Presence of axial spondyloarthritis associated sacroiliitis and structural changes on MR enterography: A direct comparison with sacroiliac joint MRI


      • Acute inflammatory and structural changes of the SI joint may readily be available on MRE.
      • MRE may alert physicians to the presence of previously undiagnosed axial spondyloarthritis.
      • MRE reveals important radiologic data on the presence of sacroiliitis.



      To investigate the acute inflammatory and structural changes of sacroiliitis as auxiliary findings on magnetic resonance enterography (MRE) and their presence on closely timed conventional magnetic resonance imaging of the sacroiliac joint (SI joint MRI).

      Materials and methods

      We screened axial spondyloarthritis patients for the simultaneous presence of MREs and SI joint MRIs. Two blinded radiologists evaluated SI joint MRIs and MREs on two separate occasions. We used the Assessment of SpondyloArthritis International Society (ASAS)/Outcome Measures in Rheumatology Network (OMERACT) definitions for SI joint MRI. We implemented previously published standard definitions for osteitis, erosion, sclerosis, and fatty infiltration of SI joint in MREs that contain T1w and T1w post-gadolinium sequences.


      SI joint MRI and MRE images were present in 43 patients. The median time between the two modalities was 14 (0–89) days. Twelve patients had ASAS-defined positive SI joint MRI. Radiologist-1 and radiologist-2 detected osteitis on MRE in nine and eight out of these 12 patients, respectively. The two radiologists detected ankylosis and fatty metaplasia with a complete agreement and sclerosis with an almost perfect agreement. Both radiologists agreed on erosions on SI joint MRI in the same 10 cases. Radiologists did not identify acute inflammatory or structural changes on MRE in patients with a negative SI joint MRI for these lesions.


      Along with intestinal findings, additional reporting of acute inflammatory and structural changes of the SI joint on a MRE is valuable and may alert physicians to the presence of previously not diagnosed axial spondyloarthritis.


      MRE (magnetic resonance enterography;), MRI (magnetic resonance imaging), SI joint (sacroiliac joint), SI joint MRI (magnetic resonance imaging of the sacroiliac joint), axSpA (axial spondyloarthritis), IBD (inflammatory bowel disease), BME (bone marrow edema), ASAS (Assessment of Spondyloarthritis International Society), HASTE (half-Fourier axial single-shot fast spin-echo), TRUFI (true fast imaging with steady-state precession images), STIR (short tau inversion recovery sequences)


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