Role of diffusion-weighted imaging and dynamic contrast enhanced magnetic resonance imaging in the diagnosis of early sacroiliitis in seronegative spondyloarthropathies, correlation with levels of acute phase reactants

Abstract

Objective: Seronegative spondyloarthropathy (SpA) is a destructive disease. Early diagnosis is crucial to prevent morbidity. Magnetic resonance imaging (MRI) is the only imaging modality that can show early sacroiliitis. We aimed to investigate the utility of dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) and diffusion-weighted imaging (DWI) in the detection, quantification and staging of early/acute SpA. We also investigated the relationship between contrast enhancement properties and apparent diffusion coefficient (ADC) values with laboratory parameters for inflammation such as ESR and CRP measurments.

Patients and Methods: Dynamic contrast-enhanced magnetic resonance imaging and DWI were performed on 85 patients that fulfilled the criteria. A positive MRI finding was defined as inflammation in subchondral bone representing active sacroiliitis. Kinetic analyses were performed, apparent diffusion coefficient (ADC) values were calculated, ESR and CRP levels were measured for quantification of inflammation. Statistical analyses were performed.

Results: In acute SpA group; quantity, area and level of enhancement, values of ADC and Fenh, levels of CRP were significantly higher than those with chronic SpA. A high level of agreement was found between the ADC threshold value of 0.831x10(-3) (mm2/s) and diagnosis according to Assessment of SpondyloArthritis International Society (ASAS) criteria (Kappa = 0.794; p < 0.001).

Conclusion: Dynamic contrast-enhanced magnetic resonance imaging and DWI are advanced MR techniques which enable quantification of active inflammation. They are hallmarks for early SpA. Their combined use is superior to one alone in the diagnosis of early sacroiliitis.