CT-guided transarticular biopsy of the sacroiliac joint: Technique and histomorphological results. A preliminary study

• Published in: Skeletal radiology Vol. 49; no. 3; pp. 453 - 460
• Main Authors: Egund, Niels, Sørensen, Flemming Brandt, Østgård, René, Loft, Anne Gitte, Boel, Lene Warner Thorup, Jurik, Anne Grethe
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-03-2020; Springer; Springer Nature B.V
• Subjects: Abnormalities; Biopsy; Bone imaging; Bone marrow; Cartilage; Computed tomography; Diagnostic imaging; Edema; Females; Imaging; Inflammation; Joints (anatomy); Magnetic resonance imaging; Medicine; Medicine & Public Health; Methods; Needles; NMR; Nuclear magnetic resonance; Nuclear Medicine; Orthopedics; Osteitis; Pathology; Radiology; Sacrum; Scientific Article; Sclerosis; Subchondral bone; Histopathology; Computed tomography; Biopsy; Sacroiliac joints; Spondyloarthritis
• ISSN: 0364-2348; 1432-2161
• DOI: 10.1007/s00256-019-03305-x

Objective
To introduce and evaluate computed tomography (CT)-guided transarticular needle biopsy of the cartilaginous sacroiliac joint (SIJ) and to assess the biopsy results microscopically.
Materials and methods
The new CT-guided transarticular biopsy of the SIJ was performed in a young corpse and ten patients, two males and eight females aged 18–81 years. All patients had abnormal findings by magnetic resonance imaging (MRI) of the SIJs, including bone marrow edema, related to different types of joint disorders. The biopsies were focused on areas with bone marrow edema. The quality of the specimens obtained, using two different types of biopsy needles, was assessed microscopically.
Results
Biopsies containing cartilage, subchondral plate, and bone marrow from the iliac and sacral sides were obtained from the corpse and three patients and from the iliac bone only in two patients. In three patients, the biopsy needles could not penetrate the bone marrow to the joint facet due to pronounced subchondral sclerosis, but adequate marrow biopsies were obtained. Two biopsies were inadequate, one due to technical problems and one was crushed during preparation. Histological assessment of eight adequate specimens revealed inflammatory bone marrow changes, except in two specimens from females with pronounced sclerosis conforming to osteitis condensans ilii.
Conclusions
Transarticular SIJ biopsies are obtainable and can be directed towards areas with MRI abnormalities. They can be used to confirm inflammatory changes histologically. With the biopsy needles used, severe bone marrow sclerosis may hinder penetration to the cartilage, but bone marrow specimens can be obtained.