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06.06.2018 | Musculoskeletal

Sacroiliac joints: anatomical variations on MR images

verfasst von: Mazen El Rafei, Sammy Badr, Guillaume Lefebvre, Francois Machuron, Benoist Capon, Rene-Marc Flipo, Anne Cotten

Erschienen in: European Radiology | Ausgabe 12/2018

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Abstract

Objective

To describe the appearance of the anatomical variations of the sacroiliac joints (SIJ) on MR images and to highlight the potential MR features that might be misleading.

Methods

Consecutive MRI examinations of SIJs performed at our department from January 2015 to December 2016 were retrospectively analyzed. As one of our goals was to describe potential misleading edematous or structural changes associated with SIJ anatomical variations, patients fulfilling the ASAS criteria were excluded from this study to ensure that signal intensity changes would not be related to sacroiliitis. Five anatomical variations and a dysmorphic appearance of the SIJ were detected.

Results

The final group consisted of 157 patients. Unilateral or bilateral anatomical variations of the SIJ were found in 50 patients (accessory SIJ, iliosacral complex and sacral defect in 17, 18 and 21 patients, respectively, and synostosis in one patient). A dysmorphic appearance of the SIJ was found in 26 patients. No case of an unfused ossification centers was depicted. Structural and/or edematous changes of the facing bones were quite frequently observed in accessory and dysmorphic SIJ. Iliosacral complex and sacral defects could be associated with prominent vessels running along their bony surfaces.

Conclusion

Several anatomical variations of the SIJs are relatively commonly seen on MR images, particularly in females. These variations may be associated with signal intensity changes, which may be mechanical and not necessarily inflammatory in nature.

Key points

• Anatomical variations of SIJ may involve the cartilaginous or ligamentous part of the joint

• Anatomical variations of SIJ are sometimes associated with edematous and/or structural changes of the adjacent bone

• Anatomical variations of the SIJ can be misleading on MR imaging

Laloo F, Herregods N, Varkas G et al (2017) MR signal in the sacroiliac joint space in spondyloarthritis: a new sign. Eur Radiol 27:2024–2030. https://doi.org/10.1007/s00330-016-4587-9 CrossRefPubMed

Rudwaleit M, Jurik AG, K-GA H et al (2009) Defining active sacroiliitis on magnetic resonance imaging (MRI) for classification of axial spondyloarthritis: a consensual approach by the ASAS/OMERACT MRI group. Ann Rheum Dis 68:1520–1527. https://doi.org/10.1136/ard.2009.110767 CrossRefPubMed

Lambert RGW, Bakker PAC, van der Heijde D et al (2016) Defining active sacroiliitis on MRI for classification of axial spondyloarthritis: update by the ASAS MRI working group. Ann Rheum Dis 75:1958–1963. https://doi.org/10.1136/annrheumdis-2015-208642 CrossRefPubMed

Plagou A, Teh J, Grainger AJ et al (2016) Recommendations of the ESSR Arthritis Subcommittee on Ultrasonography in Inflammatory Joint Disease. Semin Musculoskelet Radiol 20:496–506. https://doi.org/10.1055/s-0036-1593533 CrossRefPubMed

Sudoł-Szopińska I, Jurik AG, Eshed I et al (2015) Recommendations of the ESSR Arthritis Subcommittee for the Use of Magnetic Resonance Imaging in Musculoskeletal Rheumatic Diseases. Semin Musculoskelet Radiol 19:396–411. https://doi.org/10.1055/s-0035-1564696 CrossRefPubMed

Marzo-Ortega H, McGonagle D, O’Connor P et al (2009) Baseline and 1-year magnetic resonance imaging of the sacroiliac joint and lumbar spine in very early inflammatory back pain. Relationship between symptoms, HLA-B27 and disease extent and persistence. Ann Rheum Dis 68:1721–1727. https://doi.org/10.1136/ard.2008.097931 CrossRefPubMed

Braun J, van den Berg R, Baraliakos X et al (2011) 2010 update of the ASAS/EULAR recommendations for the management of ankylosing spondylitis. Ann Rheum Dis 70:896–904. https://doi.org/10.1136/ard.2011.151027 CrossRefPubMedPubMedCentral

Weber U, Jurik AG, Lambert RGW, Maksymowych WP (2016) Imaging in spondyloarthritis: controversies in recognition of early disease. Curr Rheumatol Rep 18:58. https://doi.org/10.1007/s11926-016-0607-7 CrossRefPubMed

Postacchini R, Trasimeni G, Ripani F et al (2017) Morphometric anatomical and CT study of the human adult sacroiliac region. Surg Radiol Anat 39:85–94. https://doi.org/10.1007/s00276-016-1703-0 CrossRefPubMed

10.

Demir M, Mavi A, Gümüsburun E et al (2007) Anatomical variations with joint space measurements on CT. Kobe J Med Sci 53:209–217PubMed

11.

Ehara S, el-Khoury GY, Bergman RA (1988) The accessory sacroiliac joint: a common anatomic variant. AJR Am J Roentgenol 150:857–859. https://doi.org/10.2214/ajr.150.4.857 CrossRefPubMed

12.

Prassopoulos PK, Faflia CP, Voloudaki AE, Gourtsoyiannis NC (1999) Sacroiliac joints: anatomical variants on CT. J Comput Assist Tomogr 23:323–327CrossRef

13.

Vleeming A, Schuenke MD, Masi AT et al (2012) The sacroiliac joint: an overview of its anatomy, function and potential clinical implications. J Anat 221:537–567. https://doi.org/10.1111/j.1469-7580.2012.01564.x CrossRefPubMedPubMedCentral

14.

Egund N, Jurik AG (2014) Anatomy and histology of the sacroiliac joints. Semin Musculoskelet Radiol 18:332–339. https://doi.org/10.1055/s-0034-1375574 CrossRefPubMed

15.

Rana SH, Farjoodi P, Haloman S et al (2015) Anatomic evaluation of the sacroiliac joint: a radiographic study with implications for procedures. Pain Physician 18:583–592PubMed

16.

Rosa Neto NS, Vitule LF, Gonçalves CR, Goldenstein-Schainberg C (2009) An accessory sacroiliac joint. Scand J Rheumatol 38:496. https://doi.org/10.3109/03009740903036008 CrossRefPubMed

17.

Klang E, Lidar M, Lidar Z et al (2017) Prevalence and awareness of sacroiliac joint alterations on lumbar spine CT in low back pain patients younger than 40 years. Acta Radiol 1987(58):449–455. https://doi.org/10.1177/0284185116656490 CrossRef

18.

Hadley LA (1950) Accessory sacroiliac articulations with arthritic changes. Radiology 55:403–409. https://doi.org/10.1148/55.3.403 CrossRefPubMed

19.

Fortin JD, Ballard KE (2009) The frequency of accessory sacroiliac joints. Clin Anat 22:876–877. https://doi.org/10.1002/ca.20772 CrossRefPubMed

20.

Benz RM, Daikeler T, Mameghani AT et al (2014) Synostosis of the sacroiliac joint as a developmental variant, or ankylosis due to sacroiliitis? Arthritis Rheumatol 66:2367. https://doi.org/10.1002/art.38691 CrossRefPubMed

21.

Maksymowych WP, Wichuk S, Dougados M et al (2017) MRI evidence of structural changes in the sacroiliac joints of patients with non-radiographic axial spondyloarthritis even in the absence of MRI inflammation. Arthritis Res Ther 19:126. https://doi.org/10.1186/s13075-017-1342-9 CrossRefPubMedPubMedCentral

22.

Bakker PAC, van den Berg R, Lenczner G et al (2017) Can we use structural lesions seen on MRI of the sacroiliac joints reliably for the classification of patients according to the ASAS axial spondyloarthritis criteria? Data from the DESIR cohort. Ann Rheum Dis 76:392–398. https://doi.org/10.1136/annrheumdis-2016-209405 CrossRefPubMed

Titel: Sacroiliac joints: anatomical variations on MR images
verfasst von: Mazen El Rafei
Sammy Badr
Guillaume Lefebvre
Francois Machuron
Benoist Capon
Rene-Marc Flipo
Anne Cotten
Publikationsdatum: 06.06.2018
Verlag: Springer Berlin Heidelberg
Erschienen in: European Radiology / Ausgabe 12/2018
Print ISSN: 0938-7994
Elektronische ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-018-5540-x

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Sacroiliac joints: anatomical variations on MR images