Magnetic resonance imaging of sacroiliac joints in patients with seronegative spondyloarthritides

Objective. To study diagnostic possibilities of magnetic resonance imaging (MRI) of sacroiliac joints (SIJ) in pts with seronegative spondyloarthritides (SS). Material and methods. MRI and radiological examination was performed in 15 pts: 10 with ankylosing spondylitis (AS) and 5 with undifferentiated SS. MRI was done with Magnetom Symphony apparatus (Siemens, Germany) with magnetic-field strength 1,5 tesla. Tl, T2 and T2-FS weighted were used. Tl-FS weighted performed in 3-4 minutes after intravenous infusion of gadolinium were additionally used in 5 pts. Inflammatory and structural (erosions, subchondral sclerosis) MRI changes of SIJ were studied. Inflammatory changes of SIJ were analyzed in subchondral bone, bone marrow, joint capsule, joint cavity, interosseous ligaments. SS activity was assessed with BASDAI. Results. Median age of pts was 24 years, median SS duration — 3 years. HLA-B27 was revealed in 13 from 15 pts. All pts had radiological signs of sacroiliitis: 13 - bilateral (12 - II or III stage and 1 — I and III stage according to Kellgren), 2 — unilateral (II stage). So radiological signs of inflammation were revealed in 28 from 30 examined SIJ. MRI signs of sacroiliitis were present in the same 28 SIJ. Subchondral edema of sacrum and/or huckle-bone was revealed in 23 SIJ of 13 pts, bone marrow edema — in 20 SIJ of 13 pts, joint cavity edema - in 21 SIJ of 14 pts, capsule edema — in 12 SIJ of 8 pts, interosseous ligaments inflammation signs — in 3 SIJ of 2 pts. Inflammatory changes of all 5 examined anatomic structures were present in 1, 4 — in 9, 3 — in 13 SIJ. In 1 SIJ inflammation was localized in capsule only. Structural changes were revealed in 22 (73%) SIJ of 14 pts. Structural MRI changes of SIJ at II radiological stage of sacroiliitis were noted in 67% and at III stage — in 83%. Combination of inflammatory and structural changes was present in 22 from 30 SIJ (73%). Frequency of such combination was similar at different radiological stages of sacroiliitis. Isolated inflammatory signs without structural changes were present in 3 SIJ of 3 pts. Gadolinium administration allowed to reveal 5 additional edema zones in SIJ region of 4 from 5 pts. Inflammatory changes of SIJ were revealed with similar frequency in presence (81%) or absence (88%) of pain in this region. Pts with high (BASDAI>40) or not high (BASDAK40) general activity of the disease had about the same mean number of SIJ inflammatory changes (7,6 and 7,8 respectively). Conclusion. MRI is highly sensitive method for revealing SIJ changes in pts with SS. Inflammatory MRI changes were present in all joints with radiological changes irrespectively from radiological stage.

sacroiliitis, ankylosing spondylitis, seronegative spondyloarthritides

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