MRI of the SI joints commonly shows non-inflammatory disease in patients clinically suspected of sacroiliitis

Eur J Radiol. 2014 Jan;83(1):179-84. doi: 10.1016/j.ejrad.2013.10.001. Epub 2013 Oct 16.


Purpose: To determine the prevalence of clinically relevant non-inflammatory disease on MRI of the sacroiliac (SI) joints in patients suspected of sacroiliitis. To assess the added value of axial imaging of the pelvis in these patients.

Methods: In a retrospective study of 691 patients undergoing MRI of the SI joints from January 2006 to December 2012 for inflammatory back pain the prevalence of sacroiliitis and non-inflammatory disease was recorded.

Results: In 285 (41%) patients MRI did not show any abnormal findings. In 36% of patients MRI features of sacroiliitis were present. Spinal degenerative changes were the most common non-inflammatory finding in 305 patients (44.1%) and consisted of disc degeneration in 222 (32%) patients, facet joint arthrosis in 58 (8.4%) patients and disc herniation in 25 (3.6%) patients. Hip joint disease in 44 (6.4%) patients, lumbosacral transitional anomaly in 41 (5.9%) patients, SI joint degenerative changes in 25 (3.6%) patients and diffuse idiopathic skeletal hyperostosis in 24 (3.5%) patients were also common. Osteitis condensans ilii in 17 (2.5%) patients, tumour in 11 (1.6%) patients, fracture in 8 (1.2%) patients, infection in 4 (0.6%) patients and acute spondylolysis in 2 patients (0.3%) were less frequently seen.

Conclusion: Our study shows that non-inflammatory disease is more common than true sacroiliitis on MRI of the SI joints in patients with inflammatory type back pain. Axial pulse sequences may demonstrate unexpected findings that remain undetected if only coronal images are obtained. Clinical relevance statement:, MRI of the SI joints may demonstrate conditions that clinically mimic sacroiliitis. Axial imaging of the pelvis may help detect these unexpected findings.

Keywords: Back pain; Inflammation; Magnetic resonance imaging; Sacroiliac joint; Sacroiliitis.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Belgium / epidemiology
  • Child
  • Comorbidity
  • Diagnosis, Differential
  • Female
  • Humans
  • Low Back Pain / diagnosis
  • Low Back Pain / epidemiology*
  • Magnetic Resonance Imaging / statistics & numerical data*
  • Male
  • Middle Aged
  • Prevalence
  • Risk Factors
  • Sacroiliac Joint / pathology*
  • Sacroiliitis / epidemiology*
  • Sacroiliitis / pathology
  • Spinal Diseases / epidemiology*
  • Spinal Diseases / pathology
  • Young Adult