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MRI - technique
MRI-SIJ sequences/planes
MRI - sacroiliitis
Grading sacroiliitis
MRI-Spine sequences/planes
MRI - spinal changes
Grading spinal changes
Grading methods

Grading of inflammatory changes at the sacroiliac joints is used to monitor the disease, especially in scientific studies. It is today usually performed in accordance with the SPARCC or Berlin scoring methods both based on semi-coronal slices.

SPARCC method

Is a method developed by the Spondylarthritis Research Consortium of Canada (SPARCC) for assessing both activity (doi:10.1002/art.21445) and structural changes (doi:10.3899/JRHEUM.140519).

Traditionally the assessments are based on 6 STIR/T2 FS (BME score) and 5 consecutive T1 (structural score) semi-coronal slices covering the cartilaginous joint compartment. Left and right SIJ are subdivided into 4 quadrants (upper/lower iliac/sacral quadrants) and a binary scoring is applied according to presence/absence of lesions. BME, FMD and erosion scorings range between 0 and 8 lesions per slice, maximal 24/40 for each joint 48/80 in total for BME and FMD+erosion, respectively. For the BME score, if intense (high signal intensity as bright as cerebrospinal fluid or intervertebral discs) and/or deep BME (lesion 1 cm from the articular surface), an additional score of 1 per joint is added, thereby adding possible scores of 12 + 12 to the total score, given a maximal SPARCC activity score of 72. The structural score encompassing FMD and erosion also contains scores for backfill (fat within erosive areas) and ankylosis based on joint halves, thereby adding a possible score of 20 for each feature, resulting in a SPARCC structural score ranging between 0-120.

However, the score range can depend on the vertical height of the joints. If the vertical height of the upper anterior joint space is >1 cm but <3 cm only the upper quadrants are scored, but when 3 cm of the joint is visible the joint is divided into upper/lower quadrants.

Drawings illustrating the joint division and an example of a scoring sheet..

Berlin method

In this method, the SIJ is divided, as in SPARCC, into 4 quadrants in the semi-coronal plane. BME are scored for the whole series of slices covering the cartilaginous joint compartment in each quadrant ranging between 0 and 3 according to the extent of BME. The following BME scores are used: 0 for absence, 1 if involvement of < 33% of the quadrant area, 2 if between >33% and <66% of the quadrant area is involved and 3 when involving > 66% of the quadrant area, giving a maximal BME score of 12 for each joint and 24 per individual, doi: 10.1136/ard.2010.147033.

Recently the Berlin method has been modified to include additional quantification of structural changes dividing the joints into anterior, middle and posterior portions thereby generating 24 regions per individual, doi:10.1136/annrheumdis-2016-210640 and doi:10.1136/rmdopen-2021-001656.

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