-T1 sequence regarding specificity (>80% for all scores). Only for sclerosis, MRI-T1 was inferior to radiography (sensitivity 30% vs 70%, respectively), however, not statistically significant (p=0.663).

Conclusions T1w MRI was superior to radiography in the detection of structural lesion of the SI joints in patients with axSpA. Future studies should focus on finding an agreement on the definition of MRI-T1 positivity.

  • Ankylosing Spondylitis
  • Spondyloarthritis
  • Inflammation
  • Magnetic Resonance Imaging

https://doi.org/10.1136/annrheumdis-2016-210640

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    Footnotes

    • Handling editor Tore K Kvien

    • Contributors TD: conception and design of the study, design of scoring system, image scoring, data evaluation, statistical calculations, article draft, critical revision of the manuscript for important intellectual content. K-GAH: conception and design of the study, design of scoring system, image scoring, data evaluation, with critical revision of the manuscript for important intellectual content and final approval of the version to be published. JG: patient acquisition, data management, image scoring, critical revision of the manuscript for important intellectual content. CS: analysis and interpretation of data, statistical calculations. DP: patient acquisition, critical revision of the manuscript for important intellectual content. BH: conception of the study, critical revision of the manuscript for important intellectual content. JS: patient acquisition, conception and design of the study with critical revision of the manuscript for important intellectual content.

    • Funding This study was funded by the Assessment of Spondyloarthritis International Society.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Ethics approval Charité Ethics Review Board.

    • Provenance and peer review Not commissioned; externally peer reviewed.