ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 678

Additional Information from CT or MRI Imaging Can Increase Rheumatologists’ Consensus on Grading Sacroiliitis By Radiography: Results of the Trimage Project

Nigil Haroon1, Xenofon Baraliakos2, Anne Grethe Jurik3, Gercek Can4, Ali Balcı5, Muhammet Cinar6, Ediz Dalkilic7, Salim Donmez8, Omer Nuri Pamuk9, Yavuz Pehlivan10, Salih Pay11, Handan Yarkan12, Gokce Kenar13 and Nurullah Akkoc13, 1Rheumatology, Toronto Western Hospital, University of Toronto, Spondylitis Clinic, Toronto, ON, Canada, 2Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Herne, Germany, 3Department of Radiology, Aarhus University Hospital, Aarhus, Denmark, 4Department of Rheumatology, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey, 5Radiology, Dokuz Eylul University, Izmir, Turkey, 6Division of Rheumatology, Gülhane Military Medical Academy, School of Medicine, Ankara, Turkey, 7Department of Rhematology, Uludag University Faculty of Medicine, Bursa, Turkey, 8Department of Rheumatology, Trakya University Faculty of Medicine, Edirne, Turkey, 9Rheumatology, Trakya University Faculty of Medicine, Edirne, Turkey, 10Rheumatology, Uludag University Medcal Faculty, Bursa, Turkey, 11Rheumatology, Yüksek Ihtisas University, Special Koru Hospital, Ankara, Turkey, 12Rheumatology, Dokuz Eylul University Faculty of Medicine, İzmir, Turkey, 13Rheumatology, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: , , ,

Session Information

Date: Sunday, November 13, 2016

Title: Spondylarthropathies and Psoriatic Arthritis – Clinical Aspects and Treatment - Poster I: Axial and Peripheral Spondyloarthritis – Clinical Aspects, Imaging and Treatment

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose:  The diagnosis of ankylosing spondylitis (AS) is anchored on definitive changes of sacroiliits by radiography. This is relevant not only to clinical diagnosis, but also for reimbursement and access to treatment modalities such as TNF inhibitors. However, radiographic grading of sacroiliitis is plagued by lack of interrater reliability. This study evaluated the impact of additional information from sacroiliac MRI or CT images on rheumatologists correctly identifying definite sacroiliitis by radiography.

Methods:  Pelvis images from all three modalities (X-ray, CT and MRI) performed within a period of 1 year were available , from 50 patients with chronic back pain. Consensus reads for radiographic sacroiliitis, based on the interpretation of all three imaging modalities by four spondyloarthritis experts (one radiologist and 3 rheumatologists) was the gold standard grading. In the TRIMAGE project 6 rheumatologists and 2 rheumatology fellows scored radiographs online in a random order for the presence of radiographic sacroiliitis, in the first round before and after viewing the MRI images and in the second round before and after viewing the CT images. The same set of images were scored again one month later, following a two day training meeting, which included lectures for each imaging modality and supervised scoring exercises on a training set of 15 patients. Intrarater agreement, was computed for each rheumatologist before and after training. Kappa statistic and percent agreement were used to compare agreement between the expert consensus scoring and those of the rheumatologists/fellows. Sensitivity and specificity of the radiographic ratings by the rheumatologists/fellows were calculated using the final expert consensus classification as the gold standard.

Results:   Based on expert consensus grading, 32 of the 50 patients (64%) had radiographic sacroiliitis. The results are summarized in Table 1 and Table 2.

Table 1. Performance of rheumatologists/fellows before and after training for diagnosing radiographic sacroiliitis when the expert consensus scoring is taken as the gold standard
BEFORE TRAINING AFTER TRAINING
Assessment with X-ray Assessment with X-ray & MRI Assessment with X-ray & CT Assessment with X-ray Assessment with X-ray & MRI Assessment with X-ray & CT
Intrarater agreement, mean/median 0.412 / 0.422 – – 0.512 / 0.521 – –
Kappa score, mean/median 0.228 / 0.253 0.305 / 0.296 0.556 / 0.554 0.363 / 0.422 0.465 / 0.480 0.533 / 0.565
Overall agreement (%), mean/median 56.5 / 58.0 62.0 / 63.0 78.3 / 78.0 67.0 / 70.0 73.8 / 75.0 78.3 / 78.0
Positive agreement (%), mean/median 51.3 / 54.3 59.6 / 61.6 81.2 / 81.7 67.1 / 72.8 75.6 / 79.0 82.1 / 82.1
Negative agreement (%), mean/median 59.8 / 60.6 62.5 / 62.6 73.3 / 73.7 63.6 / 67.5 68.3 / 68.3 69.2 / 74.7
Sensitivity, mean/median 37.9 / 40.6 48.1 / 46.9 75.4 / 75.0 59.8 / 65.6 71.5 / 73.5 80.1 / 76.6
Specificity, mean/median 89.6 / 91.7 86.8 / 91.7 83.3 / 88.9 79.9 / 83.4 77.8 / 86.1 75.0 / 86.1
Table 2. Kappa scores before and after training for the agreement between the rheumatologists/fellows and experts at different rounds of scoring
BEFORE TRAINING AFTER TRAINING
Assessment with X-ray Assessment with X-ray & MRI Assessment with X-ray & CT Assessment with X-ray Assessment with X-ray & MRI Assessment with X-ray & CT
Rheumatologist 1 0.178 0.205 0.503 0.491 0.491 0.327
Rheumatologist 2 0.288 0.363 0.707 0.468 0.525 0.55
Rheumatologist 3 0.11 0.492 0.399 0.045 0.478 0.33
Rheumatologist 4 0.258 0.288 0.684 0.528 0.532 0.769
Rheumatologist 5 0.363 0.413 0.826 0.376 0.48 0.579
Rheumatologist 6 0.288 0.304 0.32 0.335 0.443 0.595
Fellow 1 0.247 0.247 0.604 0.595 0.669 0.632
Fellow 2 0.093 0.126 0.407 0.069 0.168 0.481

Conclusion:  Compared to expert consensus, rheumatologists/fellows had poor to fair performance in identifying radiographic sacroiliitis on plain radiographs, but most of them improved with training. Availability of CT images improved their diagnostic performance even before training while MRI improved it only after training.

Disclosure: N. Haroon, None; X. Baraliakos, None; A. G. Jurik, None; G. Can, None; A. Balcı, None; M. Cinar, None; E. Dalkilic, None; S. Donmez, None; O. N. Pamuk, None; Y. Pehlivan, None; S. Pay, None; H. Yarkan, None; G. Kenar, None; N. Akkoc, None.

To cite this abstract in AMA style:

Haroon N, Baraliakos X, Jurik AG, Can G, Balcı A, Cinar M, Dalkilic E, Donmez S, Pamuk ON, Pehlivan Y, Pay S, Yarkan H, Kenar G, Akkoc N. Additional Information from CT or MRI Imaging Can Increase Rheumatologists’ Consensus on Grading Sacroiliitis By Radiography: Results of the Trimage Project [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/additional-information-from-ct-or-mri-imaging-can-increase-rheumatologists-consensus-on-grading-sacroiliitis-by-radiography-results-of-the-trimage-project/. Accessed .

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