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Abstract Number: 548

Assessment of the T1-Weighted Sequence Is Essential in Defining a Positive MRI Scan of the Sacroiliac Joints in Spondyloarthritis

Ulrich Weber1, Veronika Zubler2, Susanne Juhl Pedersen3, Kaspar Rufibach4, Robert GW Lambert5, Stanley Chan6, Mikkel Ostergaard7 and Walter P. Maksymowych8, 1Rheumatology, Balgrist University Hospital, Zurich, Switzerland, 2Radiology, Balgrist University Hospital, Zurich, Switzerland, 3Dept. of Rheumatology, Copenhagen Center for Arthritis Research, Copenhagen, Denmark, 4Institute for Social and Preventive Medicine, Division of Biostatistics, University of Zurich, Zurich, Switzerland, 5Radiology, University of Alberta, Edmonton, AB, Canada, 6Division of Ophthalmology, University of Alberta, Edmonton, AB, Canada, 7Dept of Rheumatology RM, Copenhagen University Hospital, Glostrup, Denmark, 8Department of Medicine, University of Alberta, Edmonton, AB, Canada

Meeting: 2012 ACR/ARHP Annual Meeting

Keywords: diagnosis, Magnetic resonance imaging (MRI) and spondylarthropathy

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Session Information

Title: Spondylarthropathies and Psoriatic Arthritis: Clinical Aspects and Treatment

Session Type: Abstract Submissions (ACR)

Background/Purpose: Inflammation on MRI of the sacroiliac joints (SIJ) in patients with spondyloarthritis (SpA) is a major criterion in the Assessment of SpondyloArthritis (ASAS) classification criteria for axial SpA, which are based on expert clinical opinion as gold standard. The definition of a positive SIJ MRI in the ASAS criteria was generated by consensus among experts. Studies using a data-driven approach are scarce. We aimed to assess candidate definitions for a positive SIJ MRI using both clinical gold standard and confidence in the diagnosis of SpA according to global assessment of MRI (T1-weighted and STIR sequences) by expert readers.

Methods: The study population comprised 2 independent cohorts (cohort A/B) of 157 consecutive patients with back pain ≤50 years newly referred to 2 university clinics, and 20 healthy controls. Patients were classified according to clinical examination and pelvic radiography as having non-radiographic SpA (n=51), ankylosing spondylitis (n=34), or mechanical back pain (n=72). SIJ MRI were assessed by 4 blinded readers according to a standardized module. Readers recorded their level of confidence in the diagnosis of SpA by global evaluation of the MRI scan on a 0-10 scale (0 = definitely not SpA; 10 = definite SpA). An MRI-based gold-standard criterion for SpA was pre-specified as the majority of readers (≥3/4) recording a confidence of 8-10. We estimated the type and extent of involvement according to number of affected SIJ quadrants attaining specificity of ≥90% for SpA using ROC analysis according to both clinical and MRI-based gold-standard criteria.

Results: The agreement between 4 readers regarding confidence for MRI-based global assessment of SpA was substantial with kappa of 0.76/0.80 for cohort A/B. BME was recorded in up to 30.0%/24.2% of controls in cohort A/B, whereas erosion was seen in only 0%/12.1% of controls. The combination of erosion and/or BME increased sensitivity compared to either lesion alone without reducing specificity irrespective of which gold standard criterion was used.

Sensitivity and cut-off for number of affected SIJ quadrants for a pre-defined specificity ≥0.90, and AUC, for the 2 gold standards and for cohort A/B

Gold standard Lesion Sensitivity Number of SIJ quadrants AUC
MRI criterion BME 0.91/0.83 3/2 0.97/0.91
Clinical evaluation BME 0.73/0.48 4/4 0.91/0.75
MRI criterion ER 1.00/1.00 1/1 1.00/1.00
Clinical evaluation ER 0.83/0.58 1/2 0.94/0.79
MRI criterion BME+ER 1.00/1.00 3/2 1.00/1.00
Clinical evaluation BME+ER 0.83/0.58 4/6 0.96/0.83

AUC: Area under the curve. BME: Bone marrow edema. ER: Erosion. Number of SIJ quadrants: Cut-off for the number of affected SIJ quadrants

Conclusion: This data driven study shows that assessment of the T1-weighted sequence enhances diagnostic certainty when viewed simultaneously with the STIR and supports the case for revision of the ASAS definition of a positive MRI in SpA.


Disclosure:

U. Weber,
None;

V. Zubler,
None;

S. J. Pedersen,
None;

K. Rufibach,
None;

R. G. Lambert,
None;

S. Chan,
None;

M. Ostergaard,
None;

W. P. Maksymowych,
None.

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