Diagnosis of pathological conditions of the sacroiliac region. MRI of the sacroiliac joint MRI of the sacroiliac joints with contrast

The sacroiliac joints do not have increased mobility. The joints provide a fixing function, create the strength of the "structure" of the sacrum and iliac bones. Damage to the area leads to pain, limited mobility of the hip joints. The most common diseases are rheumatoid arthritis, sacroiliitis, ankylosing spondylitis Bekhterev. Early detection of changes in the ileosacral region using radiography, magnetic resonance and computed tomography prevents irreversible consequences with proper treatment.

The latest types of MRI of the joints are able to verify formations larger than one millimeter in diameter.

What is magnetic resonance imaging

The harmlessness of the MRI method (MRI) for human health is due to the use of a magnetic field that promotes the resonance of hydrogen atoms. Magnetization results in distortion of the radio frequency by tissues containing water. Signal registration, subsequent processing by a software application, provides a graphic image.

The phenomenon of magnetic resonance is used by medicine for diagnostic purposes. The operating modes of the tomograph show tissues of different densities - connective, fat, muscle.

Explaining what MRI is, it is necessary to note the different design features of the installations according to the weight limits of the table, the design of the tunnel. The open type of devices is rarely used for diagnosing sacroiliac joints due to low resolution. The equipment is used for tomography of patients with a fear of closed spaces.

Qualitatively shows tomography of the sacral joints when scanning with closed tomographs. The products have a powerful magnet (1.5-3 Tesla) that allows you to verify lesions with a diameter of more than 0.3 mm.

MRI is an expensive diagnostic method. Well visualizes soft tissue structures - ligaments, muscles, cartilage. Sacred articulations are clearly visible on tomograms, which makes it possible to verify inflammatory, oncological, degenerative-dystrophic processes.

The price of a limb scan is different. The high cost of MRI of the legs is due to the complexity of examining the knee.

What are sacroiliac joints

Located on both sides of the sacrum. They have limited mobility. They consist of developed cartilaginous structures, a strong capsular membrane. The anatomical design firmly fixes the formation to the pelvis and spinal column.

MRI of the sacroiliac region - what shows

Inflammatory changes in the ileosacral joints are specific. Due to the abundance of cartilage tissue, there is a danger of bacterial damage, reactive arthritis. Bilateral or unilateral sacroiliitis accompanies several types of inflammatory processes:

reactive arthritis;
Spondyloarthritis;
Bechterew's disease.

The consequence of the condition is the syndrome of the sacroiliac joint, which causes pain in the hip joint, thigh, leg. Symptoms are caused by infringement of the nerve fibers emerging from the spinal column, extending to the lower extremities. Compression is not necessarily achieved by an inflammatory process. The increased tone of the piriformis, iliopsoas, abductors and piriformis muscles contributes to the infringement of the nerve fibers extending to the legs.

Ankylosing spondylitis on MRI of the sacrum

The initial stage of Bechterew's disease (ankylosing spondyloarthrosis) is determined by MRI of the sacroiliac joints by identifying a narrowing of the joint space, subchondral osteosclerosis of the surfaces, and accumulation of inflammatory fluid. The inflammatory process is proliferative in nature with bone growths, deposition of calcium salts along the ligaments of the spine. Syndesmophytes and enthesophytes are well seen on radiographs in the form of a “bamboo stick” symptom. Changes are typical for stage 3 of the disease.

What changes are determined by MRI in Bechterew's disease:

Destruction of the femoral head;
Sclerotic changes in bones;
Erosion formation;
Inflammation of the joint capsule (capsilitis);
Ligament infiltration (synovitis).

The late stage of ankylosing spondylitis is accompanied by a narrowing of the gap of the ileosacral joint. An MRI is not required. Signs of sacroiliitis stage 4 will show the x-ray of the pelvis.

An MRI scan in a patient with an early stage of Bechterew's disease reveals comorbidities:

Tarzit;
Fusion of the frontal joint;
Inflammatory processes of large joints (hip, knee).

Magnetic resonance imaging of inflammation of the sacral areas

Sacroiliitis is classified into primary and secondary. The first form is due to changes in the connection of the sacrum and ilium. Accompanies trauma, infectious processes, tumors.

Secondary sacroiliitis occurs against the background of other diseases - systemic changes in the connective tissue (scleroderma, lupus erythematosus, seronegative spondyloarthropathies). With the help of magnetic resonance imaging, it is possible to identify early signs of pathology - subchondral osteosclerosis, erosion, loss of bone density.

An MRI of the knee is performed for arthrosis simultaneously with an examination of the iliac joints to exclude Bechterew's disease (ankylosing spondylitis).

How is an MRI of the ileosacral joints done in the stir mode

Over the past ten years, approaches to sacroiliitis have changed significantly. The complex of pathological changes that occur in psoriatic and a number of other arthritis, specialists have combined the term "spondyloarthritis". The classification summarizes the pathology complex with lesions of the spinal column and sacroiliac joints. Isolation of "pre-radiological arthritis" allows the use of MRI of the joints for early verification of diseases.

According to the international classification, all changes in the sacroiliac regions are divided into 2 categories - structural and inflammatory. The first manifestations are irreversible. Timely detection of inflammation can prevent the development of the disease.

Inflammatory signs of sacroiliitis on MRI:

Capsulitis;
Enthesitis;
synovitis.

Structural manifestations:

fatty infiltration;
erosion;
osteosclerotic changes.

Modern MRI of the joints of the pelvis and sacrum with the presence of the stil mode helps to detect the described morphological manifestations. A feature of scanning is the use of an echo gradient with suppression of the adipose tissue signal.

Complex diagnostics of MRI of sacral joints involves the use of MRI modes with T1-weighted display. The dark signal is formed from inflammatory hyperintense areas. A similar picture is created by the intervertebral disc, cerebrospinal fluid.

Differential diagnosis is helped by MRI with contrast for the sacroiliac joints. Gadolinium changes the intensity of the signal in the inflammatory segment.

Tumors of the sacrum on MRI

Sacral neoplasms are diagnosed late due to the presence of a large free space inside. More than two years pass from the appearance of a tumor to the infringement of the nerves.

What formations does an MRI of the joints of the pelvis show:

Perineural cysts;
Myelomeningocele;
Abscesses;
Arteriovenous malformations;
Vascular aneurysms.

Clinical symptoms occur gradually as the neoplasm grows and nerves are pinched.

Principles of decoding magnetic resonance imaging

The interpretation of tomograms in St. Petersburg is carried out by qualified specialists. Depending on the occupation of the doctor, the description is made in at least 30 minutes. Private clinics in St. Petersburg offer the service of sending tomograms by e-mail.

The initial changes in the sacroiliac joints are shown by a high-power tomograph. When choosing a diagnostic center, pay attention to the presence of the stil mode in the device, which allows you to verify inflammatory processes.

Diseases of the musculoskeletal system include symptoms such as prolonged back pain, spasm of the back muscles, decreased mobility of the spine, swelling of soft tissues in the region of various parts of the spine, lameness, and muscle pain. Some ailments, such as ankylosing spondylitis or ankylosing spondylitis or ankylosing spondylitis, are difficult to treat and can make a person disabled. With osteochondrosis, working capacity usually decreases, but this is a disease that, with adequate therapy, gives a lasting positive effect. True, the prognosis here also depends on how timely the patient went to the hospital, as well as how correctly the diagnosis was made. Computed tomography or plain radiography can suspect inflammatory diseases of the joints of the spinal column - spondyloarthritis. For example, with sacroiliitis (inflammation of the ileosacral joints) only at the second stage of disease progression. While magnetic resonance imaging (MRI) of the sacroiliac joints is able to detect the disease at a very early stage.

The sacroiliac joints are located near the lower spine, below the lumbar spine and above the coccyx. They connect the sacrum to the pelvis. The sacrum is a triangular bone in the lower part of the spine, located in the center under the lumbar spine. While most of the bones of the vertebrae are movable, the sacrum is made up of five vertebrae that are fused together and do not move. The ilium are the two large bones that form the pelvis. As a result, the sacroiliac or ileosacral joints connect the spine to the pelvis. The sacroiliac bone is held together by strong ligaments.

There is relatively little movement in the ileosacral junctions. Typically, these joints have less than 4 degrees of rotation, which is approximately 2 mm. Most of the movement in the pelvis occurs either in the hips or in the lumbar spine. These joints must support the entire weight of the upper torso when the human body is upright, which in turn places enormous stress on them. They also serve as a cushioning structure. Since these joints help support the upper body of a person on themselves, over time this can lead to wear of the cartilage of these sacroiliac joints with the development of serious diseases.

Dysfunction of the constituent sacroiliac joints is believed to cause pain in the back and legs. Pain in the legs can be especially severe and the person may feel the same way as with a serious illness - a hernia of the lumbar spine. Treatment for sacroiliac joint pain is usually non-surgical and focuses on restoring normal movement of the joint.

What is an MRI of the sacroiliac joints?

Magnetic resonance imaging of the sacroiliac joints is an absolutely painless and safe procedure for diagnosing inflammatory diseases of these joints. Peter Mansfield and Paul Lauterbur invented this method of research, for which they received the Nobel Prize in 2004. Its main difference is the fact that MRI does not contain harmful ionizing radiation for the human body. MRI does not use x-rays, but examines bone tissue, articular processes, adjacent soft tissues using magnetic fields. As a result, we get a high-quality high-contrast image, and with its help the doctor can make an accurate and quick diagnosis for the patient.

Sometimes the study is carried out using the introduction of contrast agents based on gadolinium, in order to conduct, if necessary, a more in-depth diagnosis.

Indications for an MRI study

Your doctor may order magnetic resonance imaging for the following conditions:

pelvic injuries (suspected fracture) and post-traumatic changes;
anomalies in the development of the pelvic bones;
suspicions of the development of tumor neoplasms and in the presence of metastases in the pelvic bones;
the presence of foreign bodies in the area of the iliac-sacral joints;
inflammatory diseases of the joints (arthritis), including the joints of the lower extremities, especially the ankles, as well as psoriatic arthritis;
excessive bone growths (osteophytes, exostoses);
the presence of ankylosing spondylitis or its predisposition, including the presence of an HLA-B27 antigen in a patient;
Crohn's disease and ulcerative colitis with the presence of pain in the pelvic area.

MRI of the ileosacral joints is performed with:

pain in the lower back, which may be aggravated by physical exertion, while sitting, at night, may radiate to the lower extremities or buttocks;
the presence of subfebrile temperature,;
sudden or persistent bouts of lameness;
the presence of inflammatory changes in the pelvic bones or surrounding tissues;
decreased flexibility of the spine.

MRI plays an important role in the early diagnosis of sacroiliitis - inflammation of the sacroiliac joints. It can also be used to predict the development of new syndesophytes. It is magnetic resonance imaging that is sensitive to assessing activity at relatively early stages of disease development; it is superior to CT scanning in detecting cartilage changes, bone erosion and subchondral changes in bones, and in detecting bone marrow edema.

In established disease, MRI can detect pseudarthrosis, diverticulum associated with cauda equina syndrome, and spinal stenosis. MRI is considered mandatory for patients with neurological symptoms, both those who are in remission and those who have a negative trend after the establishment of spinal cord injury.

Contraindications for MRI of the sacroiliac joints

MRI is a fairly safe research method, but there are several relative and absolute contraindications to this examination.

Relative contraindications include: pregnancy in the first trimester, the presence of claustrophobia, overweight.

During the procedure, the patient must be in a special long tunnel of equipment, exclusively in an immovable state. For claustrophobic patients who are afraid of confined spaces, such a study may not bring good results, but only provoke an even greater attack of panic and anxiety. Therefore, medical staff may use sedatives or mild tranquilizers to relieve discomfort.

MRI of the sacroiliac joints during pregnancy should only be performed if there is a serious vital indication in the first trimester and if indicated in the second and third, if it is believed that the potential benefit of MRI outweighs the possible risks. Although there have been no large studies of the effect of magnetic tomography on the fetus, since it is forbidden to conduct experiments on embryos.

For obese patients who are overweight, it is not possible to perform an MRI examination for purely technical reasons. After all, the load capacity of the table and the size of the channel of the apparatus have their limitations. Depending on the type of device, patients weighing over 130-150 kilograms will not be able to undergo an MRI.

Absolute contraindications are the presence of metallic foreign bodies and medical devices in the body, the impossibility of MRI with contrast in patients allergic to gadolinium.

MRI of the sacroiliac joints is performed without any prior preparation. It is absolutely contraindicated to perform the procedure with contrast in patients with a history of allergy to gadolinium. This can provoke anaphylactic shock, which has serious consequences, especially with untimely and incorrect first aid.

If patients have metal and electronic objects, they are not allowed into the room with a magnetic tomograph. After all, this affects expensive equipment, the magnetic field and can worsen the state of human health. All jewelry must be left at home or removed immediately before entering the room with a tomograph. It is also forbidden to bring credit cards, hairpins, metal zippers, pocket knives or pens, items containing microchips. It is recommended to remove hearing aids and removable dental work, piercings.

It is forbidden to conduct an MRI study of the ileosacral joints in patients with pacemakers, artificial pacemakers or cardiac defibrillators. If it is not known whether foreign objects are present in the human body (for example, fragments of ammunition), he is advised to take an x-ray for clarification.

MRI technique

An MRI examination is performed in a special room that houses the MRI system or "scanner". You will be escorted into the room by a medical officer and asked to lie down on a special slide-out table that will slowly slide out of the scanner. A typical scanner is open at both ends.

In general, you may need to use earplugs or hearing protection when preparing for an MRI exam, as certain scanners may make loud noises when they are used. These loud noises are normal and should not be a concern.

If a study with a contrast agent is required during the examination, the radiologist controls the extension of the table from the scanner to introduce contrast.

The most important thing for the patient to do is to relax and lie still. Most MRI exams take between 15 and 45 minutes. You will be told in advance how long the scan will take. During the examination, the radiographer will be able to talk to you, hear you and observe you at any time. If the patient has any questions or a feeling of fear and anxiety, it is imperative to report this using a special signal bulb. When the procedure is complete, you may be asked to wait while the images are examined to determine if more images are needed for an accurate and correct diagnosis. After the scan, the patient has no restrictions and can safely perform their normal activities.

What does the study show?

Depending on what kind of disease the patient has, how long it has been developing, whether the sacroiliac joints are diagnosed with or without contrast, what imaging modes are used, you can see different things. Usually, the doctor sees the presence of edema, fatty degeneration of the bone, osteosclerotic changes in bone tissue, in the articular cartilage - the presence of subchondral sclerosis, perichondritis, cartilage destruction, the state of the joint space - narrowing, expansion, absence of it, are there signs of inflammation of the ligamentous apparatuses. The doctor will be able to see the joint effusion, foci of inflammation, fatty degeneration, degenerative changes, fusion of the articular surface of the bone - ankylosis.

With sacroiliitis, STIR ("short tau inversion recovery") mode is often used. This means that when the doctor turns on this mode on the equipment, the scanner suppresses the fat signal, and thus improves the visualization of various pathologies. For example, detection of fatty degenerations of bone and connective tissues.

Training:

1. In 2016, at the Russian Medical Academy of Postgraduate Education, she underwent advanced training in the additional professional program "Therapy" and was admitted to medical or pharmaceutical activities in the specialty of therapy.

2. In 2017, by the decision of the examination committee at a private institution of additional professional education "Institute for Advanced Training of Medical Personnel", she was admitted to medical or pharmaceutical activities in the specialty radiology.

Work experience: therapist - 18 years, radiologist - 2 years.

Magnetic resonance imaging of the sacroiliac joints is suitable for early detection of ankylosing spondylitis and rheumatoid arthritis. This diagnostic method does not use X-ray radiation, therefore it is absolutely safe for the patient.

When appointed

The doctor prescribes a diagnosis for the following indications:

suspicion of the development of ankylosing spondylitis and its particular manifestation - sacroiliitis
genetic predisposition to ankylosing spondylitis (its diagnosis in parents or relatives) or isolation of the HLA-B27 gene from a patient
diagnosed with osteochondrosis, in which the pain syndrome does not go away for a long time and is not removed by anti-inflammatory drugs, cervical and lumbar backache
inflammatory diseases of the joints of the lower extremities (especially the ankle)
chronic back pain leading to decreased performance and difficulty moving
decreased flexibility and mobility of the spine
lower back and pelvic injuries

Also, an examination can be prescribed to see the dynamics of the already diagnosed Bechterew's disease or other rheumatoid arthritis.

What does an MRI of the sacroiliac joints show?

foci of inflammation in the spinal cord, vertebral discs and joints
expansion of the joint space
bone formation
foci of calcium deposition in the articular-ligamentous apparatus
joint injury
tumor processes

MRI with contrast

In some cases, the most detailed visualization of the problem area is necessary to make a diagnosis. The patient is then asked to use a gadolinium-containing contrast agent. This procedure allows you to better visualize small inflammatory foci in the spine and joints. The contrast agent is injected intravenously, and after the procedure, it is excreted from the body naturally within a few hours.

In rare cases, allergic reactions may occur, so this study is carried out only in the direction of the attending physician or radiologist.

MRI with contrast increases the cost and duration of the procedure by 1.5 - 2 times, without the introduction of contrast lasts from 15 to 20 minutes.

The standard limitation is pregnancy, the presence of metal grafts in the body and other factors. More information about them can be found on the website in the section General contraindications for MRI.

In addition to magnetic resonance imaging at the Ramsey Diagnostic Centers, patients are given the opportunity to do CT / MSCT of the lumbosacral spine.

Advantages over CT

MRI allows diagnosing pathological changes in the joints and spinal cord at the earliest stages of the disease, when the patient does not feel any unpleasant symptoms. Computed tomography allows you to identify obvious degenerative changes in bone and joint tissue, when the treatment becomes almost ineffective. It should not be forgotten that the majority of patients are men of reproductive age and X-ray irradiation of the SIJ region is highly undesirable for their offspring.

The sacroiliac joint is an inactive joint that unites the bones of the pelvis with the final links of the spine, and is strengthened by powerful ligaments.

In functional terms, it carries significant loads, transferring the inertia of movement from the upper body to the lower limbs, and performs the function of depreciation.

With excessive mobility in this joint, pain occurs, with irradiation to the legs and inguinal zone; with low mobility - the pain is concentrated locally on one side, during physical exertion it spreads to the level of the knee joint, less often the ankle joint.

In view of such symptoms in the presence of intervertebral hernias of the lumbar spine and radiculopathies of a different origin, the diagnosis of pain caused precisely by disorders in the sacroiliac joint is clinically difficult. As a rule, the diagnosis is specified by the method of clinical tests and diagnostic blockade.

However, the safety and information content of the MRI method allows today to detect a number of problems in this anatomical region objectively, thus clarifying the origin of pain.

Information about the source of pain allows you to quickly and efficiently provide medical care to patients.

What does an MRI of the sacroiliac joints show?

MRI of the sacroiliac joints is an informative research method that allows you to examine the condition of the soft tissues, in addition to the X-ray data on the condition of the bones.

What exactly pathologies can be detected:

ankylosing spondylitis (in which the vertebrae and the surrounding musculo-ligamentous apparatus literally “ossify”, the spinal column takes on the appearance of a bamboo stick)
inflammatory processes in the spinal cord, vertebrae (even at the initial stages)
manifestations of sacroiliitis (at the same time, MRI of the sacroiliac joints in the STIR mode - fat suppression - is the most informative)
tumor processes
deposits of calcium salts in the articular-ligamentous apparatus
arthrosis (especially early degenerative changes in the vertebrae, such as swelling of the bone tissue, precedes further structural changes)
spinal injury
study of the effectiveness of ongoing therapy (method of monitoring in dynamics)

Diagnosis of pathological changes in the early stages allows you to stop the process in time, preventing progression and starting the "vicious circle" of the disease. In some cases, this makes it possible to avoid disability, maintain and improve the quality of life. In addition, unlike CT, MRI of the sacroiliac zone excludes x-ray exposure.

Deciphering the MRI of the sacroiliac joints is carried out by an MRI specialist, after the completion of the study. The result is presented in the form of a conclusion. However, it should be remembered that this is not a diagnosis, but only an indication of the problem. Only a specialist of the appropriate profile (vertebrologist, orthopedist-traumatologist, neurologist) has the right to establish a diagnosis.

When dysfunction of the sacroiliac joint is detected, the treatment is in most cases conservative, the direction of inflammation and pain.