A modern 3-dimensional magnetic resonance imaging (MRI) sequence with volumetric interpolated breath-hold examination (MR-VIBE) had higher sensitivity without loss of specificity in detecting erosions of the sacroiliac joints compared with a conventional MRI with T1-weighted sequence, according to a study published in Annals of the Rheumatic Diseases.
With high-contrast imaging of joint spaces and thinner slices provided by state-of-the-art MRI techniques, this prospective cross-sectional study sought to compare the performance of MR-VIBE with the performance of standard-of-care T1-weighted MRI sequence for erosion detection in the sacroiliac joints.
The study included 110 patients (53 men and 57 women) with lower back pain and suspected axial spondyloarthritis (axSpA) and 18 healthy controls matched for age and gender. Participants were evaluated for the presence of erosions on the patient level and erosion sum score using low dose CT imaging as a reference. Sensitivity and specificity of both MRI sequences were assessed in participants (not including the healthy controls). Low-dose CT, MR-T1, and MR-VIBE datasets were anonymized and scored by 2 readers trained to evaluate the images; positive findings required agreement of both readers.
Using low-dose CT findings as a standard reference, MR-VIBE was found to be more sensitive than MR-T1 (95% vs 79%, respectively) with no loss in specificity, maintaining 93% in both MRI sequences. Thirty-eight participants had positive low-dose CT findings; MR-VIBE identified 36 of the 38 patients with erosions, whereas MR-TI identified 30 of 38 patients with erosions. The mean sum score for erosions was higher for MR-VIBE (8.1±9.3; P =.003) vs MR-TI (6.7±8.4; P =.003). The agreement on erosion detection was good for MR-VIBE (kappa =0.71; 95% CI; 0.57-0.84) but only moderate for MR-T1 (kappa =0.56; 95% CI; 0.40-0.71).
Limitations related to the single-center study design indicate that the application of MR-VIBE sequences should be tested and interpreted in a larger multicenter trial. Another limitation was the potential influence of T2 fat-suppressed images available during reading.
Researchers conclude that the 3-dimensional MR-VIBE technique was able to detect erosions in the sacroiliac joints with higher sensitivity and with superior reliability in patients with lower back pain; however, the ability of MR-VIBE to diagnose axSpA was not determined by the study and could be valuable in making a differential diagnosis.
Diekhoff T, Greese J, Sieper J, Poddubnyy D, Hamm B, Herman KGA. Improved detection of erosions in the sacroiliac joints on MRI with volumetric interpolated breath-hold examination (VIBE): results from the SIMACT study [published online August 10, 2018]. Ann Rheum Dis. doi:10.1136/annrheumdis-2018-213393