Magnetic Resonance Imaging (MRI)

Magnetic Resonance Imaging - The Hong Kong Society of Rheumatology
A Professional Website Design Company

Member List

Chairman
  • Dr Chung, Ho Yin James
  • jameschunghoyin@gmail.com
Members
  • Dr Chan Chiu Wai, Shirley
  • Dr Ciang Chu Oi, Natalia
  • Dr Lau Wing Hang, Vince
  • Dr Lee Kam Ho, Victor
  • Dr Wong Ching Han, Priscilla
  • Dr Wong Pui Yan, Stella

Preface

Axial spondyloarthritis (SpA) is a spectrum of autoimmune diseases characterized by axial joint inflammation and pathological new bone formation.  Encompassing a heterogenous group of rheumatologic conditions including psoriatic arthritis (PsA), inflammatory bowel disease (IBD) related spondyloarthritis, undifferentiated spondyloarthritis (UspA), reactive arthritis (ReA), and ankylosing spondylitis (AS), it is associated with increased risk of cardiovascular (3, 4) and cerebrovascular events (5), and may result in significant functional, social, psychological impairment (1, 2).

Biologic therapies improve prognosis by suppressing inflammation, improving functional status (6), slowing radiographic progression (7), and reducing atherosclerosis (8). However, biologics are not without risks, the most common being non-fatal infection. Upper respiratory tract infection, herpes simplex infection, candida infection, pneumonia, and tuberculosis have been reported (9-11). A rigorous assessment of disease activity on which therapeutic decisions are based becomes increasingly necessary.  Serum markers of inflammation, of which the acute phase reactant C-reactive protein (CRP) is the most clinically used, show only a partial picture of disease activity.  Studies showed CRP performed poorly in reflecting axial disease activity (12), with a weak discriminative power for axial joint inflammation on short tau inversion recovery (STIR) sequence MRI (13). Another commonly used self-assessment tool, the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) (14), was found to be poorly correlated with spinal inflammation (15). 

Magnetic resonance imaging (MRI) is the main tool for assessment of disease activity due to the absence of reliable serum biomarkers. Inflammation visualized on MRI was found to be correlated with inflammatory cellularity in tissue biopsy (16). In addition, SI joint MRI has diagnostic value in the Assessment of SpondyoArthritis international Society (ASAS) criteria of axial SpA (17). Spinal MRI has also been shown to have additional diagnostic value (18, 19). MRI for assessment of disease activity in equivocal cases is endorsed by the American College of Rheumatology (ACR) / Spondylitis Association of America / Spondyloarthritis Research and Treatment Network (20). MRI scoring systems including the Spondyloarthritis Research Consortium of Canada (SPARCC) MRI indices (21, 22) have been used extensively in research. 

In view of the growing importance of MRI in axial SpA, the Hong Kong Society of Rheumatology (HKSR) has established a special interest group (SIG) to develop and promote the use of MRI in axial SpA, and to provide up-to-date information for local rheumatologists.

MRI SIG Event 2022

2022

MRI Workshop for axial Spondyloarthritis 2023


Date: 25th November, 2023


Time: 9AM-12PM


Venue: Cordis, Hong Kong


Speakers: Dr. Chung Ho Yin, Dr. Victor Lee



  • An overview of MRI sacroiliac joint & Spine

  • Challenges and hidden pitfalls of MRI

  • Highlighted case studies


References

  1. Chung HY, Chan CYY, Tsang HHL, et al. The socio-economic impacts on household income, employment status, need for public assistance, and marriage opportunities in patients with Spondyloarthritis: A comparison with the Hong Kong population. Hong King Bull Rheum Dis 2013: 13: 39-46.
  2. Chan CYY, Tsang HHL, Lau CS, et al. Prevalence of depressive and anxiety disorders and validation of the Hospital Anxiety and Depression Scale as a screening tool in Axial Spondyloarthritis Patients. Int J Rhuem Dis. 2017 Mar; 20(3): 317-325. 
  3. Essers I, Stolwijk C, Boonen A, et al. Ankylosing spondylitis and risk of ischaemic heart disease: a population-based cohort study. Ann Rheum Dis. 2016; 75:203-209.
  4. Chen Y, Chung HY, Zhao CT, et al. Left ventricular myocardial dysfunction and premature atherosclerosis in patients with axial Spondyloarthritis. Rheumatology (Oxford). 2015 Feb; 54(2): 292-301.
  5. Szabo SM, Levy AR, Rao SR, et al. Increased risk of cardiovascular and cerebrovascular diseases in individuals with ankylosing spondylitis: a population-based study. Arthritis Rheum. 2011; 63:3294-3304.
  6. Maksymowych WP, Dougados M, van der Heijde D et al. Clinical and MRI responses to etanercept in early non-radiographic axial spondyloarthritis: 48-week results from the EMBARK study. Ann Rheum Dis 2016; 75:1328-35
  7. Osman MS, Maksymowych WP. An update on the use of tumor necrosis factor alpha inhibitors in the treatment of ankylosing spondylitis. Expert Rev Clin Immunol 2017; 13: 125-31.
  8. Arida A, Protogerou AD, Konstantonis G, et al. Subclinical atherosclerosis is not accelerated in patients with ankylosing spondylitis with low disease activity: new data and meta-analysis of published studies. J Rheumatol. 2015 Nov; 42(11): 2098-105.
  9. Calin A, Dijkmans BA, Emery P et al. Outcomes of a multicentre randomised clinical trial of etanercept to treat ankylosing spondylitis. Ann Rheum Dis 2004; 63: 1590-600.
  10. Davis JCJr, Van Der Heijde D, Braun J et al. Recombinant human tumor necrosis factor receptor (etanercept) for treating ankylosing spondylitis: a randomized, controlled trial. Arthritis Rheum 2003; 48: 3230-6.
  11. Baeten D, Sieper J, Braun J et al. Secukinumab, an interleukin-17A inhibitor, in ankylosing spondylitis. N Engl J Med 2015; 373: 2534-48.
  12. Turina MC, Yeremenko N, van Gaalen F, et al. Serum inflammatory biomarkers fail to identify early axial spondyloarthritis: results from the SpondyloArthritis Caught Early (SPACE) cohort. RMD Open. 2017 Jan 11; 3(1):e000319.
  13. Tsang HHL, HY Chung. The discriminative values of BASDAI, ASDAS, C-reactive protein and erythrocyte sedimentation rate in spondyloarthritis related axial arthritis. J Clin Rheumatol. 2017 Aug; 23(5): 367-272.
  14. Garrett S, Jenkinson T, Kennedy LG, et al. A new approach to defining disease status in ankylosing spondylitis: the Bath Ankylosing Spondylitis Disease Activity Index. J Rheumatol 1994; 21: 2286-91.
  15. Kiltz U, Baraliakos X, Karakostas P et al. The degree of spinal inflammation is similar in patients with axial spondyloarthritis who report high or low levels of disease activity: a cohort study. Ann Rheum Dis 2012; 71: 1207-11.
  16. Bollow M, Fischer T, Reisshauer H, et al. Quantitative analyses of sacroiliac biopsies in spondyloarthropathies: T cells and macrophages predominate in early and active sacroiliitis – cellularity correlates with the degree of enhancement detected by magnetic resonance imaging. Ann Rheum Dis. 2000 Feb; 59 (2): 135-40.
  17. Rudwaleit M, van der Heijde D, Landewe R, et al. The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): validation and final selection. Ann Rheum Dis. 2009;68(6):777-83.
  18. Chan SCW, Li PH, Lee KH, Tsang HHL, Lau CS, Chung HY. Diagnostic utility of whole spine and thoracic spine MRI corner inflammatory lesions in axial spondyloarthritis. Ther Adv Musculoskelet Dis. 2020;24;12:1759720X20973922.
  19. Chung HY, Yiu RSW, Chan SCW, Lee KH, Lau CS. Fatty corner lesions in T1-weighted magnetic resonance imaging as an alternative to sacroiliitis for diagnosis of axial spondyloarthritis. BMC Rheumatol. 2019;3:17.
  20. Ward MM, Deodhar A, Gensler LS, et al. Update of the American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network recommendations for the treatment of ankylosing spondylitis and nonradiographic axial spondyloarthritis. Arthritis Rheumatol. 2019;71(10):1599-1613
  21. Maksymowych WP, Inman RD, Salonen D, et al. Spondyloarthritis Research Consortium of Canada magnetic resonance imaging index for assessment of spinal inflammation in ankylosing spondylitis. Arthritis Rheum. 2005;15;53(4):502-9.
  22. Maksymowych WP, Inman RD, Salonen D, et al. Spondyloarthritis research Consortium of Canada magnetic resonance imaging index for assessment of sacroiliac joint inflammation in ankylosing spondylitis. Arthritis Rheum. 2005;15;53(5):703-9.

MRI SIG publications:

  1. Chung HY*, Xu X, Lau V, Ho G, Lee KL, Li P, Tsang H, Kwok SK, Lau CS, Wong CS. Comparing diffusion weighted imaging (DWI) with clinical and blood

parameters, and with short tau inversion recovery (STIR) sequence in detecting spinal

and sacroiliac (SI) joint inflammation in axial Spondyloarthritis (axSpA). Clin Exp

Rheumatol, 2017 Mar-Apr; 35(2):262-269.

  1. Chan CWS, Tsang HHL, Li PH, Lee KH, Lau CS, Wong PYS, Chung HY^.

Diffusion-weighted imaging versus short tau inversion recovery sequence: Usefulness

in detection of active sacroiliitis and early diagnosis of axial spondyloarthritis. PLoS

one. 2018 Aug 7; 13(8).

  1. Lee KH, Chung HY^, Xu X, Lau VWH, Lau CS. Apparent diffusion coefficient as

an imaging biomarker for spinal disease activity in axial spondyloarthritis. Radiology.

2019; Apr; 291(1): 121-128

  1. PH Li, HY Chung*^, CS Wong, HHL Tsang, VWH Lau, G Ho, X Xu, CS Lau, KY

Ma. The association between age and clinical and radiological activity in axial

spondyloarthritis. Journal of Clinical Rheumatology and Immunology, 1-8.

  1. Chung HY*, Yiu RSW, Chan SCW, Lee KH, Lau CS. Fatty corner lesions in T1-

weighted magnetic resonance imaging as an alternative to sacroiliitis for diagnosis of

axial spondyloarthritis. BMC Rheumatol. 2019 May 30; 3:17.

  1. Chung HY*^, Chui ETF, Lee KH, Tsang HHL, Chan SCW, Lau CS. ASDAS is

associated with both the extent and intensity of DW-MRI spinal inflammation in

active axial spondyloarthritis. RMD Open. 2019 Aug 6; 5(2): e001008.

  1. Huang JX, Chung HY*^, Chui ETF, Lee KH, Chan SCW, Tsang HHL, Ng AHY.

Intensity of spinal inflammation is associated with radiological structural damage in

patients with active axial spondyloarthritis. Rheumatol Adv Pract 2019; 18;4(1),

rkz049.

  1. Chui ETF, Tsang HHL, Lee KH, Lau CS, Wong CH, Chung HY^. MRI

inflammation of facet and costovertebral joints is associated with restricted spinal

mobility and worsened functional status. Rheumatology (Oxford). 2020;1;59(9):2591-

2602.

  1. Chan SCW, Li PH, Lee KH, Tsang HHL, Lau CS, Chung HY^. Diagnostic utility of

whole spine and thoracic spine MRI corner inflammatory lesions in axial

spondyloarthritis. Ther Adv Musculoskeletal Dis. 2020;24;12:1759720X20973922.

  1. Li PH, Chung HY, Lau CS. Epidemiology and outcomes of geriatric and non-

geriatric patients with drug allergy labels in Hong Kong. Hong Kong Med J.

2021;27(3):192-7.

  1. Chung HY*, Chan SCW, Lee KH, Tsang HL, Ng LL, Lau CS. Both ASDAS and

ADC are associated with spinal mobility in active axial spodyloarthritis: a comparison

between early and later disease. Int J Rheum Dis. 2002 Jan 12.

  1. HY Chung*, PCH Wong, KH Lee, NCO Ciang, SPY Wong, P Cao, SCW Chan,

VWH Lau, BA Lo, RKL Lee, Hong Kong Society of Rheumatology. MRI in axial

spondyloarthritis: position statements from the Hong Kong Society of Rheumatology.

Journal of Clinical Rheumatology and Immunology. 2022;1-7.

  1. Lin KYY, Peng C, Lee KH, Chan SCW, Chung HY^. Deep learning algorithms for

magnetic resonance imaging of inflammatory sacroiliitis in axial spondyloarthritis.

Rheumatology(Oxford). 2022 Feb 1:keac059.

  1. Lin KYY, Cao P, Lee KH, Chan SCW, Chung HY^. Comment on: deep learning

algorithms for magnetic resonance imaging of inflammatory sacroiliitis in axial

spondyloarthritis: reply. Rheumatology (Oxford). 2022 Apr 13:keac216.

 

MRI SIG awards:

  1. 2018-APLAR-Celltrion Best Abstract Award: Fatty corner lesions in T1-weighted

magnetic resonance imaging as an alternative to sacroiliitis for diagnosis of axial

spondyloarthritis.

  1. 2021-APLAR-Celltrion Best Abstract Award: MRI lesions in SpA. A comparison

with non-inflammatory back pain using propensity score adjustment method.

  1. ICCR outstanding free paper award bronze prize: deep learning algorithms for

magnetic resonance imaging of inflammatory sacroiliitis in axial

spondyloarthritis.

 

 

  • Symposium and Workshop List

2.2 Symposium and Workshop details page

Member Login
Forgot Password?
Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form
Search