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Rofo 2015; 187(2): 109-114
DOI: 10.1055/s-0034-1385264
Musculoskeletal System
© Georg Thieme Verlag KG Stuttgart · New York

Magnetic Resonance Imaging of the Sacroiliac Joints in Patients with Suspected Spondyloarthritis – Comparison of Turbo Spin-Echo and Gradient-Echo Sequences for the Detection of Structural Alterations

MRT-Bildgebung der Sakroiliakalgelenke bei Verdacht auf Spondyloarthritis – Vergleich von Turbospinecho- und Gradientenechosequenzen zum Nachweis struktureller Veränderungen
C. Dornia
1   Department of Radiology, University Medical Center, Regensburg
2   Department of Radiology, Asklepios Medical Center, Bad Abbach
,
M. Fleck
3   Department of Internal Medicine I, University Medical Center, Regensburg
4   Department of Rheumatology and Clinical Immunology, Asklepios Medical Center, Bad Abbach
,
W. Hartung
4   Department of Rheumatology and Clinical Immunology, Asklepios Medical Center, Bad Abbach
,
C. Niessen
1   Department of Radiology, University Medical Center, Regensburg
,
C. Stroszczynski
1   Department of Radiology, University Medical Center, Regensburg
,
P. Hoffstetter
1   Department of Radiology, University Medical Center, Regensburg
2   Department of Radiology, Asklepios Medical Center, Bad Abbach
› Author Affiliations
Further Information

Publication History

21 March 2014

18 August 2014

Publication Date:
12 November 2014 (online)

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Abstract

Purpose: Magnetic resonance imaging (MRI) is the method of choice for the evaluation of spondyloarthritis (SpA). According to the guidelines of the Assessment of Spondyloarthritis International Society (ASAS) and Outcome Measures in Rheumatology (OMERACT), MRI findings in SpA of the spine and the sacroiliac joints (SIJ) are classified as inflammatory and structural alterations. Modern gradient-echo sequences (GRE) are recommended for optimized detection of structural alterations of the SIJ. We assess the benefit of GRE in the detection of structural alterations of the SIJ in comparison to conventional turbo spin-echo sequences (TSE).

Material and Methods: Retrospective study of 114 patients who received MRI of the SIJ for the evaluation of SpA. Structural alterations of the SIJ were assessed by two blinded readers separately for T1 TSE and T2* GRE. The findings were classified according to a previously published chronicity score separately for both sides and sequences. Interobserver reliability was calculated with Cohen’s Kappa, and the significance of findings was assessed with the Wilcoxon test. P-values < 0.05 were required for statistical significance.

Results: 68 of 114 (60 %) patients showed SpA-typical findings of the SIJ. The average chronicity score for GRE (score 3.3) was significantly higher than for TSE (score 2.6), p = 0.001. The Kappa-values for the interobserver reliability were 0.86 – 0.90 without any statistically significant differences between both sides and sequences.

Conclusion: Both T1 TSE and T2* GRE showed a high interobserver reliability in the detection of structural alterations in patients with SpA. However, T2* GRE detected significantly more structural alterations than T1 TSE and should be an integral part of a modern MRI protocol for the diagnostic workup of patients with suspected SpA.

Key points:

• T2* gradient-echo sequences are superior to T1 turbo spin-echo sequences in the detection of structural SI-joint alterations.

Citation Format:

• Dornia C, Fleck M, Hartung W et al. Magnetic Resonance Imaging of the Sacroiliac Joints in Patients with Suspected Spondyloarthritis – Comparison of Turbo Spin-Echo and Gradient-Echo Sequences for the Detection of Structural Alterations. Fortschr Röntgenstr 2015; 187: 109 – 114

Zusammenfassung

Hintergrund: Die Magnetresonanztomografie (MRT) ist das bildgebende Verfahren der Wahl zur Diagnose der Spondyloarthritis (SpA). Gemäß Empfehlungen der Assessment of Spondyloarthritis International Society (ASAS) und Outcome Measures in Rheumatology (OMERACT) werden die bei SpA zu beobachtenden MRT-Befunde in entzündliche und strukturelle Veränderungen unterteilt. Die Einteilung gilt für die Wirbelsäule und die Sakroiliakalgelenke (SIG). Zum Nachweis struktureller Veränderungen der SIG wie Erosionen und Knochenneubildungen empfiehlt die ASAS den Einsatz moderner Gradientenechosequenzen (GRE).

Ziel: Vergleich von konventionellen Turbospinechosequenzen (TSE) und modernen GRE-Sequenzen hinsichtlich der Nachweismöglichkeit struktureller Veränderungen der SIG bei Patienten mit Verdacht auf SpA.

Methodik: Retrospektive Studie an 114 Patienten mit MRT der SIG bei Verdacht auf SpA. Die MRT wurden verblindet von zwei Radiologen getrennt hinsichtlich struktureller Veränderungen ausgewertet. In einer ersten Auswertungwurde nur eine axiale T1 TSE-Sequenz beurteilt, in einer zweiten Auswertung nur eine axiale T2* GRE-Sequenz. Die SIG wurden entsprechend eines Chronizitätsscores getrennt für rechts und links von 0 – 4 klassifiziert und ein Summenscore gebildet (Maximalwert 8). Die Interobserverreliabilität wurde nach Cohens Kappa ermittelt, die Signifikanz der Unterschiede der Summenscores mit dem Wilcoxon-Test berechnet. P-Werte < 0,05 wurden als signifikant gewertet.

Ergebnisse: 68 von 114 (60 %) Patienten zeigten in der MRT der SIG SpA-typische Befunde. Der durchschnittliche Summenscore für die strukturellen Veränderungen der SIG war für die GRE-Sequenzen (Score 3,3) signifikant höher als für die TSE-Sequenzen (Score 2,6), p = 0,001. Die Übereinstimmungsgrade der Scores zwischen den beiden Auswertern betrugen 93 – 95 %, die Kappa-Werte betrugen 0,86 – 0,90 ohne signifikanten Unterschied zwischen beiden Seiten und Sequenzen.

Schlussfolgerung: T1 TSE- und T2* GRE-Sequenzen weisen in der Beurteilung struktureller SIG-Veränderungen eine hohe Interobserverreliabilität auf. Mit der verwendeten T2* GRE-Sequenz lassen sich signifikant mehr strukturelle Veränderungen der SIG nachweisen als mit der T1 TSE-Sequenz. T2* GRE-Sequenzen sollten fester Bestandteil eines modernen Untersuchungsprotokolls der SIG bei Verdacht auf SpA sein.

Key words

spondyloarthritis (SpA) - sacroiliac joints (SIJ) - magnetic resonance imaging (MRI)

Deutscher Artikel/German Article

 

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