Herregods N, Jaremko J L, Baraliakos X, Dehoorne J, Leus A, Verstraete K, Jans L
Department of Radiology and Medical Imaging, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium.
Department of Radiology & Diagnostic Imaging, University of Alberta Hospital, 8440-112 Street, Edmonton, T6G 2B7, AB, Canada.
Skeletal Radiol. 2015 Nov;44(11):1637-46. doi: 10.1007/s00256-015-2211-8. Epub 2015 Jul 24.
The aim of this study is to determine the added diagnostic value of contrast-enhanced (CE) magnetic resonance imaging (MRI) compared to routine non contrast-enhanced MRI to detect active sacroiliitis in clinically juvenile spondyloarthritis (JSpA).
A total of 80 children clinically suspected for sacroiliitis prospectively underwent MRI of the sacroiliac (SI) joints. Axial and coronal T1-weighted (T1), Short-tau inversion recovery (STIR) and fat-saturated T1-weighted gadolinium-DTPA (Gd) contrast-enhanced (T1/Gd) sequences were obtained. The presence of bone marrow edema (BME), capsulitis, enthesitis, high intra-articular STIR signal, synovial enhancement and a global diagnostic impression of the MRI for diagnosis of sacroiliitis was recorded.
STIR and T1/Gd sequences had 100% agreement for depiction of BME, capsulitis and enthesitis. High intra-articular STIR signal was seen in 18/80 (22.5%) patients, 15 (83%) of whom also showed synovial enhancement in the T1/Gd sequence. Sensitivity (SN) and specificity (SP) for a clinical diagnosis of JSpA were similar for high STIR signal (SN = 33%, SP = 85%) and T1/Gd synovial enhancement (SN = 36%, SP = 92%). Positive likelihood ratio (LR+) for JSpA was twice as high for synovial enhancement than high STIR signal (4.5 compared to 2.2). Global diagnostic impression was similar (STIR: SN = 55%, SP = 87%, LR + =4 .2; T1/Gd: SN = 55%, SP = 92%, LR + = 6.9).
MRI without contrast administration is sufficient to identify bone marrow edema, capsulitis and retroarticular enthesitis as features of active sacroiliitis in juvenile spondyloarthritis. In selected cases when high STIR signal in the joint is the only finding, gadolinium-enhanced images may help to confirm the presence of synovitis.
本研究旨在确定与常规非增强磁共振成像（MRI）相比，对比增强（CE）MRI在检测临床诊断为幼年型脊柱关节炎（JSpA）的活动性骶髂关节炎时的额外诊断价值。
共有80名临床怀疑患有骶髂关节炎的儿童前瞻性地接受了骶髂（SI）关节的MRI检查。获取了轴位和冠状位T1加权（T1）、短tau反转恢复（STIR）以及脂肪饱和T1加权钆-二乙三胺五乙酸（Gd）对比增强（T1/Gd）序列图像。记录骨髓水肿（BME）、关节囊炎、附着点炎、关节内高STIR信号、滑膜强化情况以及MRI对骶髂关节炎诊断的整体诊断印象。
STIR和T1/Gd序列在显示BME、关节囊炎和附着点炎方面一致性为100%。80名患者中有18名（22.5%）出现关节内高STIR信号，其中15名（83%）在T1/Gd序列中也显示出滑膜强化。对于JSpA的临床诊断，高STIR信号（敏感性[SN]=33%，特异性[SP]=85%）和T1/Gd滑膜强化（SN=36%，SP=92%）的敏感性和特异性相似。JSpA的阳性似然比（LR+）滑膜强化是高STIR信号的两倍（分别为4.5和2.2）。整体诊断印象相似（STIR：SN=55%，SP=87%，LR+=4.2；T1/Gd：SN=55%，SP=92%，LR+=6.9）。
未使用对比剂的MRI足以识别骨髓水肿、关节囊炎和关节后方附着点炎等幼年型脊柱关节炎活动性骶髂关节炎的特征。在某些仅有关节内高STIR信号这一唯一发现的特定病例中，钆增强图像可能有助于确认滑膜炎的存在。
