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Diagnostic and Interventional MRI of the Sacroiliac Joints Using a 1.5-T Open-Bore Magnet: A One-Stop-Shopping Approach

¹ The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 600 N Wolfe St., Baltimore, MD 21287.
² Department of Diagnostic Radiology, Eberhard-Karls-University Tübingen, Tübingen, Germany.
³ Department of Internal Medicine, Division of Rheumatology, Eberhard-Karls-University Tübingen, Tübingen, Germany.

View larger version (21K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1 —Flow diagram shows study design.

View larger version (130K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —32-year-old woman with clinical diagnosis of nonspecific lower back pain suspected to originate from sacroiliac joints who underwent combined diagnostic and interventional MRI of sacroiliac joints. Visual analog scale (VAS) score was 7 on 11-point scale (0 = no pain, 10 = worst pain) before diagnostic MRI. Photograph shows setup for diagnostic MRI of sacroiliac joints with patient in prone position and use of body matrix coil. Because diagnostic MR images showed normal findings, diagnostic sacroiliac joint injections were performed.

View larger version (125K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —32-year-old woman with clinical diagnosis of nonspecific lower back pain suspected to originate from sacroiliac joints who underwent combined diagnostic and interventional MRI of sacroiliac joints. Visual analog scale (VAS) score was 7 on 11-point scale (0 = no pain, 10 = worst pain) before diagnostic MRI. Bilateral needle paths (white lines) were planned on axial T1-weighted turbo spin-echo MR image (TR/TE, 400/17; slice thickness, 4 mm; field of view [FOV], 22 cm; FOV phase, 100%; base resolution, 320; phase resolution, 75%; acquisition time, 3 minutes 45 seconds).

View larger version (136K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2C —32-year-old woman with clinical diagnosis of nonspecific lower back pain suspected to originate from sacroiliac joints who underwent combined diagnostic and interventional MRI of sacroiliac joints. Visual analog scale (VAS) score was 7 on 11-point scale (0 = no pain, 10 = worst pain) before diagnostic MRI. Photograph shows interventional phase with puncture sites prepared and draped for MR-guided injection of sacroiliac joints.

View larger version (102K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2D —32-year-old woman with clinical diagnosis of nonspecific lower back pain suspected to originate from sacroiliac joints who underwent combined diagnostic and interventional MRI of sacroiliac joints. Visual analog scale (VAS) score was 7 on 11-point scale (0 = no pain, 10 = worst pain) before diagnostic MRI. FLASH 2D MR sequence (9.3/3.5; slice thickness, 5 mm; FOV, 36 cm; FOV phase, 75%; base resolution, 256; phase resolution, 56%; bandwidth, 170 Hz; acquisition time, 1 second) for continuous MRI guidance shows determination of skin entry points using syringe filled with gadolinium-enhanced saline (arrowhead) and subsequent joint puncture (arrows). Real-time imaging guided joint puncture, Figure S2F, can be seen in the AJR electronic supplement to this article, available at www.ajronline.org.

View larger version (125K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2E —32-year-old woman with clinical diagnosis of nonspecific lower back pain suspected to originate from sacroiliac joints who underwent combined diagnostic and interventional MRI of sacroiliac joints. Visual analog scale (VAS) score was 7 on 11-point scale (0 = no pain, 10 = worst pain) before diagnostic MRI. Coronal oblique fat-saturated T1-weighted spin-echo MR image obtained after bilateral sacroiliac joint injections shows intraarticular accumulation of injectant (arrows). Thirty minutes after procedure VAS score had decreased to 2, indicating that sacroiliac joints were contributing significantly to patient's chronic lower back pain.

View larger version (9K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —Curve estimation regression analysis of different phases of procedure and total length of time of procedures over 12-month period. Graphs show significant accelerations of all phases compatible with significant learning curve. Solid lines indicate median time. f(x) = function of exponential decay curve, r = correlation coefficient, p = significance level. Diagnostic phase.

View larger version (10K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —Curve estimation regression analysis of different phases of procedure and total length of time of procedures over 12-month period. Graphs show significant accelerations of all phases compatible with significant learning curve. Solid lines indicate median time. f(x) = function of exponential decay curve, r = correlation coefficient, p = significance level. Interventional phase.

View larger version (10K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3C —Curve estimation regression analysis of different phases of procedure and total length of time of procedures over 12-month period. Graphs show significant accelerations of all phases compatible with significant learning curve. Solid lines indicate median time. f(x) = function of exponential decay curve, r = correlation coefficient, p = significance level. Postinterventional phase.

View larger version (10K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3D —Curve estimation regression analysis of different phases of procedure and total length of time of procedures over 12-month period. Graphs show significant accelerations of all phases compatible with significant learning curve. Solid lines indicate median time. f(x) = function of exponential decay curve, r = correlation coefficient, p = significance level. Total time needed for procedure (i.e., all three phases).

View larger version (20K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4 —Changes of 11-point visual analog scale (VAS) score (0 = no pain, 10 = worst pain) after diagnostic sacroiliac joint injections on day of procedure (baseline) and 30 minutes after procedure divided into positive test results and negative test results. Line diagrams represent individual changes in VAS score.

View larger version (14K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5A —Changes after therapeutic sacroiliac joint injections on day of procedure (baseline) and 3 months. Visual analog scale (VAS) score, volume of subchondral sacroiliac STIR hyperintensity (volumehyper), and average signal intensity of subchondral sacroiliac STIR hyperintensity (SIRelHyper) significantly decreased. Line diagrams show individual changes.

View larger version (16K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5B —Changes after therapeutic sacroiliac joint injections on day of procedure (baseline) and 3 months. Visual analog scale (VAS) score, volume of subchondral sacroiliac STIR hyperintensity (volumehyper), and average signal intensity of subchondral sacroiliac STIR hyperintensity (SIRelHyper) significantly decreased. Line diagrams show individual changes.

View larger version (13K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5C —Changes after therapeutic sacroiliac joint injections on day of procedure (baseline) and 3 months. Visual analog scale (VAS) score, volume of subchondral sacroiliac STIR hyperintensity (volumehyper), and average signal intensity of subchondral sacroiliac STIR hyperintensity (SIRelHyper) significantly decreased. Line diagrams show individual changes.

View larger version (121K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6A —24-year-old woman who underwent combined diagnostic and interventional MRI of sacroiliac joints. Inflammatory arthropathy was diagnosed on diagnostic MRI, which was followed by therapeutic sacroiliac joint injections. STIR MR images of sacroiliac joints obtained at baseline (A) and 3 months after intervention (B) show marked decrease of subchondral sacroiliac STIR hyperintensity as pathologic correlate of sacroiliitis.

View larger version (111K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6B —24-year-old woman who underwent combined diagnostic and interventional MRI of sacroiliac joints. Inflammatory arthropathy was diagnosed on diagnostic MRI, which was followed by therapeutic sacroiliac joint injections. STIR MR images of sacroiliac joints obtained at baseline (A) and 3 months after intervention (B) show marked decrease of subchondral sacroiliac STIR hyperintensity as pathologic correlate of sacroiliitis.

View larger version (89K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6C —24-year-old woman who underwent combined diagnostic and interventional MRI of sacroiliac joints. Inflammatory arthropathy was diagnosed on diagnostic MRI, which was followed by therapeutic sacroiliac joint injections. Pixel-based morphometry of volume of STIR hyperintensity (volumehyper)corresponding to A and B. Volumehyper decreased from 15.2 cm3 (coefficient of variation [CV] = 4.3%) to 3.1 cm3 (CV = 7.0%), whereas average relative signal intensity of sacroiliac STIR hyperintensity (SIRelHyper) decreased from 1.43 (CV = 1.4%) to 0.73 (CV = 2.1%).

View larger version (88K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6D —24-year-old woman who underwent combined diagnostic and interventional MRI of sacroiliac joints. Inflammatory arthropathy was diagnosed on diagnostic MRI, which was followed by therapeutic sacroiliac joint injections. Pixel-based morphometry of volume of STIR hyperintensity (volumehyper)corresponding to A and B. Volumehyper decreased from 15.2 cm3 (coefficient of variation [CV] = 4.3%) to 3.1 cm3 (CV = 7.0%), whereas average relative signal intensity of sacroiliac STIR hyperintensity (SIRelHyper) decreased from 1.43 (CV = 1.4%) to 0.73 (CV = 2.1%).

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