[Show abstract][Hide abstract] ABSTRACT: To determine the prevalence and diagnostic value of pelvic enthesitis on MRI of the sacroiliac (SI) joints in spondyloarthritis (SpA).
A retrospective study in 444 patients aged 17-45 years old with MRI of the SI joints and with clinically suspected sacroiliitis was performed. Patients were classified as having SpA if they fulfilled the Assessment of Spondyloarthritis International Society (ASAS) criteria. Pelvic enthesitis on MRI was correlated with the final diagnosis. Sensitivity, specificity, positive and negative likelihood ratio (LR) and predictive values (PV) of pelvic enthesitis for the diagnosis of SpA were calculated.
MRI showed pelvic enthesitis in 24.4 % of patients with SpA and in 7.1 % of patients without SpA. Presence of any enthesitis had sensitivity, specificity, LR+, LR-, PPV and NPV of 24.4 %, 92.9 %, 3.45, 0.81, 69.4 % and 65.2 % for the diagnosis of SpA, respectively. The most commonly affected entheses were the longitudinal ligament insertion (4.5 %), the retroarticular ligaments (4.1 %) and the pubic symphysis (4.1 %). The sites of enthesitis with the highest PPV for SpA were the iliac crest/wing (85.7 %) and the retroarticular ligaments (81.3 %).
Nearly one fourth of SpA patients with suspected sacroiliitis showed pelvic enthesitis on MRI. Such pelvic enthesitis has a high specificity for the diagnosis of spondyloarthritis.
• Enthesitis is the primary clinical feature of spondyloarthritis. • Magnetic resonance imaging of the sacroiliac joints can demonstrate pelvic enthesitis. • Pelvic enthesitis has a high specificity for the diagnosis of spondyloarthritis.
European Radiology 11/2013; 24(4). DOI:10.1007/s00330-013-3074-9 · 4.01 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To determine the prevalence of clinically relevant non-inflammatory disease on MRI of the sacroiliac (SI) joints in patients suspected of sacroiliitis. To assess the added value of axial imaging of the pelvis in these patients.
In a retrospective study of 691 patients undergoing MRI of the SI joints from January 2006 to December 2012 for inflammatory back pain the prevalence of sacroiliitis and non-inflammatory disease was recorded.
In 285 (41%) patients MRI did not show any abnormal findings. In 36% of patients MRI features of sacroiliitis were present. Spinal degenerative changes were the most common non-inflammatory finding in 305 patients (44.1%) and consisted of disc degeneration in 222 (32%) patients, facet joint arthrosis in 58 (8.4%) patients and disc herniation in 25 (3.6%) patients. Hip joint disease in 44 (6.4%) patients, lumbosacral transitional anomaly in 41 (5.9%) patients, SI joint degenerative changes in 25 (3.6%) patients and diffuse idiopathic skeletal hyperostosis in 24 (3.5%) patients were also common. Osteitis condensans ilii in 17 (2.5%) patients, tumour in 11 (1.6%) patients, fracture in 8 (1.2%) patients, infection in 4 (0.6%) patients and acute spondylolysis in 2 patients (0.3%) were less frequently seen.
Our study shows that non-inflammatory disease is more common than true sacroiliitis on MRI of the SI joints in patients with inflammatory type back pain. Axial pulse sequences may demonstrate unexpected findings that remain undetected if only coronal images are obtained. Clinical relevance statement:, MRI of the SI joints may demonstrate conditions that clinically mimic sacroiliitis. Axial imaging of the pelvis may help detect these unexpected findings.
European journal of radiology 10/2013; 83(1). DOI:10.1016/j.ejrad.2013.10.001 · 2.37 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Purpose
The aim of this prospective study was to compare routine MRI scans of the knee at 1.5 and 3 T obtained in the same individuals in terms of their performance in the diagnosis of cartilage lesions.
One hundred patients underwent MRI of the knee at 1.5 and 3 T and subsequent knee arthroscopy. All MR examinations consisted of multiplanar 2D turbo spin-echo sequences. Three radiologists independently graded all articular surfaces of the knee joint seen at MRI. With arthroscopy as the reference standard, the sensitivity, specificity, and accuracy of 1.5- and 3-T MRI for detecting cartilage lesions and the proportion of correctly graded cartilage lesions within the knee joint were determined and compared using resampling statistics.
For all readers and surfaces combined, the respective sensitivity, specificity, and accuracy for detecting all grades of cartilage lesions in the knee joint using MRI were 60, 96, and 87 % at 1.5 T and 69, 96, and 90 % at 3 T. There was a statistically significant improvement in sensitivity (p < 0.05), but not specificity or accuracy (n.s.) for the detection of cartilage lesions at 3 T. There was also a statistically significant (p < 0.05) improvement in the proportion of correctly graded cartilage lesions at 3 T as compared to 1.5 T.
A 3-T MR protocol significantly improves diagnostic performance for the purpose of detecting cartilage lesions within the knee joint, when compared with a similar protocol performed at 1.5 T.
Level of evidence
[Show abstract][Hide abstract] ABSTRACT: MRI (magnetic resonance imaging) is widely used to diagnose meniscal pathology and ACL (anterior cruciate ligament) tears. Because of the enhanced signal-to-noise ratio and improved image quality at higher field strength, knee MRI equipment is shifting from 1.5 to 3.0 T. To date, objective evidence of improved diagnostic ability at 3.0 T is lacking. The purpose of this prospective study was to assess the accuracy of 1.5 and 3.0-T MRI of the knee, in the same individuals, for diagnosing meniscal pathology and ACL tears, utilizing arthroscopy as the reference standard.
Two hundred patients underwent MRI of the knee at 1.5 and 3.0 T. All MRI examinations consisted of multiplanar turbo spin-echo sequences. One hundred patients underwent subsequent knee arthroscopy. Two blinded independent radiologists assessed all MRI studies to identify meniscal pathology and ACL tears. In patients with MRI results indicating the need for surgical treatment, the sensitivity and specificity of the 1.5 and 3.0-T protocols for detecting these lesions were determined, utilizing arthroscopy as the reference standard, and compared with use of the McNemar test. The kappa statistic for inter-reader agreement in the 200 patients was calculated.
For medial meniscal tears, the mean sensitivity and specificity for the two readers were 93% and 90%, respectively, at 1.5 T and 96% and 88%, respectively, at 3.0 T. For lateral meniscal tears, the mean sensitivity and specificity were 77% and 99%, respectively, at 1.5 T and 82% and 98%, respectively, at 3.0 T. For ACL tears, the mean sensitivity and specificity were 78% and 100%, respectively, at 1.5 T and 80% and 100%, respectively, at 3.0 T. None of the values for either reader differed significantly between the 1.5 and 3.0-T MRI protocols. Inter-reader agreement was almost perfect to perfect (kappa = 0.82 to 1.00).
Routine use of a 3.0-T MRI protocol did not significantly improve accuracy for evaluating the knee menisci and ACL compared with a similar 1.5-T protocol.
Diagnostic Level I. See Instructions for Authors for a complete description of levels of evidence.
The Journal of Bone and Joint Surgery 05/2013; 95(10):916-24. DOI:10.2106/JBJS.L.01195 · 5.28 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective:
To study the value of 3 T dynamic contrast-enhanced (DCE)-MRI for assessment of synovitis of the interphalangeal joints in patients with erosive osteoarthritis (EOA) for treatment response monitoring.
Materials and methods:
The interphalangeal joints of fingers two to five were examined at 3 T MRI in nine patients with EOA. Two musculoskeletal radiologists recorded erosions, bone marrow oedema (BME), synovitis and osteophytes. Interobserver reliability was calculated using κ statistics. In six patients, DCE-MRI time intensity curves of synovitis in two affected joints were analysed. The maximum upslope, absolute and relative enhancement of synovitis were compared with MRI after 12 months of anti-tumour necrosis factor treatment. Intraobserver reproducibility was calculated using intra-class correlation coefficient.
Interobserver reliability was 'good' for detection of erosions (κ = 0.70), BME (κ = 0.77) and synovitis (κ = 0.77), but 'poor' for osteophytes (κ = 0.12). Post-treatment DCE-MRI showed decreasing maximum upslope (p = 0.002) and absolute (p = 0.002) and relative (p = 0.01) enhancement compared to the initial scan. Intraobserver reproducibility of DCE-MRI was 'almost perfect' or 'strong' for all parameters.
3 T DCE-MRI demonstrates changes in time intensity curves of synovitis in EOA of the interphalangeal joints in a longitudinal study, indicating this technique is promising for monitoring therapy response.
[Show abstract][Hide abstract] ABSTRACT: PURPOSE
To determine if ossification variants of the femoral condyles involving the subchondral bone plate predispose or progress to osteochondritis dissecans.
METHOD AND MATERIALS
(a) Follow-up MRI (magnetic resonance imaging) studies of 188 patients with ossification variants of the femoral condyles on the initial MRI of the knee were compared side by side with the baseline study for progression of the ossification variants to OCD (osteochondritis dissecans). (b) The prevalence of ossification variants of the unaffected femoral condyle in 127 patients (aged 9-14 years) with unicondylar OCD on MRI of the knee was compared to a control group of 286 patients (aged 9-14 years). The progression of the ossification variants in both groups was studied by reviewing the follow-up MR examinations side by side with the baseline study. Basic descriptive statistics were performed where appropriate.
(a) Progression of ossification variants to osteochondritis dissecans was not seen on follow-up MR examinations. (b) The prevalence of ossification variants in the unaffected condyle in patients with OCD and in the control group was similar. In both the OCD group and in the control group, no follow-up MRI studies demonstrated progression of the ossification variants to OCD.
Ossification variants of the femoral condyle involving the subchondral bone plate do not progress or predispose to osteochondritis dissecans.
Children affected with ossification variability of the femoral condyles do not require routine follow-up MR imaging since these variants do not progress or predispose to OCD.
Radiological Society of North America 2011 Scientific Assembly and Annual Meeting; 12/2011
[Show abstract][Hide abstract] ABSTRACT: To describe rupture patterns of partial anterior cruciate ligament (ACL) tears on magnetic resonance (MR) imaging.
MR images of 51 patients with a surgically confirmed partial ACL tear were retrospectively and independently interpreted by 2 experienced, blinded radiologists. Using previously described MR criteria, ACLs were categorized as follows: complete tear, partial tear, isolated anteromedial or posterolateral bundle tear, mucoid degeneration or normal ACL. MR interpretations were compared with the arthroscopic results as the standard of reference. Inter- and intraobserver agreements were determined using kappa (к) coefficients.
On MR imaging, ACL injuries were categorized as complete tears (16-23%), partial tears (20-47%), mucoid degeneration (12-27%) or normal ACLs (18-23%). Isolated ACL bundle tears were diagnosed on MR in 6% of our patients. Accuracy of MR for the diagnosis of partial ACL tears was 25-53%. Interobserver agreement was moderate (к = 0.48-0.56). Intraobserver agreement was good (к = 0.72-0.76).
MR diagnosis of a partial ACL tear is difficult because various tear patterns may be seen. Many partial tears demonstrate MR features that are indistinguishable from complete ACL tear, mucoid ACL degeneration or normal ACL. An isolated ACL bundle tear is infrequently detected on MR images.
[Show abstract][Hide abstract] ABSTRACT: To study the reliability and construct validity of ultrasound in interphalangeal finger joints affected by erosive osteoarthritis (EOA) and non-EOA with MRI as the reference method.
252 joints were examined by ultrasound, conventional radiography and clinical examination. Ultrasound was performed using a high-frequency linear transducer (12 × 18 MHz). On the same day, magnetic resonance images of 112 joints were obtained on a 3.0 T magnetic resonance unit. The ultrasound and MRI images were re-read independently by other readers unaware of the diagnosis, clinical and other imaging findings. Interobserver reliability was calculated by the percentage of exact agreement obtained and κ statistics. With MRI as the reference method, the sensitivity and specificity of ultrasound in detecting structural (bone erosions and osteophytes) and soft tissue (effusion and grey-scale synovitis) changes in EOA were calculated.
Ultrasound and MRI were found to be more sensitive in detecting erosions than conventional radiography in EOA. A high agreement between ultrasound and MRI in the assessment of bone erosions (77.7%), osteophytes (75.9%) and synovitis (86.5%) was present. A high percentage of inflammatory changes was found in EOA, and in smaller amount in non-EOA, both confirmed by MRI. Good interobserver reliability of ultrasound was obtained for all variables (all median κ > 0.8).
Grey-scale ultrasound proved to be a reliable and valid imaging technique to assess erosions and soft tissue changes, compared with MRI as a reference method in EOA.
Annals of the rheumatic diseases 11/2010; 70(2):278-83. DOI:10.1136/ard.2010.134932 · 10.38 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: In this review, the radiographic features of ankylosing spondylitis of the axial skeleton will be discussed shortly. Three pathologic processes, including inflammation, bony repair and ossification occurring consecutively or simultaneously, will contribute to the radiographic picture of ankylosing spondylitis. Typical target sites at which these processes take place are the synovial joints, discovertebral joints and ligamentous attachments or entheses of the axial skeleton.
JBR-BTR: organe de la Société royale belge de radiologie (SRBR) = orgaan van de Koninklijke Belgische Vereniging voor Radiologie (KBVR) 88(1):25-30.