Sacroiliac Arthrograms and Post-Arthrography Computerized Tomography An Original Contribution

From *Spine Technology and Rehabilitation, Fort Wayne, IN, Indiana University School of Medicine, Fort Wayne, IN, Associates in Rehab, Miami Beach, FL. Address Correspondence: Joseph D. Fortin, DO, Spine Technology and Rehabilitation, 7230 Engle Road, Suite 210, Fort Wayne, IN 46804. Email: [email protected] Funding: There was no external funding in preparation of this manuscript. Sacroiliac joint (SIJ) injection and arthrography have been described, yet no study has specifi cally categorized the morphological characteristics of SIJ arthrograms versus post arthrogram computerized tomography (CT). Forty-three patients with a mean age of 33 years (range 20-48 years) and an equal male to female distribution were studied radiographically for SIJ pathology. A total of 74 SIJ injections were performed using Image-intensifi er-control and a posterior-inferior approach. Symptom reproduction indicating a provocation positive outcome, was reported in 63.5% with a mean injected volume of contrast media of 1.08 cc (S.D. 0.29). SIJ fi ndings were then classifi ed and scored in each aspect of the SIJ capsule by plain fi lm arthrography followed by post arthrogram CT (anterior, posterior, superior and inferior aspects of the capsule). There was a signifi cant direct correlation between the plain fi lm and CT arthrography fi ndings in each category (Kendall correlation coeffi cients 0.63 – 0.99, p‹0.01). In addition, there was a signifi cant direct correlation between provocation positive outcomes and volume of contrast injected (Kendall correlation 0.25, p‹0.01; ANOVA, p‹0.03). Post arthrogram CT revealed signifi cantly more positive anterior capsule fi ndings compared to plain fi lm arthrography (McNemar’s test, p‹0.04). Conversely, plain fi lm arthrography noted more diverticula compared to post arthrogram CT (McNemer’s test, p‹0.01). These fi ndings demonstrate that a detailed radiographic analysis of the SIJ capsule is reasonable by either plain fi lm arthrography or post arthrogram CT, with excellent agreement between the two techniques. Further, each test has specifi c regional benefi ts that may be appreciated in certain cases.