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Frequency and Anatomic Distribution of Magnetic Resonance Imaging Features in the Sacroiliac Joints of Young Athletes
Author(s) -
Weber Ulrich,
Jurik Anne Grethe,
Zejden Anna,
Larsen Ejnar,
Jørgensen Steen Hylgaard,
Rufibach Kaspar,
Schioldan Christian,
SchmidtOlsen Søren
Publication year - 2018
Publication title -
arthritis and rheumatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.106
H-Index - 314
eISSN - 2326-5205
pISSN - 2326-5191
DOI - 10.1002/art.40429
Subject(s) - medicine , sacroiliitis , ice hockey , magnetic resonance imaging , sacroiliac joint , sacrum , quadrant (abdomen) , radiology , physical therapy , nuclear medicine , surgery , physical medicine and rehabilitation
Objective Low‐grade bone marrow edema ( BME ) has been reported in the sacroiliac ( SI ) joints of 25% of healthy individuals and patients with nonspecific mechanical back pain, thus challenging the specificity and predictive value of magnetic resonance imaging ( MRI ) for the discrimination of early spondyloarthritis (SpA). It is unknown whether stress injury in competition sports may trigger BME . This study sought to explore the frequency and anatomic distribution of SI joint MRI lesions in recreational and elite athletes. Methods After pretest calibration, semicoronal MRI scans of the SI joints of 20 recreational runners before and after running and 22 elite ice hockey players were assessed for BME and structural lesions. Three readers assessed the MRI scans in a blinded manner, using an SI joint quadrant–based module; scans from tumor necrosis factor inhibitor–treated patients with SpA served for masking. The readers recorded subjects who met the Assessment of SpondyloArthritis international Society ( ASAS ) definition of active sacroiliitis. For descriptive analysis, the frequency of SI joint quadrants exhibiting BME and structural lesions, as concordantly recorded by ≥2 of 3 readers, and their distribution in 8 anatomic SI joint regions (the upper and lower ilium and sacrum, subdivided in anterior and posterior slices) were determined. Results The proportions of recreational runners and elite ice hockey players fulfilling the ASAS definition of active sacroiliitis, as recorded concordantly by ≥2 of 3 readers, were 30–35% and 41%, respectively. In recreational runners before and after running, the mean ± SD number of SI joint quadrants showing BME was 3.1 ± 4.2 and 3.1 ± 4.5, respectively, while in elite ice hockey players, it was 3.6 ± 3.0. The posterior lower ilium was the single most affected SI joint region, followed by the anterior upper sacrum. Erosion was virtually absent. Conclusion In recreational and elite athletes, MRI revealed BME in an average of 3–4 SI joint quadrants, meeting the ASAS definition of active sacroiliitis in 30–41% of subjects. The posterior lower ilium was the single most affected SI joint region. These findings in athletes could help refine data‐driven thresholds for defining sacroiliitis in early SpA.