Aims:
Sacroiliitis is difficult to diagnose and harder still to quantify or monitor response. Dynamika is a stand-alone, cloud-based software using complex algorithms to allow real-time, user-defined analysis of regions of interest (ROI)in 3D and allows quantification of signal intensity (and/or contrast enhancement) within these ROIs on scans. The ROI evaluation technique in simplest guise was used to evaluate isotope imaging as proof of principle but we aim to show similar/better success with this software on STIR MR images.

Content:
50 MRI and 30 bone scans were analysed to evaluate initial validity of Dynamika software, including some follow-up imaging - giving insight into how disease monitoring could be undertaken. This analysis was benchmarked against scintigraphy standard peak-trough algorithm analysis.

Impact:
Potential to diagnose and grade disease and also monitor response with MRI, as well as show its superiority compared with bone scanning - though show utility of the software with bone scans also.

Outcomes:
Positive Negative Total
Bone scan 5 25 30
MRI scan (visual) 13 37 50
MRI (+Dynamika) 21 29 50
Clinical picture 19 31 50


Quantitative assessment:
“Positivity” of result: visual v ‘score’
Score rating Mild/ Moderate/ Severe
MRI result 11 mild; 1 moderate; 1 severe
MRI Dynamika outcome 7 mild; 7 moderate, 7 severe
Dynamika clinical correlation 2 false positive, no false negative:
100% sens; 94% spec; NPV 100%

Patients can be quantitatively graded into mild, moderate or severe sacroiliitis with greatest reliability using MRI +Dynamika.


Discussion:
Needs validating in bigger studies but initial results of Dynamika software are promising and simple to reproduce in evaluating sacroiliitis, with some correlation between results and the clinical scenario in a way not applicable to bone scintigraphy without the penalty of ionising radiation or contract administration.

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