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Magnetic resonance imaging of sacroiliitis in children: frequency of findings and interobserver reliability

Research output: Contribution to journalArticle

  • Katharine E. Orr
  • Savvas Andronikou
  • Marc James Bramham
  • Izidora Holjar-Erlic
  • Flavia Menegotto
  • Athimalaipet V. Ramanan
Original languageEnglish
Pages (from-to)1621-1628
Number of pages8
JournalPediatric Radiology
Issue number11
Early online date9 Jul 2018
DateAccepted/In press - 13 Jun 2018
DateE-pub ahead of print - 9 Jul 2018
DatePublished (current) - 1 Oct 2018


Background: Clinicians increasingly rely on imaging in juvenile idiopathic arthritis (JIA) to identify sacroiliitis and guide treatment. However, there is limited evidence about magnetic resonance imaging (MRI) for sacroiliitis in children, and interobserver reliability is variable. Objective: Identify the frequency of MRI findings in children with suspected sacroiliitis, calculate inter-reporter reliability and assess the value of diffusion-weighted imaging and contrast-enhanced sequences. Materials and methods: We retrospectively reviewed 3 years of sacroiliac joint MRI records for suspected sacroiliitis in patients <21 years at a United Kingdom tertiary referral paediatric hospital. Five radiologists (panel of three radiologists and two independent radiologists) reviewed all MRI examinations using a pictorial checklist to identify oedema, effusions, diffusion-weighted signal abnormality, enhancement, erosions and sclerosis. The frequency of panel findings was reported. Interobserver agreement was calculated using the Cohen kappa coefficient. Results: An MRI diagnosis of sacroiliitis was made in 12 of 99 examinations (12%). The findings in all scans included oedema (9%), erosions (8%), diffusion-weighted signal abnormality (6%), abnormal enhancement (6%) and effusion (4%). All scans with abnormal contrast enhancement had other MRI features of sacroiliitis. Interobserver agreement was slight to moderate. Conclusion: Oedema and erosions were the most common findings. Inter-reporter reliability was variable with at best moderate agreement for the presence of sacroiliitis and erosions. The use of contrast enhancement for diagnosing sacroiliitis in children with JIA may be questionable.

    Research areas

  • Children, Interobserver variability, Magnetic resonance imaging, Sacroiliac joint, Sacroiliitis

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