ArticleEuropean radiology2026
Does adding a high-resolution 3D sequence improve the accuracy of erosion detection in pediatric sacroiliac joint MRI?
Article in European radiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveTo evaluate whether adding an erosion-sensitive high-resolution 3D sequence to sacroiliac joint (SIJ) MRI protocols in children improves erosion detection and diagnosis of Juvenile Spondyloarthritis (JSpA). MATERIALS AND
methodsSIJ-MRI were prospectively obtained in 84 children (50 girls, mean age 13.3 y) clinically suspected of JSpA, conforming to 2024 ASAS/SPARTAN recommendations including a volumetric interpolated breath-hold examination (VIBE) sequence. Three experienced radiologists recorded the presence of erosions, non-erosion bony defects, and the presence of JSpA, with confidence scoring for each, in 3 blinded re-randomized reading exercises: (1) T1-weighted spin-echo (T1) and short-tau inversion recovery (STIR) sequences only; (2) VIBE only; (3) all sequences. Discrepancies were resolved by consensus read-out. The reference standard was rheumatologist diagnosis of JSpA.
resultsMRI was considered indicative of JSpA in 14 cases (16.7%) on T1/STIR, 21 (25.0%) on VIBE only, and 15 (17.9%) with all sequences. In the three exercises, erosions were scored in 12 (14.3%), 22 (26.2%), and 13 (15.5%) cases, and non-erosion bony defects in 43 (51.2%), 79 (94.0%), and 80 (95.2%) cases. Sensitivity/specificity for JSpA diagnosis was 34.6/91.4%, 42.3/82.8%, and 38.5/91.4%, after consensus read-out 38.5/94.8%. Mean absolute values of confidence scores significantly improved for all features after adding VIBE, although inter-reader agreement did not consistently improve.
conclusionAdding VIBE to T1/STIR significantly increased reader confidence in JSpA diagnosis. However, a trend toward improved sensitivity and specificity was not statistically significant. If the ASAS-SPARTAN SIJ MRI protocol is applied to children, all sequences must be interpreted together to avoid mistaking non-erosion defects for true erosions. KEY POINTS: Question Can the recently published ASAS-SPARTAN adult standardized image acquisition protocol for sacroiliac joint MRI be used for diagnostic evaluation of sacroiliitis in children suspected for Juvenile Spondyloarthropathy (JSpA)? Findings The ASAS/SPARTAN recommendations including a high-resolution 3D erosion-sensitive sequence can also be applied to children, resulting in significantly increased reader confidence, with a trend toward improved sensitivity/specificity for diagnosing JSpA, although not statistically significant. Clinical relevance The ASAS-SPARTAN adult sacroiliac joint MRI protocol can also be beneficially applied to children, as long as all sequences are interpreted together to avoid mistaking non-erosion defects (almost universally seen on the 3D erosion-sensitive sequences in children) for true erosions.
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