Development and Validation of MRI Sacroiliac Joint Scoring Methods for the Semiaxial Scan Plane Corresponding to the Berlin and SPARCC MRI Scoring Methods, and of a New Global MRI Sacroiliac Joint Method.

OBJECTIVE: To develop semiaxial magnetic resonance imaging (MRI) scoring methods for assessment of sacroiliac joint (SIJ) bone marrow edema (BME) in patients with axial spondyloarthritis, and to compare the reliability with equivalent semicoronal scoring methods. METHODS: Two semiaxial SIJ MRI scoring methods were developed based on the principles of the semicoronal Berlin and Spondyloarthritis Research Consortium of Canada (SPARCC) methods. A global quadrant-based method was also developed. Baseline and 12-week MRI of the SIJ from 51 patients participating in a randomized double-blind placebo-controlled trial of adalimumab 40 mg every other week versus placebo were scored by the semiaxial and the corresponding semicoronal methods. Results were compared by linear regression analysis. The reproducibility and sensitivity were evaluated by intraclass correlation coefficients (ICC) and smallest detectable change [SDC, absolute values and percentage of the highest observed score (SDC-HOS)]. RESULTS: Interreader and intrareader ICC were moderate to very high for semiaxial scoring methods (baseline 0.83-0.88 and 0.85-0.97; change 0.33-0.78), while high to very high for semicoronal scoring methods (baseline 0.90-0.92 and 0.93-0.97; change 0.77-0.89). Association between semiaxial and semicoronal scores were high for both the Berlin and SPARCC method (baseline: R2 = 0.93 and 0.88; change: R2 = 0.82 and 0.87, respectively), while lower for the global method (baseline: R2 = 0.79; change: R2 = 0.54). The SDC-HOS were 9.8-18.6% and 5.9-10.7% for the semiaxial and semicoronal methods, respectively. CONCLUSION: Detection of SIJ BME in the semiaxial scan plane is feasible and reproducible. However, a slightly lower reliability of all 3 semiaxial methods supports the general practice of using the coronal scan-plane in therapeutic studies.

Optimal set-up for ultrasound guided punctures using new scanner applications: an in-vitro study.

OBJECTIVE: To investigate if US-visualisation of the needle tip echo during US-guided punctures could be improved by use of new technological applications. METHOD: an US-guided 18 G Trocar needle was inserted into targets of a puncture phantom. The punctures were performed in series of 10 using different settings of the US-scanner (GE Logic 700 Expert). At 7-cm of puncture depth the quality of the echo was tested using four different settings; normal (N), N + automatic tissue optimising (ATO), coded harmonic imaging (CHI), CHI + ATO and at 13-cm of puncture depths six different settings; N, N + ATO, coded excitation (CE), CE+ATO, CHI, CHI+ATO. In total 100 (40 + 60) images were randomly numbered and read independently by three radiologists with regard to scoring of the quality of the echoes from the needle tip, needle shaft and the target. RESULTS: US visualisation of the needle tip was significantly (P < 0.005) improved as compared to normal settings (N) when the settings of ATO and CE were used. CHI resulted in the lowest score. A high agreement between observers was registered. Similar results were registered with regard to scorings from the needle shaft and target. CONCLUSION: Not only changes of needle designs and puncture techniques can enhance echoes from the needle but also changes in the settings of the US-scanner with the use of new technological applications can improve visualisation of the needle echo.