Zero echo time MRI improved detection of erosions and sclerosis in the sacroiliac joint in comparison with LAVA-flex

Churong Lin; Dong Liu; Huiquan Wen; Budian Liu; Liudan Tu; Jieruo Gu

doi:10.3389/fendo.2023.1167334

Zero echo time MRI improved detection of erosions and sclerosis in the sacroiliac joint in comparison with LAVA-flex

Front Endocrinol (Lausanne). 2023 May 29:14:1167334. doi: 10.3389/fendo.2023.1167334. eCollection 2023.

Authors

Churong Lin¹, Dong Liu², Huiquan Wen¹, Budian Liu², Liudan Tu², Jieruo Gu²

Affiliations

¹ Department of Radiology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China.
² Department of Rheumatology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China.

Abstract

Background: T1-weighted spoiled 3D Gradient Recalled Echo pulse sequences, exemplified by Liver Acquisition with Volume Acceleration-flexible MRI (LAVA-Flex), are currently the preferred MR sequence for detecting erosions of the sacroiliac joint (SIJ). However, zero echo time MRI (ZTE) is recently reported to provide excellent visualization of the cortical bone.

Purpose: To directly compare the diagnostic accuracy of ZTE and LAVA-Flex in the detection of structural lesions of the SIJ, including erosions, sclerosis and joint space changes.

Materials and methods: Two readers independently reviewed the ldCT, ZTE and LAVA-Flex images of 53 patients diagnosed as axSpA and scored the erosions, sclerosis and joint space changes. Sensitivity, specificity and Cohen's kappa (κ) of ZTE and LAVA-Flex were calculated, while McNemar's test was employed to compare the two sequences for the positivity of detecting the structural lesions.

Results: Analysis of diagnostic accuracy showed a higher sensitivity of ZTE in comparison with LAVA-Flex in the depiction of erosions (92.5% vs 81.5%, p<0.001), especially first-degree erosions (p<0.001) and second-degree erosions (p<0.001), as well as sclerosis (90.6% vs 71.2%, p<0.001), but not joint space changes (95.2% vs 93.8%, p=0.332). Agreement with ldCT was also higher in ZTE in the detection of erosions than LAVA-Flex as indicated by the κ values (0.73 vs 0.47), as well as in the detection of sclerosis (0.92 vs 0.22).

Conclusion: With ldCT as the reference standard, ZTE could improve diagnostic accuracy of erosions and sclerosis of the SIJ in patients suspected of axSpA, in comparison with LAVA-Flex.

Keywords: LAVA; MRI; axSpA; structural lesions; zero echo time (ZTE).

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Cortical Bone
Humans
Joints
Magnetic Resonance Imaging*
Sacroiliac Joint* / diagnostic imaging
Sclerosis / diagnostic imaging

Grants and funding

This work was supported by grants from the National Natural Science Foundation of China (81871294); the Science and Technology Planning Project of Guangdong Province, China (2019B030316004); Guangdong Clinical Research Center of Immune diseases (2020B1111170008).