King Christian 10th Hospital for Rheumatic Diseases, Gråsten, Denmark, and University of Southern Denmark, Odense, Denmark.
Aarhus University, Aarhus, Denmark.
Arthritis Rheumatol. 2018 May;70(5):736-745. doi: 10.1002/art.40429. Epub 2018 Mar 23.
Low-grade bone marrow edema (BME) has been reported in the sacroiliac (SI) joints of 25% of healthy individuals and patients with nonspecific mechanical back pain, thus challenging the specificity and predictive value of magnetic resonance imaging (MRI) for the discrimination of early spondyloarthritis (SpA). It is unknown whether stress injury in competition sports may trigger BME. This study sought to explore the frequency and anatomic distribution of SI joint MRI lesions in recreational and elite athletes.
After pretest calibration, semicoronal MRI scans of the SI joints of 20 recreational runners before and after running and 22 elite ice hockey players were assessed for BME and structural lesions. Three readers assessed the MRI scans in a blinded manner, using an SI joint quadrant-based module; scans from tumor necrosis factor inhibitor-treated patients with SpA served for masking. The readers recorded subjects who met the Assessment of SpondyloArthritis international Society (ASAS) definition of active sacroiliitis. For descriptive analysis, the frequency of SI joint quadrants exhibiting BME and structural lesions, as concordantly recorded by ≥2 of 3 readers, and their distribution in 8 anatomic SI joint regions (the upper and lower ilium and sacrum, subdivided in anterior and posterior slices) were determined.
The proportions of recreational runners and elite ice hockey players fulfilling the ASAS definition of active sacroiliitis, as recorded concordantly by ≥2 of 3 readers, were 30-35% and 41%, respectively. In recreational runners before and after running, the mean ± SD number of SI joint quadrants showing BME was 3.1 ± 4.2 and 3.1 ± 4.5, respectively, while in elite ice hockey players, it was 3.6 ± 3.0. The posterior lower ilium was the single most affected SI joint region, followed by the anterior upper sacrum. Erosion was virtually absent.
In recreational and elite athletes, MRI revealed BME in an average of 3-4 SI joint quadrants, meeting the ASAS definition of active sacroiliitis in 30-41% of subjects. The posterior lower ilium was the single most affected SI joint region. These findings in athletes could help refine data-driven thresholds for defining sacroiliitis in early SpA.
低级别骨髓水肿（BME）已在 25%的健康个体和非特异性机械性腰痛患者的骶髂（SI）关节中报道，这对磁共振成像（MRI）用于区分早期脊柱关节炎（SpA）的特异性和预测价值提出了挑战。目前尚不清楚竞技运动中的应力损伤是否会引发 BME。本研究旨在探讨运动型和精英运动员的骶髂关节 MRI 病变的频率和解剖分布。
在预测试校准后，对 20 名运动型跑步者在跑步前后和 22 名精英冰球运动员的半冠状位骶髂关节 MRI 进行评估，以检测 BME 和结构病变。三名读者使用基于骶髂关节象限的模块对 MRI 扫描进行盲法评估；接受肿瘤坏死因子抑制剂治疗的 SpA 患者的 MRI 扫描用于掩蔽。读者记录符合脊柱关节炎评估协会（ASAS）活跃性骶髂关节炎定义的受试者。对于描述性分析，确定≥3 名读者中≥2 名记录的具有 BME 和结构病变的骶髂关节象限的频率及其在 8 个解剖学骶髂关节区域（髂骨上、下和骶骨，分为前、后切片）的分布。
根据≥3 名读者中≥2 名读者的一致性记录，运动型跑步者和精英冰球运动员符合 ASAS 活跃性骶髂关节炎定义的比例分别为 30-35%和 41%。在运动型跑步者跑步前后，出现 BME 的骶髂关节象限的平均（±SD）数量分别为 3.1 ± 4.2 和 3.1 ± 4.5，而在精英冰球运动员中，该数量为 3.6 ± 3.0。后下髂骨是受影响最严重的单个骶髂关节区域，其次是前上骶骨。侵蚀几乎不存在。
在运动型和精英运动员中，MRI 显示平均有 3-4 个骶髂关节象限出现 BME，符合 ASAS 定义的活跃性骶髂关节炎的受试者比例为 30-41%。后下髂骨是受影响最严重的单个骶髂关节区域。这些运动员中的发现可以帮助细化用于定义早期 SpA 骶髂关节炎的数据驱动阈值。
