Magnetic Resonance Imaging of Sacroiliitis in Patients with Spondyloarthritis: Correlation with Anatomy and Histology

Abstract

Magnetic resonance imaging (MRI) of the sacroiliac joints (SIJs) has become established as a valuable modality for the early diagnosis of sacroiliitis in patients with inconclusive radiographic findings. Positive MRI findings have the same significance as a positive test for HLA-B27. Sacroiliitis is one of the key features of axial spondyloarthritis (SpA) in the classification proposed by the Assessments in Ankylosing Spondylitis (ASAS) group. Early signs of sacroiliitis include enthesitis of articular fibrocartilage, capsulitis, and osteitis. In more advanced disease, structural (chronic) lesions will be visible, including periarticular fatty deposition, erosions, subchondral sclerosis, and transarticular bone buds and bridges. In this article we describe magnetic resonance (MR) findings and provide histologic biopsy specimens of the respective disease stages. The predominant histologic feature of early and active sacroiliitis is the destruction of cartilage and bone by proliferations consisting of fibroblasts and fibrocytes, T-cells, and macrophages. Advanced sacroiliitis is characterized by new bone formation with enclosed cartilaginous islands and residual cellular infiltrations, which may ultimately lead to complete ankylosis. Knowledge of the morphologic appearance of the sacroiliac joints and their abnormal microscopic and gross anatomy is helpful in correctly interpreting MR findings.

Citation Format:

• Hermann KGA, Bollow M. Magnetic Resonance Imaging of Sacroiliitis in Patients with Spondyloarthritis: Correlation with Anatomy and Histology. Fortschr Röntgenstr 2014; 186: 230 – 237

Zusammenfassung

Die Magnetresonanztomografie (MRT) der Sakroiliakalgelenke hat sich als probates Mittel zur Frühdiagnostik der Sakroiliitis bei inkonklusivem Röntgenbild etabliert. Ein positiver MRT-Befund hat dabei eine ähnlich hohe Bedeutung wie der Nachweis von HLA-B27. Der Nachweis der Sakroiliitis in der Bildgebung ist einer der Schlüsselbefunde in der Klassifikation der axialen Spondyloarthritis ensprechend der Kriterien der Assessments in Ankylosing Spondylitis (ASAS) Gruppe. Frühe Zeichen der Sakroiliitis sind die Enthesitis des artikulären Faserknorpels, Kapsulitiden und Osteitiden. In späteren Stadien kommen strukturelle (chronische) Veränderungen hinzu, dazu gehören Fettdepositionen, Erosionen, subchondrale Sklerosierungen und transartikulären Knochenbrücken bis hin zur Ankylose. Diese MRT-Befunde werden histologischen Darstellungen von Gelenkbiopsaten gegenüber gestellt. Bei aktiver Sakroiliitis dominiert histologisch ein proliferatives, pannusartiges Bindegewebe, welches Knorpel und Knochen destruiert. Dieses besteht neben Fibroblasten und Fibrozyten aus T-Zellen und Makrophagen. Später dominieren von neu gebildetem Knochen umgebene Knorpelinseln sowie Reste zellulärer Infiltrate. Kenntnisse der Morphologie der Sakroiliakalgelenke und der pathologischen Mikro- und Makroanatomie der Sakroiliitis sind hilfreich für das Verständnis der magnetresonanztomografischen Befunde.

Key words

skeletal-axial - MR imaging - inflammation - arthritides

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