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Sudoł-Szopińska I, Lanckoroński M, Diekhoff T, Ključevšek D, Del Grande F, Doria A. Update on MRI in Rheumatic Diseases. Radiol Clin North Am 2024; 62:821-836. [PMID: 39059974 DOI: 10.1016/j.rcl.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Abstract
Over the past decade, MRI has significantly advanced the diagnosis of rheumatic disease in both adults and juveniles. In this article, the authors present an update on MRI applications in rheumatology, based on a review of the most recent publications. New developments in adults related to, among others, axial spondyloarthritis, peripheral arthritis, and the whole body-MRI (WB-MRI) are presented. In juveniles, this update addresses the latest advancements in diagnostic MRI of peripheral joints, followed by MRI of the axial skeleton and implementation of the WB-MRI for the screening of inflammation. The authors also discuss topics of interest concerning contrast-enhanced MRI examinations in children.
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Affiliation(s)
- Iwona Sudoł-Szopińska
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland.
| | - Michał Lanckoroński
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Torsten Diekhoff
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Damjana Ključevšek
- Department of Radiology, University Children's Hospital Ljubljana, Slovenia
| | - Filippo Del Grande
- Clinica di Radiologia EOC, Istituto di Imaging della Svizzera Italiana (IIMSI), Ente Ospedaliero Cantonale (EOC), Ospedale Civico via Tesserete 47, Lugano-Ti 6900, Switzerland
| | - Andrea Doria
- Department of Diagnostic Imaging, Research Institute, The Hospital for Sick Children; Department of Medical Imaging, University of Toronto, Toronto, Canada
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2
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Lacroix M, Tordjman M, Bouchut A, Bordner A, Laporte A, Feydy A. Imaging of Sacroiliac Joints. Radiol Clin North Am 2024; 62:783-797. [PMID: 39059971 DOI: 10.1016/j.rcl.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Abstract
The central role of imaging in diagnosing disorders affecting the sacroiliac joints (SIJs) necessitates a comprehensive understanding of the advantages, limitations, and potential pitfalls of the imaging techniques that can be used. In this article, the anatomy and biomechanics of SIJs are exposed, outlining their unique features, particularly the division into anteroinferior cartilaginous and postero-superior ligamentous parts. Overall, the goal of this article is to offer a comprehensive understanding of imaging techniques, anatomic complexity, and diagnostic considerations relevant to SIJs disorders, facilitating accurate diagnosis and patient management in clinical practice and research.
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Affiliation(s)
- Maxime Lacroix
- Department of Musculoskeletal Radiology, Hôpital Cochin, AP-HP Centre, Université Paris Cité, Paris, France.
| | - Mickaël Tordjman
- Department of Musculoskeletal Radiology, Hôpital Cochin, AP-HP Centre, Université Paris Cité, Paris, France
| | - Arthur Bouchut
- Department of Rheumatology, Hôpital Cochin, AP-HP Centre, Université Paris Cité, Paris, France
| | - Adrien Bordner
- Department of Musculoskeletal Radiology, Hôpital Cochin, AP-HP Centre, Université Paris Cité, Paris, France
| | - Amandine Laporte
- Department of Musculoskeletal Radiology, Hôpital Cochin, AP-HP Centre, Université Paris Cité, Paris, France
| | - Antoine Feydy
- Department of Musculoskeletal Radiology, Hôpital Cochin, AP-HP Centre, Université Paris Cité, Paris, France
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3
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Lambert RGW, Baraliakos X, Bernard SA, Carrino JA, Diekhoff T, Eshed I, Hermann KGA, Herregods N, Jaremko J, Jans LB, Jurik AG, O'Neill JMD, Reijnierse M, Tuite MJ, Maksymowych WP. Development of international consensus on a standardised image acquisition protocol for diagnostic evaluation of the sacroiliac joints by MRI: an ASAS-SPARTAN collaboration. Ann Rheum Dis 2024:ard-2024-225882. [PMID: 39107080 DOI: 10.1136/ard-2024-225882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 07/14/2024] [Indexed: 08/09/2024]
Abstract
BACKGROUND A range of sacroiliac joint (SIJ) MRI protocols are used in clinical practice but not all were specifically designed for diagnostic ascertainment. This can be confusing and no standard diagnostic SIJ MRI protocol is currently accepted worldwide. OBJECTIVE To develop a standardised MRI image acquisition protocol (IAP) for diagnostic ascertainment of sacroiliitis. METHODS 13 radiologist members of Assessment of SpondyloArthritis International Society (ASAS) and the SpondyloArthritis Research and Treatment Network (SPARTAN) plus two rheumatologists participated in a consensus exercise. A draft IAP was circulated with background information and online examples. Feedback on all issues was tabulated and recirculated. The remaining points of contention were resolved and the revised IAP was presented to the entire ASAS membership. RESULTS A minimum four-sequence IAP is recommended for diagnostic ascertainment of sacroiliitis and its differential diagnoses meeting the following requirements. Three semicoronal sequences, parallel to the dorsal cortex of the S2 vertebral body, should include sequences sensitive for detection of (1) changes in fat signal and structural damage with T1-weighting; (2) active inflammation, being T2-weighted with fat suppression; (3) bone erosion optimally depicting the bone-cartilage interface of the articular surface and (4) a semiaxial sequence sensitive for detection of inflammation. The IAP was approved at the 2022 ASAS annual meeting with 91% of the membership in favour. CONCLUSION A standardised IAP for SIJ MRI for diagnostic ascertainment of sacroiliitis is recommended and should be composed of at least four sequences that include imaging in two planes and optimally visualise inflammation, structural damage and the bone-cartilage interface.
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Affiliation(s)
- Robert G W Lambert
- Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
| | | | | | - John A Carrino
- Radiology and Imaging, Hospital for Special Surgery, New York, New York, USA
| | - Torsten Diekhoff
- Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Iris Eshed
- Radiology, Sheba Medical Center, Tel Hashomer, Israel
| | - Kay Geert A Hermann
- Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | - Jacob Jaremko
- Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
| | | | - Anne Grethe Jurik
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - John M D O'Neill
- Radiology, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | | | - Michael J Tuite
- Radiology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Walter P Maksymowych
- Medicine, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
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4
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Ulas ST, Radny F, Ziegeler K, Eshed I, Greese J, Deppe D, Stelbrink C, Biesen R, Haibel H, Rios Rodriguez V, Rademacher J, Protopopov M, Proft F, Poddubnyy D, Diekhoff T. Self-reported diagnostic confidence predicts diagnostic accuracy in axial spondyloarthritis imaging. Rheumatology (Oxford) 2024; 63:2199-2204. [PMID: 37882740 PMCID: PMC11292042 DOI: 10.1093/rheumatology/kead564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 10/03/2023] [Accepted: 10/06/2023] [Indexed: 10/27/2023] Open
Abstract
OBJECTIVES Reporting diagnostic confidence (DC) in axial spondyloarthritis (axSpA) imaging is recommended by the ASAS guidelines. Our aim was to investigate whether self-reported DC predicts diagnostic accuracy in axSpA imaging using X-ray (XR), computed tomography (CT) and magnetic resonance imaging (MRI). METHODS We performed a post hoc analysis including 163 patients with low back pain (89 axSpA and 56 non-axSpA). Nine blinded readers with different experience levels [inexperienced (<1 year), semi-experienced (3-8 years) and experienced (>12 years)] scored the sacroiliac joint images for compatibility with axSpA. DC was reported on a scale from 1 (not sure) to 10 (very sure). Mean DC scores and standard deviations were calculated for correct and incorrect responses using XR, CT, MRI, XR+MRI and CT+MRI. Differences in DC were assessed using the Mann-Whitney U test. RESULTS DC scores were higher for correct axSpA diagnoses and differed significantly between correct and incorrect responses for all modalities (P < 0.001), with a mean DC of 7.1 ± 2.1 and 6.3 ± 2.1 for XR, 8.3 ± 1.8 and 6.7 ± 2.0 for CT, 8.1 ± 1.9 and 6.2 ± 1.9 for MRI, 8.2 ± 1.8 and 6.7 ± 1.8 for XR+MRI and 8.4 ± 1.8 and 6.8 ± 1.8 for CT+MRI, respectively. This was also the case when looking at the results by experience group, except for XR in the inexperienced group. CONCLUSION Providing self-reported DC in radiological reports is useful information to predict diagnostic reliability in axSpA imaging.
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Affiliation(s)
- Sevtap Tugce Ulas
- Department of Radiology, Charité – Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
- Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Felix Radny
- Department of Radiology, Charité – Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Katharina Ziegeler
- Department of Radiology, Charité – Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Iris Eshed
- Department of Diagnostic Imaging, Sheba Medical Center, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Juliane Greese
- Department of Radiology, Charité – Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Dominik Deppe
- Department of Radiology, Charité – Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Carsten Stelbrink
- Department of Radiology, Charité – Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Robert Biesen
- Department of Rheumatology, Charité – Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Hildrun Haibel
- Department of Rheumatology, Charité – Universitätsmedizin Berlin, Campus Benjamin Franklin, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Valeria Rios Rodriguez
- Department of Rheumatology, Charité – Universitätsmedizin Berlin, Campus Benjamin Franklin, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Judith Rademacher
- Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Berlin, Germany
- Department of Rheumatology, Charité – Universitätsmedizin Berlin, Campus Benjamin Franklin, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Mikhail Protopopov
- Department of Rheumatology, Charité – Universitätsmedizin Berlin, Campus Benjamin Franklin, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Fabian Proft
- Department of Rheumatology, Charité – Universitätsmedizin Berlin, Campus Benjamin Franklin, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Denis Poddubnyy
- Department of Rheumatology, Charité – Universitätsmedizin Berlin, Campus Benjamin Franklin, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Torsten Diekhoff
- Department of Radiology, Charité – Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
- Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Berlin, Germany
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Diekhoff T, Deppe D, Poddubnyy D, Ziegeler K, Proft F, Radny F, Niedermeier C, Hermann KG, Makowski MR. Characterization of bone marrow lesions in axial spondyloarthritis using quantitative T1 mapping MRI. Skeletal Radiol 2024; 53:1295-1302. [PMID: 38224381 PMCID: PMC11093786 DOI: 10.1007/s00256-024-04583-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 01/08/2024] [Accepted: 01/08/2024] [Indexed: 01/16/2024]
Abstract
OBJECTIVE Conventional magnetic resonance imaging (MRI) uses T1-weighted and short-tau inversion recovery (STIR) sequences to characterize bone marrow in axial spondyloarthritis. However, quantification is restricted to estimating the extent of lesions because signal intensities are highly variable both within individuals and across patients and MRI scanners. This study evaluates the performance of quantitative T1 mapping for distinguishing different types of bone marrow lesions of the sacroiliac joints. MATERIALS AND METHODS In this prospective study, 62 patients underwent computed tomography (CT) and MRI of the sacroiliac joints including T1, STIR, and T1 mapping. Bone marrow lesions were characterized by three readers and assigned to one of four groups: sclerosis, osteitis, fat lesions, and mixed marrow lesions. Relaxation times on T1 maps were compared using generalized estimating equations and receiver operating characteristics (ROC) analysis. RESULTS A total of 119 lesions were selected (sclerosis: 38, osteitis: 27, fat lesions: 40; mixed lesions: 14). T1 maps showed highly significant differences between the lesions with the lowest values for sclerosis (1516±220 ms), followed by osteitis (1909±75 ms), and fat lesions (2391±200 ms); p<0.001. T1 mapping differentiated lesions with areas under the ROC curve of 99% (sclerosis vs. osteitis) and 100% (other comparisons). CONCLUSION T1 mapping allows accurate characterization of sclerosis, osteitis, and fat lesions at the sacroiliac joint but only for homogeneous, non-mixed lesions. Thus, further sequence development is needed before implementation in clinical routine.
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Affiliation(s)
- Torsten Diekhoff
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Dominik Deppe
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Denis Poddubnyy
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Katharina Ziegeler
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Fabian Proft
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Felix Radny
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Christoph Niedermeier
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Kay Geert Hermann
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Marcus R Makowski
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Institute of Diagnostic and Interventional Radiology, School of Medicine and Health, Technical University of Munich, Munich, 81675, Germany
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Ulas ST, Deppe D, Ziegeler K, Diekhoff T. New Bone Formation in Axial Spondyloarthritis: A Review. ROFO-FORTSCHR RONTG 2024; 196:550-559. [PMID: 37944938 PMCID: PMC11111289 DOI: 10.1055/a-2193-1970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/06/2023] [Indexed: 11/12/2023]
Affiliation(s)
- Sevtap Tugce Ulas
- Department of Radiology (Campus Charité Mitte), Charité Universitätsmedizin Berlin, Germany
- Charité - Universitätsmedizin, Berlin Institute of Health at Charite, Berlin, Germany
| | - Dominik Deppe
- Department of Radiology (Campus Charité Mitte), Charité Universitätsmedizin Berlin, Germany
| | - Katharina Ziegeler
- Department of Radiology (Campus Charité Mitte), Charité Universitätsmedizin Berlin, Germany
| | - Torsten Diekhoff
- Department of Radiology (Campus Charité Mitte), Charité Universitätsmedizin Berlin, Germany
- Charité - Universitätsmedizin, Berlin Institute of Health at Charite, Berlin, Germany
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Gassert FT, Kufner A, Renz M, Gassert FG, Bollwein C, Kronthaler S, Feuerriegel GC, Kirschke JS, Ganter C, Makowski MR, Braun C, Schwaiger BJ, Woertler K, Karampinos DC, Gersing AS. Comparing CT-Like Images Based on Ultra-Short Echo Time and Gradient Echo T1-Weighted MRI Sequences for the Assessment of Vertebral Disorders Using Histology and True CT as the Reference Standard. J Magn Reson Imaging 2024; 59:1542-1552. [PMID: 37501387 DOI: 10.1002/jmri.28927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 07/14/2023] [Accepted: 07/14/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Several magnetic resonance (MR) techniques have been suggested for radiation-free imaging of osseous structures. PURPOSE To compare the diagnostic value of ultra-short echo time and gradient echo T1-weighted MRI for the assessment of vertebral pathologies using histology and computed tomography (CT) as the reference standard. STUDY TYPE Prospective. SUBJECTS Fifty-nine lumbar vertebral bodies harvested from 20 human cadavers (donor age 73 ± 13 years; 9 male). FIELD STRENGTH/SEQUENCE Ultra-short echo time sequence optimized for both bone (UTEb) and cartilage (UTEc) imaging and 3D T1-weighted gradient-echo sequence (T1GRE) at 3 T; susceptibility-weighted imaging (SWI) gradient echo sequence at 1.5 T. CT was performed on a dual-layer dual-energy CT scanner using a routine clinical protocol. ASSESSMENT Histopathology and conventional CT were acquired as standard of reference. Semi-quantitative and quantitative morphological features of degenerative changes of the spines were evaluated by four radiologists independently on CT and MR images independently and blinded to all other information. Features assessed were osteophytes, endplate sclerosis, visualization of cartilaginous endplate, facet joint degeneration, presence of Schmorl's nodes, and vertebral dimensions. Vertebral disorders were assessed by a pathologist on histology. STATISTICAL TESTS Agreement between T1GRE, SWI, UTEc, and UTEb sequences and CT imaging and histology as standard of reference were assessed using Fleiss' κ and intra-class correlation coefficients, respectively. RESULTS For the morphological assessment of osteophytes and endplate sclerosis, the overall agreement between SWI, T1GRE, UTEb, and UTEc with the reference standard (histology combined with CT) was moderate to almost perfect for all readers (osteophytes: SWI, κ range: 0.68-0.76; T1GRE: 0.92-1.00; UTEb: 0.92-1.00; UTEc: 0.77-0.85; sclerosis: SWI, κ range: 0.60-0.70; T1GRE: 0.77-0.82; UTEb: 0.81-0.92; UTEc: 0.61-0.71). For the visualization of the cartilaginous endplate, UTEc showed the overall best agreement with the reference standard (histology) for all readers (κ range: 0.85-0.93). DATA CONCLUSIONS Morphological assessment of vertebral pathologies was feasible and accurate using the MR-based bone imaging sequences compared to CT and histopathology. T1GRE showed the overall best performance for osseous changes and UTEc for the visualization of the cartilaginous endplate. LEVEL OF EVIDENCE 1 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Florian T Gassert
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Alexander Kufner
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Martin Renz
- Department of Neuroradiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Felix G Gassert
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Christine Bollwein
- Department of Pathology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Sophia Kronthaler
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Georg C Feuerriegel
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Jan S Kirschke
- Department of Neuroradiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Carl Ganter
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Marcus R Makowski
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Christian Braun
- Institute of Forensic Medicine, University Hospital of Munich, LMU Munich, Munich, Germany
| | - Benedikt J Schwaiger
- Department of Neuroradiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Klaus Woertler
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
- Musculoskeletal Radiology Section, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Dimitrios C Karampinos
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Alexandra S Gersing
- Department of Neuroradiology, University Hospital of Munich, LMU Munich, Munich, Germany
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Huang H, Yan Y, Jiang D, Zhao X, Cao D, She D. Is 3T MR nerve-bone fusion imaging a viable alternative to MRI-CBCT to identify the relationship between the inferior alveolar nerve and mandibular third molar. Clin Oral Investig 2024; 28:256. [PMID: 38630324 DOI: 10.1007/s00784-024-05649-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 04/02/2024] [Indexed: 04/19/2024]
Abstract
OBJECTIVES To investigate the feasibility of MRI nerve-bone fusion imaging in assessing the relationship between inferior alveolar nerve (IAN) / mandibular canal (MC) and mandibular third molar (MTM) compared with MRI-CBCT fusion. MATERIALS AND METHODS The MRI nerve-bone fusion and MRI-CBCT fusion imaging were performed in 20 subjects with 37 MTMs. The Hausdorff distance (HD) value and dice similarity coefficient (DSC) was calculated. The relationship between IAN/MC and MTM roots, inflammatory, and fusion patterns were compared between these two fused images. The reliability was assessed using a weighted κ statistic. RESULTS The mean HD and DSC ranged from 0.62 ~ 1.35 and 0.83 ~ 0.88 for MRI nerve-bone fusion, 0.98 ~ 1.50 and 0.76 ~ 0.83 for MRI-CBCT fusion. MR nerve-bone fusion had considerable reproducibility compared to MRI-CBCT fusion in relation classification (MR nerve-bone fusion κ = 0.694, MRI-CBCT fusion κ = 0.644), direct contact (MR nerve-bone fusion κ = 0.729, MRI-CBCT fusion κ = 0.720), and moderate to good agreement for inflammation detection (MR nerve-bone fusion κ = 0.603, MRI-CBCT fusion κ = 0.532, average). The MR nerve-bone fusion imaging showed a lower ratio of larger pattern compared to MR-CBCT fusion (16.2% VS 27.3% in the molar region, and 2.7% VS 5.4% in the retromolar region). And the average time spent on MR nerve-bone fusion and MRI-CBCT fusion was 1 min and 3 min, respectively. CONCLUSIONS Both MR nerve-bone fusion and MRI-CBCT fusion exhibited good consistency in evaluating the spatial relationship between IAN/MC and MTM, fusion effect, and inflammation detection. CLINICAL RELEVANCE MR nerve-bone fusion imaging can be a preoperative one-stop radiation-free examination for patients at high risk for MTM surgery.
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Affiliation(s)
- Hao Huang
- Department of Radiology, First Affiliated Hospital of Fujian Medical University, 20 Cha-Zhong Road, Fuzhou, Fujian, 350005, People's Republic of China
- Department of Radiology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, People's Republic of China
| | - Yalan Yan
- Department of Radiology, First Affiliated Hospital of Fujian Medical University, 20 Cha-Zhong Road, Fuzhou, Fujian, 350005, People's Republic of China
- Department of Radiology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, People's Republic of China
| | - Dongmei Jiang
- Department of Radiology, First Affiliated Hospital of Fujian Medical University, 20 Cha-Zhong Road, Fuzhou, Fujian, 350005, People's Republic of China
- Department of Radiology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, People's Republic of China
| | - Xiance Zhao
- Philips Healthcare, Shanghai, 200000, People's Republic of China
| | - Dairong Cao
- Department of Radiology, First Affiliated Hospital of Fujian Medical University, 20 Cha-Zhong Road, Fuzhou, Fujian, 350005, People's Republic of China.
- Department of Radiology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, People's Republic of China.
- Key Laboratory of Radiation Biology of Fujian Higher Education Institutions, the First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, 350005, People's Republic of China.
- Department of Radiology, Fujian Key Laboratory of Precision Medicine for Cancer, the First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, 350005, People's Republic of China.
| | - Dejun She
- Department of Radiology, First Affiliated Hospital of Fujian Medical University, 20 Cha-Zhong Road, Fuzhou, Fujian, 350005, People's Republic of China.
- Department of Radiology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, People's Republic of China.
- Key Laboratory of Radiation Biology of Fujian Higher Education Institutions, the First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, 350005, People's Republic of China.
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9
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Willesen ST, Hadsbjerg AE, Møller JM, Vladimirova N, Vora BMK, Seven S, Pedersen SJ, Østergaard M. MRI-based synthetic CT: a new method for structural damage assessment in the spine in patients with axial spondyloarthritis - a comparison with low-dose CT and radiography. Ann Rheum Dis 2024:ard-2023-225444. [PMID: 38490729 DOI: 10.1136/ard-2023-225444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 02/29/2024] [Indexed: 03/17/2024]
Abstract
OBJECTIVE To investigate the ability of MRI-based synthetic CT (sCT), low-dose CT (ldCT) and radiography to detect spinal new bone formation (NBF) in patients with axial spondyloarthritis (axSpA). METHODS Radiography of lumbar and cervical spine, ldCT and sCT of the entire spine were performed in 17 patients with axSpA. sCT was reconstructed using the BoneMRI application (V.1.6, MRIGuidance BV, Utrecht, NL), a quantitative three-dimensional MRI-technique based on a dual-echo gradient sequence and a machine learning processing pipeline that can generate CT-like MR images. Images were anonymised and scored by four readers blinded to other imaging/clinical information, applying the Canada-Denmark NBF assessment system. RESULTS Mean scores of NBF lesions for the four readers were 188/209/37 for ldCT/sCT/radiography. Most NBF findings were at anterior vertebral corners with means 163 on ldCT, 166 on sCT and 35 on radiography. With ldCT of the entire spine as reference standard, the sensitivity to detect NBF was 0.67/0.13 for sCT/radiography; both with specificities >0.95. For levels that were assessable on radiography (C2-T1 and T12-S1), the sensitivity was 0.61/0.48 for sCT/radiography, specificities >0.90. For facet joints, the sensitivity was 0.46/0.03 for sCT/radiography, specificities >0.94. The mean inter-reader agreements (kappa) for all locations were 0.68/0.58/0.56 for ldCT/sCT/radiography, best for anterior corners. CONCLUSION With ldCT as reference standard, MRI-based sCT of the spine showed very high specificity and a sensitivity much higher than radiography, despite limited reader training. sCT could become highly valuable for detecting/monitoring structural spine damage in axSpA, not the least in clinical trials.
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Affiliation(s)
- Simone Tromborg Willesen
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark
- University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | - Anna Ef Hadsbjerg
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark
- University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | | | - Nora Vladimirova
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark
- University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | - Bimal M K Vora
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore
| | - Sengül Seven
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark
| | - Susanne Juhl Pedersen
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark
- University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark
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10
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Radny F, Ziegeler K, Eshed I, Greese J, Deppe D, Stelbrink C, Biesen R, Haibel H, Rios Rodriguez V, Rademacher J, Protopopov M, Proft F, Hermann KGA, Poddubnyy D, Diekhoff T, Ulas ST. Learning imaging in axial spondyloarthritis: more than just a matter of experience. RMD Open 2024; 10:e003944. [PMID: 38443089 PMCID: PMC11146358 DOI: 10.1136/rmdopen-2023-003944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 02/19/2024] [Indexed: 03/07/2024] Open
Abstract
OBJECTIVE Reliable interpretation of imaging findings is essential for the diagnosis of axial spondyloarthritis (axSpA) and requires a high level of experience. We investigated experience-dependent differences in diagnostic accuracies using X-ray (XR), MRI and CT. METHODS This post hoc analysis included 163 subjects with low back pain. Eighty-nine patients had axSpA, and 74 patients had other conditions (mechanical, degenerative or non-specific low back pain). Final diagnoses were established by an experienced rheumatologist before the reading sessions. Nine blinded readers (divided into three groups with different levels of experience) scored the XR, CT and MRI of the sacroiliac joints for the presence versus absence of axSpA. Parameters for diagnostic performance were calculated using contingency tables. Differences in diagnostic performance between the reader groups were assessed using the McNemar test. Inter-rater reliability was assessed using Fleiss kappa. RESULTS Diagnostic performance was highest for the most experienced reader group, except for XR. In the inexperienced and semi-experienced group, diagnostic performance was highest for CT&MRI (78.5% and 85.3%, respectively). In the experienced group, MRI showed the highest performance (85.9%). The greatest difference in diagnostic performance was found for MRI between the inexperienced and experienced group (76.1% vs 85.9%, p=0.001). Inter-rater agreement was best for CT in the experienced group with κ=0.87. CONCLUSION Differences exist in the learnability of the imaging modalities for axSpA diagnosis. MRI requires more experience, while CT is more suitable for inexperienced radiologists. However, diagnosis relies on both clinical and imaging information.
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Affiliation(s)
- Felix Radny
- Department of Radiology, Charité Universitätsmedizin Berlin Campus Charité Mitte, Berlin, Germany
| | - Katharina Ziegeler
- Department of Radiology, Charité Universitätsmedizin Berlin Campus Charité Mitte, Berlin, Germany
- Department of Hematology, Oncology, Tumor Immunology, Charité Universitätsmedizin Berlin Campus Charité Mitte, Berlin, Germany
| | - Iris Eshed
- Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Israel
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Juliane Greese
- Department of Radiology, Charité Universitätsmedizin Berlin Campus Charité Mitte, Berlin, Germany
| | - Dominik Deppe
- Department of Radiology, Charité Universitätsmedizin Berlin Campus Charité Mitte, Berlin, Germany
| | - Carsten Stelbrink
- Department of Radiology, Charité Universitätsmedizin Berlin Campus Charité Mitte, Berlin, Germany
| | - Robert Biesen
- Department of Rheumatology, Charité Universitätsmedizin Berlin Campus Charité Mitte, Berlin, Germany
| | - Hildrun Haibel
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité Universitatsmedizin Berlin Campus Benjamin Franklin, Berlin, Germany
| | - Valeria Rios Rodriguez
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité Universitatsmedizin Berlin Campus Benjamin Franklin, Berlin, Germany
| | - Judith Rademacher
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité Universitatsmedizin Berlin Campus Benjamin Franklin, Berlin, Germany
- Berlin Institute of Health at Charité, Berlin, Germany
| | - Mikhail Protopopov
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité Universitatsmedizin Berlin Campus Benjamin Franklin, Berlin, Germany
| | - Fabian Proft
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité Universitatsmedizin Berlin Campus Benjamin Franklin, Berlin, Germany
| | - Kay Geert A Hermann
- Department of Radiology, Charité Universitätsmedizin Berlin Campus Charité Mitte, Berlin, Germany
| | - Denis Poddubnyy
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité Universitatsmedizin Berlin Campus Benjamin Franklin, Berlin, Germany
| | - Torsten Diekhoff
- Department of Radiology, Charité Universitätsmedizin Berlin Campus Charité Mitte, Berlin, Germany
- Berlin Institute of Health at Charité, Berlin, Germany
| | - Sevtap Tugce Ulas
- Department of Radiology, Charité Universitätsmedizin Berlin Campus Charité Mitte, Berlin, Germany
- Berlin Institute of Health at Charité, Berlin, Germany
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11
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Feuerriegel GC, Kronthaler S, Weiss K, Haller B, Leonhardt Y, Neumann J, Pfeiffer D, Hesse N, Erber B, Schwaiger BJ, Makowski MR, Woertler K, Karampinos DC, Wurm M, Gersing AS. Assessment of glenoid bone loss and other osseous shoulder pathologies comparing MR-based CT-like images with conventional CT. Eur Radiol 2023; 33:8617-8626. [PMID: 37453986 PMCID: PMC10667374 DOI: 10.1007/s00330-023-09939-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 04/24/2023] [Accepted: 05/16/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVES To evaluate and compare the diagnostic performance of CT-like images based on a 3D T1-weighted spoiled gradient-echo sequence (T1 GRE), an ultra-short echo time sequence (UTE), and a 3D T1-weighted spoiled multi-echo gradient-echo sequence (FRACTURE) with conventional CT in patients with suspected osseous shoulder pathologies. MATERIALS AND METHODS Patients with suspected traumatic dislocation of the shoulder (n = 46, mean age 40 ± 14.5 years, 19 women) were prospectively recruited and received 3-T MR imaging including 3D T1 GRE, UTE, and 3D FRACTURE sequences. CT was performed in patients with acute fractures and served as standard of reference (n = 25). Agreement of morphological features between the modalities was analyzed including the glenoid bone loss, Hill-Sachs interval, glenoid track, and the anterior straight-line length. Agreement between the modalities was assessed using Bland-Altman plots, Student's t-test, and Pearson's correlation coefficient. Inter- and intrareader assessment was evaluated with weighted Cohen's κ and intraclass correlation coefficient. RESULTS All osseous pathologies were detected accurately on all three CT-like sequences (n = 25, κ = 1.00). No significant difference in the percentage of glenoid bone loss was found between CT (mean ± standard deviation, 20.3% ± 8.0) and CT-like MR images (FRACTURE 20.6% ± 7.9, T1 GRE 20.4% ± 7.6, UTE 20.3% ± 7.7, p > 0.05). When comparing the different measurements on CT-like images, measurements performed using the UTE images correlated best with CT. CONCLUSION Assessment of bony Bankart lesions and other osseous pathologies was feasible and accurate using CT-like images based on 3-T MRI compared with conventional CT. Compared to the T1 GRE and FRACTURE sequence, the UTE measurements correlated best with CT. CLINICAL RELEVANCE STATEMENT In an acute trauma setting, CT-like images based on a T1 GRE, UTE, or FRACTURE sequence might be a useful alternative to conventional CT scan sparing associated costs as well as radiation exposure. KEY POINTS • No significant differences were found for the assessment of the glenoid bone loss when comparing measurements of CT-like MR images with measurements of conventional CT images. • Compared to the T1 GRE and FRACTURE sequence, the UTE measurements correlated best with CT whereas the FRACTURE sequence appeared to be the most robust regarding motion artifacts. • The T1 GRE sequence had the highest resolution with high bone contrast and detailed delineation of even small fractures but was more susceptible to motion artifacts.
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Affiliation(s)
- Georg C Feuerriegel
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany.
| | - Sophia Kronthaler
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | | | - Bernhard Haller
- Institute of Medical Informatics, Statistics and Epidemiology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Yannik Leonhardt
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Jan Neumann
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
- Musculoskeletal Radiology Section, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Daniela Pfeiffer
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Nina Hesse
- Department of Radiology, University Hospital of Munich, LMU Munich, Munich, Germany
| | - Bernd Erber
- Department of Radiology, University Hospital of Munich, LMU Munich, Munich, Germany
| | - Benedikt J Schwaiger
- Department of Neuroradiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Marcus R Makowski
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Klaus Woertler
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
- Musculoskeletal Radiology Section, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Dimitrios C Karampinos
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Markus Wurm
- Department of Trauma Surgery, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Alexandra S Gersing
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
- Department of Neuroradiology, University Hospital of Munich, LMU Munich, Munich, Germany
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12
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Pastor M, Lukas C, Ramos-Pascual S, Saffarini M, Wantz W, Cyteval C. Sacroiliac joint MRI for diagnosis of ax-SpA: algorithm to improve the specificity of the current ASAS MRI criteria. Eur Radiol 2023; 33:8645-8655. [PMID: 37498385 DOI: 10.1007/s00330-023-09969-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 03/31/2023] [Accepted: 05/26/2023] [Indexed: 07/28/2023]
Abstract
OBJECTIVE To compare sacroiliac joint (SIJ) lesions on MRI in women with versus without axial spondyloarthritis (ax-SpA) and establish an algorithm to determine whether such lesions are due to ax-SpA. METHODS This retrospective comparative study assessed bone marrow edema (BME), sclerosis, erosions, osteophytes, and ankylosis at the SIJ in two groups of women, one with and another without ax-SpA. Sensitivity and specificity were calculated for combinations/characteristics of lesions, using rheumatologists' assessment with assessment of spondyloarthritis international society (ASAS) criteria as the gold standard for diagnosis of ax-SpA. RESULTS Compared to women without ax-SpA, women with ax-SpA had more BME (61% vs 17%, p < 0.001), sclerosis (40% vs 22%, p < 0.001), erosions (35% vs 5%, p < 0.001), and ankylosis (2% vs 0%, p = 0.007), but less osteophytes (5% vs 33%, p < 0.001). The ASAS MRI criteria yielded 59% sensitivity and 88% specificity, while a new algorithm achieved 56% sensitivity and 95% specificity using the following criteria: no osteophytes at the SIJ and either (i) BME at the SIJ with at least one dimension ≥ 8 mm or (ii) at least one erosion at the SIJ. CONCLUSIONS We recommend the following pragmatic algorithm for MRI diagnosis of ax-SpA in women: no osteophytes at the SIJ and either (i) BME at the SIJ with at least one dimension ≥ 8 mm or (ii) at least one erosion at the SIJ. The false positive rate when using the new algorithm (3.3%) is less than half than when using the ASAS MRI criteria (7.7%); thus, its application in clinical practice could reduce overdiagnosis and prevent overtreatment of ax-SpA. CLINICAL RELEVANCE STATEMENT The developed algorithm has a false-positive rate that is less than half than when using the ASAS MRI criteria (3.3% vs 7.7%), thus its application in clinical practice could reduce overdiagnosis and prevent overtreatment of axial spondyloarthritis. KEY POINTS • Compared to women without axial spondyloarthritis (ax-SpA), women with ax-SpA had a significantly higher prevalence of bone marrow edema (BME), sclerosis, erosions, and ankylosis, but a significantly lower prevalence of osteophytes. • A new algorithm for positive ax-SpA based on sacroiliac joint MRI was developed: no osteophytes at the sacroiliac joint (SIJ) and either (i) BME at the SIJ with at least one dimension ≥ 8 mm or (ii) at least one erosion at the SIJ. • We recommend this new algorithm for diagnosis of ax-SpA in women, as it has a significantly better specificity than the assessment of spondyloarthritis international society (ASAS) MRI criteria and less than half the false positive rate; thus, its application in clinical practice could reduce overdiagnosis and prevent overtreatment of ax-SpA.
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Affiliation(s)
- Maxime Pastor
- Osteoarticular Medical Imaging Section, Department of Medical Imaging, Montpellier University Hospital, 34295, Montpellier, France
| | - Cedric Lukas
- Department of Rheumatology, Montpellier University Hospital, 34295, Montpellier, France
| | | | - Mo Saffarini
- ReSurg SA, 22 Rue Saint-Jean, 1260, Nyon, Switzerland
| | - William Wantz
- Osteoarticular Medical Imaging Section, Department of Medical Imaging, Montpellier University Hospital, 34295, Montpellier, France
| | - Catherine Cyteval
- Osteoarticular Medical Imaging Section, Department of Medical Imaging, Montpellier University Hospital, 34295, Montpellier, France
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13
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Diekhoff T, Poddubnyy D, Proft F, Ziegeler K, Deppe D, Niedermeier C, Hermann KGA. New bone formation at the sacroiliac joint in axial spondyloarthritis: characterization of backfill in MRI and CT. Rheumatology (Oxford) 2023; 62:3893-3898. [PMID: 37018132 PMCID: PMC10691921 DOI: 10.1093/rheumatology/kead142] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 03/02/2023] [Accepted: 03/20/2023] [Indexed: 04/06/2023] Open
Abstract
OBJECTIVE MRI findings of the SI joint space in axial SpA (axSpA) include inflammation and fat metaplasia inside an erosion; the latter is also termed 'backfill'. We compared such lesions with CT to better characterize whether they represent new bone formation. METHODS We identified patients with axSpA who underwent both CT and MRI of the SI joints in two prospective studies. MRI datasets were jointly screened by three readers for joint space-related findings and grouped into three categories: type A-high short tau inversion recovery (STIR) and low T1 signal; type B-high signal in both sequences; type C-low STIR and high T1 signal. Image fusion was used to identify MRI lesions in CT before we measured Hounsfield units (HU) in each lesion and surrounding cartilage and bone. RESULTS Ninety-seven patients with axSpA were identified and we included 48 type A, 88 type B, and 84 type C lesions (maximum 1 lesion per type and joint). The HU values were 73.6 (s.d. 15.0) for cartilage, 188.0 (s.d. 69.9) for spongious bone, 1086.0 (s.d. 100.3) for cortical bone, 341.2 (s.d. 96.7) for type A, 359.3 (s.d. 153.5) for type B and 446.8 (s.d. 123.0) for type C lesions. Lesion HU values were significantly higher than those for cartilage and spongious bone, but lower than those for cortical bone (P < 0.001). Type A and B lesions showed similar HU values (P = 0.93), whereas type C lesions were denser (P < 0.001). CONCLUSION All joint space lesions show increased density and might contain calcified matrix, suggesting new bone formation, with a gradual increase in the proportion of calcified matrix towards type C lesions (backfill).
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Affiliation(s)
- Torsten Diekhoff
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Denis Poddubnyy
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité, Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Fabian Proft
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité, Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Katharina Ziegeler
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Dominik Deppe
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Christoph Niedermeier
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Kay Geert A Hermann
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
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14
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Zhang K, Luo G, Li W, Zhu Y, Pan J, Li X, Liu C, Liang J, Zhan Y, Zheng J, Li S, Cai W, Hong G. Automatic Image Segmentation and Grading Diagnosis of Sacroiliitis Associated with AS Using a Deep Convolutional Neural Network on CT Images. J Digit Imaging 2023; 36:2025-2034. [PMID: 37268841 PMCID: PMC10501961 DOI: 10.1007/s10278-023-00858-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/18/2023] [Accepted: 05/22/2023] [Indexed: 06/04/2023] Open
Abstract
Ankylosing spondylitis (AS) is a chronic inflammatory disease that causes inflammatory low back pain and may even limit activity. The grading diagnosis of sacroiliitis on imaging plays a central role in diagnosing AS. However, the grading diagnosis of sacroiliitis on computed tomography (CT) images is viewer-dependent and may vary between radiologists and medical institutions. In this study, we aimed to develop a fully automatic method to segment sacroiliac joint (SIJ) and further grading diagnose sacroiliitis associated with AS on CT. We studied 435 CT examinations from patients with AS and control at two hospitals. No-new-UNet (nnU-Net) was used to segment the SIJ, and a 3D convolutional neural network (CNN) was used to grade sacroiliitis with a three-class method, using the grading results of three veteran musculoskeletal radiologists as the ground truth. We defined grades 0-I as class 0, grade II as class 1, and grades III-IV as class 2 according to modified New York criteria. nnU-Net segmentation of SIJ achieved Dice, Jaccard, and relative volume difference (RVD) coefficients of 0.915, 0.851, and 0.040 with the validation set, respectively, and 0.889, 0.812, and 0.098 with the test set, respectively. The areas under the curves (AUCs) of classes 0, 1, and 2 using the 3D CNN were 0.91, 0.80, and 0.96 with the validation set, respectively, and 0.94, 0.82, and 0.93 with the test set, respectively. 3D CNN was superior to the junior and senior radiologists in the grading of class 1 for the validation set and inferior to expert for the test set (P < 0.05). The fully automatic method constructed in this study based on a convolutional neural network could be used for SIJ segmentation and then accurately grading and diagnosis of sacroiliitis associated with AS on CT images, especially for class 0 and class 2. The method for class 1 was less effective but still more accurate than that of the senior radiologist.
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Affiliation(s)
- Ke Zhang
- Department of Radiology, the Fifth Affiliated Hospital, Sun Yat-Sen University, Zhuhai, 519000 China
| | - Guibo Luo
- Department of Radiology, Massachusetts General Hospitaland, Harvard Medical School
, 25 New Chardon Street 400C, Boston, MA 02114 USA
- Shenzhen Graduate School, Peking University, Nanshan District, XiliShenzhen, 518055 China
| | - Wenjuan Li
- Department of Radiology, the Fifth Affiliated Hospital, Sun Yat-Sen University, Zhuhai, 519000 China
| | - Yunfei Zhu
- Department of Radiology, the Fifth Affiliated Hospital, Sun Yat-Sen University, Zhuhai, 519000 China
| | - Jielin Pan
- Department of Radiology, Zhuhai People’s Hospital, Zhuhai Hospital Affiliated With Jinan University, Zhuhai, 519000 China
| | - Ximeng Li
- Department of Radiology, the Fifth Affiliated Hospital, Sun Yat-Sen University, Zhuhai, 519000 China
| | - Chaoran Liu
- Department of Radiology, the Fifth Affiliated Hospital, Sun Yat-Sen University, Zhuhai, 519000 China
| | - Jianchao Liang
- Department of Radiology, Zhuhai People’s Hospital, Zhuhai Hospital Affiliated With Jinan University, Zhuhai, 519000 China
| | - Yingying Zhan
- Department of Radiology, the Fifth Affiliated Hospital, Sun Yat-Sen University, Zhuhai, 519000 China
| | - Jing Zheng
- Department of Rheumatology, the Fifth Affiliated Hospital, Sun Yat-Sen University, Zhuhai, 519000 China
| | - Shaolin Li
- Department of Radiology, the Fifth Affiliated Hospital, Sun Yat-Sen University, Zhuhai, 519000 China
| | - Wenli Cai
- Department of Radiology, Massachusetts General Hospitaland, Harvard Medical School
, 25 New Chardon Street 400C, Boston, MA 02114 USA
| | - Guobin Hong
- Department of Radiology, the Fifth Affiliated Hospital, Sun Yat-Sen University, Zhuhai, 519000 China
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15
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Hermann KGA, Diekhoff T. [Computed tomography versus magnetic resonance imaging : Pros and cons in axial spondyloarthritis]. Z Rheumatol 2023; 82:638-645. [PMID: 37815608 DOI: 10.1007/s00393-023-01415-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2023] [Indexed: 10/11/2023]
Abstract
The diagnosis of axial spondyloarthritis depends on direct visualization of the sacroiliitis in addition to clinical assessment and determination of the histocompatibility antigen HLA-B27. While the value of conventional radiographic images has meanwhile been described in many studies as insufficient to diagnose the disease at an early stage, magnetic resonance imaging and also computed tomography now offer the possibility to visualize findings, such as bone marrow edema, erosion, fat metaplasia, backfill and ankylosis. Thus, it is necessary to decide which procedure should be used and when. Furthermore, both cross-sectional imaging techniques are currently undergoing major changes, and technical advancements are making great strides every year. This article provides an overview of which future technologies will be included in the rheumatological diagnostics of the sacroiliac joints. This overview also illustrates which standard methods are established in the diagnostics of axial spondyloarthritis and how they are used.
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Affiliation(s)
- Kay Geert A Hermann
- Klinik für Radiologie, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
| | - Torsten Diekhoff
- Klinik für Radiologie, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
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16
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Ulas ST, Proft F, Diekhoff T, Rios V, Rademacher J, Protopopov M, Greese J, Eshed I, Adams LC, Hermann KGA, Ohrndorf S, Poddubnyy D, Ziegeler K. Sex-specific diagnostic efficacy of MRI in axial spondyloarthritis: challenging the 'One Size Fits All' notion. RMD Open 2023; 9:e003252. [PMID: 37899091 PMCID: PMC10619004 DOI: 10.1136/rmdopen-2023-003252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 10/16/2023] [Indexed: 10/31/2023] Open
Abstract
OBJECTIVES Sex-specific differences in the presentation of axial spondyloarthritis (axSpA) may contribute to a diagnostic delay in women. The aim of this study was to investigate the diagnostic performance of MRI findings comparing men and women. METHODS Patients with back pain from six different prospective cohorts (n=1194) were screened for inclusion in this post hoc analysis. Two blinded readers scored the MRI data sets independently for the presence of ankylosis, erosion, sclerosis, fat metaplasia and bone marrow oedema. Χ2 tests were performed to compare lesion frequencies. Contingency tables were used to calculate markers for diagnostic performance, with clinical diagnosis as the standard of reference. The positive and negative likelihood ratios (LR+/LR-) were used to calculate the diagnostic OR (DOR) to assess the diagnostic performance. RESULTS After application of exclusion criteria, 526 patients (379 axSpA (136 women and 243 men) and 147 controls with chronic low back pain) were included. No major sex-specific differences in the diagnostic performance were shown for bone marrow oedema (DOR m: 3.0; f: 3.9). Fat metaplasia showed a better diagnostic performance in men (DOR 37.9) than in women (DOR 5.0). Lower specificity was seen in women for erosions (77% vs 87%), sclerosis (44% vs 66%), fat metaplasia (87% vs 96%). CONCLUSION The diagnostic performance of structural MRI markers is substantially lower in female patients with axSpA; active inflammatory lesions show comparable performance in both sexes, while still overall inferior to structural markers. This leads to a comparably higher risk of false positive findings in women.
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Affiliation(s)
- Sevtap Tugce Ulas
- Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
| | - Fabian Proft
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Torsten Diekhoff
- Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Valeria Rios
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Judith Rademacher
- Berlin Institute of Health, Berlin, Germany
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Mikhail Protopopov
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Juliane Greese
- Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Iris Eshed
- Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Israel
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Lisa C Adams
- Department of Radiology, Technische Universität München, Munich, Germany
- Department of Radiology, Stanford University School of Medicine, Stanford, California, USA
| | - Kay Geert A Hermann
- Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Sarah Ohrndorf
- Department of Rheumatology and Clinical Immunology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Denis Poddubnyy
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Katharina Ziegeler
- Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany
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Ulas ST, Proft F, Diekhoff T, Rios Rodriguez V, Rademacher J, Poddubnyy D, Ziegeler K. HLA-B27 status and inflammatory MRI lesions of the sacroiliac joints: a post hoc analysis in patients without axial spondyloarthritis. RMD Open 2023; 9:e003357. [PMID: 37739448 PMCID: PMC10533781 DOI: 10.1136/rmdopen-2023-003357] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 09/05/2023] [Indexed: 09/24/2023] Open
Abstract
OBJECTIVE The assessment of inflammatory and structural lesions in the sacroiliac joint (SIJ) is crucial in axial spondyloarthritis (axSpA). HLA-B27 status plays an important role in axSpA diagnosis and has been linked to MRI lesion burden in the general population. We aimed to investigate the sex-specific influence of HLA-B27 status on inflammatory and structural MRI findings in patients with low back pain of non-inflammatory origin. METHODS This post hoc analysis included 139 non-axSpA patients (90 women) with chronic low back pain. Two readers scored MRIs of the SIJ for the presence of sclerosis, erosion, fat metaplasia, bone marrow oedema (BMO) and ankylosis. Frequencies and extent of lesions were compared regarding the HLA-B27 status using χ2 tests and t-tests. Regression models to assess the sex-dependent influence of HLA-B27 on lesion burden were computed. RESULTS HLA-B27 was positive in 33 women (36.7%) and 23 men (46.9%). The overall occurrence of all SIJ lesions did not differ in HLA-B27 negative and positive individuals. There were no significant differences in the extent of lesions considering the HLA-B27 positivity, for erosion (mean sum score (MSS) of 0.91 vs 0.48; p=0.144), sclerosis (MSS 1.65 vs 1.88; p=0.576), fat metaplasia (MSS 0.56 vs 0.27; p=0.425), BMO (MSS 0.75 vs 0.59; p=0.460) and ankylosis (MSS 0.06 vs 0.04; p=0.659). CONCLUSION HLA-B27 status has no significant influence on the occurrence and extent of SIJ lesions in patients with low back pain of non-inflammatory origin in either men or women.
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Affiliation(s)
- Sevtap Tugce Ulas
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Fabian Proft
- Department of Gastroenterology, Infectiology and Rheumatology (Including Nutrition Medicine), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Torsten Diekhoff
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Valeria Rios Rodriguez
- Department of Gastroenterology, Infectiology and Rheumatology (Including Nutrition Medicine), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Judith Rademacher
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
- Department of Gastroenterology, Infectiology and Rheumatology (Including Nutrition Medicine), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Denis Poddubnyy
- Department of Gastroenterology, Infectiology and Rheumatology (Including Nutrition Medicine), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Katharina Ziegeler
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
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18
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Di Dier K, Deppe D, Diekhoff T, Herregods N, Jans L. Clash of the titans: Current CT and CT-like imaging modalities in sacroiliitis in spondyloarthritis. Best Pract Res Clin Rheumatol 2023; 37:101876. [PMID: 37953120 DOI: 10.1016/j.berh.2023.101876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 07/07/2023] [Accepted: 10/16/2023] [Indexed: 11/14/2023]
Abstract
Sacroiliitis is characterised by active and structural changes of the joint. While the Assessment of Spondyloarthritis international Society (ASAS) classification criteria stress the importance of bone marrow inflammation, recent reports suggest that osteitis can occur in various diseases, mechanical conditions and healthy individuals. Thus, structural lesions such as joint surface erosion and ankylosis are important factors for differential diagnosis. Various imaging modalities are available to examine these changes. However, computed tomography (CT) is generally considered the reference standard. Nonetheless, recent advances in magnetic resonance imaging (MRI) allow for direct bone imaging and the reconstruction of CT-like images that can provide similar information. This way, the ability of MRI to detect and measure structural lesions is strengthened. The aim of this review is to provide an overview of the pros and cons of CT and CT-like imaging modalities in sacroiliitis.
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Affiliation(s)
- Kelly Di Dier
- Department of Radiology, Faculty of Medicine, Ghent University Hospital, De Pintelaan 185, 9000, Gent, Belgium.
| | - Dominik Deppe
- Department of Radiology (CCM), Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt - Universität Zu Berlin, Freie Unversität Berlin, Charitéplaz 1, 10117, Berlin, Germany.
| | - Torsten Diekhoff
- Department of Radiology (CCM), Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt - Universität Zu Berlin, Freie Unversität Berlin, Charitéplaz 1, 10117, Berlin, Germany.
| | - Nele Herregods
- Department of Radiology, Faculty of Medicine, Ghent University Hospital, De Pintelaan 185, 9000, Gent, Belgium.
| | - Lennart Jans
- Department of Radiology, Faculty of Medicine, Ghent University Hospital, De Pintelaan 185, 9000, Gent, Belgium.
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19
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Lin C, Liu D, Wen H, Liu B, Tu L, Gu J. Zero echo time MRI improved detection of erosions and sclerosis in the sacroiliac joint in comparison with LAVA-flex. Front Endocrinol (Lausanne) 2023; 14:1167334. [PMID: 37313443 PMCID: PMC10258343 DOI: 10.3389/fendo.2023.1167334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 05/05/2023] [Indexed: 06/15/2023] Open
Abstract
Background T1-weighted spoiled 3D Gradient Recalled Echo pulse sequences, exemplified by Liver Acquisition with Volume Acceleration-flexible MRI (LAVA-Flex), are currently the preferred MR sequence for detecting erosions of the sacroiliac joint (SIJ). However, zero echo time MRI (ZTE) is recently reported to provide excellent visualization of the cortical bone. Purpose To directly compare the diagnostic accuracy of ZTE and LAVA-Flex in the detection of structural lesions of the SIJ, including erosions, sclerosis and joint space changes. Materials and methods Two readers independently reviewed the ldCT, ZTE and LAVA-Flex images of 53 patients diagnosed as axSpA and scored the erosions, sclerosis and joint space changes. Sensitivity, specificity and Cohen's kappa (κ) of ZTE and LAVA-Flex were calculated, while McNemar's test was employed to compare the two sequences for the positivity of detecting the structural lesions. Results Analysis of diagnostic accuracy showed a higher sensitivity of ZTE in comparison with LAVA-Flex in the depiction of erosions (92.5% vs 81.5%, p<0.001), especially first-degree erosions (p<0.001) and second-degree erosions (p<0.001), as well as sclerosis (90.6% vs 71.2%, p<0.001), but not joint space changes (95.2% vs 93.8%, p=0.332). Agreement with ldCT was also higher in ZTE in the detection of erosions than LAVA-Flex as indicated by the κ values (0.73 vs 0.47), as well as in the detection of sclerosis (0.92 vs 0.22). Conclusion With ldCT as the reference standard, ZTE could improve diagnostic accuracy of erosions and sclerosis of the SIJ in patients suspected of axSpA, in comparison with LAVA-Flex.
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Affiliation(s)
- Churong Lin
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Dong Liu
- Department of Rheumatology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Huiquan Wen
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Budian Liu
- Department of Rheumatology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Liudan Tu
- Department of Rheumatology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Jieruo Gu
- Department of Rheumatology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
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20
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Ziegeler K, Ulas ST, Poddubnyy D, Proft F, Rios Rodriguez V, Rademacher J, Hermann KGA, Diekhoff T. Anatomical variation of the sacroiliac joint carries an increased risk for erosion and bone marrow oedema in axial spondyloarthritis. Rheumatology (Oxford) 2023; 62:1117-1123. [PMID: 35532084 DOI: 10.1093/rheumatology/keac282] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 04/24/2022] [Accepted: 04/24/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To assess the impact of joint shape variations on inflammatory lesions on SI joint MRIs in patients with axial spondyloarthritis (axSpA). METHODS A total of 1194 patients from four different prospective cohorts were evaluated, with 684 (57.3%) having sufficient imaging data for inclusion (379 axSpA, 305 controls). All images were evaluated for joint form, erosion, sclerosis, fat metaplasia and bone marrow oedema (BMO) by two independent readers. Logistic regression analyses were used to assess the association of joint form and lesions on imaging for axSpA patients and controls. RESULTS Atypical joint forms were common in both axSpA (43.5% [154/354]) and control patients (44.2% [134/303]); both intra-articular variants and a crescent joint shape were significantly more common in axSpA patients (18.4% vs 11.6% and 11.0% vs 5.3.%, respectively; P < 0.001). The axSpA patients with intra-articular joint form variants had 2-fold higher odds of exhibiting erosions [odds ratio (OR) 2.09 (95% CI 1.18, 3.69)] and BMO [OR 1.79 (95% CI 1.13, 2.82)]; this association was not observed in controls. Accessory joints increased the odds for sclerosis in axSpA patients [OR 2.54 (95% CI 1.10, 5.84)] and for sclerosis [OR 17.91 (95% CI 6.92, 46.37)] and BMO [OR 2.05 (95% CI 1.03, 4.07)] in controls. CONCLUSIONS Joint form variations are associated with the presence of inflammatory lesions on SI joint MRIs of axSpA patients. This should be taken into consideration in future research on the interplay of mechanical strain and inflammation in axSpA.
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Affiliation(s)
| | | | - Denis Poddubnyy
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin
| | - Fabian Proft
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin
| | - Valeria Rios Rodriguez
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin
| | - Judith Rademacher
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin.,Berlin Institute of Health, Berlin, Germany
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21
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Feuerriegel GC, Ritschl LM, Sollmann N, Palla B, Leonhardt Y, Maier L, Gassert FT, Karampinos DC, Makowski MR, Zimmer C, Wolff KD, Probst M, Fichter AM, Burian E. Imaging of traumatic mandibular fractures in young adults using CT-like MRI: a feasibility study. Clin Oral Investig 2023; 27:1227-1233. [PMID: 36208329 PMCID: PMC9985557 DOI: 10.1007/s00784-022-04736-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 10/01/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To assess and compare the diagnostic performance of CT-like images based on a three- dimensional (3D) T1-weighted spoiled gradient-echo sequence (3D T1 GRE) with CT in patients with acute traumatic fractures of the mandible. MATERIALS AND METHODS Subjects with acute mandibular fractures diagnosed on conventional CT were prospectively recruited and received an additional 3 T MRI with a CT-like 3D T1 GRE sequence. The images were assessed by two radiologists with regard to fracture localization, degree of dislocation, and number of fragments. Bone to soft tissue contrast, diagnostic confidence, artifacts, and overall image quality were rated using a five-point Likert-scale. Agreement of measurements was assessed using an independent t-test. RESULTS Fourteen subjects and 22 fracture sites were included (26 ± 3.9 years; 4 females, 10 males). All traumatic fractures were accurately detected on CT-like MRI (n = 22, κ 1.00 (95% CI 1.00-1.00)). There was no statistically significant difference in the assessment of the fracture dislocation (axial mean difference (MD) 0.06 mm, p = 0.93, coronal MD, 0.08 mm, p = 0.89 and sagittal MD, 0.04 mm, p = 0.96). The agreement for the fracture classification as well as the inter- and intra-rater agreement was excellent (range κ 0.92-0.98 (95% CI 0.96-0.99)). CONCLUSION Assessment of mandibular fractures was feasible and accurate using CT-like MRI based on a 3D T1 GRE sequence and is comparable to conventional CT. CLINICAL RELEVANCE For the assessment of acute mandibular fractures, CT-like MRI might become a useful alternative to CT in order to reduce radiation exposure particularly in young patients.
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Affiliation(s)
- Georg C Feuerriegel
- Department of Diagnostic and Interventional Radiology, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, Munich, Germany.
| | - Lucas M Ritschl
- Department of Oral and Maxillofacial Surgery, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Nico Sollmann
- Department of Diagnostic and Interventional Neuroradiology, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, Munich, Germany.,TUM-Neuroimaging Center, Klinikum Rechts Der Isar, Technical University of Munich, Munich, Germany.,Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
| | - Benjamin Palla
- Department of Oral and Maxillofacial Surgery, University of Illinois Chicago, Chicago, USA
| | - Yannik Leonhardt
- Department of Diagnostic and Interventional Radiology, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Lisa Maier
- Department of Oral and Maxillofacial Surgery, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Florian T Gassert
- Department of Diagnostic and Interventional Radiology, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Dimitrios C Karampinos
- Department of Diagnostic and Interventional Radiology, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Marcus R Makowski
- Department of Diagnostic and Interventional Radiology, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Claus Zimmer
- Department of Diagnostic and Interventional Neuroradiology, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Klaus-Dietrich Wolff
- Department of Oral and Maxillofacial Surgery, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Monika Probst
- Department of Diagnostic and Interventional Neuroradiology, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Andreas M Fichter
- Department of Oral and Maxillofacial Surgery, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Egon Burian
- Department of Diagnostic and Interventional Radiology, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, Munich, Germany
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22
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Ulas ST, Diekhoff T, Ziegeler K. Sex Disparities of the Sacroiliac Joint: Focus on Joint Anatomy and Imaging Appearance. Diagnostics (Basel) 2023; 13:diagnostics13040642. [PMID: 36832130 PMCID: PMC9955570 DOI: 10.3390/diagnostics13040642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/03/2023] [Accepted: 02/07/2023] [Indexed: 02/11/2023] Open
Abstract
The sacroiliac joint (SIJ) is an anatomically complex joint which, as a functional unit with the pelvis and spine, is of decisive biomechanical importance for the human body. It is also a commonly overlooked source of lower back pain. Like the entire bony pelvis, the SIJ exhibits major sexual dimorphisms; thus, the sex-dependent evaluation of this joint is becoming increasingly important in clinical practice, both anatomically with joint shape variations and biomechanical differences as well as in terms of image appearance. The influence of the SIJ shape, which differs in women and men, is crucial for the different biomechanical joint properties. These differences are important in the development of joint diseases at the SIJ, which shows a specific difference between the sexes. This article aims to provide an overview of sex disparities of the SIJ regarding different anatomical and imaging appearances to further understand the insights into the interplay of sex differences and SIJ disease.
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Affiliation(s)
- Sevtap Tugce Ulas
- Department of Radiology, Charité–Universitätsmedizin Berlin, Campus Mitte, Humboldt–Universität zu Berlin, Freie Universität Berlin, 10117 Berlin, Germany
- Berlin Institute of Health, Charité–Universitätsmedizin Berlin, 10117 Berlin, Germany
- Correspondence: ; Tel.: +0049-30-450-627044
| | - Torsten Diekhoff
- Department of Radiology, Charité–Universitätsmedizin Berlin, Campus Mitte, Humboldt–Universität zu Berlin, Freie Universität Berlin, 10117 Berlin, Germany
- Berlin Institute of Health, Charité–Universitätsmedizin Berlin, 10117 Berlin, Germany
| | - Katharina Ziegeler
- Department of Radiology, Charité–Universitätsmedizin Berlin, Campus Mitte, Humboldt–Universität zu Berlin, Freie Universität Berlin, 10117 Berlin, Germany
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23
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Lombardi AF, Ma YJ, Jang H, Jerban S, Du J, Chang EY, Chung CB. Synthetic CT in Musculoskeletal Disorders: A Systematic Review. Invest Radiol 2023; 58:43-59. [PMID: 36070535 PMCID: PMC9742139 DOI: 10.1097/rli.0000000000000916] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
ABSTRACT Repeated computed tomography (CT) examinations increase patients' ionizing radiation exposure and health costs, making an alternative method desirable. Cortical and trabecular bone, however, have short T2 relaxation times, causing low signal intensity on conventional magnetic resonance (MR) sequences. Different techniques are available to create a "CT-like" contrast of bone, such as ultrashort echo time, zero echo time, gradient-echo, and susceptibility-weighted image MR sequences, and artificial intelligence. This systematic review summarizes the essential technical background and developments of ultrashort echo time, zero echo time, gradient-echo, susceptibility-weighted image MR imaging sequences and artificial intelligence; presents studies on research and clinical applications of "CT-like" MR imaging; and describes their main advantages and limitations. We also discuss future opportunities in research, which patients would benefit the most, the most appropriate situations for using the technique, and the potential to replace CT in the clinical workflow.
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Affiliation(s)
- Alecio F Lombardi
- From the Department of Radiology, University of California San Diego, La Jolla, and the Research Service, Veterans Affairs San Diego Healthcare System, California
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24
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The diagnostic value of susceptibility-weighted imaging for identifying acute intraarticular hemorrhages. Skeletal Radiol 2022; 51:1777-1785. [PMID: 35212784 DOI: 10.1007/s00256-022-04016-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 02/08/2022] [Accepted: 02/08/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the diagnostic performance of susceptibility-weighted imaging (SWI) in identifying acute intraarticular hemorrhages and differentiating blood from other types of joint effusions. METHODS Thirty-two patients (21 men, 11 women; mean age 38.7 ± 16.5 SD) clinically suspected of having joint effusion were prospectively included. All the patients underwent both conventional MRI and SWI. Two radiologists independently reviewed the conventional MRI images and scored the likelihood of intraarticular hemorrhage using a 5-level scoring system. Immediately thereafter, SWI images of each patient were also provided for the radiologists, and the scoring was repeated evaluating the conventional MRI and SWI images together. The patients underwent joint aspiration or surgical operation as the reference standard. The area under the curve (AUC) of conventional MRI and conventional MRI + SWI methods were calculated and compared. The weighted kappa analysis was used to evaluate the interobserver agreement. RESULTS Traumatic knee injury comprised the majority of study sample. Eighteen out of 32 of the patients were proven to have intraarticular hemorrhage. Using the conventional MRI, reader 1 and 2 achieved AUCs of 0.67 (p = 0.09) and 0.53 (p = 0.76), respectively. Following the addition of SWI, reader 1 and 2 achieved AUCs of 0.96 (p = 0.0001) and 0.95 (p = 0.0001), respectively, and interobserver agreement improved from Κ = 0.61 to Κ = 0.93. Accordingly, difference between the AUCs was 0.28 (p = 0.003) and 0.42 (p = 0.0001) for reader 1 and 2, respectively. CONCLUSIONS If confirmed by future studies, SWI enables the reliable and accurate diagnosis of acute intraarticular hemorrhages.
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25
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Vereecke E, Herregods N, Morbée L, Laloo F, Chen M, Jans L. Imaging of Structural Abnormalities of the Sacrum: The Old Faithful and Newly Emerging Techniques. Semin Musculoskelet Radiol 2022; 26:469-477. [PMID: 36103888 DOI: 10.1055/s-0042-1754342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
The sacrum and sacroiliac joints pose a long-standing challenge for adequate imaging because of their complex anatomical form, oblique orientation, and posterior location in the pelvis, making them subject to superimposition. The sacrum and sacroiliac joints are composed of multiple diverse tissues, further complicating their imaging. Varying imaging techniques are suited to evaluate the sacrum, each with its specific clinical indications, benefits, and drawbacks. New techniques continue to be developed and validated, such as dual-energy computed tomography (CT) and new magnetic resonance imaging (MRI) sequences, for example susceptibility-weighted imaging. Ongoing development of artificial intelligence, such as algorithms allowing reconstruction of MRI-based synthetic CT images, promises even more clinical imaging options.
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Affiliation(s)
- Elke Vereecke
- Department of Radiology, Ghent University Hospital, Gent, Belgium
| | - Nele Herregods
- Department of Radiology, Ghent University Hospital, Gent, Belgium
| | - Lieve Morbée
- Department of Radiology, Ghent University Hospital, Gent, Belgium
| | - Frederiek Laloo
- Department of Radiology, Ghent University Hospital, Gent, Belgium
| | - Min Chen
- Department of Radiology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Lennart Jans
- Department of Radiology, Ghent University Hospital, Gent, Belgium
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Navarro-Compán V, Ermann J, Poddubnyy D. A glance into the future of diagnosis and treatment of spondyloarthritis. Ther Adv Musculoskelet Dis 2022; 14:1759720X221111611. [PMID: 35898564 PMCID: PMC9310200 DOI: 10.1177/1759720x221111611] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 06/18/2022] [Indexed: 11/16/2022] Open
Abstract
The last two decades have seen major developments in the field of
spondyloarthritis (SpA), but there are still important unmet needs to address.
In the future, we envisage important advances in the diagnosis and treatment of
SpA. In the diagnosis of SpA, the use of online and social media tools will
increase awareness of the disease and facilitate the referral of patients to
rheumatology clinics. In addition, more specific diagnostic tests will be
available, especially advanced imaging methods and new biomarkers. This will
allow most patients to be diagnosed at an early stage of the disease. In the
treatment of SpA, an increasing number of novel treatment targets can be
expected, most of which will be directed against intracellular enzymes. We hope
to see more strategy trials shaping treatment pathways in SpA and accommodating
principals of precision medicine. Approved treatment options will be available
for both axial and peripheral SpA. We also hope to intervene not only at the
inflammation level but also at the level of underlying immunological processes
that might be associated with a higher probability of long-standing remission if
not a cure. Finally, artificial intelligence techniques will allow for the
analysis of large-scale data to answer relevant research questions for the
diagnosis and management of patients with SpA.
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Affiliation(s)
| | - Joerg Ermann
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Denis Poddubnyy
- Department of Gastroenterology, Infectiology and Rheumatology (Including Nutrition Medicine), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, Berlin 12203, Germany
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Morbée L, Jans LBO, Herregods N. Novel imaging techniques for sacroiliac joint assessment. Curr Opin Rheumatol 2022; 34:187-194. [PMID: 35699310 DOI: 10.1097/bor.0000000000000871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW Imaging of the sacroiliac joints is one of the cornerstones in the diagnosis and monitoring of axial spondyloarthritis. We aim to present an overview of the emerging imaging techniques for sacroiliac joint assessment and provide an insight into their relevant benefits and pitfalls. RECENT FINDINGS Evaluation of structural and active inflammatory lesions in sacroiliitis are both important for understanding the disease process. Dual-energy computed tomography (CT) can detect inflammatory bone marrow edema in the sacroiliac joints and provides an alternative for magnetic resonance imaging (MRI). Three-dimensional gradient echo sequences improve the visualization of erosions on MRI. Susceptibility weighted MRI and deep learning-based synthetic CT are innovative MRI techniques that allow for generating 'CT-like' images and better depict osseous structural lesions than routine MRI sequences. SUMMARY New imaging innovations and developments result in significant improvements in the imaging of spondyloarthritis. Advanced MRI techniques enhance its potential for the accurate detection of structural and active inflammatory lesions of sacroiliitis in one single imaging session.
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Affiliation(s)
- Lieve Morbée
- Department of Radiology, Ghent University Hospital, Ghent, Belgium
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Future of Low-Dose Computed Tomography and Dual-Energy Computed Tomography in Axial Spondyloarthritis. Curr Rheumatol Rep 2022; 24:198-205. [PMID: 35397047 PMCID: PMC9184454 DOI: 10.1007/s11926-022-01075-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2022] [Indexed: 11/08/2022]
Abstract
Purpose of Review Recent technical advances in computed tomography (CT) such as low-dose CT and dual-energy techniques open new applications for this imaging modality in clinical practice and for research purposes. This article will discuss the latest innovations and give a perspective on future developments. Recent Findings Low-dose CT has increasingly been used for assessing structural changes at the sacroiliac joints and the spine. It has developed into a method with similar or even lower radiation exposure than radiography while outperforming radiography for lesion detection. Despite being incompatible with low-dose scanning, some studies have shown that dual-energy CT can provide additional information that is otherwise only assessable with magnetic resonance imaging (MRI). However, it is unclear whether this additional information is reliable enough and if it would justify the additional radiation exposure, i.e. whether the performance of dual-energy CT is close enough to MRI to replace it in clinical practice. Summary While the role of dual-energy CT in patients with axial spondyloarthritis remains to be established, low-dose CT has developed to an appropriate modality that should replace radiography in many circumstances and might supplement MRI.
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Ulas ST, Ziegeler K, Richter ST, Ohrndorf S, Poddubnyy D, Makowski MR, Diekhoff T. CT-like images in MRI improve specificity of erosion detection in patients with hand arthritis: a diagnostic accuracy study with CT as standard of reference. RMD Open 2022; 8:rmdopen-2021-002089. [PMID: 35177555 PMCID: PMC8860086 DOI: 10.1136/rmdopen-2021-002089] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 01/26/2022] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To compare the diagnostic accuracy of susceptibility-weighted imaging (SWI), standard T1-weighted (T1w) images and high-resolution 3D-gradient echo sequences (volumetric interpolated breath-hold examination (VIBE)) for detection of erosions in patients with peripheral arthritis using CT as standard of reference. MATERIALS AND METHODS A total of 36 patients were included in the study. All patients underwent CT and MRI, including SWI, VIBE and T1w sequences of the clinically more affected hand. Two trained readers scored all imaging datasets separately for erosions in a blinded fashion. Specificity, sensitivity and diagnostic accuracy of MRI sequences were calculated on a per-patient level. RESULTS CT was positive for erosion in 16 patients and 77 bones (Rheumatoid Arthritis MRI Score >0), T1w in 28 patients, VIBE in 25 patients and SWI in 17 patients. All MRI sequences performed with comparably high sensitivities (T1w 100%, VIBE 94% and SWI 94%). SWI had the highest specificity of 90%, followed by VIBE (50%) and T1w (40%). Both T1w and VIBE produced significantly higher sum scores than CT (341 and 331 vs 148, p<0.0001), while the sum score for SWI did not differ from CT (119 vs 148; p=0.411). CONCLUSION Specificity for erosion detection remains a challenge for MRI when conventional and high-resolution sequences are used but can be improved by direct bone depiction with SWI. Both T1w and VIBE tend to overestimate erosions, when CT is used as the standard of reference.
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Affiliation(s)
- Sevtap Tugce Ulas
- Department of Radiology, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
| | - Katharina Ziegeler
- Department of Radiology, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
| | - Sophia-Theresa Richter
- Department of Radiology, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
| | - Sarah Ohrndorf
- Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
| | - Denis Poddubnyy
- Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Marcus R Makowski
- Department of Radiology, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany.,Department of Radiology, Klinikum rechts der Isar der Technischen Universität München, Munchen, Germany
| | - Torsten Diekhoff
- Department of Radiology, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
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30
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Hermann KGA, Ziegeler K, Kreutzinger V, Poddubnyy D, Proft F, Deppe D, Greese J, Sieper J, Diekhoff T. What amount of structural damage defines sacroiliitis: a CT study. RMD Open 2022; 8:rmdopen-2021-001939. [PMID: 35064092 PMCID: PMC8785200 DOI: 10.1136/rmdopen-2021-001939] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 11/25/2021] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To propose a data-driven definition for structural changes of sacroiliac (SI) joints in the context of axial spondyloarthritis (axSpA) imaging on a large collective of CT datasets. METHODS 546 individuals (102 axSpA, 80 non-axSpA low back pain and 364 controls without back pain) with SI joint CTs were evaluated for erosions, sclerosis and ankylosis using a structured scoring system. Lesion frequencies and spatial distribution were compared between groups. Diagnostic performance (sensitivity (SE), specificity (SP), positive predictive values, negative predictive values and positive and negative likelihood ratios) was calculated for different combinations of imaging findings. Clinical diagnosis served as standard of reference. RESULTS Ankylosis and/or erosions of the middle and dorsal joint portions yielded the best diagnostic performance with SE 67.6% and SP 96.3%. Inclusion of ventral erosions and sclerosis resulted in lower diagnostic performance with SE 71.2%/SP 92.5% and SE 70.6%/SP 90.0%, respectively. CONCLUSIONS Sclerosis and ventrally located erosions of SI joints have lower specificity on CT of the SI joint in the context of axSpA imaging. Ankylosis and/or erosions of the middle and dorsal joint portions show a strong diagnostic performance and are appropriate markers of a positive SI joint by CT.
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Affiliation(s)
- Kay Geert A Hermann
- Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Katharina Ziegeler
- Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | - Denis Poddubnyy
- Division of Gastroenterology, Infectious Diseases and Rheumatology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Fabian Proft
- Division of Gastroenterology, Infectious Diseases and Rheumatology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Dominik Deppe
- Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Juliane Greese
- Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Joachim Sieper
- Division of Gastroenterology, Infectious Diseases and Rheumatology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Torsten Diekhoff
- Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany
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31
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MR Imaging of the Pelvic Bones: The Current and Cutting-Edge Techniques. J Belg Soc Radiol 2022; 106:123. [PMID: 36475022 PMCID: PMC9695217 DOI: 10.5334/jbsr.2874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 09/24/2022] [Indexed: 01/25/2023] Open
Abstract
UNLABELLED This review presents an overview of the spectrum of the current and cutting-edge MRI techniques for pelvic bone imaging in clinical practice. The current MRI sequences and their advantages, disadvantages and usefullness in the imaging of this complex anatomical region are addressed. Finally, cutting-edge techniques are discussed, including susceptibility weighted MRI, ultrashort echo time MRI, zero echo time MRI and a deep learning-based multiparametric MRI technique named 'synthetic CT,' creating CT-like images without ionizing radiaton. MAIN POINTS GRE, SWI, UTE, ZTE MRI and synthetic CT sequences depict the cortical outline of the bones better in comparison to conventional MR images.MRI-based synthetic CT can create HU maps and allows for automated segmentation of pelvic bones.The current and cutting-edge MR techniques for bone imaging are complementary in the characterization of a variety of musculoskeletal disorders.
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32
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Diekhoff T, Lambert R, Hermann KG. MRI in axial spondyloarthritis: understanding an 'ASAS-positive MRI' and the ASAS classification criteria. Skeletal Radiol 2022; 51:1721-1730. [PMID: 35199195 PMCID: PMC9283193 DOI: 10.1007/s00256-022-04018-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 02/15/2022] [Accepted: 02/15/2022] [Indexed: 02/02/2023]
Abstract
In 2009, the Assessment of SpondyloArthritis international Society (ASAS) published a definition of 'active sacroiliitis on magnetic resonance imaging (MRI) for classification of axial spondyloarthritis'. This new definition of an 'ASAS-positive MRI' was integral to new classification criteria for axial spondyloarthritis that were published in the same year. The ASAS MRI definition had the considerable advantage of simplicity and the definition gained popularity as guidance for interpreting MRI of the sacroiliac joints in clinical practice. However, classification criteria are not designed for use in clinical practice with the consequence that overreliance on the presence of bone marrow edema, which is the principal determinant of an 'ASAS-positive MRI', may result in a tendency to overcall inflammatory sacroiliitis in the clinical setting. This article aims to inform the reader about the rationale behind the ASAS definition of a positive MRI and ASAS classification criteria, their proper use in research and why they should not be used in clinical practice. The article also contains guidance for an updated imaging protocol and interpretation of images including typical imaging findings, differential diagnosis, and common pitfalls.
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Affiliation(s)
- Torsten Diekhoff
- Department of Radiology (CCM), Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität Zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Robert Lambert
- Department of Radiology & Diagnostic Imaging, University of Alberta, 2A2.41MC, 8440 - 112 Street, Edmonton, AB, T6G 2B7, Canada
- Medical Imaging Consultants, 202-11010 - 101 Street, Edmonton, AB, T5H 4B9, Canada
| | - Kay Geert Hermann
- Department of Radiology (CCM), Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität Zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117, Berlin, Germany
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33
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Braun J, Kiltz U, Baraliakos X. Significance of structural changes in the sacroiliac joints of patients with axial spondyloarthritis detected by MRI related to patients symptoms and functioning. Ann Rheum Dis 2021; 81:11-14. [PMID: 34711586 DOI: 10.1136/annrheumdis-2021-221406] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 10/19/2021] [Indexed: 12/17/2022]
Abstract
Axial spondyloarthritis (axSpA) is a chronic inflammatory rheumatic disease that manifests primarily in the axial skeleton, initially mostly in the sacroiliac joints (SIJ), usually later spreading to the spine. The disease is characterised by inflammation and new bone formation which are mainly assessed by conventional radiography (CR) and magnetic resonance imaging (MRI). Tumour necrosis factor inhibitors (TNFi) and interleukin-17 antagonists have been shown to be efficacious and efficient in patients with axSpA. This treatment seems to also inhibit structural damage, for example, retard radiographic progression. Indeed, a reduction of new bone formation in the spine, as assessed by CR, has been reported to occur after at least 2 years of therapy with TNFi. Recently, a reduction of erosions and ankylosis in the SIJ has also been observed in axSpA patients treated with etanercept and filgotinib. In this narrative review, we discuss the limited significance of such findings.
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Affiliation(s)
- Juergen Braun
- Rheumazentrum Ruhrgebiet, Ruhr Universität Bochum, Herne, Germany
| | - Uta Kiltz
- Rheumazentrum Ruhrgebiet, Ruhr Universität Bochum, Herne, Germany
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Chong LR, Lee K, Sim FY. 3D MRI with CT-like bone contrast - An overview of current approaches and practical clinical implementation. Eur J Radiol 2021; 143:109915. [PMID: 34461599 DOI: 10.1016/j.ejrad.2021.109915] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 08/13/2021] [Accepted: 08/15/2021] [Indexed: 12/24/2022]
Abstract
CT is the imaging modality of choice for assessment of 3D bony morphology but incurs the penalty of ionizing radiation. Improving the ability of 3D MRI to provide high-resolution images of cortical bone with CT-like bone contrast has been a focus of recent research. The ability of 3D MRI to deliver cortical bone information with similar diagnostic performance to CT would complement assessment of soft tissues and medullary bone from a single MRI examination, simplifying evaluation and obviating radiation exposure from additional CT. This article presents an overview of current 3D MRI approaches for imaging cortical bone with CT-like bone contrast including ultrashort echo time, zero echo time, T1-weighted gradient recalled echo, susceptibility-weighted imaging and deep learning techniques. We also discuss clinical implementation of an optimized stack-of-stars 3D gradient recalled echo pulse sequence (3D-Bone) on commercially available MRI scanners for rendering 3D MRI with CT-like bone contrast in our institutional practice.
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Affiliation(s)
- Le Roy Chong
- Department of Radiology, Changi General Hospital, 2 Simei Street 3, Singapore 529889, Republic of Singapore.
| | - Kathy Lee
- Department of Radiology, Changi General Hospital, 2 Simei Street 3, Singapore 529889, Republic of Singapore.
| | - Fang Yang Sim
- Department of Radiology, Changi General Hospital, 2 Simei Street 3, Singapore 529889, Republic of Singapore.
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