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Abstract Number: 1187

Scoring of Spinal Lesions Compatible with Axial Spondyloarthritis on MRI in Clinical Practice By Local Radiologist or Rheumatologist in Desir; Comparison with Central Reading

Manouk de Hooge1, Jean-Baptiste Pialat2, Monique Reijnierse1, Désirée van der Heijde1, Pascal Claudepierre3, Alain Saraux4, Maxime Dougados5 and Antoine Feydy5, 1Leiden University Medical Center, Leiden, Netherlands, 2Hôpital Edouard Herriot, Lyon, France, 3Henri Mondor Teaching Hospital, Creteil, France, 4CHU Brest and EA 2216, UBO, Brest, France, 5Descartes University, Cochin Hospital, Paris, France

Meeting: 2014 ACR/ARHP Annual Meeting

Keywords: MRI, spine involvement and spondylarthritis

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Session Information

Session Title: Imaging of Rheumatic Diseases: Magnetic Resonance Imaging (MRI)

Session Type: Abstract Submissions (ACR)

Background/Purpose: In clinical practice radiologists and rheumatologists assess whether lesions compatible with axial SpondyloArthritis (axSpA) are present on spinal MRI. The objective was to compare the results of local readings (LocR) to centralized reading (CentR) as external standard of BME and structural lesions on MRI-spine, in patients (pts) with inflammatory back pain (IBP).

Methods: Pts aged 18-50 with recent IBP (³3 months, ²3 years) from 25 participating centers in France were included in the DESIR-cohort (n=708). All available baseline MRIs-spine were scored on BME and structural lesions as present, absent or doubtful by the local radiologist/rheumatologist who might have access to clinical data. In addition, 2 well-calibrated centralized readers independently scored the same MRIs for BME lesions and structural lesions (fatty lesions, erosions and (bridging) syndesmophytes). In case the centralized readers disagreed, an experienced radiologist served as adjudicator. Agreement between CentR and LocR was calculated excluding the cases assessed as doubtful by LocR (kappa κ).

Results: BME/structural lesions were in 492/492 pts scored by a radiologist, 206/205 by a rheumatologist and in 32/32 pts by both. The k agreement between LocR and CentR was 0.27 for BME lesions and 0.13 for structural lesions. For radiologists,  κ=0.36 for BME, and κ=0.15 for structural lesions. For rheumatologists κ=0.006 for BME and κ=0.12 for structural lesions.

Overall, local specialists are highly overrating positive findings: 42.3% and 85.7% of the positive MRIs for BME are scored negative by the central read (radiologists and rheumatologist respectively). Similarly findings for structural lesions: 48.4% and 70% of MRIs positive for structural lesions are scored normal by central reading.

Conclusion: Both local radiologists, but especially rheumatologists overrate the presence of BME lesions and structural lesions on MRI of the spine compared to trained central readers. These results do not even take doubtful cases into account. 

BME lesions

Structural lesions

LocR (rheumatologist)

LocR (rheumatologist)

Positive

Negative

Doubt

Positive

Negative

Doubt

CentR

Positive

4

20

21

CentR

Positive

6

26

7

Negative

24

126

11

Negative

14

146

6

LocR (radiologist)

LocR (radiologist)

Positive

Negative

Doubt

Positive

Negative

Doubt

Positive

30

29

58

Positive

16

87

21

Negative

41

304

30

Negative

15

338

15


Disclosure:

M. de Hooge,
None;

J. B. Pialat,
None;

M. Reijnierse,
None;

D. van der Heijde,
None;

P. Claudepierre,
None;

A. Saraux,
None;

M. Dougados,
None;

A. Feydy,
None.

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