Date: Monday, November 9, 2020
Session Type: Poster Session D
Session Time: 9:00AM-11:00AM
Background/Purpose: A broad spectrum of MRI lesions has been described in the spine of patients with axial spondyloarthritis (axSpA) and a recent consensus from the ASAS MRI group has culminated in updated spine lesion definitions (ASAS_MRI_defn)1. There has been no central reader evaluation of MRI spine scans from the ASAS Classification Cohort (ASAS-CC)2. We aimed to determine the spectrum and compare the frequencies of active and structural lesions on MRI images of the spine from the ASAS-CC according to the consensus ASAS_MRI_defn update, the diagnosis of axSpA, and the presence of radiographic sacroiliitis.
Methods: ASAS_MRI_defn were recorded by 9 central readers in an eCRF that comprises global assessment (MRI indicative of axSpA yes/no) and detailed scoring of each discovertebral unit as well as lateral and posterior structures. Detailed scoring is based on slices viewed in sagittal orientation and for the thoracic and lumbar spine is subdivided into assessment of central and lateral slices that include or do not include the spinal canal, respectively. Vertebral corner bone marrow edema (VCBME) and corner fat (VCFAT) lesions were recorded if present on 2 slices; facet joint, lateral slice, and posterior element inflammatory lesions were recorded if present on a single slice. Vertebral corner erosion, bone spurs, and ankylosis (intervertebral, facet) were each scored on a single slice. Comparison of active and structural lesion frequencies according to local rheumatologist diagnosis of axSpA and the presence of radiographic sacroiliitis was assessed descriptively according to individual, ≥2, and majority reader (≥5/9) concordant data.
Results: MRI scans of the entire spine were available from 69 cases and rheumatologist diagnosis in 64. AxSpA was diagnosed in 44 (68.8%). VCBME was most frequent, ≥1 lesion being recorded in 32(46.4%) and 19 (27.5%) by ≥2 and majority of readers, respectively. VCFAT was the most frequent structural lesion, ≥1 lesion being recorded in 24 (34.8%) and 14 (20.3%) by ≥2 and majority of readers, respectively. There were significantly more VCBME lesions in axSpA patients (mean(SD):1.8 (2.7)) than non-axSpA (mean(SD):0.3 (0.5)) (p< 0.001) while differences in VCFAT were not significant (Table 1). The presence of ≥2 VCBME lesions had 90-95% specificity for axSpA. Significantly more VCBME and VCFAT were observed in the setting of radiographic sacroiliitis (modified New York criteria (mNY)) (Table 2).
Conclusion: Spine lesions on MRI are relatively frequent in patients with undiagnosed back pain presenting to the rheumatologist. The presence of at least 2 VCBME lesions (each on 2 consecutive sagittal slices and without degenerative disc disease), but not VCFAT, may have some diagnostic utility.
- Maksymowych WP, et al. Arthritis Rheumatol 70 (suppl 10): 654, 2018
- Rudwaleit et al. Ann Rheum Dis 2009;68: 777-83
To cite this abstract in AMA style:Maksymowych W, Eshed I, Machado P, Pedersen S, Weber U, de Hooge M, Sieper J, Wichuk S, Poddubnyy D, Rudwaleit M, van der Heijde D, Landewé R, Lambert R, Østergaard M, Baraliakos X. Consensus Definitions for MRI Lesions in the Spine of Patients with Axial Spondyloarthritis: First Analysis from the Assessments in SpondyloArthritis International Society Classification Cohort [abstract]. Arthritis Rheumatol. 2020; 72 (suppl 10). https://acrabstracts.org/abstract/consensus-definitions-for-mri-lesions-in-the-spine-of-patients-with-axial-spondyloarthritis-first-analysis-from-the-assessments-in-spondyloarthritis-international-society-classification-cohort/. Accessed May 12, 2021.
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