Prevalence and awareness of sacroiliac joint alterations on lumbar spine CT in low back pain patients younger than 40 years

Background: Computed tomography (CT) examinations of the lumbar spine are commonly performed in patients aged <= 40 years due to low back pain (LBP). Purpose: To investigate the prevalence and awareness of radiologists for the presence of structural post-inflammatory/other sacroiliac joint (SIJ) alterations on lumbar spine CTs of young patients with LBP. Material and Methods: A total of 484 lumbar spine CTexaminations (272 men, 212 women; average age, 31 years; age range, 18-40 years) of patients with LBP in which the entire SIJs were visualized were retrospectively reviewed. SIJs were scored (consensus) by two senior radiologists (study reading) for the presence of post-inflammatory structural SIJ findings or other SIJs alterations. The original reports were compared to the study reading. Fifty CT examinations were re-evaluated for reliability assessment (intra-class correlation coefficient [ICC]). Results: A total of 150 (31%) abnormal SIJ examinations were registered (ICC: r = 0.7-0.8; P < 0.0001): suspected sacroiliitis = 50 (10.2%); definite sacroiliitis = 16 (3.3%); osteitis-condensans-ilii = 38 (7.8%); diffuse idiopathic skeletal hyperostosis = 24 (5%); degenerative changes = 22 (4.5%); accessory SIJ = 22 (4.5%); and tumor = 1. The SIJs were referenced 39 times (8.0%) in the original readings: pathological findings (n = 15); and normal SIJ (n = 24). Total diagnostic accuracy for these reports only and for the entire readings were 49% and 69%, respectively, and 13% and 1.3%, respectively, for the pathological findings. Conclusion: Sacroiliitis and other SIJ alterations are prevalent in young individuals with LBP, albeit, the majority of these alterations are not recognized nor reported by senior radiologists thus may delay efficacious treatment.