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Is there a role for DWI in the diagnosis of sacroiliitis based on ASAS criteria?
Neslin Sahin1, Hatice Hacibeyoglu2, Ozlem Ince1
1Department of Radiology, Sifa University School of Medicine Turkey.
Purpose:
Sacroiliitis based on MRI is one of the main diagnostic criteria of axial spondyloarthritis (SpA). Our purpose was to assess (a) whether apparent diffusion coefficient (ADC) values on diffusion-weighted imaging (DWI) differ between regions of bone marrow edema (BME) and subchondral normal-appearing bone marrow (NABM) in active sacroiliitis, (b) whether ADC values can differentiate early SpA and chronic SpA, both in the active and inactive phase, and (c) whether ADC values are related to laboratory findings.
Materials And Methods:
47 patients (24 female, 23 male, mean age: 38.53 years) with the diagnosis of SpA were included in this retrospective study. 20 age- and sex-matched subjects without SpA constituted the control group. ADC measurements were taken from all lesions and NABM of each sacroiliac joint.
Results:
A total number of 120 subchondral BME lesions (acute: 17, chronic active: 103) were noted. The mean ADC values of the BME lesions (1.30 ± 0.18 × 10(-3) mm(2)/s) were significantly higher than the ADC values in the NABM regions (0.55 ± 0.08 × 10(-3) mm(2)/s) as well as in both the control group (0.56 ± 0.05 × 10(-3) mm(2)/s) and the chronic inactive group (0.54 ± 0.03 × 10(-3) mm(2)/s). There were more BME regions in patients with chronic active sacroiliitis than early SpA patients. Correlation was found between the CRP values and ADC values.
Conclusion:
DWI with ADC values may be complementary to FS T2-weighted or STIR MR images for accurately diagnosing inflammatory sacroiliitis. The value of DWI versus dynamic contrast-enhanced imaging in the follow-up needs to be clarified.
Insights
Diffusion-weighted imaging (DWI) with apparent diffusion coefficient (ADC) values can help diagnose sacroiliitis in axial spondyloarthritis (SpA). Higher ADC values in bone marrow edema indicate active inflammation, correlating with CRP levels.
Area of Science:
- Radiology
- Medical Imaging
- Rheumatology
Background:
- Sacroiliitis on MRI is a key diagnostic criterion for axial spondyloarthritis (SpA).
- Diffusion-weighted imaging (DWI) offers insights into tissue microstructure.
- Apparent diffusion coefficient (ADC) values quantify water molecule diffusion, reflecting tissue characteristics.
Purpose of the Study:
- To determine if ADC values differ between bone marrow edema (BME) and normal-appearing bone marrow (NABM) in active sacroiliitis.
- To assess if ADC values can distinguish early vs. chronic SpA, and active vs. inactive disease.
- To investigate the correlation between ADC values and laboratory inflammatory markers.
Main Methods:
- Retrospective analysis of 47 SpA patients and 20 controls.
- ADC measurements from sacroiliac joint lesions and normal bone marrow.
- Comparison of ADC values across different patient groups and controls.
Main Results:
- Mean ADC values were significantly higher in BME lesions compared to NABM, controls, and chronic inactive groups.
- Active sacroiliitis showed higher BME prevalence than early SpA.
- A correlation was observed between C-reactive protein (CRP) levels and ADC values.
Conclusions:
- DWI with ADC values may complement standard MRI sequences for diagnosing inflammatory sacroiliitis.
- Further research is needed to clarify the role of DWI versus contrast-enhanced imaging in disease follow-up.
