Christoph Amadeus Agten MD, Presenter: Nothing to Disclose

Veronika Zubler, Abstract Co-Author: Nothing to Disclose

Andrea Rosskopf MD, Abstract Co-Author: Nothing to Disclose

Christian W. A. Pfirrmann MD, MBA, Abstract Co-Author: Advisory Board, Siemens AG Consultant, Medtronic, Inc

To compare detection of enthesitis in the lumbar spine between gadolinium-enhanced fat saturated T1 (T1+Gd) and STIR in patients with suspected Spondyloarthritis.

Sixty-eight patients (37 males, 31 females, mean age 42 years) with suspected spondyloarthritis and MRI of the sacroiliac joints (SIJ) were included. Sagittal T1+Gd and STIR sequences of the lumbar spine were assessed for enthesitis (defined as enhancement or edema) in the supraspinous ligaments, interspinous ligaments, and joint-capsules of the facet joints (capsulitis). Patients were grouped according to ASAS (Assessment of SpondyloArthritis international Society) criteria into having a positive SIJ (group A) or negative SIJ (group B). Enthesitis and bone marrow enhancement/edema in the lumbar spine were compared between the two groups. Descriptive statistics and Wilcoxon signed rank test were used for statistical analysis.

More patients with supraspinous enthesitis were found with T1+Gd (60.3%, 41/68) compared to STIR (19.1%, 13/68), also more areas per patient (T1+Gd 1.32±1.46, STIR 0.29±0.71, P<.0005). No statistically significant difference in detection of interspinous enthesitis was found between T1+Gd (64.7%, 44/68) and STIR (72.1%, 49/68), with P=.455. More patients with capsulitis of the facet joints were found with T1+Gd (61.8%, 42/68) compared to STIR (30.9%, 21/68), also more facet joints per patient (T1+Gd 1.76±1.99, STIR 0.51±0.94, P<.0005). 76.5% (52/68) of SIJ were positive (group A), 23.5% (16/68) of SIJ were negative (group B). In more patients of group A vs. group B supraspinous enthesitis (T1+Gd 65.4% vs. 43.8%, STIR 19.2% vs. 18.8%), interspinous enthesitis (T1+Gd 69.2% vs. 50%, STIR 75% vs. 62.5%), and capsulitis (T1+Gd 69.2% vs. 37.5%, STIR 34.6% vs. 18.8%) were detected. Bone marrow enhancement or edema in group A vs. group B was found in 36.5% vs. 37.5% (T1+Gd) and 46.2% vs. 50% (STIR).  

In patients with clinically suspected spondyloarthritis, enthesitis and capsulitis in the lumbar spine are common findings. T1+Gd detects more enthesitis of the supraspinous ligaments and capsulitis of the facet joints compared to STIR.

Gadolinium detects a higher number of enthesitis of the supraspinous ligaments and capsulitis of the facet joints compared to STIR in patients with suspected spondyloarthritis.

Agten, C, Zubler, V, Rosskopf, A, Pfirrmann, C, MR Imaging of Enthesitis in the Lumbar Spine in Suspected Spondyloarthritis: Gadolinium vs. STIR.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14013254.html