Prevalence and neglected rate of sacroiliitis on lumbar spine CT in patients with low back pain

Abstract

Objective: The study aims to investigate the prevalence and neglected rate of sacroiliitis on lumbar spine computed tomography (CT) in patients with low back pain.

Materials and methods: From January 2016 to December 2020, a total of 4827 patients (mean age: 35.4 ± 9.5 years) who underwent lumbar spine CT examinations were included in this retrospective study. The CT degree of sacroiliitis in all study population were retrospectively reviewed by two radiologists. The independent sample t-test was used to compare the continuous values and chi-squared or Fisher's exact test was used to compare the categorized values.

Results: Sacroiliitis was identified in 514 of 4827 patients (10.6%). Patients with sacroiliitis were significantly younger than those without sacroiliitis (32.1 ± 8.9 vs. 35.8 ± 9.5 years, p < 0.001). Moreover, significantly more patients with sacroiliitis had HLA-B27 (p < 0.001) positivity and inflammatory back pain syndrome (p = 0.003) than those without sacroiliitis. Among the 514 patients, sacroiliitis was recognized on primary reading in 386 patients (75.1%) but was neglected in the remaining 128 patients (24.9%). Of the 386 patients, 371 patients were followed up, and finally, 295 patients of them (79.5%) were diagnosed with axSpA.

Conclusion: Radiologists should pay careful and more attention to sacroiliac joint on lumbar spine CT for early diagnosis of sacroiliitis in young patients with low back pain, which could result in early diagnosis and treatment of axSpA.