Sacroiliac Joints In Patients Research Articles

Assessment of the sacroiliac joint in patients with axial spondyloarthritis via three-dimensional ultrashort echo time magnetic resonance imaging

Assessment of the sacroiliac joint in patients with axial spondyloarthritis via three-dimensional ultrashort echo time magnetic resonance imaging

Fatty Acids Composition of the Sacroiliac Joint in Axial Spondyloarthritis: Analysis Using 3.0 T Chemical Shift-Encoded MRI.

Axial spondyloarthritis (axSpA) is a group of inflammatory diseases that may lead to ankylosis of the sacroiliac joint and spine. Fat lesion in the sacroiliac joint is an important feature in diagnosis and disease progression of axSpA. However, whether there is alteration of fatty acids (FAs) composition has not been investigated using MRI. To investigate bone marrow FA composition of the sacroiliac joint in patients with axSpA compared to controls. Prospective. Eighty five participants (mean age, 32.3 ± 6.1 years): 48 axSpA (25 male, 23 female) and 37 non-SpA controls (18 male, 19 female). 3.0 T/Two multiple gradient-echo chemical shift-encoded (CSE) MRI which differed only in echo times (TEs) were scanned consecutively. Axial multi-echo CSE MRI was performed in the sacroiliac joints in vivo. Regions of interest (ROIs) were manually placed on subchondral bone with and without fat lesion in axSpA patients, and on subchondral bone without fat lesion in controls. FA composition was computed within the ROIs using a nonlinear least square method from literature. Intergroup comparisons were performed using t tests. In axSpA, male patients had significantly higher monounsaturated FA compared to controls in areas with fat lesion in the sacrum (+12%) and in the ilium (+9%), and in areas without fat lesion in the sacrum (+10%). Significantly lower polyunsaturated FAs were found in areas with fat lesion in the sacrum (-10%) and ilium (-11%), and lower saturated FAs were found in areas without fat lesion in the sacrum (-6%). In female, patients with axSpA had significantly higher saturated FAs in areas with fat lesion in the ilium (+7%) in comparison to controls. FA composition of the sacroiliac joint alters in patients with axSpA, and it can be detected using CSE MRI based analysis.

Ultrasound characteristics of soft tissues near sacroiliac joints and in the lumbar region of patients with ankylosing spondylitis.

To investigate the musculoskeletal morphomechanical properties (i.e., the thickness and elastic modulus) and the total count of power Doppler signals near the sacroiliac joints in patients with ankylosing spondylitis (AS) and non-AS individuals. Twenty participants with AS [median age (interquartile range): 31.7 (11.04) years] and 19 controls [36.3 (10.5) years] with no AS history were recruited. Bilateral ultrasound image acquisition was performed, including the short posterior sacroiliac ligament, interosseous sacroiliac ligament, long posterior sacroiliac ligament, iliolumbar ligament, proximal piriformis muscle, and sacrotuberous ligament. The intraclass correlation coefficients (ICC) of ultrasound parameters, laboratory test results of human leukocyte antigen B27, C-reactive protein, and erythrocyte sedimentation rate, and self-reported physical and disease activity scores were also obtained. The ligaments and piriformis muscle were thicker and stiffer (greater elastic modulus) in participants with AS than in non-AS participants (all p<0.01). The measurements showed good or excellent reliability (all ICC(3,1) >0.85). The numbers of power Doppler signals detected in the iliolumbar ligament, proximal piriformis muscle, and sacrotuberous ligament were higher in participants with AS than in non-AS participants (all p<0.001). A correlation was identified between disease duration and the elastic modulus of the piriformis muscle (r=0.640, p=0.003). We conclude that the ligaments and proximal piriformis muscle of AS participants have increased thickness, elastic modulus, and power Doppler signal than those of non-AS individuals. These reliable findings may serve as potential markers for the early diagnosis of AS and for assessing medication effects.

Tomosynthesis performance compared to radiography and computed tomography for sacroiliac joint structural damage detection in patients with suspected axial spondyloarthritis

PurposeTo compare tomosynthesis performance to radiography for the differentiation of sacroiliitis versus normal or degenerative changes in sacroiliac joints in patients with suspected axial spondyloarthritis (SpA). Materials and methodsRadiography, tomosynthesis and CT of sacroiliac joints (29 patients) were performed on the same day in consecutive patients with suspected SpA. The examinations were retrospectively read independently, blinded by two radiologists (one junior and one senior, and twice by one junior). Interobserver and intraobserver agreement was evaluated using the kappa coefficient. Effective doses for each imaging sensitivity, specificity and accuracy were assessed and compared with CT as gold standard. ResultsCT detected 15/58 joints with sacroiliitis. The imaging sensitivity, specificity and accuracy were 60%, 84% and 44%, respectively, for radiography and 87%, 91% and 77% for tomosynthesis. The mean effective dose for tomosynthesis was significantly lower than that of CT (5-fold less) and significantly higher than that of radiography (8-fold more). ConclusionTomosynthesis is superior to radiography for sacroiliitis detection in patients with suspected SpA, with 5-fold less radiation exposure than CT.

Zero echo time MRI improved detection of erosions and sclerosis in the sacroiliac joint in comparison with LAVA-flex.

T1-weighted spoiled 3D Gradient Recalled Echo pulse sequences, exemplified by Liver Acquisition with Volume Acceleration-flexible MRI (LAVA-Flex), are currently the preferred MR sequence for detecting erosions of the sacroiliac joint (SIJ). However, zero echo time MRI (ZTE) is recently reported to provide excellent visualization of the cortical bone. To directly compare the diagnostic accuracy of ZTE and LAVA-Flex in the detection of structural lesions of the SIJ, including erosions, sclerosis and joint space changes. Two readers independently reviewed the ldCT, ZTE and LAVA-Flex images of 53 patients diagnosed as axSpA and scored the erosions, sclerosis and joint space changes. Sensitivity, specificity and Cohen's kappa (κ) of ZTE and LAVA-Flex were calculated, while McNemar's test was employed to compare the two sequences for the positivity of detecting the structural lesions. Analysis of diagnostic accuracy showed a higher sensitivity of ZTE in comparison with LAVA-Flex in the depiction of erosions (92.5% vs 81.5%, p<0.001), especially first-degree erosions (p<0.001) and second-degree erosions (p<0.001), as well as sclerosis (90.6% vs 71.2%, p<0.001), but not joint space changes (95.2% vs 93.8%, p=0.332). Agreement with ldCT was also higher in ZTE in the detection of erosions than LAVA-Flex as indicated by the κ values (0.73 vs 0.47), as well as in the detection of sclerosis (0.92 vs 0.22). With ldCT as the reference standard, ZTE could improve diagnostic accuracy of erosions and sclerosis of the SIJ in patients suspected of axSpA, in comparison with LAVA-Flex.

Magnetic Resonance Imaging/Ultrasound Fusion-Guided Corticosteroid Injection to Synovial and Ligamentous Portion of Sacroiliac Joint in Patients with Axial Spondyloarthritis

Magnetic Resonance Imaging/Ultrasound Fusion-Guided Corticosteroid Injection to Synovial and Ligamentous Portion of Sacroiliac Joint in Patients with Axial Spondyloarthritis

Added value of 3D THRIVE (T1-weighted high-resolution isotropic volume examination) MRI pulse sequence in the detection of bony erosions of sacroiliac joints in patients of spondyloarthritis.

Early depiction of bony erosions in sacroiliac (SI) joints increases the diagnostic accuracy of spondyloarthritis. The new 3D magnetic resonance imaging (MRI) sequence THRIVE (T1-weighted high-resolution isotropic volume examination) can depict cartilage erosions in sacroiliac joints. The aim of the study was to compare the diagnostic capacity of the new MRI sequence 3D THRIVE (T1-weighted high-resolution isotropic volume examination) with the routinely used T1 TSE pulse sequence in the depiction of structural erosions in sacroiliac joints by using MRI sequence zero echo time (zero ET) as a reference standard. Seventy five adult patients were included in this study. They underwent MRI sacroiliac joints examination using routine T1 TSE and STIR pulse sequences with the addition of the new 3D THRIVE and zero echo time (zero ET) sequences. Images of T1 TSE, 3D THRIVE, and zero ET sequences were evaluated by 2 radiolo-gists separately for the detection of sacroiliac joints erosions, then a comparison between T1 TSE and 3D THRIVE sequences was done using a CT-like image MRI sequence zero ET as a reference standard. Sensitivity, specificity, and accuracy for each sequence were calculated by the 2 readers. Sensitivity, specificity, and accuracy of 3D THRIVE were higher than those of T1 TSE for reader 1 (sensitivity: 94.5% vs. 86.2%; specificity: 93.4% vs. 85.1%; and accuracy 95.2% vs. 88.5%) and for reader 2 (sensitivity: 93.3% vs. 79.9%; specificity: 94.7% vs. 86.2%; and accuracy 95.8% vs. 82.1%). Using CT-like image MRI sequence zero ET as the reference standard, 3D THRIVE pulse sequencing of the sacroiliac joints has much better diagnostic value in the depiction of bony erosions in patients suspected having spondyloarthritis as compared to the routinely used T1 TSE sequence.

Detection of erosions and fat metaplasia of the sacroiliac joints in patients with suspected sacroiliitis using a chemical shift-encoded sequence (IDEAL-IQ)

PurposeTo evaluate the performance of a chemical shift-encoded sequence called IDEAL-IQ for detecting sacroiliac joint (SIJ) erosions and fat metaplasia compared to T1-weighted fast spin echo (T1 FSE) using qualitative and quantitative analysis. MethodThirty-four patients with suspicion of sacroiliitis who underwent both MRI and CT were included. Each SIJ was divided into four quadrants for analysis. For qualitative analysis, the diagnostic performance of IDEAL-IQ and T1 FSE for erosions were compared by the McNemar test, using CT as the gold standard. Cochran’s Q and McNemar tests were used to determine differences in structural changes detected by different imaging methods. For quantitative analysis, two-sample t test and receiver operating characteristic (ROC) analysis were used for the analysis of histogram parameters of proton density fat fraction (PDFF). ResultsDiagnostic sensitivity and accuracy of IDEAL-IQ were greater than T1 FSE for erosions (all P < 0.05). IDEAL-IQ and CT detected more erosions than T1 FSE (all P < 0.05). IDEAL-IQ did not statistically significantly differ from T1 FSE for the detection of fat metaplasia (P = 0.678). All histogram parameters were different between groups with and without fat metaplasia (all P < 0.05) and could distinguish the two groups (all P < 0.05). PDFF75th was the most effective histogram parameter. ConclusionIDEAL-IQ detects SIJ erosions with better accuracy than T1 FSE and is similar to T1 FSE for detection of fat metaplasia, enabling further quantitative analysis of the latter via histogram analysis.

Effect on ankylosing spondylitis at early-middle stage and bone marrow edema of sacroiliac joint treated with acupuncture and governor vessel moxibustion

To observe the efficacy of the combined treatment with acupuncture and governor vessel moxibustion on ankylosing spondylitis (AS) at early-middle stage and investigate the effect on bone marrow edema of sacroiliac joint. Seventy patients of AS at early-middle stage were randomized into an observation group (35 cases) and a control group (35 cases, 1 case dropped off ). In the control group, the recombinant human tumor necrosis factor receptor-antibody of type Ⅱ fusion protein for injection was injected subcutaneously, 25 mg each time, once on every Monday and Friday, consecutively for 3 weeks. In the observation group, on the base of the intervention as the control group, acupuncture combined with governor vessel moxibustion were provided. Acupuncture was applied to Dazhui (GV 14), Changqiang (GV 1), Zhibian (BL 54), Baihui (GV 20), etc.; the thermal needling technique was adopted at Dazhui (GV 4) and Changqiang (GV 1) for promoting the circulation of the governor vessel, and the ginger-isolated moxibustion on the governor vessel was combined. Such intervention measure was provided once daily. One treatment session contained 7 treatments and 3 sessions were required. Before and after treatment, the scores of Spondyloarthritis Research Consortium of Canada (SPARCC), Bath ankylosing spondylitis disease activity index (BASDAI) and Bath ankylosing spondylitis functional index (BASFI) and Bath ankylosing spondylitis patient global score (BAS-G) were observed in the two groups separately. The efficacy and adverse effects were assessed in the two groups after treatment. The scores of SPARCC, BASDAI, BASFI and BAS-G were all reduced after treatment compared with those before treatment in the two groups (P<0.05), and those in the observation group were lower than the control group (P<0.05). The total effective rate was 97.1% (34/35) in the observation group, higher than 82.4% (28/34) in the control group (P<0.05). There were 4 cases of gastrointestinal reactions and 1 case of skin rashes in the control group; and 3 cases of local skin redness and pruritus after governor vessel moxibustion, no any drug adverse effect was found in the observation group. Based on the western medicine treatment, the combined therapy of acupuncture and governor vessel moxibustion may relieve bone marrow edema of sacroiliac joint in patients with AS at early-middle stage, control the progression of disease and improve the daily life activity. This therapy is relatively safe and effective.

The influence of age on the prevalence of inflammatory and structural MRI lesions in the sacroiliac joints of patients with and without axial spondyloarthritis.

To compare the influence of age on inflammatory (bone marrow oedema [BME]) and structural (fat lesions [FL], erosions and ankylosis) MRI lesions in the sacroiliac joints (SIJ) of patients with and without axial spondyloarthritis (axSpA). In a retrospective study, SIJ MRI (STIR/T1 sequences) of consecutive patients with chronic back pain diagnosed with axSpA or non-SpA were evaluated based on SIJ quadrants (SIJ-Q). Two blinded readers evaluated BME and structural lesions. Reader agreement was evaluated for prevalence of MRI lesions related to age. MRIs of 309 (175 axSpA, 134 non-SpA) patients were evaluated. Their mean age was 38.5 (11.4) and 43.4 (13.8) years, 67% and 36% were male, CRP was 1.6 (2.4) and 1.1 (2.1) mg/dl and median symptom duration was 48 and 60 months for axSpA and non-SpA, respectively. SIJ-Q with BME and erosions were significantly more frequent in axSpA vs non-SpA patients independent of age, while this difference was seen for FL only in patients ≥50 years. The proportion of patients with ≥1 or ≥3 BME or chronic lesions except for FL increased with age in both groups, and was constantly higher in axSpA vs non-SpA. In univariate analyses, only female sex was significantly associated with more FL. The proportion of patients with MRI lesions was high in both axSpA and non-SpA patients. However, the prevalence of BME and erosions was significantly more frequent in patients with axSpA, was independent of age and also allowed for discrimination. FL occurred more frequently only in older age groups and were less reliable for discrimination vs non-SpA patients.

Effects of ixekizumab treatment on structural changes in the sacroiliac joint: MRI assessments at 16 weeks in patients with non-radiographic axial spondyloarthritis.

There is limited understanding regarding the inhibition of structural damage in the sacroiliac joint of patients with non-radiographic axial spondyloarthritis. This study evaluated the effect of the interleukin-17A inhibitor ixekizumab versus placebo on structural lesions in the sacroiliac joints as assessed by MRI at week 16 in patients with non-radiographic axial spondyloarthritis from the COAST-X study. COAST-X was a 52-week, randomised, double-blind, placebo-controlled, parallel-group study done at 107 sites in 15 countries in Europe, Asia, North America, and South America. Eligible participants were adults (aged ≥18 years) with active axial spondyloarthritis without definite radiographic sacroiliitis (non-radiographic axial spondyloarthritis), objective signs of inflammation (via MRI or C-reactive protein), and an inadequate response or intolerance to non-steroidal anti-inflammatory drugs. Patients were randomly allocated to placebo or double-blind ixekizumab 80 mg every 4 weeks (Q4W) or 2 weeks (Q2W), with an 80 mg or 160 mg starting dose. We report a post-hoc analysis of 266 patients with available MRI scans from baseline and week 16. MRI scans were scored using the Spondyloarthritis Research Consortium of Canada (SPARCC) sacroiliac joint structural score (SSS) method independently by two masked readers. Treatment comparisons used analysis of covariance based on observed cases. Correlations were evaluated among changes in SPARCC SSS for erosion, fat lesions, and backfill, and between changes in SPARCC SSS and sacroiliac joint inflammation scores and clinical measures. COAST-X was registered with ClinicalTrials.gov, NCT02757352. Between Aug 2, 2016, and Jan 29, 2018, 303 patients were enrolled to the COAST-X study. 290 (96%) of 303 participants completed the week 16 visit (95 in the ixekizumab Q4W group, 98 in the ixekizumab Q2W group, and 97 in the placebo group), and MRI scans were available for 266 patients at baseline and week 16 (85 in the ixekizumab Q4W group, 91 in the ixekizumab Q2W group, and 90 in the placebo group). Changes from baseline to week 16 in mean SPARCC SSS for erosion were -0·39 for ixekizumab Q4W (p=0·003 vs placebo), -0·40 for ixekizumab Q2W (p=0·002), and 0·16 for placebo; for fat lesions: 0·16 for ixekizumab Q4W (p=0·013), 0·10 for ixekizumab Q2W (p=0·067), and -0·04 for placebo; and for backfill: 0·21 for ixekizumab Q4W (p=0·011), 0·22 for ixekizumab Q2W (p=0·006), and -0·10 for placebo. Ankylosis did not change. Effects of ixekizumab versus placebo on structural changes were most pronounced in patients with baseline inflammation in the sacroiliac joints. Changes from baseline at week 16 in erosion, fat lesions, and backfill were correlated. Although the clinical relevance is not yet clear, patients with non-radiographic axial spondyloarthritis receiving ixekizumab had significant reductions in erosions and increases in fat lesions and backfill in the sacroiliac joints versus placebo at week 16, suggesting an early repair process with ixekizumab treatment. Eli Lilly and Company.

217. Improved outcomes with concurrent instrumentation and fusion of the sacroiliac joint in patients with long lumbosacral constructs

217. Improved outcomes with concurrent instrumentation and fusion of the sacroiliac joint in patients with long lumbosacral constructs

The value of chemical shift imaging and T1-Dixon MRI in evaluation of structural changes in sacroiliac joint in ankylosing spondylitis

BackgroundThe aim of this study was to assess the diagnostic value of dual gradient-echo T1-weighted sequence (in phase and out of phase) and the related Dixon images in evaluation of structural changes observed in sacroiliac joint in patients diagnosed with ankylosing spondylitis. Forty patients with low back pain were included in the study; they underwent T1-Dixon and routine MRI study on the sacroiliac joint in addition to pelvic CT.ResultsThis study was carried out on forty patients, 27 (67.5%) males and 13 (32.5%) females, their mean age was 34.93 ± 11.21 years, and mean duration of symptoms was 8.1 ± 7.4 years. The mean Ankylosing Spondylitis Disease Activity Score ASDAS value was 4.03 ± 0.85 years. The most common structural change was subchondral fat deposition. Dixon MRI was significantly superior to T1WI in simple quantification of the amount of fat with P = 0.036 and excellent inter-rater reliability (96%), P = 0.0001. The number of erosions/backfills detected on Dixon was higher than that detected in T1WI with higher accuracy (97.5%) and excellent inter-rater reliability (95%), P = 0.0001. ASDAS showed significant positive correlation with erosion/backfill (r = 69, P = 0.0001) and with maximal fat deposition detected on Dixon (r = 32, P = 0.044). There were significant difference between the patients having high ASDAS and others having very high ASDAS scores regarding the sub-articular sclerosis (P = 0.013).Conclusion3D T1-based Dixon is a helpful imaging technique in proper assessment of different structural changes in sacroiliitis, its integration into routine MR protocol is recommend as it could yield a better depiction of erosive/backfill and fat deposition.

AB0796 Quantitative bone marrow lesion characterization at the sacroiliac joint with T1-mapping

BackgroundConventional magnetic resonance imaging (MRI) uses T1-weighted and short-tau inversion recovery (STIR) sequences to characterize bone marrow lesions in axial spondyloarthritis. However, quantification is restricted to the extent of marrow lesions because signal intensities are highly variable within and across patients and scanners. Furthermore, some marrow lesions are less visible in MRI and need further characterization with computed tomography (CT), e.g. sclerosis. Quantitative MRI in form of mapping sequences might help to better characterize bone marrow lesions.ObjectivesTo evaluate the performance of T1-mapping for differentiating different bone marrow lesions at the sacroiliac joints in patients with suspected axial spondyloarthritis.MethodsSixty-two patients (mean age 41±12.5; thirty-two were finally diagnosed with axial spondyloarthritis and 30 with another condition) underwent CT and MRI of the sacroiliac joints. Besides standard oblique coronal T1 and STIR sequences a T1-mapping sequence (Modified Look-Locker Inversion Recovery) was added to the protocol. Bone marrow lesions (maximum 4 lesions per patient, 1 lesion of the same type per joint) were characterized by an expert radiologist into four groups, namely sclerosis (lesion type (LT) 1), osteitis (LT2), fat lesion (LT3) and mixed marrow lesions (LTm). Relaxation times on T1-maps were compared using Kruskal-Wallis test correcting for multiple comparisons and correlated to quantitative measures from conventional MRI sequences and CT.Results119 lesions were selected (LT1: 38, LT2: 27, LT3: 40; LTm: 14). T1-map showed highly significant differences between LT1-3 with the lowest values for sclerosis (1522±227 ms), followed by osteitis (1906±82 ms) and fat lesions (2391±200 ms); p&lt;0.0005. However, mixed lesions showed a broad distribution of values (1869±670), irrespective of their characteristics. T1-map correlated to a high degree with conventional T1-values (r = 0.74) and Hounsfield units in CT (r = -0.69) with p &lt; 0.0001, respectively, but not with STIR (p = 0.8).ConclusionT1-Mapping allows for accurately characterizing lesions at the sacroiliac joint in patients with suspected axial spondyloarthritis and, thus, may combine information from two conventional sequences and CT into one in the future while providing superior capacity for quantification. However, in our study mixed lesions and inhomogeneous bone marrow remained problematic. Thus, further sequence development is needed before its implementation in clinical routine.Figure 1.T1-mapping values of the different lesions, LT1: Sclerosis, LT2: Osteitis, LT3: Fat lesion, LTm: Mixed lesion. Differences are highly significant, which allows T1-mapping to characterize those different lesions in one sequence.Disclosure of InterestsTorsten Diekhoff Speakers bureau: Novartis, Eli Lilly, MSD, Canon MS, Consultant of: Novartis, Dominik Deppe: None declared, Denis Poddubnyy: None declared, Katharina Ziegeler: None declared, Fabian Proft: None declared, Kay-Geert Hermann: None declared, Mikhail Protopopov: None declared, Felix Radny: None declared, Marcus Makowski: None declared

Association of Genetic Marker HLA-B27 with Spondyloarthritis In A Tertiary Care Centre In South India

Human leukocyte antigens (HLA) are gene products found in the major histocompatibility complex, aiding in differentiation of “self” from “non-self” antigens, and is crucial for the communication between immune cells of the human body. HLA-B27, in specific, has a strong interrelation with different types of Spondyloarthritis (SpA). The aim of this study is to study the frequency of HLA-B27 in suspected Spondyloarthritis patients presenting with axial and peripheral joint involvement, who attended our tertiary care centre from August-2017 to January-2021. Patients fulfilling Assessment of Spondyloarthritis International Society (ASAS) criteria for Spondyloarthritis were included in the study, and were further classified into Spondyloarthritis sub-groups. Blood samples were collected for CRP and ESR tests along with HLA-B27 detection by RT-PCR method. Magnetic resonance imaging was done for sacroiliac joints in patients with lower back pain. Analysis of 289 samples of SpA patients revealed 156 (54%) to be HLA-B27 positive and 133 (46%) to be HLA-B27 negative. There were 98 patients (63%) with Ankylosing spondylitis, 33 (21%) had Reactive arthritis, 19 (12%) had Psoriatic arthritis, 6 (4%) had Undifferentiated Spondyloarthritis, and inflammatory bowel disease was diagnosed in 0% in HLA-B27 positive Spondyloarthritis patients. The frequency of HLA-B27 among the Spondyloarthritis (SpA) patients in our study was found to be 54% (156), more common clinical manifestation in men belonging to the age group of 16-25 years positive patients. Ankylosing spondylitis (AS) was found to be the most common sub-groups observed among the SpA patients.

Quantification of Fat Metaplasia in the Sacroiliac Joints of Patients With Axial Spondyloarthritis by Chemical Shift-Encoded MRI: A Diagnostic Trial.

ObjectiveTo study the diagnostic performance of chemical shift-encoded MRI (CSE-MRI) in the diagnosis of axial spondyloarthritis (axSpA).MethodsCSE-MRI images were acquired for consecutive patients complaining of back pain as well as healthy volunteers. Proton density fat fraction (PDFF) values were measured independently by two readers. Diagnostic performance of CSE-MRI was analyzed by sensitivity analysis and ROC curve analysis. Logistic regression analysis was employed to investigate the risk factors of extensive fat deposition in the SIJs.ResultsA total of 52 r-axSpA patients, 37 nr-axSpA patients, 24 non-SpA patients and 34 healthy volunteers were included. Mean PDFF values in the SIJs of patients with r-axSpA and nr-axSpA (72.7% and 64.5%) were significantly higher than non-SpA patients and healthy volunteers (56.0% and 57.6%) (p<0.001). By defining extensive fat deposition in the SIJs as ≥8 ROIs with PDFF values over 70%, its sensitivity and specificity in diagnosing axSpA reached 72.47% and 86.21%%. By joining bone marrow edema (BME) with ≥8 ROIs (PDFF>70%), 22 (24.71%) and 23 (25.84%) more axSpA patients were classified as SIJ MRI (+) by reader 1 and 2, but specificities decreased by 15.52% and 10.34%. Multivariate logistic regression analysis confirmed longer disease duration as the independent risk factor of extensive fat deposition in SIJs (OR=1.15, 95%CI[1.03, 1.32]), while bDMARDs medication was a protective factor (OR=0.15, 95%CI[0.04, 0.51]).ConclusionCSE-MRI is a reliable tool to quantitively assess the fat metaplasia in the SIJs of axSpA patients. Extensive fat deposition in the SIJs could add incremental diagnostic value to BME, but at the cost of decreased specificities.

Improved Outcomes with Concurrent Instrumentation and Fusion of the Sacroiliac Joint in Patients with Long Lumbosacral Constructs.

Retrospective Cohort Study. Spinal fusion, specifically constructs connected to pelvic bones, has been consistently reported as a predisposing factor to sacroiliac joint (SIJ) pain. The aim of this study is to compare SIJ outcomes in patients with constructs to the pelvis following instrumentation vs instrumentation plus fusion of the SIJ. Data of study subjects was extracted from a prospectively maintained database as well as retrospectively collected from records at a tertiary academic medical center in the United States between 2018 and 2020. A cohort of 103 patients was divided into 2 groups: 65 in Group 1 [S2AI screw without fusion device] and 38 in Group 2 [S2AI screw with fusion device]. None of the patients in Group 2 developed postoperative SIJ pain compared to 44.6% in Group 1. Sacroiliac joint fusion occurred in all Group 2 but none of Group 1 patients. The postoperative Visual Analogue Scale (VAS) for lower extremity (LE) pain (.8 vs .5; P = .03) and postoperative Oswestry Disability Index (ODI) (18.7 vs 14.2; P < .01) were significantly higher in Group 1. The rate of distal junctional break, failure, and/or kyphosis (DJBFK) and time to DJBFK were not significantly different between the two groups, and the rate of DJBFK did not change in the presence of multiple covariates. The SIJs carry the heavy load of long lumbosacral fusion constructs extending to the pelvis. Simultaneous SIJ instrumentation and fusion decreases the risk of disability, prevents the development of postoperative SIJ pain, and may also protect the S2AI screw from loosening and failure.

Distribution of Acute and Chronic Lesions in the Sacroiliac Joints of Patients with Axial Spondyloarthritis.

ObjectiveIn this study, we aimed to investigate whether there was a pattern of distribution of acute and chronic lesions in the sacroiliac joints (SIJ) of patients with axial spondyloarthritis (axSpA).MethodsA total of 96 patients diagnosed as axSpA were retrospectively included in this study. The Spondyloarthritis Research Consortium of Canada sacroiliac joint inflammation score (SIS) and structural score (SSS) were used to evaluate the acute and chronic lesions in the SIJs. Scores representing the distribution of bone marrow edema, fatty lesions and erosions were extracted respectively. By dividing the SIJs into sacral or iliac sections, upper or lower sections, anterior and posterior levels, differences of scores representing acute and chronic lesions were analyzed by Kruskal Wallis’ tests.ResultsSIS scores were not significantly different in sacral or iliac sections, in upper or lower sections, on anterior or posterior levels. SSS scores were also not significantly different in different sections, except for higher occurrence rates of erosions in the iliac sections. Post-hoc analysis showed that there was a higher erosion score in the left ilium than left sacrum, as well as in right ilium than left sacrum.ConclusionThere was no specific distribution pattern of acute or chronic lesions in the SIJs in patients with axSpA. A bigger study sample was needed to confirm the distribution of erosions in sacral or iliac sections.

Bone cement filling combined with lumbo-iliac screw internal fixation in the treatment of benign sacroiliac joint tumours.

To investigate the method of reconstruction of the sacroiliac joint in patients who underwent benign tumour curettage and analyse the effect of internal fixation with lumbo-iliac screws and connecting rod insertion after filling the defect with bone cement. Twenty-four patients with benign sacroiliac joint tumours underwent curettage and filling of the defect with bone cement, followed by lumbo-iliac screw and connecting rod insertion. The visual analogue scale (VAS) was used to assess pain, and the Musculoskeletal Tumour Society (MSTS) score was used to assess hip function. All patients were followed-up for 24-96 months (average, 42.2months). The postoperative VAS score was significantly lower than the preoperative score (p< 0.05), while the postoperative MSTS score was significantly higher than the preoperative score (p< 0.05). One patient had delayed healing of the surgical incision; no complications occurred in the remaining patients. For benign sacroiliac joint tumours, the combination of filling of defects with bone cement and internal lumbo-iliac fixation can relieve pain quickly, and achieve good limb function.

Біоелектрична активність м’язів-стабілізаторів крижово-клубового суглоба в пацієнтів з дисфункцією цього суглоба

Мета: дослідження біоелектричної активності (БЕА) м’язів — основних стабілізаторів крижово­клубового суглоба (ККС) і вертикальної пози в умовах двохопорного та одноопорного стояння у хворих з дисфункцією ККС порівняно з БЕА цих м’язів у здорових волонтерів. Матеріали та методи. Досліджено 36 практично здорових волонтерів — студентів факультету фізичної культури та 56 пацієнтів з дисфункцією ККС. Критеріями включення пацієнтів були: локалізація болі в ділянці posterior spinae iliaca superior, що іррадіює в пах, сідниці та стегно; анамнез болю більш ніж 3 місяці; безуспішність попереднього консервативного лікування; позитивні мінімум 4 із 6 провокаційних тестів. Критеріями виключення були позитивні тільки 1 або 2 провокаційні тести. В результаті 50 пацієнтів були включені в дослідження. Пацієнтам та волонтерам проводили електроміографічне дослідження м’язів, що стабілізують ККС. Вивчали біоелектричну активність m. erector spinae, m. obliques abdominis externus, m. gluteus medius, m. rectus femoris, m. biceps femoris у положенні двохопорного та одноопорного стояння (тест Stork). Всі волонтери та пацієнти були обстежені рентгенологічно. На отриманих рентгенограмах вимірювали: кут нахилу крижі, кут нахилу таза, кут ротації крижі; ширину суглобових щілин ККС в трьох відділах (вентральному, медіальному та дорсальному). Отримані результати були оброблені статистично. Результати. В результаті кластерного аналізу всі пацієнти з дисфункцією ККС були поділені на 4 кластери. Для 1­го кластера був характерний високий ступінь асиметрії ширини суглобових щілин у вентральному відділі ККС та невеликий в двох остальних відділах, 2­й кластер характеризувався мінімальним ступенем асиметрії ширини суглобових щілин у всіх відділах ККС, 3­й — високим ступенем асиметрії ширини суглобових щілин у медіальному відділі ККС і невеликим у дор­сальному, а 4­й — високим ступенем асиметрії у дорсальному відділі ККС і невеликим у вентальному та медіальному. Аналіз попарних відмінностей значень відокремлених показників БЕА м’язів з групою умовної норми в міжах кластерних типів повністю відповідав характеристикам кластерів з позицій дисфункції ККС: найбільше відходження від показників БЕА в нормі мали пацієнти 4­го кластера, наступними були пацієнти 3­го, потім — 1­го кластера. У пацієнтів 2­го кластера відмінностей з нормою виявлено не було. Висновки. За допомогою кластерного аналізу було встановлено, що всі пацієнти були розподілені на чотири рентгенометричні кластери, для кожного з яких були характерні свої рентгенометричні параметри. Найбільш несприятливий прогноз із математичної та біомеханічної точки зору мали пацієнти 1, 3, 4­го рентгенометричних кластерів. У цих пацієнтів була асиметрія ширини суглобових щілин ККС в двох відділах. Найбільші відмінності БЕА м’язів­стабілізаторів ККС з показниками БЕА цих м’язів волонтерів мали пацієнти 4­го кластера, наступними були пацієнти 3­го, потім — 1­го кластера. У пацієнтів 2­го кластера відмінностей БЕА цих м’язів від показників БЕА м’язів волонтерів виявлено не було.