Download PDF
Semin Musculoskelet Radiol 2018; 22(02): 180-188
DOI: 10.1055/s-0038-1639470
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Sacroiliitis in Axial Spondyloarthritis: Assessing Morphology and Activity

Lennart Jans
1   Ghent University Hospital, Gent, Belgium
,
Niels Egund
2   Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
,
Iris Eshed
3   Department of Diagnostic Imaging, Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
,
Iwona Sudoł-Szopińska
4   Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland and Imaging Diagnostic Department, Warsaw Medial University, Warsaw, Poland
,
Anne Grethe Jurik
2   Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
› Author Affiliations
Further Information

Publication History

Publication Date:
19 April 2018 (online)

Also available at
    Permissions and Reprints

Abstract

Objective To review the strengths, limitations, and new insights in the anatomy and magnetic resonance imaging (MRI) features of active and structural lesions of sacroiliitis in spondyloarthritis.

Discussion MRI plays a key role in the diagnosis and follow-up of sacroiliitis in spondyloarthritis. MRI of the sacroiliac joints in affected patients may show active lesions such as bone marrow edema, capsulitis, enthesitis, or synovitis as well as structural changes such as erosion, fat infiltration, sclerosis, backfill, and ankylosis. Active lesions of sacroiliitis on MRI are particularly important for the diagnosis and assessment of ongoing active inflammation. Structural lesions increasingly gain importance for diagnosis and follow-up.

Conclusion Active lesions remain the hallmark for assessment of inflammation in sacroiliitis. Structural lesions increasingly play a role in the diagnosis of spondyloarthritis.

Keywords

magnetic resonance imaging - sacroiliitis - spondyloarthritis - active lesion - structural lesion
 

  • References

  • 1 Braun J, Sieper J. Ankylosing spondylitis. Lancet 2007; 369 (9570): 1379-1390
    CrossrefPubMedSearch in Google Scholar
  • 2 Lacout A, Rousselin B, Pelage JP. CT and MRI of spine and sacroiliac involvement in spondyloarthropathy. AJR Am J Roentgenol 2008; 191 (04) 1016-1023
    CrossrefPubMedSearch in Google Scholar
  • 3 Dougados M, van der Linden S, Juhlin R. , et al. The European Spondylarthropathy Study Group preliminary criteria for the classification of spondylarthropathy. Arthritis Rheum 1991; 34 (10) 1218-1227
    CrossrefPubMedSearch in Google Scholar
  • 4 Dougados M, Baeten D. Spondyloarthritis. Lancet 2011; 377 (9783): 2127-2137
    CrossrefPubMedSearch in Google Scholar
  • 5 Mager AK, Althoff CE, Sieper J, Hamm B, Hermann KG. Role of whole-body magnetic resonance imaging in diagnosing early spondyloarthritis. Eur J Radiol 2009; 71 (02) 182-188
    CrossrefPubMedSearch in Google Scholar
  • 6 Lambert RG, Salonen D, Rahman P. , et al. Adalimumab significantly reduces both spinal and sacroiliac joint inflammation in patients with ankylosing spondylitis: a multicenter, randomized, double-blind, placebo-controlled study. Arthritis Rheum 2007; 56 (12) 4005-4014
    CrossrefPubMedSearch in Google Scholar
  • 7 Eshed I, Bollow M, McGonagle DG. , et al. MRI of enthesitis of the appendicular skeleton in spondyloarthritis. Ann Rheum Dis 2007; 66 (12) 1553-1559
    CrossrefPubMedSearch in Google Scholar
  • 8 Sieper J, Rudwaleit M, Baraliakos X. , et al. The Assessment of SpondyloArthritis International Society (ASAS) handbook: a guide to assess spondyloarthritis. Ann Rheum Dis 2009; 68 (Suppl. 02) ii1-ii44
    CrossrefPubMedSearch in Google Scholar
  • 9 Bereau M, Prati C, Wendling D. Sacroiliac edema by MRI does not always indicate spondylarthritis. Joint Bone Spine 2011; 78 (06) 646
    CrossrefPubMedSearch in Google Scholar
  • 10 Jans L, Coeman L, Van Praet L. , et al. How sensitive and specific are MRI features of sacroiliitis for diagnosis of spondyloarthritis in patients with inflammatory back pain?. JBR-BTR 2014; 97 (04) 202-205
    PubMedSearch in Google Scholar
  • 11 Egund N, Jurik AG. Anatomy and histology of the sacroiliac joints. Semin Musculoskelet Radiol 2014; 18 (03) 332-339
    Thieme ConnectPubMedSearch in Google Scholar
  • 12 Puhakka KB, Melsen F, Jurik AG, Boel LW, Vesterby A, Egund N. MR imaging of the normal sacroiliac joint with correlation to histology. Skeletal Radiol 2004; 33 (01) 15-28
    CrossrefPubMedSearch in Google Scholar
  • 13 François RJ, Gardner DL, Degrave EJ, Bywaters EG. Histopathologic evidence that sacroiliitis in ankylosing spondylitis is not merely enthesitis. Arthritis Rheum 2000; 43 (09) 2011-2024
    CrossrefPubMedSearch in Google Scholar
  • 14 Benjamin M, McGonagle D. The anatomical basis for disease localisation in seronegative spondyloarthropathy at entheses and related sites. J Anat 2001; 199 (Pt 5): 503-526
    CrossrefPubMedSearch in Google Scholar
  • 15 Lambert RG, Bakker PA, van der Heijde D. , et al. Defining active sacroiliitis on MRI for classification of axial spondyloarthritis: update by the ASAS MRI working group. Ann Rheum Dis 2016; 75 (11) 1958-1963
    CrossrefPubMedSearch in Google Scholar
  • 16 Rudwaleit M, Jurik AG, Hermann KG. , et al. Defining active sacroiliitis on magnetic resonance imaging (MRI) for classification of axial spondyloarthritis: a consensual approach by the ASAS/OMERACT MRI group. Ann Rheum Dis 2009; 68 (10) 1520-1527
    CrossrefPubMedSearch in Google Scholar
  • 17 Weber U, Maksymowych WP. Advances and challenges in spondyloarthritis imaging for diagnosis and assessment of disease. Curr Rheumatol Rep 2013; 15 (08) 345
    CrossrefPubMedSearch in Google Scholar
  • 18 Weber U, Jurik AG, Lambert RG, Maksymowych WP. Imaging in spondyloarthritis: controversies in recognition of early disease. Curr Rheumatol Rep 2016; 18 (09) 58
    CrossrefPubMedSearch in Google Scholar
  • 19 Marzo-Ortega H, McGonagle D, O'Connor P. , et al. Baseline and 1-year magnetic resonance imaging of the sacroiliac joint and lumbar spine in very early inflammatory back pain. Relationship between symptoms, HLA-B27 and disease extent and persistence. Ann Rheum Dis 2009; 68 (11) 1721-1727
    CrossrefPubMedSearch in Google Scholar
  • 20 Weber U, Lambert RG, Østergaard M, Hodler J, Pedersen SJ, Maksymowych WP. The diagnostic utility of magnetic resonance imaging in spondylarthritis: an international multicenter evaluation of one hundred eighty-seven subjects. Arthritis Rheum 2010; 62 (10) 3048-3058
    CrossrefPubMedSearch in Google Scholar
  • 21 Weber U, Zubler V, Pedersen SJ. , et al. Development and validation of a magnetic resonance imaging reference criterion for defining a positive sacroiliac joint magnetic resonance imaging finding in spondyloarthritis. Arthritis Care Res (Hoboken) 2013; 65 (06) 977-985
    CrossrefPubMedSearch in Google Scholar
  • 22 Arnbak B, Grethe Jurik A, Hørslev-Petersen K. , et al. Associations between spondyloarthritis features and magnetic resonance imaging findings: a cross-sectional analysis of 1,020 patients with persistent low back pain. Arthritis Rheumatol 2016; 68 (04) 892-900
    CrossrefPubMedSearch in Google Scholar
  • 23 Hetland ML, Stengaard-Pedersen K, Junker P. , et al; CIMESTRA study group. Radiographic progression and remission rates in early rheumatoid arthritis—MRI bone oedema and anti-CCP predicted radiographic progression in the 5-year extension of the double-blind randomised CIMESTRA trial. Ann Rheum Dis 2010; 69 (10) 1789-1795
    CrossrefPubMedSearch in Google Scholar
  • 24 Barrie HJ. Histologic changes in rheumatoid disease of the metacarpal and metatarsal heads as seen in surgical material. J Rheumatol 1981; 8 (02) 246-257
    PubMedSearch in Google Scholar
  • 25 Bollow M, Fischer T, Reisshauer H. , et al. Quantitative analyses of sacroiliac biopsies in spondyloarthropathies: T cells and macrophages predominate in early and active sacroiliitis—cellularity correlates with the degree of enhancement detected by magnetic resonance imaging. Ann Rheum Dis 2000; 59 (02) 135-140
    CrossrefPubMedSearch in Google Scholar
  • 26 Marzo-Ortega H, O'Connor P, Emery P, McGonagle D. Sacroiliac joint biopsies in early sacroiliitis. Rheumatology (Oxford) 2007; 46 (07) 1210-1211
    CrossrefPubMedSearch in Google Scholar
  • 27 Gong Y, Zheng N, Chen SB. , et al. Ten years' experience with needle biopsy in the early diagnosis of sacroiliitis. Arthritis Rheum 2012; 64 (05) 1399-1406
    CrossrefPubMedSearch in Google Scholar
  • 28 Rudwaleit M, van der Heijde D, Landewé R. , et al. The Assessment of SpondyloArthritis International Society classification criteria for peripheral spondyloarthritis and for spondyloarthritis in general. Ann Rheum Dis 2011; 70 (01) 25-31
    CrossrefPubMedSearch in Google Scholar
  • 29 Wick MC, Weiss RJ, Jaschke W, Klauser AS. Erosions are the most relevant magnetic resonance imaging features in quantification of sacroiliac joints in ankylosing spondylitis. J Rheumatol 2010; 37 (03) 622-627
    CrossrefPubMedSearch in Google Scholar
  • 30 Weber U, Lambert RG, Pedersen SJ, Hodler J, Østergaard M, Maksymowych WP. Assessment of structural lesions in sacroiliac joints enhances diagnostic utility of magnetic resonance imaging in early spondylarthritis. Arthritis Care Res (Hoboken) 2010; 62 (12) 1763-1771
    CrossrefPubMedSearch in Google Scholar
  • 31 Weber U, Maksymowych WP, Chan SM. , et al. Does evaluation of the ligamentous compartment enhance diagnostic utility of sacroiliac joint MRI in axial spondyloarthritis?. Arthritis Res Ther 2015; 17: 246
    CrossrefPubMedSearch in Google Scholar
  • 32 Madsen KB, Schiøttz-Christensen B, Jurik AG. Prognostic significance of magnetic resonance imaging changes of the sacroiliac joints in spondyloarthritis—a followup study. J Rheumatol 2010; 37 (08) 1718-1727
    CrossrefPubMedSearch in Google Scholar
  • 33 Braun J, Khan MA, Sieper J. Enthesitis and ankylosis in spondyloarthropathy: what is the target of the immune response?. Ann Rheum Dis 2000; 59 (12) 985-994
    CrossrefPubMedSearch in Google Scholar
  • 34 Jans L, Van Praet L, Elewaut D. , et al. MRI of the SI joints commonly shows non-inflammatory disease in patients clinically suspected of sacroiliitis. Eur J Radiol 2014; 83 (01) 179-184
    CrossrefPubMedSearch in Google Scholar
  • 35 Madsen KB, Egund N, Jurik AG. Grading of inflammatory disease activity in the sacroiliac joints with magnetic resonance imaging: comparison between short-tau inversion recovery and gadolinium contrast-enhanced sequences. J Rheumatol 2010; 37 (02) 393-400
    CrossrefPubMedSearch in Google Scholar
  • 36 de Hooge M, van den Berg R, Navarro-Compán V. , et al. Magnetic resonance imaging of the sacroiliac joints in the early detection of spondyloarthritis: no added value of gadolinium compared with short tau inversion recovery sequence. Rheumatology (Oxford) 2013; 52 (07) 1220-1224
    CrossrefPubMedSearch in Google Scholar
  • 37 Slobodin G, Rimar D, Boulman N. , et al. Acute sacroiliitis. Clin Rheumatol 2016; 35 (04) 851-856
    CrossrefPubMedSearch in Google Scholar
  • 38 Herregods N, Dehoorne J, Van den Bosch F. , et al. ASAS definition for sacroiliitis on MRI in SpA: applicable to children?. Pediatr Rheumatol Online J 2017; 15 (01) 24
    CrossrefPubMedSearch in Google Scholar
  • 39 Herregods N, Jaremko JL, Baraliakos X. , et al. Limited role of gadolinium to detect active sacroiliitis on MRI in juvenile spondyloarthritis. Skeletal Radiol 2015; 44 (11) 1637-1646
    CrossrefPubMedSearch in Google Scholar
  • 40 Ahlström H, Feltelius N, Nyman R, Hällgren R. Magnetic resonance imaging of sacroiliac joint inflammation. Arthritis Rheum 1990; 33 (12) 1763-1769
    CrossrefPubMedSearch in Google Scholar
  • 41 Weber U, Pedersen SJ, Østergaard M, Rufibach K, Lambert RG, Maksymowych WP. Can erosions on MRI of the sacroiliac joints be reliably detected in patients with ankylosing spondylitis? A cross-sectional study. Arthritis Res Ther 2012; 14 (03) R124
    CrossrefPubMedSearch in Google Scholar
  • 42 Althoff CE, Sieper J, Song IH. , et al. Active inflammation and structural change in early active axial spondyloarthritis as detected by whole-body MRI. Ann Rheum Dis 2013; 72 (06) 967-973
    CrossrefPubMedSearch in Google Scholar
  • 43 de Hooge M, van den Berg R, Navarro-Compán V. , et al. Patients with chronic back pain of short duration from the SPACE cohort: which MRI structural lesions in the sacroiliac joints and inflammatory and structural lesions in the spine are most specific for axial spondyloarthritis?. Ann Rheum Dis 2016; 75 (07) 1308-1314
    CrossrefPubMedSearch in Google Scholar
  • 44 Diekhoff T, Greese J, Krohn M, Huppertz A, Hamm B, Hermann KG. Erosion detection on the SI-joints—a comparison between X-ray, low dose CT and MRI including high resolution sequences. Ann Rheum Dis 2014; 73 (Suppl. 02) 79-80
    CrossrefPubMedSearch in Google Scholar
  • 45 Weber U, Maksymowych WP. Sensitivity and specificity of magnetic resonance imaging for axial spondyloarthritis. Am J Med Sci 2011; 341 (04) 272-277
    CrossrefPubMedSearch in Google Scholar
  • 46 Schueller-Weidekamm C, Mascarenhas VV, Sudol-Szopinska I. , et al. Imaging and interpretation of axial spondylarthritis: the radiologist's perspective—consensus of the Arthritis Subcommittee of the ESSR. Semin Musculoskelet Radiol 2014; 18 (03) 265-279
    Thieme ConnectPubMedSearch in Google Scholar
  • 47 Haliloglu M, Kleiman MB, Siddiqui AR, Cohen MD. Osteomyelitis and pyogenic infection of the sacroiliac joint. MRI findings and review. Pediatr Radiol 1994; 24 (05) 333-335
    CrossrefPubMedSearch in Google Scholar
  • 48 Pedersen SJ, Zhao Z, Lambert RG. , et al. The FAt Spondyloarthritis Spine Score (FASSS): development and validation of a new scoring method for the evaluation of fat lesions in the spine of patients with axial spondyloarthritis. Arthritis Res Ther 2013; 15 (06) R216
    CrossrefPubMedSearch in Google Scholar
  • 49 Schueller-Weidekamm C, Schueller G. Sakroiliitis oder Pseudosakroiliitis? [in German]. Radiologe 2012; 52 (02) 132-140
    CrossrefPubMedSearch in Google Scholar
  • 50 Daïen CI, Sellam J. Obesity and inflammatory arthritis: impact on occurrence, disease characteristics and therapeutic response. RMD Open 2015; 1 (01) e000012
    CrossrefPubMedSearch in Google Scholar
  • 51 Laloo F, Herregods N, Varkas G. , et al. MR signal in the sacroiliac joint space in spondyloarthritis: a new sign. Eur Radiol 2017; 27 (05) 2024-2030
    CrossrefPubMedSearch in Google Scholar
  • 52 Maksymowych WP, Wichuk S, Chiowchanwisawakit P, Lambert RG, Pedersen SJ. Fat metaplasia and backfill are key intermediaries in the development of sacroiliac joint ankylosis in patients with ankylosing spondylitis. Arthritis Rheumatol 2014; 66 (11) 2958-2967
    CrossrefPubMedSearch in Google Scholar
  • 53 Leibushor N, Slonimsky E, Aharoni D, Lidar M, Eshed I. CT abnormalities in the sacroiliac joints of patients with diffuse idiopathic skeletal hyperostosis. AJR Am J Roentgenol 2017; 208 (04) 834-837
    CrossrefPubMedSearch in Google Scholar