Scoring MRI Structural Lesions in Sacroiliac Joints of Patients with Axial Spondyloarthritis: How Many Slices Are Optimal?

Walter Maksymowych¹, Ulrich Weber², Xenofon Baraliakos³, Pedro Machado⁴, Susanne Pedersen⁵, Joachim Sieper⁶, Stephanie Wichuk⁷, Denis Poddubnyy⁸, Martin Rudwaleit⁹, Désirée van der Heijde¹⁰, Robert Landewé¹¹, Joel Paschke¹², Mikkel Ostergaard¹³ and Robert Lambert⁷, ¹Department of Medicine, University of Alberta, Alberta, Canada, Edmonton, AB, Canada, ²Practice Buchsbaum Schaffhausen, Schaffhausen, Switzerland, ³Rheumazentrum Ruhrgebiet Herne, Ruhr-Universität Bochum, Herne, Germany, ⁴Centre for Rheumatology & Department of Neuromuscular Diseases, University College London, London, United Kingdom, ⁵Rigshospitalet, Center for Arthritis Research, Glostrup, Denmark, ⁶Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany, ⁷University of Alberta, Edmonton, AB, Canada, ⁸Department of Rheumatology, Charité – Universitätsmedizin, Berlin, Germany, ⁹University of Bielefeld, Klinikum Bielefeld, Bielefeld, Germany, ¹⁰Department of Rheumatology, Leiden University Medical Center, Meerssen, Netherlands, ¹¹Amsterdam Rheumatology & Clinical Immunology Center, Amsterdam, Netherlands; Zuyderland MC, Heerlen, Netherlands, ¹²CARE Arthritis, Edmonton, AB, Canada, ¹³Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, and Department of Clinical Medicine, University of Copenhagen, Glostrup, Denmark

Meeting: ACR Convergence 2021

Keywords: Ankylosing spondylitis (AS), classification criteria, Magnetic resonance imaging (MRI), spondyloarthritis

Session Information

Date: Sunday, November 7, 2021

Session Title: Spondyloarthritis Including PsA – Diagnosis, Manifestations, & Outcomes Poster II: Imaging in Spondyloarthritis (0897–0907)

Session Type: Poster Session B

Session Time: 8:30AM-10:30AM

Background/Purpose: There is no international consensus on the optimal number of slices for evaluation of MRI structural lesions in the SIJ. An “all slice” method evaluates lesions from the most anterior slice, defined as the first slice with vertical height of ≥1cm of the SIJ joint cavity, up to the most posterior slice, defined as the most posterior slice where ≥1cm vertical height of the cartilaginous portion is still visible. The SPARCC method scores the transitional slice between cartilaginous and ligamentous compartments as the first slice and then an additional 4 slices anterior to the transitional slice. We aimed to investigate inter-reader reliability, the extent of detection of lesions, and frequency of cases with a positive MRI for structural lesions when using an “all slice” approach versus the SPARCC scoring of 5 central slices.

Methods: MRI T1W images with DICOM series were available from 148 cases who had MRI performed in the ASAS-Classification Cohort. Seven central readers recorded MRI lesions in an eCRF that recorded global assessments of presence/absence of changes suggestive of axSpA and structural lesions typical of axSpA. Structural lesions per the ASAS definitions were also recorded in consecutive semicoronal slices using the “all slice” approach, but also recording the transitional slice, according to their presence/absence in SIJ quadrants (erosion, fat lesion, sclerosis) or halves (backfill, ankylosis). Structural lesion frequencies were assessed descriptively according to majority agreement (≥4/7) of central readers and also any 2 central readers. Reliability for detection of MRI lesions was compared between central and local readers using the ICC.

Results: The mean (SD) (range) number of anterior and posterior slices peripheral to the 5 central slices was 1.0 (1.0) (0-4) and 2.2 (1.8) (0-6) per case, respectively. There were 2 cases (1.4%) where >2 readers scored structural lesions in peripheral slices but not in the 5 central slices. The mean percentage of the total structural lesion score that was captured by the 5 central slices was >75% for all types of lesions except ankylosis (59%) (Table 1). Inter-reader reliability was greater for all lesions when assessing the 5 central slices and especially for erosion and backfill (Table 2).

Conclusion: The major component of structural lesion data is captured by assessment of 5 slices, which includes the transitional slice and the subsequent 4 anterior slices. Moreover, reliability for detection of structural lesions is substantially worse in peripheral slices.

Disclosures: W. Maksymowych, AbbVie, 2, 5, 6, Bristol-Myers Squibb, 2, 5, Boehringer Ingelheim, 2, Celgene, 2, 5, Eli Lilly, 2, 5, Galapagos, 2, 5, Janssen, 6, Novartis, 2, 5, 6, Pfizer Inc, 2, 5, 6, UCB, 2, 5, 6; U. Weber, None; X. Baraliakos, AbbVie, 2, 5, 6, Chugai, 2, 5, 6, Novartis, 2, 5, 6, Pfizer, 2, 5, 6, UCB, 2, 5, 6, Bristol-Myers Squibb, 2, 5, 6, Celegene, 2, 5, 6, Merck, 2, 6, Werfen, 2; P. Machado, Abbvie, 6, BMS, 6, Celgene, 6, Eli Lilly, 2, Janssen, 2, MSD, 6, Galapagos, 6, Novartis, 2, 6, Pfizer, 6, Roche, 6, UCB, 2, 6, Orphazyme, 5, 6; S. Pedersen, None; J. Sieper, AbbVie, 2, 5, 6, Merck, 2, 5, 6, Pfizer, 2, 5, 6, Janssen, 2, 6, Lilly, 2, 6, Novartis, 2, 6, UCB, 2, 6, Roche, 2, 6; S. Wichuk, None; D. Poddubnyy, AbbVie, 2, 5, 6, Eli Lilly and Company, 2, 5, 6, MSD, 2, 5, 6, Novartis, 2, 5, 6, Pfizer, 2, 5, 6, UCB, 2, 6, BMS, 2, 6, Roche, 2, 6; M. Rudwaleit, AbbVie, 2, Celgene, 2, Eli Lilly, 2, Janssen, 2, UCB Pharma, 2, AbbVie, 6, Eli Lilly, 6, Novartis, 6, Novartis, 2, UCB Pharma, 6; D. van der Heijde, AbbVie, 2, Amgen, 2, Astellas, 2, AstraZeneca, 2, Bayer, 2, BMS, 2, Boehringer Ingelheim, 2, Celgene, 2, Cyxone, 2, Daiichi, 2, Eisai, 2, Eli Lilly, 2, Galapagos, 2, Gilead, 2, GlaxoSmithKline, 2, Janssen, 2, Merck, 2, Novartis, 2, Pfizer, 2, Regeneron, 2, Roche, 2, Sanofi, 2, Takeda, 2, UCB Pharma, 2, Imaging and Rheumatology BV, 4; R. Landewé, AbbVie, 5, 6, Novartis, 5, 6, Pfizer, 5, 6, UCB, 5, 6, Astra-Zeneca, 6, Bristol Myers Squibb, 6, Celgene, 6, Eli-Lilly, 6, Janssen, 6, Gilead, 6, Galapagos, 6, Glaxo-Smith-Kline, 6; J. Paschke, None; M. Ostergaard, AbbVie, 2, 5, 6, Bristol-Myers Squibb, 2, 6, Celgene, 2, 6, Novartis, 2, 5, 6, Boehringer Ingelheim, 2, 6, Eli Lilly, 2, 6, Hospira, 2, 6, Janssen, 2, 6, Merck, 2, 5, 6, Novo, 2, 6, Orion, 2, 6, Pfizer Inc, 2, 6, Regeneron, 2, 6, Roche, 2, 6, UCB, 2, 6, GSK, 2, 6, Mundipharma, 2, 6, Schering-Plough, 2, 6, Takeda, 2, 6, Wyeth, 2, 6, Centocor, 2, 5, 6; R. Lambert, Pfizer, 2.

To cite this abstract in AMA style:

Maksymowych W, Weber U, Baraliakos X, Machado P, Pedersen S, Sieper J, Wichuk S, Poddubnyy D, Rudwaleit M, van der Heijde D, Landewé R, Paschke J, Ostergaard M, Lambert R. Scoring MRI Structural Lesions in Sacroiliac Joints of Patients with Axial Spondyloarthritis: How Many Slices Are Optimal? [abstract]. Arthritis Rheumatol. 2021; 73 (suppl 9). https://acrabstracts.org/abstract/scoring-mri-structural-lesions-in-sacroiliac-joints-of-patients-with-axial-spondyloarthritis-how-many-slices-are-optimal/. Accessed January 27, 2023.

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