MRI assessment of bone marrow oedema in the sacroiliac joints of patients with spondyloarthritis: is the SPAIR T2w technique comparable to STIR?

Objective

To compare short tau inversion-recovery (STIR) with another fat saturation method in the assessment of sacroiliac joint inflammation.

Methods

This prospective cross-sectional study comprised 76 spondyloarthritis (SpA) patients who underwent magnetic resonance imaging of the sacroiliac joints in a 1.5-T scanner, using STIR, spectral attenuated inversion recovery (SPAIR) T2w and spectral presaturation with inversion recovery (SPIR) T1w post-contrast sequences.Two independent readers (R1 and R2) assessed the images using the Spondyloarthritis Research Consortium of Canada (SPARCC) score. We assessed agreement of the SPARCC scores for SPAIR T2w and STIR with that for T1 SPIR post-contrast (reference standard) using the St. Laurent coefficient. We evaluated each sequence using the concordance correlation coefficient (CCC).

Results

We observed a strong agreement between STIR and SPAIR T2w sequences. Lin’s CCC was 0.94 for R1 and 0.84 for R2 for STIR and 0.94 for R1 and 0.84 for R2 for SPAIR. The interobserver evaluation revealed a good CCC of 0.79 for SPAIR and 0.78 for STIR.

Conclusion

STIR technique and SPAIR T2w sequence showed high agreement in the evaluation of sacroiliac joint subchondral bone marrow oedema in patients with SpA. SPAIR T2w may be an alternative to the STIR sequence for this purpose.

Key points

? There are no studies evaluating which fat saturation technique should be used. ? SPAIR T2w may be an alternative to STIR for sacroiliac joint evaluation. ? The study will lead to changes in guidelines for spondyloarthritis.

     

Diagnosis of chondral lesions of the knee joint: can MRI replace arthroscopy?

The role of magnetic resonance tomography (MRI) for the diagnosis of chondral lesions of the knee joint is still unclear. The sensitivity of the method ranges from 15% to 96%. The scope of our daily experiences showed that there were considerable deviations between the tomographical and arthoscopical results, which vary from the results of experimental studies. Therefore we have conducted a prospective study to investigate the question of how MRI can replace arthroscopy (ASC) in the diagnosis of cartilage damages in the scope of daily routine. All 195 patients included in this study received a magnetic resonance tomography followed by an arthroscopy. A clear diagnosis of supposition had to be determined before the magnetic resonance tomography. The patients were divided into 3 Groups. Group A ( n =86) received a standard Military Hospital Ulm (MH) MRI — sagittal STIR TSE and PD TSE, coronal and transversal T2 FFE (TR=660 ms, TE=18 ms, FA=30°, 512 matrix). In addition, one sub-Group, AK (n =21) was examined with a special cartilage sequence of the cartilage fs T1 W FFE. Neither patients in Group AK nor in Group A as a whole received any contrast medium. Group B (n =88) was examined with an alternate MRI protocol (Radiological Joint Practice, Neu-Ulm — sagittal T1 SE, T2 SE and T2 FLASH (TR=608 ms, TE=18 ms, FA=20°, 256 matrix), coronal PD fs), employing gadolinium as a contrast medium. 156 cartilage lesions were found arthroscopically. In Group A the sensitivity was 33%, the specificity 99%, and the positive and negative prediction values 75% and 98% respectively. Group B reached a sensitivity of 53% and a specificity of 98%. The positive prediction value was 48% and the negative was 98%. Group AK showed a sensitivity of 38% and specificity of 98%; the positive and negative prediction values came to 50% and 97% respectively. In conclusion, our results indicate that the MRI examination techniques recommended in the literature at present are not able to replace the ASC for the diagnosis of cartilage damages of the knee joint. In view of the high specificity (97%–99%) and the high negative prediction value (97%–98%), MRI is suitable for the exclusion of cartilage lesions. For a negative MRI associated with a cartilage injury, a cautious attitude towards an operative cartilage treatment is therefore justified. Because the MRI can not replace the ASC for diagnostic of cartilage damage, the ASC still has to be seen as the method of choice for the evaluation of cartilage damage.     

Can contrast-enhanced ultrasonography replace multidetector-computed tomography in the detection of liver metastases from colorectal cancer?

Purpose

To compare the sensitivity and specificity of contrast-enhanced ultrasonography (CEUS) and 4-slice multidetector-computed tomography (MDCT) in the detection of liver metastases in patients with colorectal cancer (CRC).

Materials and methods

Candidates for this prospective study were 461 consecutive patients referred to the Department of Colorectal Surgery, Aarhus University Hospital with primary or local recurrence of CRC. The patients underwent liver ultrasonography (US), CEUS, MDCT and intraoperative ultrasonography (IOUS). Fine-needle biopsy was performed on all suspicious lesions. The examinations were interpreted blindly and the combination of US, CEUS, biphasic MDCT, IOUS, follow up and biopsy was the gold standard.

Results

Three hundred and sixty-five patients were included. All patients had undergone preoperative US, CEUS and MDCT and 65.5% had received IOUS. The gold standard found liver metastases in 54 patients (14.8%). Multidetector CT found significantly more metastases than CEUS in 15 (28%) of the patients (p = 0.02). In a patient-by-patient analysis MDCT had a non-significantly higher sensitivity in the detection of liver metastases compared to CEUS (0.89 versus 0.80, p = 0.06). The specificity of CEUS (0.98) was slightly better than that of MDCT (0.94) (p = 0.02).

Conclusion

Multidetector CT found significant more metastases than CEUS, and MDCT had in patient-by-patient analysis a non-significant better sensitivity (p = 0.06) in detecting liver metastases in patients with CRC.     

Which MR sequences should we use for the reliable detection and localization of bone marrow edema in spondyloarthritis?

Objectives

To assess the diagnostic confidence in detecting and localizing areas of bone marrow edema in the sacroiliac joint of patients with suspected spondyloarthritis using a single-plane method and comparing it with multiplanar unenhanced and enhanced methods.

Materials and methods

Patients with clinical suspicion of spondyloarthritis undergoing an MRI of the sacroiliac joint were included in this retrospective study. To assess sacroiliitis, three methods were applied: single-plane (i.e., para-coronal STIR alone), multiplanar unenhanced (i.e., para-coronal STIR and para-axial PD-fs), and multiplanar enhanced method (i.e., para-coronal and para-axial post-contrast T1-fs). Two 4-point scales were used to evaluate, respectively, the diagnostic confidence in detection and localization of bone marrow edema. The distribution of certain and uncertain rating according to signal intensity and size of the lesions was also calculated.

Results

Seventy-four patients met the inclusion criteria. Both multiplanar methods increased the diagnostic confidence in detection (p < 0.001) and localization (p < 0.001) of sacroiliitis; no significant difference occurred between the multiplanar unenhanced and enhanced methods (p = 0.405 and p = 1.00, respectively, for detection and localization). A statistically significant difference between the distributions of certain and uncertain rating for detection based on the size and signal intensity of each lesion emerged (p = 0.006 and p < 0.001, respectively), whereas no statistically significant difference occurred for the confidence of localization (p = 0.452 and p = 0.694, respectively).

Conclusions

The multiplanar methods increased the diagnostic confidence in detection and localization of sacroiliitis. The absence of a significant difference between the proposed unenhanced and enhanced methods suggests that contrast medium is not mandatory for the detection of sacroiliitis.

     

Heterogeneous signal in bone marrow on MRI of children’s feet: a normal finding?

Objective To describe the magnetic resonance (MR) appearances of the bone marrow of children’s feet and to determine their frequency and significance. Design and patients. A review of MR studies obtained in a retrospective series of 35 children with foot pain and in a prospective series of 19 asymptomatic children was performed. The MR appearances on T1-weighted, T2-weighted and STIR sequences were assessed and the frequency of patchy areas of low signal intenstiy on T1-weighted and high signal intenstiy on T2-weighted or STIR sequences was determined and correlated with clinical features. Results and conclusions. Low signal intenstiy on T1-weighted and high signal intenstiy on T2-weighted and STIR sequences were seen in 63% of symptomatic and 57% of asymptomatic children. In all cases where both feet were imaged, the changes were seen bilaterally. The marrow pattern varied from multiple discrete foci to more extensive confluent areas of high signal on the STIR sequence. These appearances are frequent and represent normal variation in the growing skeleton, and should not necessarily be interpreted as a sign of pathology. Received: 2 October 1998 Revision requested: 20 January 1999 Revision received: 18 February 1999 Accepted: 2 March 1999     

MRI of the liver: Can true FISP replace HASTE?

PURPOSE: To determine the diagnostic accuracy of two fast breath-hold magnetic resonance (MR) imaging sequences, half-Fourier acquired single turbo spin-echo (HASTE) and true fast imaging with steady state precession (TrueFISP), for the detection and characterization of focal liver lesions MATERIALS AND METHODS: A total of 186 patients with suspected focal liver lesions were enrolled in this study. All patients underwent the same standardized study protocol including HASTE and TrueFISP. A consensus reading based on all available image data served as a standard of reference for classifying lesions into cysts, hemangiomas, focal nodular hyperplasia, or malignant/other lesions. All malignant lesions, as well as hepatic adenomas and abscesses, were histologically verified. Each separated by an eight-week interval, HASTE and TrueFISP images were retrospectively reviewed in random order for the detection and characterization of focal hepatic lesions. Finally, a receiver operating characteristic (ROC) analysis was calculated. RESULTS: HASTE images had an overall sensitivity of 0.86 and a specificity of 0.91, whereas TrueFISP showed an overall sensitivity and specificity of 0.79 and 0.83, respectively (p>0.1). CONCLUSION: Neither HASTE nor TrueFISP alone are sufficient for the detection and characterization of hepatic lesions.     

Is MRI screening for bone marrow oedema useful in predicting lumbar bone stress injuries in adult male professional cricketers? A New Zealand pilot study

ObjectivesThe aims were to (1) prospectively observe the incidence of bone marrow oedema in asymptomatic adult male domestic professional cricketers during a season and evaluate its relationship to the development of lumbar bone stress injury and (2) further understand the practicalities of implementing a Magnetic Resonance Imaging-based screening program to prevent lumbar bone stress injury in New Zealand cricket.DesignProspective observational cohort.MethodsAdult male pace bowlers received 6-weekly pre-planned Magnetic Resonance Imaging scans over a single season to determine the presence and intensity of bone marrow oedema in the posterior vertebral arches of the lumbar spine. The participants bowling volume and back pain levels were monitored prospectively.Results22 participants (mean age 25.3 years (range 20–32 years)) completed all 4 scans. Ten participants had a prior history of lumbar bone stress injury. Ten participants (45 %, 95 % confidence interval 24-68 %) had bone marrow oedema evident on at least one scan, with 9 (41 %) participants recording a bone marrow oedema intensity ≥ 2 and 5 (23 %) participants demonstrated an intensity ≥ 3. During the study one participant was diagnosed with a lumbar bone stress reaction. No participants developed a lumbar bone stress fracture.ConclusionsDue to the lower incidence of lumbar bone stress injuries in adult bowlers coupled with uncertainty over appropriate threshold values for bone marrow oedema intensity, implementation of a resource intense screening program aimed at identifying adult domestic cricketers at risk of developing a lumbar bone stress injury is not currently supported.     

Is there a need for contrast-enhanced T1-weighted MRI of the spine after inconspicuous short τ inversion recovery imaging?

To assess the use of contrast-enhanced T1-weighted images in comparison with short inversion recovery (STIR) images for the detection of vertebral bone marrow abnormalities. A total of 201 vertebral magnetic resonance (MR) examinations were included in a prospective trial. Examinations were performed on a 0.5-T MR scanner. The examination protocol included STIR, T2-weighted turbo spin-echo and T1-weighted spin-echo images before and after administration of gadopentetate dimeglumine. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of STIR images were calculated. In the case of abnormal STIR images the additional information from contrast-enhanced images was evaluated using Fishers exact test. The value of the combined evaluation of STIR and contrast-enhanced T1-weighted images was compared with that of the combined assessment of T2-weighted and contrast-enhanced T1-weighted images. The PPV and the NPV of STIR images for detection of vertebral bone marrow abnormalities were 99.3 and 95.9%. In the case of normal STIR images no relevant additional information was found with contrast-enhanced T1-weighted images, while in the case of abnormal STIR images significant supplementary information was obtained. There was no difference in the diagnostic value when comparing combined assessment of STIR and contrast-enhanced T1-weighted images with combined evaluation of T2-weighted and contrast-enhanced T1-weighted images. Normal STIR images allow contrast-enhanced T1-weighted images for detection of bone marrow abnormalities to be omitted, whereas further imaging is needed in case of abnormal STIR images.     

“One-stop-shop” staging: Should we prefer FDG-PET/CT or MRI for the detection of bone metastases?

Aim

The aim of this study was to compare the diagnostic accuracy of fully diagnostic, contrast-enhanced whole-body FDG-PET/CT and whole-body MRI for detection of bone metastases in patients suffering from newly diagnosed non-small cell lung cancer and malignant melanoma.

Material and Methods

109 consecutive non-small cell lung cancer (n = 54) and malignant melanoma (n = 55) patients underwent whole-body FDG-PET/CT and whole-body MRI for initial tumor staging. All images were evaluated by four experienced physicians (three radiologists, one nuclear medicine physician). The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for detection of bone metastases were determined for both modalities. Statistically significant differences between FDG-PET/CT and MRI were calculated with Fisher's Exact test (p < 0.05). Clinical and imaging follow-up data with a mean follow-up time of 434 days served as the reference standard.

Results

According to the reference standard 11 patients (10%) suffered from bone metastases. The sensitivity, specificity, PPV, NPV, and accuracy for the detection of osseous metastases was 45%, 99%, 83%, 94%, and 94% with whole-body FDG-PET/CT and 64%, 94%, 54%, 96%, and 91% with whole-body MRI. The difference was not statistically significant (p = 0.6147).

Conclusions

FDG-PET/CT and MRI seem to be equally suitable for the detection of skeletal metastases in patients suffering from newly diagnosed non-small cell lung cancer and malignant melanoma. Both modalities go along with a substantial rate of false-negative findings requiring a close follow-up of patients who are staged free of bone metastases at initial staging.     

Osteoarthritis of the knee at 3.0 T: comparison of a quantitative and a semi-quantitative score for the assessment of the extent of cartilage lesion and bone marrow edema pattern in a 24-month longitudinal study

Objective  

To compare a semi-quantitative and a quantitative morphological score for assessment of early osteoarthritis (OA) evolution.     

Lung MRI at 3.0 T: a comparison of helical CT and high-field MRI in the detection of diffuse lung disease

The purpose of this study was to evaluate the feasibility of high-field magnetic resonance imaging (MRI) of the lung using a T2-weighted fast-spin echo (TSE) sequence. Comparison was made with helical computed tomography CT findings in patients with diffuse pulmonary diseases. Prospective segment-wise analysis of high-field MR imaging findings in 15 patients with diffuse pulmonary diseases was made using helical CT and HRCT as the standard of reference. The MR studies were performed on a 3.0-T whole body system (Intera 3T, Philips Medical Systems) using a T2w TSE sequence with respiratory and cardiac gating (TE 80 ms TR 1,500–2,500 ms; turbo factor 17; 22 slices with 7/2-mm slice thickness and gap; 256×192 matrix). MR artifacts were graded on a three-point scale (low, moderate, high). Lung MR studies were prospectively analyzed segment-by-segment and diagnosed as healthy or pathological; results were compared with helical CT findings. In all 15 patients, MR imaging of the lung was successful. All 15 MR studies were compromised by artifacts; however, the severity of these artifacts was classified as low or moderate in 8/15, respectively, 7/15 cases. A total of 143/285 lung segments showed diffuse lung disease in helical CT. With MRI, 133 of these 143 segments (93%) were judged to be diseased. The ten segments that received false negative MR diagnoses displayed non-acute pulmonary lesions with inherently low proton density (scars, granulomas). MRI at 3.0 T can detect diffuse pulmonary disease with a high sensitivity. Based on this experience, further pulmonary studies with high-field systems appear justified and promising.     

Comparison of T2-weighted and contrast-enhanced T1-weighted MR imaging at 1.5?T for assessing the local extent of cervical carcinoma

Objective  

To compare two MR sequences at 1.5 T—T2-weighted and contrast-enhanced T1-weighted images—by using macroscopic sections to determine which image type enables the most accurate assessment of cervical carcinoma.     

Vesicoureteral reflux: can the urethra be adequately assessed by using contrast-enhanced voiding US of the bladder?

PURPOSE: To prospectively evaluate contrast material-enhanced voiding ultrasonography (US) for assessment of the urethra by using voiding cystourethrography (VCUG) as the reference standard. MATERIALS AND METHODS: This study was approved by the ethics committee on human research. Written informed consent was obtained for all patients. A total of 146 pediatric patients suspected of having vesicoureteral reflux underwent US with a galactose-based contrast agent. The bladder was instilled with contrast agent and then filled with saline. US images of the urethra were videotaped before catheterization and during voiding. VCUG was subsequently performed in all patients. In female patients, the probe (a 3.5- or 5-MHz sector array or a 7.5-MHz linear transducer) was positioned longitudinally between the labia. In male patients, the transducer was placed longitudinally on the scrotum and then displaced distally toward the penile urethra. During voiding, attention was focused on the distention of the urethral walls and on the caliber of both the posterior and anterior urethra, which were measured with calipers. Sensitivity and specificity were estimated by using a confidence interval (CI) of 95%. RESULTS: All female patients and 75 male patients showed a normal urethra at both US and VCUG. Posterior urethral valves (PUV) were diagnosed in three patients at voiding US and were confirmed with findings from VCUG. Urethral stenosis was diagnosed in two male patients at voiding US and was confirmed with findings from VCUG. Seven male patients who had undergone surgery for PUV were adequately evaluated with both modalities. Sensitivity of voiding US was 100% (CI 95%: 96.5%, 100%); specificity was 100% (CI 95%: 69.9%, 100%). CONCLUSION: Voiding US is a reliable imaging modality for studying the urethra.     

Perfusion parameters analysis of the vertebral bone marrow in patients with Ph¹⁻ chronic myeloproliferative neoplasms (Ph(neg) MPN): a dynamic contrast-enhanced MRI (DCE-MRI) study

Purpose:

To evaluate perfusion parameters of the vertebral bone marrow in patients with Philadelphia negative chronic myeloproliferative neoplasms (Ph^negMPN) using dynamic contrast‐enhanced MRI (DCE‐MRI).

Materials and Methods:

The study enrolled 24 patients with Ph^negMPN: 12 patients with myelofibrosis (Group A), 6 with essential thrombocythemia (ET), and 6 with polycythemia vera (PV) (Group B) who underwent DCE‐MRI of the lumbosacral spine. Twelve normal individuals served as control group (Group C). Wash‐in (WIN), wash‐out (WOUT), maximum contrast‐enhancement (CE), time‐to‐peak (TTPK), time‐to‐maximum slope (TMSP), and the WIN/TMSP ratio (WTSP) were calculated.

Results:

WIN, CE_max, and WTSP parameters were higher in Group A than in Group C (P < 0.05). These parameters were significant (P < 0.0001) in discriminating patients with myelofibrosis from normal individuals with sensitivities 74.14%, 87.93%, 74.14%, and specificities 91.07%, 83.93%, 91.07%, respectively. WIN, WOUT, CE_max, and WTSP parameters were higher in Group A than in Group B (P < 0.05). Group B exhibited no differences in perfusion parameters as compared with Group C with the exception of WOUT.

Conclusion:

Patients with myelofibrosis exhibited increased perfusion parameters in vertebral bone marrow, which could be consisted with increased vascularity, probably related to neoangiogenesis as opposed to ET or PV patients showing no increased perfusion. DCE‐MRI may be of value in discriminating subgroups of Ph^negMPN patients and in indicating those progressing to myelofibrosis. J. Magn. Reson. Imaging 2012;35:696‐702. © 2011 Wiley Periodicals, Inc.