The Diagnostic Utility of the Relation between MRI Bone Marrow Edema and Other Types of MRI Lesions in the Sacroiliac Joints in Axial Spondyloarthritis

Sengül Seven¹, Pernille Hededal², Mikkel Østergaard³, Lone Morsel-Carlsen⁴, Inge Juul Sørensen⁵, Birthe Bonde⁶, Gorm Thamborg⁷, Oliver Hendricks⁸, Niklas Rye Jørgensen⁹ and Susanne J Pedersen¹⁰, ¹Copenhagen Center for Arthritis Research, Dept. of Rheumatology, Rigshospitalet, University of Copenhagen, Glostrup., 2600 Glostrup, Denmark, ²Dept. of Radiology, Rigshospitalet, University of Copenhagen, Glostrup., Glostrup, Denmark, ³Copenhagen Center for Arthritis Research, Dept. of Rheumatology, Rigshospitalet, University of Copenhagen, Glostrup., Glostrup, Denmark, ⁴Department of Radiology, Bispebjerg-Frederiksberg Hospital, Copenhagen, Copenhagen, Denmark, ⁵Dept. of Rheumatology, Rigshospitalet, University of Copenhagen, Glostrup, Glostrup, Denmark, ⁶Birthe Bonde Clinic of Physiotherapy, Copenhagen, Denmark, ⁷Copenhagen Center for Arthritis Research, Dept. of Rheumatology, Rigshospitalet, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark, ⁸King Christian 10th Hospital for Rheumatic Diseases, University of Southern Denmark, Institute of Regional Health Research, Graasten, Denmark, ⁹Dept. of Clinical Biochemistry, Rigshospitalet, University of Copenhagen, Glostrup, Glostrup, Denmark, ¹⁰Copenhagen Center for Arthritis Research, Dept. of Rheumatology, Rigshospitalet, University of Copenhagen, Glostrup, Glostrup, Denmark

Meeting: ACR/ARHP Annual Meeting 2018

Keywords: axial spondyloarthritis and spondylarthritis, MRI

Session Information

Date: Sunday, October 21, 2018

Title: 3S082 ACR Abstract: Imaging of Rheumatic Diseases I: MRI & CT (863–868)

Session Type: ACR Concurrent Abstract Session

Session Time: 2:30PM-4:00PM

Background/Purpose:

MRI detected bone marrow edema (BME) plays a central role in the ASAS (Assessment of Spondyloarthritis International Society) classification criteria for axial spondyloarthritis (axSpA). However, several studies have shown that BME in the sacroiliac joints (SIJs) is also present in other conditions^{1, 2.}. The aim of the study was to investigate the utility of the relation between MRI BME and different types of MRI lesions in the sacroiliac joint to separate patients with axSpA from persons with other conditions.

Methods:

The MASH study is a prospective cross-sectional study of 204 participants, aged ≤45 yrs. The study included 41 patients with axSpA, 46 women with and 14 without pain related to pregnancy or postpartum within 12 months after delivery, 25 patients with lumbar disc herniation, 26 persons with hard physical labor (cleaning assistants), 23 long-distance runners (≥30 km/week) and 29 healthy men. Participants with pain should all have VAS pain >2 (on a scale 0-10) for ≥2 months. Participants in the non-axSpA groups were not allowed to have any clinical SpA features or rheumatological conditions. All participants underwent clinical, laboratory and MRI examination including semi-coronal STIR and T1-weighted sequences of the SIJs. MRIs were evaluated for BME, erosion, fat, ankylosis, and sclerosis according to the SPARCCMRI definitions of lesions^3,4 by two independent readers. In each of the nine slices of the cartilaginous compartment, the left and right SIJs were separately assessed for presence of BME in relation to each of the above mentioned structural lesions (range of total score per patient: 0-18).

Results:

The table shows the clinical characteristics within each participant group, and MRI results based on the mean scores of the two readers. BME located adjacent to joint space, adjacent to erosions and adjacent to fat were more frequent in patients with axSpA, but these lesions were also seen in the other study groups, mainly women with postpartum pain. When increasing amounts of lesions were required (higher cut-offs), almost only AxSpA patients fulfilled the requirements (table). BME adjacent to sclerosis was most frequent in women with postpartum pain, whereas BME adjacent to ankylosis was only seen in patients with axSpA.

Conclusion:

BME located adjacent to joint space, adjacent to erosion and adjacent to fat was most frequent, but did not exclusively occur in patients with axSpA, whilst BME adjacent to sclerosis was most frequent in women with postpartum pain. Detailed analysis of lesions and their anatomical location may help differentiate axSpA from other conditions.

References:

1. Weber et al. AR 2010;62(10):3048-3058

2. Seven et al. Annrheumdis-2018-eular.2586

3. Maksymowych et al. AR 2005;53:703-9.

4. Maksymowich et al. J Rheumatol. 2015;42:79-86.

Clinical characteristics and relations between MRI BME and other MRI lesions
		AxSpA (N=41)	Post-partum with pain (N=46)	Post-partum without Pain (N=14)	Disc herniation (N=25)	Cleaning staff (N=26)	Long distance Runners (N=24)	Healthy men (N=30)
Age (years)		30.9 30.5 (19; 44)	32.6 32.5 (26; 41)	33.1 32.5 (27; 41)	35.2 37.0 (21; 43)	39.1 39.0 (28; 45)	32.7 32.0 (22; 43)	30.9 30.0 (20; 45)
Male sex		25 (61)	0 (0)	0 (0)	11 (44)	0 (0)	19 (79)	30 (100)
HLA-B27 positive		33.0 (80.5)	5.0 (10.9)	1.0 (7,1)	0 (0)	0 (0)	1.0 (4.3)	4.0 (13.8)
CRP (mg/L)		11.4 6.0 (0.3; 58)	1.6 0.8 (0.3; 7.1)	2.4 0.7 (0.3; 13)	2.2 0.9 (0.3; 14)	2.6 1.0 (0.3; 20)	1.4 0.4 (0.3; 7.6)	0.9 0.3 (0.3; 4.9)
Body mass index (kg/m²)		23.1 22.7 (18.3; 31.7)	25.0 24.0 (17.3; 37.1)	22.1 21.1 (11.8; 31.6)	26.2 25.2 (19.6; 34.9)	26.3 25.3 (20.5; 35.8)	23.0 22.8 (19.0; 25.8)	25.0 24.8 (19.5; 31.4)
Childbirths		1.7 2.0 (0; 2)	1.5 1.0 (1; 4)	1.9 2.0 (1; 3)	1.6 2.0 (0; 3)	2.5 2.5 (0; 5)	0.5 0 (0; 2)	NA
Low back pain (VAS, 0-100 mm)		37.5 37.0 (0; 100)	54.6 59.5 (0; 98)	3.9 0 (0; 19)	54.7 62.0 (3; 96)	7.8 0 (0; 68)	2.4 0 (0; 15)	1.3 0 (0; 12)
BME adjacent to joint space		5.0 4.0 (0; 15.5)	2.1 0.5 (0; 13) ǂ	1.0 0 (0; 5.5) ǂ	0.3 0 (0; 2) §	0.2 0 (0; 2.5) §	0.2 0 (0; 1.5) §	0.2 0 (0; 1.5) §
BME adjacent to fat		1.2 0 (0; 10)	0.1 0 (0; 3.5) §	0 0 (0; 0.5) Ɨ	0 0 (0; 0) §	0 0 (0; 0) §	0 0 (0; 0) §	0 0 (0; 0) §
BME adjacent to sclerosis		0.8 0 (0;10)	1.7 0 (0; 13)	0.7 0 (0; 3.5)	0 0 (0; 0.5) ǂ	0.2 0 (0; 3.5) Ɨ	0 0 (0; 0.5) Ɨ	0 0 (0; 1) ǂ
BME adjacent to erosion		1.6 0.5 (0; 14)	0.2 0 (0; 6.5) §	0 0 (0; 0) ǂ	0 0 (0; 0) §	0 0 (0; 0) §	0.1 0 (0; 1.5) §	0 0 (0; 0) §
BME adjacent to ankylosis		0.1 0 (0; 1)	0 0 (0; 0)	0 0 (0; 0)	0 0 (0; 0)	0 0 (0; 0)	0 0 (0; 0)	0 0 (0; 0)
BME adjacent to joint space	≥ 1	26 (63)	20 (44)	3 (21)	2 (8)	2 (8)	0	1 (3)
	≥ 3	23 (56)	13 (28)	1 (7)	0	0	0	0
	≥ 5	19 (46)	4 (9)	1 (7)	0	0	0	0
	≥ 10	7 (17)	1 (2)	0	0	0	0	0
BME adjacent to fat	≥ 1	7 (17)	1 (2)	0	0	0	0	0
	≥ 3	2 (5)	0	0	0	0	0	0
	≥ 5	2 (5)	0	0	0	0	0	0
BME adjacent to sclerosis	≥ 1	7 (17)	13 (28)	2 (14)	0	1 (4)	0	0
	≥ 3	2 (5)	6 (13)	1 (7)	0	1 (4)	0	0
	≥5	1 (2)	6 (13)	0	0	0	0	0
BME adjacent to erosion	≥ 1	11 (27)	2 (4)	0	0	0	0	0
	≥ 3	7 (17)	1 (2)	0	0	0	0	0
	≥ 5	4 (10)	0	0	0	0	0	0
	≥ 10	1 (2)	0	0	0	0	0	0
BME adjacent to ankylosis	≥ 1	1 (2)	0	0	0	0	0	0
In cells with 1 row, values are N (%). In cells with 2 rows, values are mean (upper row) and median (min; max) (lower row). Mann-Whitney test, compared with patients with axSpA. §:p<0.001; ǂ: p<0.01; Ɨ: p<0.05 CRP: C-Reactive Protein; HLA-B27: Human Leucocyte Antigen B27; VAS: Visual Analogue Scale; BME: Bone marrow edema.

Disclosure: S. Seven, None; P. Hededal, None; M. Østergaard, None; L. Morsel-Carlsen, None; I. Juul Sørensen, None; B. Bonde, None; G. Thamborg, None; O. Hendricks, None; N. R. Jørgensen, None; S. J. Pedersen, None.

To cite this abstract in AMA style:

Seven S, Hededal P, Østergaard M, Morsel-Carlsen L, Juul Sørensen I, Bonde B, Thamborg G, Hendricks O, Jørgensen NR, Pedersen SJ. The Diagnostic Utility of the Relation between MRI Bone Marrow Edema and Other Types of MRI Lesions in the Sacroiliac Joints in Axial Spondyloarthritis [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/the-diagnostic-utility-of-the-relation-between-mri-bone-marrow-edema-and-other-types-of-mri-lesions-in-the-sacroiliac-joints-in-axial-spondyloarthritis/. Accessed .

ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-diagnostic-utility-of-the-relation-between-mri-bone-marrow-edema-and-other-types-of-mri-lesions-in-the-sacroiliac-joints-in-axial-spondyloarthritis/