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Detection of Sacroiliac Joint Lesions in Axial Spondyloarthritis:Utility of Synthetic MRI
Ke Zhang1 and Guobin Hong1
1Radiology, the Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China

Synopsis

The current diagnosis of the sacroiliac joint lesions with axSpA is most concentrated on qualitative or semi-quantitative methods.There is an urgent need for a quantitative method that can objectively and accurately evaluate the severity of the disease.Synthetic MRI(MAGiC) can generate multiple contrast images and quantitative maps simultaneously based on the same scan.In this study the synthetic MRI can achieve similar qualitative diagnostic performance in detection of sacroiliac joint lesions compared with conventional MRI.And it could be used for distinguishing BME and fat metaplasia.

Purpose: To assess the qualitative diagnostic value of synthetic MRI in detecting sacroiliac joint lesions of participants with axial spondyloarthritis (axSpA) by comparison with conventional MRI, and to determine the quantitative diagnostic performance of quantitative maps generated by synthetic MRI in the distinguish bone marrow edema (BME) and fat metaplasia from normal marrow in the sacroiliac joint. Materials and Methods: One hundred five consecutive participants (age range 18–57 years; mean age, 33.8 years [74 men; age range, 18–57 years; mean age, 33.4 years] [31 women; age range, 19-53 years; mean age, 34.7 years]) with confirmed axSpA who underwent synthetic and conventional 3.0-T MRI from October 2019 to October 2020 were included in this prospective study. The presence and extent of active changes (BME, capsulitis, enthesitis, joint space fluid) and structural changes (erosion, fat metaplasia, sclerosis, ankylosis) on conventional and synthetic MR images were analyzed by two musculoskeletal radiologists independently in random order. The inter-reader and inter-method agreements were performed using the weighted Cohen kappa test and Cohen kappa test without weights. Sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) were calculated using qualitative analysis. Moreover, the diagnostic performance of T1, T2, and proton density (PD) values, which were generated by synthetic quantitative maps for detecting BME and fat metaplasia in the sacroiliac joint, were determined with region-of-interest–based quantitative analysis. Results: The inter-reader and inter-method agreements of sacroiliac joint lesions were all good to almost perfect (kappa, 0.610–0.872). Sensitivity, specificity, and accuracy respectively were 77.8% (7 of 9) –95.8% (46 of 48), 85.9% (85 of 99) –99.0% (199 of 201), and 88.6% (186 of 210) –98.1% (206 of 210) in the detection of sacroiliac joint lesions on synthetic MR images. The T1, T2 values for BME showed significantly higher than normal marrow (all P＜0.001). However, There was no significant difference in PD value between BME and normal marrow (P=0.855). The T1, T2, and PD values for fat metaplasia showed significant differences from normal marrow (all P＜0.001). The area under the receiver operating characteristic curve were 0.99 (95%CI:0.99,1) (P＜0.001) and 0.74 (95%CI:0.65,0.84) (P＜0.001) for T1 and T2 values in the differentiation of BME from normal marrow. The area under the receiver operating characteristic curve were 0.91(95%CI:0.85,0.96) (P＜0.001), 0.86 (95%CI:0.80,0.92) (P＜0.001) and 0.87(95%CI:0.80,0.93) (P＜0.001) for T1, T2 and PD values in the detection of fat metaplasia. Conclusion: Compared with conventional MRI, the synthetic MRI could achieve similar qualitative diagnostic performance to detect sacroiliac joint lesions in axSpA. Furthermore, synthetic quantitative maps could be used for accurate relaxation time quantitative diagnosis, accurately distinguishing BME and fat metaplasia from normal marrow.

Acknowledgements

No acknowledgement found.

References

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Figures

Images in a 38-year-old woman with axSpA.Conventional and synthetic MR images of the sacroiliac joint show the clear presence of BME in the left sacrum articular surface(yellow arrow)that is hyperintense on STIR.The lesion on T1-mapping and T2-mapping show higher value than the surrounding.Conventional and synthetic MR images of the sacroiliac joint show the fat metaplasia in the left iliac articular surface(white arrow)that is hyperintense on T1-FSE.The lesion on T2-mapping and PD-mapping show higher value than the surrounding while T1-mapping shows lower value.

Proc. Intl. Soc. Mag. Reson. Med. 29 (2021)
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