Role of diffusion-weighted imaging and dynamic contrast enhanced magnetic resonance imaging in the diagnosis of early sacroiliitis in seronegative spondyloarthropathies, correlation with levels of acute phase reactants

Year 2022, , 79 - 87, 31.01.2022

Sibel Aydın Aksu Hasan Gundogdu

https://doi.org/10.5472/marumj.1061146

Abstract

Objective: Seronegative spondyloarthropathy (SpA) is a destructive disease. Early diagnosis is crucial to prevent morbidity. Magnetic
resonance imaging (MRI) is the only imaging modality that can show early sacroiliitis. We aimed to investigate the utility of dynamic
contrast enhanced magnetic resonance imaging (DCE-MRI) and diffusion-weighted imaging (DWI) in the detection, quantification
and staging of early/acute SpA. We also investigated the relationship between contrast enhancement properties and apparent diffusion
coefficient (ADC) values with laboratory parameters for inflammation such as ESR and CRP measurments.
Patients and Methods: Dynamic contrast-enhanced magnetic resonance imaging and DWI were performed on 85 patients that fulfilled
the criteria. A positive MRI finding was defined as inflammation in subchondral bone representing active sacroiliitis. Kinetic analyses
were performed, apparent diffusion coefficient (ADC) values were calculated, ESR and CRP levels were measured for quantification of
inflammation. Statistical analyses were performed.
Results: In acute SpA group; quantity, area and level of enhancement, values of ADC and Fenh, levels of CRP were significantly higher
than those with chronic SpA. A high level of agreement was found between the ADC threshold value of 0.831x10 − 3 mm2/s and
diagnosis according to Assessment of SpondyloArthritis International Society (ASAS) criteria (Kappa=0.794;p<0.001).
Conclusion: Dynamic contrast-enhanced magnetic resonance imaging and DWI are advanced MR techniques which enable
quantification of active inflammation. They are hallmarks for early SpA. Their combined use is superior to one alone in the diagnosis
of early sacroiliitis.

Keywords

Seronegative spondyloarthropathy, Early sacroiliitis, Dynamic contrast enhanced magnetic resonance ımaging, Diffusionweighted magnetic resonance imaging, Acute phase reactants

References

• [1] Rudwaleit M, Van Der Heijde D, Landewe R, et al. The Assessment of SpondyloArthritis International Society Classification Criteria for Peripheral Spondyloarthritis and for spondyloarthritis ın general. Ann Rheum Dis 2011;70:25-31. doi: /10.1136/ard.2010.133645
• [2] Mandl P, Navarro-Compán V, Terslev L, et al. EULAR Recommendations for the use of Imaging in the Diagnosis and Management of Spondyloarthritis in Clinical Practice. Ann Rheum Dis 2015;74:1327-39. doi:/10.1136/ annrheumdis-2014-206971
• [3] Sieper J, Rudwaleit M, Baraliakos X, et al. The Assessment of SpondyloArthritis International Society (ASAS) handbook: a guide to assess spondyloarthritis. Ann Rheum Dis 2009;68(Suppl 2):1-44 doi: 10.1136/ard.2008.104018
• [4] Imkamp M, Lima Passos V, Boonen A, et al. Uncovering the heterogeneity of disease ımpact ın axial spondyloarthritis: bivariate trajectories of disease activity and quality of life. RMD Open 2018;14;4:e000755. doi:/10.1136/ rmdopen-2018-000755
• [5] Barkham N, Keen H, Coates L, et al. A randomized controlled trial of ınfliximab shows clinical and MRI efficacy in patients with HLA-B27 positive very early ankylosing spondylitis. Arthritis Rheum 2007;56(Suppl.):L11. doi: 10.1002/art.24408
• [6] Hermann KG, Bollow M. Magnetic resonance ımaging of sacroiliitis ın patients with spondyloarthritis: correlation with anatomy and histology. Rofo 2014;186:230-7. doi:10.1055/s-0033.135.0411
• [7] Jevtic V, Kos-Golja M, Rozman B, McCall I. Marginal erosive discovertebral “romanus” lesions ın ankylosing spondylitis demonstrated by contrast enhanced gd-dtpa magnetic resonance ımaging. Skeletal Radiol 2000;29:27-33. doi: 10.1007/s002.560.050005
• [8] Ward R, Caruthers S, Yablon C, Blake M, DiMasi M, Eustace S. Analysis of diffusion changes ın posttraumatic bone marrow using navigator-corrected diffusion gradients. AJR Am J Roentgenol 2000;174:731-4. doi: 10.2214/ajr.174.3.1740731
• [9] Navallas M, Ares J, Beltrán B, Lisbona MP, Maymó J, Solano A. Sacroiliitis associated with axial spondyloarthropathy: new concepts and latest trends. Radiographics 2013;33:933–56. doi: 10.1148/rg.334125025
• [10] Catan Rudwaleit M, Haibel H, Baraliakos X, et al. The early disease stage ın axial spondylarthritis: results from the German spondyloarthritis inception cohort. Arthritis Rheum 2009 Mar;60:717-27. doi: 10.1002/art.24483. doi: 10.1002/ art.24483.
• [11] Catan L, Boariu M, Amaricai E, et al. Predicting functional disability in patients with spondyloarthritis using a crpbased algorithm: a 3-year prospective study. Exp Ther Med 2021;21:89. doi:10.3892/etm.2020.9521.Epub 2020 Nov 26.
• [12] Braun J, Bollow M, Eggens U, König H, Distler A, Sieper J. Use of dynamic magnetic resonance ımaging with fast ımaging ın detection of early and advanced sacroiliitis ın spondylarthropathy patients. Arthritis Rheumatol 1994;37:1039-45 doi: 10.1002/ art. 178.037.0709
• [13] Braun J, Bollow M, Sieper J. Radiologic diagnosis and patology of the spondyloarthropathies. Rheum Dis Clin North Am 1998;24:697-735. doi: 10.1016/s0889-857x(05)70038-7
• [14] Van den Berg R, Lenczner G, Feydy A, et al. Agreement between clinical practice and trained central reading in reading of sacroiliac joints on plain pelvic radiographs. Results from the DESIR cohort. Arthritis Rheumatol 2014; 66:2403- 11. doi: 10.1002/art.38738
• [15] Baraliakos X, Landewe R, Braun J. Magnetic resonance imaging in ankylosing spondylitis. Future Rheumatol 2006;1:423-31. doi: 10.2217/17460816.1.4.423
• [16] Bredella MA, Steinbach LS, Morgan S, Ward M, Davis JC. MRI of the sacroiliac joints ın patients with moderate to severe ankylosing spondylitis. AJR 2006;187:1420-6. doi: 10.2214/ AJR.05.1423
• [17] Jans L, Egund N, Eshed I, Sudol-Szopińska I, Jurik AG. Sacroiliitis in axial spondyloarthritis: assessing morphology and activity. Semin Musculoskelet Radiol 2018;22:180-8. doi:10.1055/s-0038.163.9470
• [18] Muche B, Bollow M, Francois RJ, Seiper J, Hamm B, Braun J. Anatomic structures ın early – and late – stage sacroiliitisin spondyloarthritis. Arthritis Rheum 2003;48:1374-84. doi:10.1002/art.10934
• [19] Otveen J, Prevo R, den Boer J, van de Laar M. Early detection of sacroiliitis on magnetic resonance imaging and subsequent development of sacroiliitis on plain radiography. A prospective, longitudinal study. J Rheumatol 1999;26:1953-8.
• [20] Althoff CE, Feist E, Burova E, et al. Magnetic resonance ımaging of active sacroiliitis: do we really need gadolinium? Eur J Radiol 2009;71:232-6. doi: 10.1016/j.ejrad.2009.04.034
• [21] Yu W, Feng B, Dion E, Yang H, Jiang M, Genant HK. Comparison of radiography, computed tomography and magnetic resonance imaging in the detection of sacroiliitis accompanying ankylosing spondylitis. Skeletal Radiol 1998; 27:311-20. doi:10.1007/s002.560.050388
• [22] Remy M, Bouillet P, Bertin P, Leblanche AF, Bonnet C, Pascaud JL. Evaluation of magnetic resonance ımaging fort the detection of sacroiliitis ın patients with early seronegative spondyloarthropathy. Rev Rheum Engl Ed 1996; 63: 577-83.
• [23] Gaspersic N, Sersa I, Jevtic V, Tomsic M, Praprotnik S. Monitoring ankylosing spondylitis therapy by dynamic contrast-enhanced and diffusion-weighted magnetic resonance ımaging. Skeletal Radiol 2008;37:123-31. doi: 10.1007/s00256.007.0407-2
• [24] Bollow M, Braun J, Hamm B, et al. Early sacroiliitis in patients with spondyloarthropathy: evaluation with dynamic gadolinium-enhanced MR imaging. Radiology 1995;194:529- 36. doi:10.1148/radiology.194.2.7824736
• [25] Sahin N, Hacibeyoglu H, Ince O, et al. Is there a role for DWI ın the diagnosis of sacroiliitis based on ASAS criteria? Int J Clin Exp Med 2015;8:7544-52.
• [26] Bozgeyik Z, Özgöcmen S, Kocakoc¸ E. Role of diffusionweighted MRI in the detection of early active sacroiliitis. Am J Roentgenol 2008;191:980-6. doi:10.2214/AJR.07.3865
• [27] Gezmis E, Donmez FY, Agildere M. Diagnosis of early sacroiliitis in seronegative spondyloarthropathies by DWI and correlation of clinical and laboratory findings with ADC values. Eur J Radiol 2013;82:2316-21. doi: 10.1016/j. ejrad.2013.08.032
• [28] Puhakka KB, Jurik AG, Schiottz-Christensen B, et al. Magnetic resonance ımaging of sacroiliitis in early seronegative spondylarthropathy. abnormalities correlated to clinical and laboratory findings. Rheumatology (Oxford) 2004;43:234-7. doi: 10.1093/rheumatology/keh008