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Zhang H, Huang H, Zhang Y, Tu Z, Xiao Z, Chen J, Cao D. Diffusion-Weighted MRI to Assess Sacroiliitis: Improved Image Quality and Diagnostic Performance of Readout-Segmented Echo-Planar Imaging (EPI) Over Conventional Single-Shot EPI. AJR Am J Roentgenol 2021; 217:450-459. [PMID: 32903053 DOI: 10.2214/ajr.20.23953] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND. DWI using single-shot echo-planar imaging (ss-EPI) is prone to artifacts, signal-intensity dropout, and T2* blurring. Readout-segmented echo-planar imaging (rs-EPI) may improve image quality in DWI of the sacroiliac joints. OBJECTIVE. The purposes of this study were, first, to qualitatively and quantitatively compare image quality between ss-EPI and rs-EPI DWI of the sacroiliac joints; and, second, to evaluate whether ADC values derived from ss-EPI and rs-EPI can differentiate disease activity in patients with axial spondyloarthritis (axSpA). METHODS. This retrospective study included 75 patients who underwent ss-EPI and rs-EPI DWI of the sacroiliac joints. Patients were classified into axSpA (n = 50) and no-ax-SpA (n = 25) groups on the basis of Assessment of SpondyloArthritis International Society (ASAS) criteria. Patients in the axSpA group were assigned to one of four disease activity states using the Ankylosing Spondylitis Disease Activity Score-C-reactive protein (ASDAS-CRP). Two radiologists independently assessed qualitative (overall image quality and diagnostic confidence) and quantitative (ADC, signal-to-noise ratio [SNR], and contrast-to-noise ratio [CNR]) imaging parameters. RESULTS. Readout-segmented EPI provided significantly better overall image quality, diagnostic confidence, SNR, and CNR than ss-EPI (both readers, p < .001). In patients with axSpA, the correlation coefficients (r) of ADC values and ASDAS-CRP values were 0.456 and 0.458 for ss-EPI and 0.537 and 0.558 for rs-EPI. ADCs showed progressive increases with increasing activity state for both sequences, although these increases were more substantial for rs-EPI than for ss-EPI. Across readers, median ADCs for ss-EPI were 0.243 and 0.234 × 10-3 mm2/s for inactive disease, 0.411 and 0.412 × 10-3 mm2/s for moderate disease activity, 0.499 and 0.447 × 10-3 mm2/s for high activity, and 0.671 and 0.575 × 10-3 mm2/s for very high activity (reader 1, p = .011; reader 2, p = .010). Across readers, ADCs for rs-EPI were 0.236 and 0.236 × 10-3 mm2/s for inactive disease, 0.483 and 0.477 × 10-3 mm2/s for moderate disease activity, 0.727 and 0.692 × 10-3 mm2/s for high activity, and 0.902 and 0.803 × 10-3 mm2/s for very high activity (reader 1, p = .002; reader 2, p = .001). ADC values for ss-EPI were significantly different only between the inactive and very high disease activity groups (p < .0083, Bonferroni-corrected threshold). ADC values for rs-EPI were significantly different between the inactive and high, inactive and very high, as well as the moderate and very high disease activity groups (p < .0083, Bonferroni-corrected threshold). CONCLUSION. Readout-segmented EPI significantly improves the image quality of DWI in imaging the sacroiliac joints. In patients with axSpA, activity states are better differentiated by rs-EPI than by ss-EPI. CLINICAL IMPACT. Readout-segmented EPI is a more robust tool than ss-EPI for imaging of axSpA and should be included in routine clinical protocols for MRI of the sacroiliac joints.
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Affiliation(s)
- Hua Zhang
- Department of Radiology, First Affiliated Hospital of Fujian Medical University, 20 Cha-Zhong Rd, Fuzhou, 350005, China
| | - Hongjie Huang
- Department of Radiology, First Affiliated Hospital of Fujian Medical University, 20 Cha-Zhong Rd, Fuzhou, 350005, China
| | - Yuyang Zhang
- Department of Radiology, First Affiliated Hospital of Fujian Medical University, 20 Cha-Zhong Rd, Fuzhou, 350005, China
| | - Zhanhai Tu
- Department of Radiology, First Affiliated Hospital of Fujian Medical University, 20 Cha-Zhong Rd, Fuzhou, 350005, China
| | - Zebin Xiao
- Department of Radiology, First Affiliated Hospital of Fujian Medical University, 20 Cha-Zhong Rd, Fuzhou, 350005, China
| | - Junmin Chen
- Department of Hematology and Rheumatology, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Dairong Cao
- Department of Radiology, First Affiliated Hospital of Fujian Medical University, 20 Cha-Zhong Rd, Fuzhou, 350005, China
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Bradbury LA, Hollis KA, Gautier B, Shankaranarayana S, Robinson PC, Saad N, Lê Cao KA, Brown MA. Diffusion-weighted Imaging Is a Sensitive and Specific Magnetic Resonance Sequence in the Diagnosis of Ankylosing Spondylitis. J Rheumatol 2018; 45:771-778. [PMID: 29449501 DOI: 10.3899/jrheum.170312] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We tested the discriminatory capacity of diffusion-weighted magnetic resonance imaging (DWI) and its potential as an objective measure of treatment response to tumor necrosis factor inhibition in ankylosing spondylitis (AS). METHODS Three cohorts were studied prospectively: (1) 18 AS patients with Bath Ankylosing Spondylitis Disease Activity Index > 4, and erythrocyte sedimentation rate > 25 and/or C-reactive protein > 10 meeting the modified New York criteria for AS; (2) 20 cases of nonradiographic axial spondyloarthritis (nr-axSpA) as defined by the Assessment of Spondyloarthritis international Society (ASAS) criteria; and (3) 20 non-AS patients with chronic low back pain, aged between 18 and 45 years, who did not meet the imaging arm of the ASAS criteria for axSpA. Group 1 patients were studied prior to and following adalimumab treatment. Patients were assessed by DWI and conventional magnetic resonance imaging (MRI), and standard nonimaging measures. RESULTS At baseline, in contrast to standard nonimaging measures, DWI apparent diffusion coefficient (ADC) values showed good discriminatory performance [area under the curve (AUC) > 80% for Group 1 or 2 compared with Group 3]. DWI ADC values were significantly lower posttreatment (0.45 ± 0.433 before, 0.154 ± 0.23 after, p = 0.0017), but had modest discriminating capacity comparing pre- and posttreatment measures (AUC = 68%). This performance was similar to the manual Spondyloarthritis Research Consortium of Canada (SPARCC) scoring system. CONCLUSION DWI is informative for diagnosis of AS and nr-axSpA, and has moderate utility in assessment of disease activity or treatment response, with performance similar to that of the SPARCC MRI score.
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Affiliation(s)
- Linda A Bradbury
- From the Institute of Health and Biomedical Innovation, Queensland University of Technology, Translational Research Institute, Princess Alexandra Hospital; University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital; Royal Brisbane and Women's Hospital; The University of Queensland, School of Medicine, Brisbane, Queensland, Australia.,L.A. Bradbury, MSc, MNPSt, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology at Translational Research Institute; K.A. Hollis, BScN, RN, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology at Translational Research Institute; B. Gautier, PhD, University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital; S. Shankaranarayana, MBBS, PhD, Princess Alexandra Hospital; P.C. Robinson, PhD, FRACP, Royal Brisbane and Women's Hospital; N. Saad, MD, FRANZCR, Princess Alexandra Hospital; K.A. Lê Cao, PhD, University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital; M.A. Brown, MD, PhD, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology at Translational Research Institute
| | - Kelly A Hollis
- From the Institute of Health and Biomedical Innovation, Queensland University of Technology, Translational Research Institute, Princess Alexandra Hospital; University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital; Royal Brisbane and Women's Hospital; The University of Queensland, School of Medicine, Brisbane, Queensland, Australia.,L.A. Bradbury, MSc, MNPSt, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology at Translational Research Institute; K.A. Hollis, BScN, RN, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology at Translational Research Institute; B. Gautier, PhD, University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital; S. Shankaranarayana, MBBS, PhD, Princess Alexandra Hospital; P.C. Robinson, PhD, FRACP, Royal Brisbane and Women's Hospital; N. Saad, MD, FRANZCR, Princess Alexandra Hospital; K.A. Lê Cao, PhD, University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital; M.A. Brown, MD, PhD, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology at Translational Research Institute
| | - Benoît Gautier
- From the Institute of Health and Biomedical Innovation, Queensland University of Technology, Translational Research Institute, Princess Alexandra Hospital; University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital; Royal Brisbane and Women's Hospital; The University of Queensland, School of Medicine, Brisbane, Queensland, Australia.,L.A. Bradbury, MSc, MNPSt, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology at Translational Research Institute; K.A. Hollis, BScN, RN, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology at Translational Research Institute; B. Gautier, PhD, University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital; S. Shankaranarayana, MBBS, PhD, Princess Alexandra Hospital; P.C. Robinson, PhD, FRACP, Royal Brisbane and Women's Hospital; N. Saad, MD, FRANZCR, Princess Alexandra Hospital; K.A. Lê Cao, PhD, University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital; M.A. Brown, MD, PhD, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology at Translational Research Institute
| | - Sateesh Shankaranarayana
- From the Institute of Health and Biomedical Innovation, Queensland University of Technology, Translational Research Institute, Princess Alexandra Hospital; University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital; Royal Brisbane and Women's Hospital; The University of Queensland, School of Medicine, Brisbane, Queensland, Australia.,L.A. Bradbury, MSc, MNPSt, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology at Translational Research Institute; K.A. Hollis, BScN, RN, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology at Translational Research Institute; B. Gautier, PhD, University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital; S. Shankaranarayana, MBBS, PhD, Princess Alexandra Hospital; P.C. Robinson, PhD, FRACP, Royal Brisbane and Women's Hospital; N. Saad, MD, FRANZCR, Princess Alexandra Hospital; K.A. Lê Cao, PhD, University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital; M.A. Brown, MD, PhD, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology at Translational Research Institute
| | - Philip C Robinson
- From the Institute of Health and Biomedical Innovation, Queensland University of Technology, Translational Research Institute, Princess Alexandra Hospital; University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital; Royal Brisbane and Women's Hospital; The University of Queensland, School of Medicine, Brisbane, Queensland, Australia.,L.A. Bradbury, MSc, MNPSt, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology at Translational Research Institute; K.A. Hollis, BScN, RN, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology at Translational Research Institute; B. Gautier, PhD, University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital; S. Shankaranarayana, MBBS, PhD, Princess Alexandra Hospital; P.C. Robinson, PhD, FRACP, Royal Brisbane and Women's Hospital; N. Saad, MD, FRANZCR, Princess Alexandra Hospital; K.A. Lê Cao, PhD, University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital; M.A. Brown, MD, PhD, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology at Translational Research Institute
| | - Nivene Saad
- From the Institute of Health and Biomedical Innovation, Queensland University of Technology, Translational Research Institute, Princess Alexandra Hospital; University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital; Royal Brisbane and Women's Hospital; The University of Queensland, School of Medicine, Brisbane, Queensland, Australia.,L.A. Bradbury, MSc, MNPSt, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology at Translational Research Institute; K.A. Hollis, BScN, RN, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology at Translational Research Institute; B. Gautier, PhD, University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital; S. Shankaranarayana, MBBS, PhD, Princess Alexandra Hospital; P.C. Robinson, PhD, FRACP, Royal Brisbane and Women's Hospital; N. Saad, MD, FRANZCR, Princess Alexandra Hospital; K.A. Lê Cao, PhD, University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital; M.A. Brown, MD, PhD, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology at Translational Research Institute
| | - Kim-Anh Lê Cao
- From the Institute of Health and Biomedical Innovation, Queensland University of Technology, Translational Research Institute, Princess Alexandra Hospital; University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital; Royal Brisbane and Women's Hospital; The University of Queensland, School of Medicine, Brisbane, Queensland, Australia.,L.A. Bradbury, MSc, MNPSt, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology at Translational Research Institute; K.A. Hollis, BScN, RN, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology at Translational Research Institute; B. Gautier, PhD, University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital; S. Shankaranarayana, MBBS, PhD, Princess Alexandra Hospital; P.C. Robinson, PhD, FRACP, Royal Brisbane and Women's Hospital; N. Saad, MD, FRANZCR, Princess Alexandra Hospital; K.A. Lê Cao, PhD, University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital; M.A. Brown, MD, PhD, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology at Translational Research Institute
| | - Matthew A Brown
- From the Institute of Health and Biomedical Innovation, Queensland University of Technology, Translational Research Institute, Princess Alexandra Hospital; University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital; Royal Brisbane and Women's Hospital; The University of Queensland, School of Medicine, Brisbane, Queensland, Australia. .,L.A. Bradbury, MSc, MNPSt, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology at Translational Research Institute; K.A. Hollis, BScN, RN, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology at Translational Research Institute; B. Gautier, PhD, University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital; S. Shankaranarayana, MBBS, PhD, Princess Alexandra Hospital; P.C. Robinson, PhD, FRACP, Royal Brisbane and Women's Hospital; N. Saad, MD, FRANZCR, Princess Alexandra Hospital; K.A. Lê Cao, PhD, University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital; M.A. Brown, MD, PhD, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology at Translational Research Institute.
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