Abstract
ObjectiveTo demonstrate proof-of-concept for a quantitative MRI method using histographic analysis to assess bone marrow oedema and fat metaplasia in the sacroiliac joints.Materials and methodsFifty-three adolescents aged 12–23 with known or suspected sacroiliitis were prospectively recruited and underwent quantitative MRI (qMRI) scans, consisting of chemical shift-encoded (at 3 T) and diffusion-weighted imaging (at 1.5 T), plus conventional MRI (at 1.5 T) and clinical assessment. qMRI scans produced proton-density fat fraction (PDFF) and apparent diffusion coefficient (ADC) maps of the sacroiliac joints (SIJs), which were analysed using an in-house software tool enabling partially automated ROI definition and histographic analysis. Logistic regression and receiver operating characteristic (ROC) analyses assessed the predictive performance of ADC- and PDFF-based parameters in identifying active inflammation (oedema) and structural damage (fat metaplasia).ResultsADC-based parameters were associated with increased odds of oedema (all p < 0.05); ROC-AUC was higher for histographic parameters representing the upper end of the ADC distribution than for simple averages. Similarly, PDFF-based parameters were associated with increased odds of fat metaplasia (all p < 0.05); ROC area-under-the-curve was higher for histographic parameters representing the upper end of the PDFF distribution than for simple averages. Both ADC- and PDFF-based histographic parameters demonstrated excellent inter- and intra-observer agreement (ICC > 0.9).ConclusionsADC-based parameters can differentiate patients with bone marrow oedema from those without, whilst PDFF-based parameters can differentiate patients with fat metaplasia from those without. Histographic analysis might improve performance compared with simple averages such as the mean and median and offers excellent agreement within and between observers.Key Points• Quantitative MRI with histographic analysis can identify bone marrow oedema (an active inflammatory lesion) and fat metaplasia (a ‘chronic’ inflammatory lesion) in patients with spondyloarthritis.• The use of histographic analysis might improve the performance of quantitative MRI for detecting bone marrow oedema and fat metaplasia compared with simple averages such as the mean and median.• Bone marrow oedema and fat metaplasia are known to be of diagnostic and prognostic significance, and the proposed method could support clinical decisions around biologic (and other) therapies in spondyloarthritis.
Highlights
Spondyloarthritis (SpA) encompasses a group of immunemediated inflammatory diseases characterised by spinal pain, stiffness and damage which commonly affect young people and have poor long-term health outcomes [1]
The use of histographic analysis might improve the performance of quantitative MRI for detecting bone marrow oedema and fat metaplasia compared with simple averages such as the mean and median
We report here the Bath Ankylosing Spondylitis Disability Index (BASDAI) and Bath Ankylosing Spondylitis Functional Index (BASFI), in addition to C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR)
Summary
Spondyloarthritis (SpA) encompasses a group of immunemediated inflammatory diseases characterised by spinal pain, stiffness and damage which commonly affect young people and have poor long-term health outcomes [1]. ‘Conventional’ MR images used to detect inflammation— typically short inversion time inversion recovery (STIR) and T1-weighted spin echo images—produce complex image contrast that depends on multiple tissue properties, including T1, T2, proton density, perfusion and diffusion [11,12,13], which may confound the identification and quantification of oedema. These factors can lead to a lack of consistency between observers and scanners/hospitals [7, 14].
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