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Limited role of gadolinium to detect active sacroiliitis on MRI in juvenile spondyloarthritis

(2015) SKELETAL RADIOLOGY. 44(11). p.1637-1646
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Abstract
OBJECTIVE: The aim of this study is to determine the added diagnostic value of contrast-enhanced (CE) magnetic resonance imaging (MRI) compared to routine non contrast-enhanced MRI to detect active sacroiliitis in clinically juvenile spondyloarthritis (JSpA). MATERIALS AND METHODS: A total of 80 children clinically suspected for sacroiliitis prospectively underwent MRI of the sacroiliac (SI) joints. Axial and coronal T1-weighted (T1), Short-tau inversion recovery (STIR) and fat-saturated T1-weighted gadolinium-DTPA (Gd) contrast-enhanced (T1/Gd) sequences were obtained. The presence of bone marrow edema (BME), capsulitis, enthesitis, high intra-articular STIR signal, synovial enhancement and a global diagnostic impression of the MRI for diagnosis of sacroiliitis was recorded. RESULTS: STIR and T1/Gd sequences had 100 % agreement for depiction of BME, capsulitis and enthesitis. High intra-articular STIR signal was seen in 18/80 (22.5 %) patients, 15 (83 %) of whom also showed synovial enhancement in the T1/Gd sequence. Sensitivity (SN) and specificity (SP) for a clinical diagnosis of JSpA were similar for high STIR signal (SN = 33 %, SP = 85 %) and T1/Gd synovial enhancement (SN = 36 %, SP = 92 %). Positive likelihood ratio (LR+) for JSpA was twice as high for synovial enhancement than high STIR signal (4.5 compared to 2.2). Global diagnostic impression was similar (STIR: SN = 55 %, SP = 87 %, LR + =4 .2; T1/Gd: SN = 55 %, SP = 92 %, LR + = 6.9). CONCLUSION: MRI without contrast administration is sufficient to identify bone marrow edema, capsulitis and retroarticular enthesitis as features of active sacroiliitis in juvenile spondyloarthritis. In selected cases when high STIR signal in the joint is the only finding, gadolinium-enhanced images may help to confirm the presence of synovitis.
Keywords
Sacroiliitis, Magnetic resonance imaging, Juvenile spondyloarthritis, Gadolinium, Diagnostic value, ENTHESITIS-RELATED ARTHRITIS, ANKYLOSING-SPONDYLITIS, DIAGNOSTIC UTILITY, CLASSIFICATION, INFLAMMATION, CHILDREN, JOINTS, STIR

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MLA
Herregods, Nele et al. “Limited Role of Gadolinium to Detect Active Sacroiliitis on MRI in Juvenile Spondyloarthritis.” SKELETAL RADIOLOGY 44.11 (2015): 1637–1646. Print.
APA
Herregods, N., Jaremko, J., Baraliakos, X., Dehoorne, J., LEUS, A., Verstraete, K., & Jans, L. (2015). Limited role of gadolinium to detect active sacroiliitis on MRI in juvenile spondyloarthritis. SKELETAL RADIOLOGY, 44(11), 1637–1646.
Chicago author-date
Herregods, Nele, Jacob Jaremko, Xenofon Baraliakos, Jo Dehoorne, ASTRID LEUS, Koenraad Verstraete, and Lennart Jans. 2015. “Limited Role of Gadolinium to Detect Active Sacroiliitis on MRI in Juvenile Spondyloarthritis.” Skeletal Radiology 44 (11): 1637–1646.
Chicago author-date (all authors)
Herregods, Nele, Jacob Jaremko, Xenofon Baraliakos, Jo Dehoorne, ASTRID LEUS, Koenraad Verstraete, and Lennart Jans. 2015. “Limited Role of Gadolinium to Detect Active Sacroiliitis on MRI in Juvenile Spondyloarthritis.” Skeletal Radiology 44 (11): 1637–1646.
Vancouver
1.
Herregods N, Jaremko J, Baraliakos X, Dehoorne J, LEUS A, Verstraete K, et al. Limited role of gadolinium to detect active sacroiliitis on MRI in juvenile spondyloarthritis. SKELETAL RADIOLOGY. 2015;44(11):1637–46.
IEEE
[1]
N. Herregods et al., “Limited role of gadolinium to detect active sacroiliitis on MRI in juvenile spondyloarthritis,” SKELETAL RADIOLOGY, vol. 44, no. 11, pp. 1637–1646, 2015.
@article{6916149,
  abstract     = {OBJECTIVE: The aim of this study is to determine the added diagnostic value of contrast-enhanced (CE) magnetic resonance imaging (MRI) compared to routine non contrast-enhanced MRI to detect active sacroiliitis in clinically juvenile spondyloarthritis (JSpA).
MATERIALS AND METHODS: A total of 80 children clinically suspected for sacroiliitis prospectively underwent MRI of the sacroiliac (SI) joints. Axial and coronal T1-weighted (T1), Short-tau inversion recovery (STIR) and fat-saturated T1-weighted gadolinium-DTPA (Gd) contrast-enhanced (T1/Gd) sequences were obtained. The presence of bone marrow edema (BME), capsulitis, enthesitis, high intra-articular STIR signal, synovial enhancement and a global diagnostic impression of the MRI for diagnosis of sacroiliitis was recorded.
RESULTS: STIR and T1/Gd sequences had 100 % agreement for depiction of BME, capsulitis and enthesitis. High intra-articular STIR signal was seen in 18/80 (22.5 %) patients, 15 (83 %) of whom also showed synovial enhancement in the T1/Gd sequence. Sensitivity (SN) and specificity (SP) for a clinical diagnosis of JSpA were similar for high STIR signal (SN = 33 %, SP = 85 %) and T1/Gd synovial enhancement (SN = 36 %, SP = 92 %). Positive likelihood ratio (LR+) for JSpA was twice as high for synovial enhancement than high STIR signal (4.5 compared to 2.2). Global diagnostic impression was similar (STIR: SN = 55 %, SP = 87 %, LR + =4 .2; T1/Gd: SN = 55 %, SP = 92 %, LR + = 6.9).
CONCLUSION: MRI without contrast administration is sufficient to identify bone marrow edema, capsulitis and retroarticular enthesitis as features of active sacroiliitis in juvenile spondyloarthritis. In selected cases when high STIR signal in the joint is the only finding, gadolinium-enhanced images may help to confirm the presence of synovitis.},
  author       = {Herregods, Nele and Jaremko, Jacob and Baraliakos, Xenofon and Dehoorne, Jo and LEUS, ASTRID and Verstraete, Koenraad and Jans, Lennart},
  issn         = {0364-2348},
  journal      = {SKELETAL RADIOLOGY},
  keywords     = {Sacroiliitis,Magnetic resonance imaging,Juvenile spondyloarthritis,Gadolinium,Diagnostic value,ENTHESITIS-RELATED ARTHRITIS,ANKYLOSING-SPONDYLITIS,DIAGNOSTIC UTILITY,CLASSIFICATION,INFLAMMATION,CHILDREN,JOINTS,STIR},
  language     = {eng},
  number       = {11},
  pages        = {1637--1646},
  title        = {Limited role of gadolinium to detect active sacroiliitis on MRI in juvenile spondyloarthritis},
  url          = {http://dx.doi.org/10.1007/s00256-015-2211-8},
  volume       = {44},
  year         = {2015},
}

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