Rationale and Objectives
Accurate assessment of the morphology of sacroiliac joint (SIJ) bone cortex and cartilage bears importance in terms of detecting sacroiliitis in its earliest period. The aim of this study was to evaluate the efficacies of fat-saturated T1-weighted (T1WFS) spin-echo, three-dimensional (3D)-fast low angle shot (3D-FLASH), and 3D-double excitation in the steady-state (3D-DESS) sequences for the detection of SIJ cartilage and bone cortex abnormalities in patients with clinically suspected active sacroiliitis.
Materials and Methods
Magnetic resonance imaging (MRI) was performed in 9 controls and 30 patients with suspected active sacroiliitis. T1WFS, short tau inversion recovery, 3D-DESS with FS, 3D-FLASH with FS, postcontrast (the same precontrast T1WFS sequence) T1WFS, and subtracted images were obtained in all the cases. The bone cortex and cartilaginous morphology were visually scored on the T1WFS, 3D-DESS, and 3D-FLASH images. MRI findings were statistically evaluated.
Results
Active sacroiliitis was observed in 28 patients (49 SIJs) that were examined by postcontrast and subtracted images. T1WFS, 3D-DESS, and 3D-FLASH images revealed cartilage erosions in 26 (47 SIJs), 28 (55 SIJs), and 28 (55 SIJs) patients, respectively. Cartilage and bone cortex erosion scores in SIJs were significantly higher in 3D-DESS and 3D-FLASH images than in T1WFS images ( P < .05). Bone erosion scores assessed on T1WFS and 3D-FLASH images of active sacroiliitis patients, were found to be significantly different ( P < .05). A similar relationship was not determined between 3D-DESS and T1WFS sequences ( P > .05).
Conclusion
3D-FLASH sequence with FS is recognized as the most useful sequence for the detection of cartilaginous and cortical bone abnormalities.
The clinical diagnosis of sacroiliitis in patients with suspected spondyloarthropathy is difficult in the presence of radiographically normal sacroiliac joints or suspected findings . Early diagnosis of sacroiliitis is essential for therapeutic decision-making . Magnetic resonance imaging (MRI) has been reported to be better than plain radiographs and CT for investigation of active sacroiliitis . Furthermore, MRI is not, as computed tomography (CT), associated with radiation exposure. In the sacroiliac joint (SIJ), determination of hyperintense areas on short tau inversion recovery (STIR) images and observation of contrast-material enhancement on T1-weighted (W) images; both support active sacroiliitis . The earliest symptom of sacroiliitis is reported to be the contour irregularity and erosions on the cartilage surface . Accurate assessment of the morphology of joint cartilage–bone cortex bears importance in terms of detecting sacroiliitis in the earliest period.
Magnetic resonance (MR) sequences for cartilage visualization have been investigated by numerous studies, and the most useful MR sequence for SIJ cartilage imaging remains a question yet to be settled . Because three-dimensional (3D) double excitation in the steady-state (3D-DESS) sequence is cartilage-specific, it is known to have an excellent sensitivity in diagnosis of cartilage abnormities. Moreover, it is used in assessment of many other joint cartilages (eg, femorotibial joint cartilage), as well .
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Materials and methods
Patients and Controls
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Inclusion and Exclusion Criteria
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MR Examinations
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Grading of Cortical Bone Erosions
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Grading of Cartilage Morphology
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Laboratory Tests
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Statistical Analysis
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Results
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Table 1
Contrast-enhanced MRI Findings of Patient Group
Negative Unilateral Positive Bilateral Positive Total Sclerosis 2 1 27 30 Bone edema 2 3 25 30 SIJ-CE on T1WFS images 6 7 17 30 SIJ-CE on subtracted images 2 7 21 30
MRI, magnetic resonance imaging; SIJ, sacroiliac joint; CE, cartilage erosion; TI WFS, fat-saturated T1-weighted.
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Table 2
Cortical Bone and Cartilage Erosion Scores of Patient Group
Cartilage Erosions Cortical Bone Erosions Score of erosions T1WFS SIJs 3D-DESS SIJs 3D-FLASH SIJs T1WFS SIJs 3D-DESS SIJs 3D-FLASH SIJs Score 0 13 5 5 13 7 7 Score 1 32 11 13 38 18 20 Score 2 14 22 25 8 24 23 Score 3 1 22 17 1 11 10 Total 60 60 60 60 60 60
SIJs, sacroiliac joints; TI WFS, fat-saturated T1-weighted; 3D, three-dimensional; DESS, double excitation in the steady-state; FLASH, fast low angle shot.
Table 3
Spearman Correlation Analyses of Patients’ Cortical Bone Erosion Scores
T1WFS 3D-DESS 3D-FLASH Correlation coefficient 0.563 0.680P value < .001 < .001
TI WFS, fat-saturated T1-weighted; 3D, three-dimensional; DESS, double excitation in the steady-state; FLASH, fast low angle shot.
Table 4
Mean Cortical Bone Erosion Scores of Patient Group
Active Sacroiliitis T1WFS (Mean ± SD) 3D-DESS (Mean ± SD) 3D-FLASH (Mean ± SD) − 0.14 ± 0.1 1 ± 0.38 0.86 ± 0.26 + 1 ± 0.08 1.74 ± 0.12 1.6 ± 0.12P value .001 ∗ .98 .046 ∗
TI WFS, fat-saturated T1-weighted; 3D, three-dimensional; DESS, double excitation in the steady-state; FLASH, fast low angle shot; SD: standard deviation.
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Table 5
Spearman Correlation Analyses of Patients’ Cartilaginous Erosion Scores
T1WFS 3D-DESS 3D-FLASH Correlation coefficient 0.569 0.699P value <.001 <.001
TI WFS, fat-saturated T1-weighted; 3D, three-dimensional; DESS, double excitation in the steady-state; FLASH, fast low angle shot;
Table 6
Mean Cartilaginous Erosion Scores of Patient Group
Active Sacroiliitis T1WFS (Mean ± SD) 3D-DESS (Mean ± SD) 3D-FLASH (Mean ± SD) − 0.43 ± 0.2 1.14 ± 0.46 0.86 ± 0.34 + 1.13 ± 0.1 2.13 ± 0.12 1.94 ± 0.12P value .023 ∗ .038 ∗ .009 ∗
TI WFS, fat-saturated T1-weighted; 3D, three-dimensional; DESS, double excitation in the steady-state; FLASH, fast low angle shot; SD: standard deviation.
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Discussion
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Acknowledgment
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