Candidate lesion-based criteria for defining a positive sacroiliac joint MRI in two cohorts of patients with axial spondyloarthritis
- 12 June 2014
- journal article
- research article
- Published by BMJ in Annals Of The Rheumatic Diseases
- Vol. 74 (11), 1976-1982
- https://doi.org/10.1136/annrheumdis-2014-205408
Abstract
Objective To determine candidate lesion-based criteria for a positive sacroiliac joint (SIJ) MRI based on bone marrow oedema (BMO) and/or erosion in non-radiographic axial spondyloarthritis (nr-axSpA); to compare the performance of lesion-based criteria with global evaluation by expert readers. Methods Two independent cohorts A/B of 69/88 consecutive patients with back pain aged ≤50 years, with median symptom duration 1.3/10.0 years, were referred for suspected SpA (A) or acute anterior uveitis plus back pain (B). Patients were classified according to rheumatologist expert opinion based on clinical examination, pelvic radiography and laboratory values as having nr-axSpA (n=51), ankylosing spondylitis (n=34) or non-specific back pain (n=72). Four blinded readers assessed SIJ MRI, recording the presence/absence of SpA by concomitant global evaluation of T1-weighted spin echo (T1SE) and short τ inversion recovery (STIR) scans and, thereafter, whether BMO and/or erosion were present/absent in each SIJ quadrant of each MRI slice. We derived candidate lesion-based criteria based on the number of SIJ quadrants with BMO and/or erosion and calculated mean sensitivity and specificity for SpA. Results For both cohorts A/B, global assessment showed high specificity (0.95/0.83) compared with the Assessment in SpondyloArthritis international Society (ASAS) definition (0.76/0.74). BMO ≥3 (0.89/0.84) or ≥4 (0.92/0.87) showed comparably high specificity to global assessment. Erosion ≥2 and/or BMO ≥3 or ≥4 were associated with comparably high sensitivity to global assessment without affecting specificity. These combined criteria showed both higher sensitivity and specificity than the ASAS definition. Conclusions Lesion-based criteria for a positive SIJ MRI based on both BMO and/or erosion performed best for classification of axial SpA, reflecting the contextual information provided by T1SE and STIR sequences.Keywords
This publication has 21 references indexed in Scilit:
- Fat Infiltration on Magnetic Resonance Imaging of the Sacroiliac Joints Has Limited Diagnostic Utility in Nonradiographic Axial SpondyloarthritisThe Journal of Rheumatology, 2013
- MR Imaging of the Spine and Sacroiliac Joints for Spondyloarthritis: Influence on Clinical Diagnostic Confidence and Patient ManagementRadiology, 2013
- Tumor Necrosis Factor α Inhibition in Radiographic and Nonradiographic Axial Spondyloarthritis: Results From a Large Observational CohortArthritis & Rheumatism, 2013
- Development and Validation of a Magnetic Resonance Imaging Reference Criterion for Defining a Positive Sacroiliac Joint Magnetic Resonance Imaging Finding in SpondyloarthritisArthritis Care & Research, 2013
- Review: Nonradiographic axial spondyloarthritis: New definition of an old disease?Arthritis & Rheumatism, 2013
- The diagnostic utility of magnetic resonance imaging in spondylarthritis: An international multicenter evaluation of one hundred eighty‐seven subjectsArthritis & Rheumatism, 2010
- Defining active sacroiliitis on magnetic resonance imaging (MRI) for classification of axial spondyloarthritis: a consensual approach by the ASAS/OMERACT MRI groupAnnals Of The Rheumatic Diseases, 2009
- The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): validation and final selectionAnnals Of The Rheumatic Diseases, 2009
- The European Spondylarthropathy Study Group Preliminary Criteria for the Classification of SpondylarthropathyArthritis & Rheumatism, 1991
- Standardised Nordic questionnaires for the analysis of musculoskeletal symptomsApplied Ergonomics, 1987