Ces radiol. 2014, 68(4):282-288

The role of magnetic resonance imaging in the diagnostic algorithm of seronegative spondyloarthritisOriginal article

Eva Korčáková¹, Hynek Mírka¹, David Suchý²

¹ Klinika zobrazovacích metod LF UK a FN, Plzeň

² Oddělení klinické farmakologie LF UK a FN, Plzeň

Aim: To refer about the posibility of diagnosis of sacroiliitis, which is one of the first signs of chronical inflammatory disease of the skeleton, the type ankylosing spondylitis (AS) or other diseases from the group of seronegative spondyloarthritis (SpA). An important role in the diagnosis plays magnetics resonance (MR), which can assess early the presence of rheumatoid inflammations in the sacroiliac joints (SI), primarily in the so called preradiological period, even when other metods (CT, RTG) do not detect any changes. We supposed, that in some stages of disease and according to the age of examined people MR loses its sovereign role in diagnosis and may cause -negative findings and therefore we try to propose more optimal protocol testing depending on the age of the pacient.

Methods: We evaluated 82 MR examinations of SI, focused on the presence of bone marrow edema in subchondral bone as evidence of active inflammation and also the presence of bone changes. In the case of a positive finding of bone marrow edema we evaluated its extent. For this purpose we devided findings into 4 categories : 0 - no edema, 1 - edema affecting less than 1/3 extent of subchondral bone, 2 - edema affecting 1/3 till 2/3 extent of subchondral bone, 3 - edema affecting more than 2/3 of subchondral bone. We evaluated both SI joints separately and we always counted the higher value.

Results: Our experience shows that MR is a sovereign diagnosis method which confirms the presence of rheumatoid inflammation in the SI in early stage of inflammatory diseases and especially at lower ages. We confirmed our assumption that MR in the age categories over 35 years loses its sovereign role in diagnosis SpA and can be a source of -negative results, because the presence of bone changes in the absence of bone marrow edema can ly lead the radiologist to diagnose arthrosis. We have shown that in the age category over 35 years subchondral bone edema is a rather rare finding, and if present at all, it is of minor extent. On the contrary, bone changes appear regularly and moreover in this age group arthritic changes commonly occur at the joints, causing differential diagnostic embarrassment.

Conclusion: Based on our experience, we in patients with suspected sacroiliitis in the age group 35 years and more to use CT examination of SI as a method of the first choice.

Keywords: bone marrow edema, MR SI joints, sacroiliitis, seronegative spondylarthritis

Accepted: September 15, 2014; Published: December 1, 2014  Show citation