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Magnetic resonance imaging of pelvic entheses—a systematic comparison between short tau inversion recovery (STIR) and T1-weighted, contrast-enhanced, fat-saturated sequences

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Abstract

Objective

To assess the contribution of contrast material in detecting and evaluating enthesitis of pelvic entheses by MRI.

Materials and methods

Sixty-seven hip or pelvic 1.5-T MRIs (30:37 male:female, mean age: 53 years) were retrospectively evaluated for the presence of hamstring and gluteus medius (GM) enthesitis by two readers (a resident and an experienced radiologist). Short tau inversion recovery (STIR) and T1-weighted pre- and post-contrast (T1+Gd) images were evaluated by each reader at two sessions. A consensus reading of two senior radiologists was regarded as the gold standard. Clinical data was retrieved from patients’ referral form and medical files. Cohen’s kappa was used for intra- and inter-observer agreement calculation. Diagnostic properties were calculated against the gold standard reading.

Results

A total of 228 entheses were evaluated. Gold standard analysis diagnosed 83 (36 %) enthesitis lesions. Intra-reader reliability for the experienced reader was significantly (p = 0.0001) higher in the T1+Gd images compared to the STIR images (hamstring: k = 0.84/0.45, GM: k = 0.84/0.47). Sensitivity and specificity increased from 0.74/0.8 to 0.87/0.9 in the STIR images and T1+Gd sequences. Intra-reader reliability for the inexperienced reader was lower (p > 0.05).

Conclusions

Evidence showing that contrast material improves the reliability, sensitivity, and specificity of detecting enthesitis supports its use in this setting.

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Funding

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Competing interests

None.

Ethics approval

SMC-9621-12.

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Not commissioned; external peer reviewed.

Contributors

All authors contributed to the manuscript.

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Authors and Affiliations

  1. Department of Diagnostic Imaging, Sheba Medical Center, Tel Aviv University, Tel Hashomer, 52621, Tel Aviv, Israel

    Eyal Klang, Dvora Aharoni, Uri Rimon & Iris Eshed

  2. Department of Radiology, Charite University Hospital, Berlin, Germany

    Kay-Geert Hermann

  3. Department of Orthopedic Surgery, Sheba Medical Center, Tel-Hashomer, Israel

    Amir Herman & Nachshon Shazar

  4. The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

    Amir Herman

Authors
  1. Eyal Klang
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  2. Dvora Aharoni
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  3. Kay-Geert Hermann
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  4. Amir Herman
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  5. Uri Rimon
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  6. Nachshon Shazar
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  7. Iris Eshed
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Correspondence to Iris Eshed.

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Klang, E., Aharoni, D., Hermann, KG. et al. Magnetic resonance imaging of pelvic entheses—a systematic comparison between short tau inversion recovery (STIR) and T1-weighted, contrast-enhanced, fat-saturated sequences. Skeletal Radiol 43, 499–505 (2014). https://doi.org/10.1007/s00256-013-1814-1

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  • DOI: https://doi.org/10.1007/s00256-013-1814-1

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