1
|
Zhao J, Lin C, Liu D, Liu B, Chen Q, Gu J. The diagnostic value of morphological features of fat deposition of sacroiliac joint steatosis in axial spondyloarthritis. Front Med (Lausanne) 2023; 10:1218834. [PMID: 37692786 PMCID: PMC10484708 DOI: 10.3389/fmed.2023.1218834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 08/04/2023] [Indexed: 09/12/2023] Open
Abstract
Background Findings of fatty lesions in the context of other imaging manifestations, especially bone marrow edema and erosions can effectively assist in the diagnosis of axSpA. Chemical shift-encoded MRI is a sequence which allows for the quantification of fat signal and has been applied in the imaging evaluation of the SIJ in axSpA. The objective of this study was to investigate the diagnostic performance of morphological features of fatty lesions visualized by CSE-MRI in the imaging evaluation of SIJ in axSpA. Methods Fatty lesions with morphological features (subchondral, homogeneity and distinct border) were assessed and recorded as a binary variable in each quadrant of the SIJ. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated for different morphological features as well as the anatomical distribution in patients with nr-axSpA and r-axSpA. T1-weighted images and CSE-MRI fat fraction maps were directly compared in the recognition of different morphological features. Results Eighty-two patients [non-SpA (n = 21), nr-axSpA (n = 23), r-axSpA (n = 38)] with lower back pain (LBP) were enrolled. Presence of the three morphological features of fatty lesions had a specificity of 90.48% in axSpA. The sensitivities of being subchondral, homogeneity and distinct border were 52.17, 39.13 and 39.13% in nr-axSpA on T1-weighted images. For patients with r-axSpA, the sensitivities reached 86.84, 76.32 and 57.89%. No significant difference was found in the distribution of fatty lesions between T1-weighted images and CSE-MRI. However, CSE-MRI fat fraction maps could detect significantly more fatty lesions with homogeneity (p = 0.0412) and distinct border (p = 0.0159) than T1-weighted images in the sacroiliac joint, but not subchondral lesions (p = 0.6831). Conclusion The homogeneity and distinct border are more relevant for the diagnosis of axSpA. Moreover, CSE-MRI could detect more typical morphological features of fatty lesions than T1-weighted images in showing these two features. The presence of all three features was more likely to be indicative of axSpA.
Collapse
Affiliation(s)
- Jiaoshi Zhao
- Department of Rheumatology and Immunology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Churong Lin
- Department of Radiology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Dong Liu
- Department of Rheumatology and Immunology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Budian Liu
- Department of Rheumatology and Immunology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Qilong Chen
- Department of Radiology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jieruo Gu
- Department of Rheumatology and Immunology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| |
Collapse
|
2
|
Use of Imaging in Axial Spondyloarthritis for Diagnosis and Assessment of Disease Remission in the Year 2022. Curr Rheumatol Rep 2022; 24:383-397. [PMID: 36242738 DOI: 10.1007/s11926-022-01091-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2022] [Indexed: 11/03/2022]
Abstract
Medical imaging remains the cornerstone of diagnostics and follow-up of axial spondyloarthritis (axSpA) patients. With the lack of specific biomarkers allowing monitoring of disease activity and progression, clinicians refer to imaging modalities for accurate evaluation of the axSpA burden. Technological advances and increasing availability of modern imaging techniques such as MRI have enabled faster diagnosis of the disease, hence dramatically changed the diagnostic delay and improved the prognosis and functional outcomes for axSpA patients.Active sacroiliitis as visualized by MRI has been widely accepted as a diagnostic tool, and definitions of inflammatory and structural lesions within the axial skeleton have been developed. Recently, it has been acknowledged that bone marrow edema, suggestive of sacroiliitis, is a common finding among non-SpA patients, and could be attributed to mechanical loading or accumulate with age in healthy individuals. Therefore, it is crucial to distinguish between true pathological and concealing imaging findings, not only for diagnostic but also for disease remission purposes. New imaging modalities, aimed for in vivo visualization of specific molecular processes, could be employed to cross-validate findings from techniques used in daily clinical practice. This review critically evaluates the use of different imaging modalities for diagnosis and assessment of disease remission in axSpA in the year 2022.
Collapse
|
3
|
MRI Changes of the Symphysis Pubis in Patients With Axial Spondyloarthritis and Association With Clinical Factors. J Comput Assist Tomogr 2021; 45:442-446. [PMID: 34297513 DOI: 10.1097/rct.0000000000001167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study aimed to evaluate the magnetic resonance imaging (MRI) changes of the symphysis pubis in patients with axial spondyloarthritis (ax-SpA) and to assess its association with clinical factors. METHODS A retrospective analysis of 172 patients with ax-SpA was performed to assess the presence of active inflammatory and structural changes of the symphysis pubis on MRI scans, and their association with clinical factors and the SPARCC (Spondyloarthritis Research Consortium of Canada) scoring of the sacroiliac joint were evaluated. RESULTS The proportions of active inflammation and structural changes of the symphysis pubis were 69/172 (40.1%) and 54/172 (31.4%), respectively. When comparing the active inflammation and no-active inflammation symphysis pubis groups, the former had higher level C-reactive protein, higher erythrocyte sedimentation rate, and younger median age of patients. Moreover, no significant correlation was noted between the active inflammation of the symphysis pubis and SPARCC score of the sacroiliac joint. When comparing the normal and abnormal symphysis pubis groups, the latter had longer symptom duration. CONCLUSIONS The MRI changes of the symphysis pubis were seen in 55.2% of the patients with ax-SpA and were associated with C-reactive protein, erythrocyte sedimentation rate, and symptom duration.
Collapse
|
4
|
Tu L, Lin C, Xie Y, Wang X, Wei Q, Zhang Y, Gu J. Active Inflammatory and Chronic Structural Damages of Sacroiliac Joint in Patients With Radiographic Axial Spondyloarthritis and Non-Radiographic Axial Spondyloarthritis. Front Immunol 2021; 12:700260. [PMID: 34386008 PMCID: PMC8353186 DOI: 10.3389/fimmu.2021.700260] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 07/12/2021] [Indexed: 01/31/2023] Open
Abstract
Objective Evaluate the MRI evidence of active inflammatory and chronic structural damages in radiographic axial spondyloarthritis (r-axSpA) and non-radiographic axial spondyloarthritis (nr-axSpA). Methods A retrospective review of 253 patients who underwent sacroiliac joint (SIJ) MRI between June 2014 and December 2019 was performed. MRI images including short tau inversion recovery scan and T1-weighted spin echo scans were assessed using the Spondyloarthritis Research Consortium of Canada (SPARCC) score and SPARCC MRI SIJ structural score by two independent readers. Results Higher mean score of inflammatory (SPARCC) was seen in r-axSpA patients when compared with nr-axSpA patients (8.08 vs 4.37, P<0.05). Frequencies of MRI structural lesions in r-axSpA patients and nr-axSpA patients were as follows: erosion (65.84 vs 88.23%, P=0.002), backfill (33.17 vs 13.73%, P<0.001), fat metaplasia (79.21 vs 60.78%, P=0.01), and ankylosis (37.13 vs 1.96%, P<0.001). Patients with r-axSpA had a higher mean score for fat metaplasia (8.93 vs 4.06, P=0.0003) and ankylosis (4.49 vs 0.04, P<0.001). Conclusion More active inflammatory and chronic structural damages except for erosion were seen in r-axSpA patients than nr-axSpA patients, while higher percentage of nr-axSpA patients presented with erosion in MRI.
Collapse
Affiliation(s)
- Liudan Tu
- Department of Rheumatology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Churong Lin
- Department of Radiology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Ya Xie
- Department of Rheumatology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xiaohong Wang
- Department of Radiology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Qiujing Wei
- Department of Rheumatology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yanli Zhang
- Department of Rheumatology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Jieruo Gu
- Department of Rheumatology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| |
Collapse
|
5
|
Lu CC, Huang GS, Lee TSH, Chao E, Chen HC, Guo YS, Chu SJ, Liu FC, Kao SY, Hou TY, Chen CH, Chang DM, Lyu SY. MRI contributes to accurate and early diagnosis of non-radiographic HLA-B27 negative axial spondyloarthritis. J Transl Med 2021; 19:298. [PMID: 34243762 PMCID: PMC8268359 DOI: 10.1186/s12967-021-02959-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 06/22/2021] [Indexed: 11/11/2022] Open
Abstract
Background Nonradiographic axial spondyloarthropathies (nr-axSpA) are diagnosed by the absence of radiographic sacroiliitis and the presence of bone marrow edema (BME) on magnetic resonance imaging (MRI). According to the classification criteria of the international Assessment of Spondyloarthritis Society (ASAS), structural changes to sacroiliac joints (SIJs) on MRI cannot be used as criteria in the absence of BME. However, less than half the Asian patients with clinically active axSpA show BME. The incidence of human leukocyte antigen (HLA)-B27 is low in Asian populations, which makes it more difficult to identify nr-axSpA. We used MRI to evaluate the structural damage to SIJs in patients with nr-axSpA with and without BME with the aim of identifying the best methodology for accurate diagnosis, especially in populations with less common BME and HLA-B27. Methods One hundred three patients with inflammatory back pain were included in this prospective study. No patient’s radiograph met the definition of positive modified New York criteria. BME and structural damage to SIJ including sclerosis and erosion were assessed independently on coronal and axial short-tau inversion recovery and T1-weighted spin echo MRI scans by two well-trained musculoskeletal radiologists using the Spondyloarthritis Research Consortium of Canada (SPARCC) score. Demographics of patients were collected. Disease characteristics and structural damage were analyzed in patients with and without BME on SIJ MRI. Receiver operating characteristic (ROC) curve analysis was used to assess the diagnostic performance of structural damage. Results All individuals in the cohort had at least one abnormal finding on SIJ MRI, including BME or structural damage; 36 of 103 patients had BME. We identified a significant positive correlation between SPARCC scores and severe erosion assessed by focal joint space widening (fJSW) (p = 0.001) in these 36 patients. Fifty-eight of the 103 enrolled patients fulfilled the ASAS criteria for nr-axSpA in the either absence or presence of BME. Of these 58 patients, 57 and 19 had erosions or fJSW, respectively, and the presence of BME was significantly correlated with fJSW (phi score of 0.319 and p = 0.015). We demonstrated a significant positive correlation between fJSW and either the presence or the severity of BME in patients with nr-axSpA who met the ASAS definition. There was a positive correlation between BME and fJSW across the whole study cohort (phi score of 0.389; p < 0.001). The area under the ROC curve (AUC) for fJSW on SIJ MRI was 0.736, p < 0.001. In both HLA-B27-positive and -negative groups, BME was more common in the presence of fJSW (phi scores of 0.370 and 0.377, p = 0.018 and 0.003, respectively) and SPARCC scores were higher in patients with fJSW (p < 0.001 and p = 0.005). We also identified a positive correlation between fJSW and BME in patients with nr-axSpA and normal serum levels of C-reactive protein (phi score of 0.362 and p = 0.001). Conclusion Structural damage detected on SIJ MRI, sclerosis, erosions and fJSW may be present in patients without detectable inflammation on SIJ MRI. However, fJSW is significantly correlated with the severity of inflammation seen on SIJ MRI, which contributes to the accurate diagnosis of nr-axSpA, and it could be used as an alternative diagnostic test for nr-axSpA in the general population, especially for those who do not carry the HLA-B27 gene, Asian patients without BME, or patients with normal serum inflammatory biomarkers.
Collapse
Affiliation(s)
- Chun-Chi Lu
- Division of Rheumatology/Immunology/Allergy, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,Department of Pathology, University of Washington, Seattle, USA
| | - Guo-Shu Huang
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, National Defense Medical Center, National Defense Medical Center, No. 100, Zhengrong St., Zhongzheng Dist, Keelung City, 202, Taiwan
| | - Tony Szu-Hsien Lee
- Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan
| | - En Chao
- Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan.,Tri-Service General Hospital Songshan Branch, Taipei, Taiwan
| | - Hsiang-Cheng Chen
- Division of Rheumatology/Immunology/Allergy, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yong-Si Guo
- Division of Rheumatology/Immunology/Allergy, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Shi-Jye Chu
- Division of Rheumatology/Immunology/Allergy, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Feng-Cheng Liu
- Division of Rheumatology/Immunology/Allergy, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - San-Yuan Kao
- Division of Rheumatology/Immunology/Allergy, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Tsung-Yun Hou
- Division of Rheumatology/Immunology/Allergy, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chen-Hung Chen
- Division of Rheumatology, Department of Internal Medicine, Taipei Tzu Chi Hospital, Taipei, Taiwan
| | - Deh-Ming Chang
- Division of Rheumatology/Immunology/Allergy, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,Division of Allergy, Immunology, Rheumatology, Department of Internal Medicine, Taipei Veteran General Hospital, Taipei, Taiwan
| | - Sin-Yi Lyu
- Division of Radiology, Tri-Service General Hospital, National Defense Medical Center, Keelung branch, Taipei, Taiwan.
| |
Collapse
|
6
|
Abstract
PURPOSE OF REVIEW MRI has, as the only imaging modality, the ability to visualize both the inflammatory and destructive aspects of sacroiliitis and is a crucial element in the diagnosis and classification of axial spondyloarthritis (axSpA). However, the MRI appearance of several potential differential diagnoses may resemble axSpA sacroiliitis. RECENT FINDINGS The appearances of sacroiliac joint (SIJ) MRIs of various diseased and healthy populations have recently been intensively studied. BME, the key requirement in the Assessment of Spondyloarthritis international Society (ASAS) definition of a 'MRI positive of sacroiliitis' may also be found in degenerative disease, athletes and healthy persons, and, particularly, postpartum women. Certain pattern of BME (high extent, large depth from articular surface, close relation to other lesion types) as well as the presence of structural lesions, particularly bone erosion, backfill or ankylosis increase the likelihood/specificity of being axSpA. Furthermore, old and novel MRI approaches to best distinguish the sacroiliitis of early axSpA from differential diagnoses have recently been tested and compared. SUMMARY Significant new and clinically relevant knowledge has been gained, but further research is still needed to optimally distinguish what is and what isn't sacroiliitis.
Collapse
|
7
|
Baraliakos X, Ghadir A, Fruth M, Kiltz U, Redeker I, Braun J. Which Magnetic Resonance Imaging Lesions in the Sacroiliac Joints Are Most Relevant for Diagnosing Axial Spondyloarthritis? A Prospective Study Comparing Rheumatologists’ Evaluations With Radiologists’ Findings. Arthritis Rheumatol 2021; 73:800-805. [DOI: 10.1002/art.41595] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 11/17/2020] [Indexed: 12/17/2022]
Affiliation(s)
- X. Baraliakos
- Rheumazentrum Ruhrgebiet, Herne, Germany, and Ruhr‐Universität Bochum Bochum Germany
| | | | | | - U. Kiltz
- Rheumazentrum Ruhrgebiet, Herne, Germany, and Ruhr‐Universität Bochum Bochum Germany
| | - I. Redeker
- German Rheumatism Research Center Berlin Berlin Germany
| | - J. Braun
- Rheumazentrum Ruhrgebiet, Herne, Germany, and Ruhr‐Universität Bochum Bochum Germany
| |
Collapse
|
8
|
Seven S, Østergaard M, Morsel-Carlsen L, Sørensen IJ, Bonde B, Thamsborg G, Lykkegaard JJ, Hendricks O, Jørgensen NR, Pedersen SJ. The utility of magnetic resonance imaging lesion combinations in the sacroiliac joints for diagnosing patients with axial spondyloarthritis. A prospective study of 204 participants including post-partum women, patients with disc herniation, cleaning staff, runners and healthy persons. Rheumatology (Oxford) 2021; 59:3237-3249. [PMID: 32240310 DOI: 10.1093/rheumatology/keaa096] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 02/04/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To investigate the diagnostic utility of different combinations of SI joint MRI lesions for differentiating patients with axial SpA (axSpA) from other conditions with and without buttock/pelvic pain. METHODS A prospective cross-sectional study included patients with axSpA (n = 41), patients with lumbar disc herniation (n = 25), women with (n = 46) and without (n = 14) post-partum (birth within 4-16 months) buttock/pelvic pain and cleaning assistants (n = 26), long-distance runners (n = 23) and healthy men (n = 29) without pain. Two independent readers assessed SI joint MRI lesions according to the Spondyloarthritis Research Consortium of Canada MRI definitions and pre-defined MRI lesion combinations with bone marrow oedema (BME) and fat lesions (FAT), respectively. Statistical analyses included the proportion of participants with scores above certain thresholds, sensitivity, specificity, positive and negative predictive values and likelihood ratios. RESULTS BME adjacent to the joint space (BME@joint space) was most frequent in axSpA (63.4%), followed by women with post-partum pain (43.5%), but was present in nearly all groups. BME adjacent to fat lesions (BME@FAT) and BME adjacent to erosions (BME@erosion) were only present in axSpA patients and in women with post-partum pain, but scores ≥3 and ≥4, respectively, were only seen in axSpA patients. FAT@erosion was exclusively recorded in axSpA patients. FAT@joint space and FAT@sclerosis were present in most groups, but with higher scores in the axSpA group. CONCLUSION BME@joint space and FAT@joint space were frequent in axSpA but also in other conditions, reducing the diagnostic utility. FAT@erosion, and BME@FAT, BME@erosion and FAT@sclerosis above certain thresholds, were exclusively seen in axSpA patients and may thus have diagnostic utility in the differentiation of axSpA from other conditions.
Collapse
Affiliation(s)
- Sengül Seven
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Center of Head and Orthopedics, Rigshospitalet Glostrup, Glostrup, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Center of Head and Orthopedics, Rigshospitalet Glostrup, Glostrup, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Inge Juul Sørensen
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Center of Head and Orthopedics, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Birthe Bonde
- Birthe Bonde Clinic of Physiotherapy, Copenhagen, Denmark
| | - Gorm Thamsborg
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Center of Head and Orthopedics, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Jens Jørgen Lykkegaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Center of Head and Orthopedics, Rigshospitalet Glostrup, Glostrup, Denmark
| | | | - Niklas Rye Jørgensen
- University of Southern Denmark, Odense, Denmark.,Department of Clinical Biochemistry, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Susanne Juhl Pedersen
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Center of Head and Orthopedics, Rigshospitalet Glostrup, Glostrup, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
9
|
Diagnostic performance of sacroiliac and spinal MRI for the diagnosis of non-radiographic axial spondyloarthritis in patients with inflammatory back pain. Joint Bone Spine 2020; 88:105106. [PMID: 33186734 DOI: 10.1016/j.jbspin.2020.105106] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The lack of specificity of the ASAS MRI criteria for non-radiographic axial spondylarthritis (NR-axSpA) justifies the evaluation of the discriminatory capacity of other MRI abnormalities in the sacroiliac joints and dorsolumbar spine. METHODS In patients hospitalized for inflammatory lumbar back pain, the diagnostic performance (sensitivity, specificity, positive likelihood ratio (PLR)) of MRI abnormalities was calculated using the rheumatologist expert opinion as a reference: (i) sacroiliac joints: Bone marrow edema (BME) (number and location), extended edema>1cm (deep lesion), fatty metaplasia (number), erosion (number and location), backfill. (ii) Dorsolumbar spine: BME (number and location), fatty metaplasia (number), posterior segment involvement. RESULTS In this prospective cohort, 40 NR-axSpA cases and 79 other diagnoses were included. The presence of at least 3 inflammatory signals in the sacroiliac joints (PLR: 25.67 [95% CI: 3.48-48.9]), the presence of at least one sacroiliac erosion (PLR: 12.80 [3.04-54]), the combination of an inflammatory signal and sacroiliac erosion (PLR: 11.85 [2.79-50]), the combination of deep lesion and fatty metaplasia (PLR: 15.80 [2.05-121.9]) or erosion (PLR: 11.86 [1.47-95.01]) had the best diagnostic performance. The combination of spinal and sacroiliac MRI criteria significantly increased diagnostic performance for the diagnosis of NR-axSpA. CONCLUSION When NR-axSpA is suspected, in addition to the presence and number of inflammatory lesions, MRI interpretation should include the location and the extent of the sacroiliac lesions, the presence of erosion or fatty metaplasia, and anterior involvement of the lumbar spine.
Collapse
|
10
|
Maksymowych WP, Pedersen SJ, Weber U, Baraliakos X, Machado PM, Eshed I, de Hooge M, Sieper J, Wichuk S, Rudwaleit M, van der Heijde D, Landewé RBM, Poddubnyy D, Ostergaard M, Lambert RGW. Central reader evaluation of MRI scans of the sacroiliac joints from the ASAS classification cohort: discrepancies with local readers and impact on the performance of the ASAS criteria. Ann Rheum Dis 2020; 79:935-942. [PMID: 32371388 DOI: 10.1136/annrheumdis-2020-217232] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 04/19/2020] [Accepted: 04/21/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVES The Assessment of SpondyloArthritis international Society (ASAS) MRI working group conducted a multireader exercise on MRI scans from the ASAS classification cohort to assess the spectrum and evolution of lesions in the sacroiliac joint and impact of discrepancies with local readers on numbers of patients classified as axial spondyloarthritis (axSpA). METHODS Seven readers assessed baseline scans from 278 cases and 8 readers assessed baseline and follow-up scans from 107 cases. Agreement for detection of MRI lesions between central and local readers was assessed descriptively and by the kappa statistic. We calculated the number of patients classified as axSpA by the ASAS criteria after replacing local detection of active lesions by central readers and replacing local reader radiographic sacroiliitis by central reader structural lesions on MRI. RESULTS Structural lesions, especially erosions, were as frequent as active lesions (≈40%), the majority of patients having both types of lesions. The ASAS definitions for active MRI lesion typical of axSpA and erosion were comparatively discriminatory between axSpA and non-axSpA. Local reader overcall for active MRI lesions was about 30% but this had a minor impact on the number of patients (6.4%) classified as axSpA. Substitution of radiography with MRI structural lesions also had little impact on classification status (1.4%). CONCLUSION Despite substantial discrepancy between central and local readers in interpretation of both types of MRI lesion, this had a minor impact on the numbers of patients classified as axSpA supporting the robustness of the ASAS criteria for differences in assessment of imaging.
Collapse
Affiliation(s)
- Walter P Maksymowych
- Medicine, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
| | - Susanne Juhl Pedersen
- Department of Rheumatology, Copenhagen University Hospital Glostrup, Glostrup, Denmark
| | - Ulrich Weber
- Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg, Denmark.,Regional Health Research, University of Southern Denmark, Odense, Denmark
| | | | - Pedro M Machado
- MRC Centre for Neuromuscular Diseases, University College London, London, UK.,Rheumatology, University College London Centre for Rheumatology, London, UK
| | - Iris Eshed
- Radiology, Sheba Medical Center, Tel Hashomer, Israel
| | - Manouk de Hooge
- VIB Center of Inflammation Research, Ghent University, Gent, Belgium
| | - Joachim Sieper
- Medical Department I, Rheumatology, University Clinic Benjamin Franklin, Berlin, Germany
| | - Stephanie Wichuk
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Martin Rudwaleit
- Internal Medicine and Rheumatology, Klinikum Bielefeld Rosenhöhe, Bielefeld, Germany
| | - Désirée van der Heijde
- Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.,Rheumatology, Diakonhjemmet Hospital, Norway
| | - Robert B M Landewé
- Amsterdam Rheumatology Center, AMC, Amsterdam, The Netherlands.,Rheumatology, Zuyderland MC, Heerlen, The Netherlands
| | - Denis Poddubnyy
- Department of Rheumatology, Infectious Diseases and Rheumatology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Mikkel Ostergaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Robert G W Lambert
- Radiology and Diagnostic Imaging and Medical Imaging Consultants, University of Alberta, Edmonton, Alberta, Canada
| |
Collapse
|
11
|
Jones A, Bray TJP, Mandl P, Hall-Craggs MA, Marzo-Ortega H, Machado PM. Performance of magnetic resonance imaging in the diagnosis of axial spondyloarthritis: a systematic literature review. Rheumatology (Oxford) 2020; 58:1955-1965. [PMID: 31046102 DOI: 10.1093/rheumatology/kez172] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 04/04/2019] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES To summarize the evidence on the performance of MRI for the diagnosis of axial SpA. METHODS This was a systematic literature review of all studies from January 2013 to March 2017 including adult patients with clinically suspected axial SpA undergoing MRI. Studies from a previously published systematic literature review up to January 2013 were also included. RESULTS Thirty-one studies were included. Six studies demonstrated good sensitivity and specificity for SI joint (SIJ) bone marrow oedema (BMO). Specificity was increased by the presence of other structural lesions alongside BMO, particularly erosions or fat infiltration. Four studies addressed the utility of SIJ fat infiltration, finding good sensitivity but poor specificity. SIJ erosions showed good specificity in five studies. Studies addressing high T1 signal in the SIJ, fluid signal in the SIJ, ankylosis, sclerosis, capsulitis, backfill and vacuum phenomenon reported limited diagnostic value. In the spine, four studies reported moderate sensitivity and specificity for corner inflammatory lesions, and four reported poor sensitivity and specificity for spinal fat infiltration. Five studies evaluated the added value of spinal MRI over SIJ MRI alone, with variable results depending on the cohort. Six studies addressed the effect of acquisition parameters on diagnostic accuracy: fat-saturated T2-weighted imaging and short tau inversion recovery (STIR) imaging showed comparable utility in identifying BMO. Three studies showed that gadolinium was of minimal added value in the detection of BMO. CONCLUSIONS These results confirmed the diagnostic utility of MRI in axial SpA. Performance varied according to the characteristics of the cohort and the number and combination of MRI lesions considered.
Collapse
Affiliation(s)
- Alexis Jones
- Department of Rheumatology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Timothy J P Bray
- Centre for Medical Imaging, University College London, London, UK
| | - Peter Mandl
- Department of Rheumatology, Medical University of Vienna, Vienna, Austria
| | | | - Helena Marzo-Ortega
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, London.,Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, London
| | - Pedro M Machado
- Department of Rheumatology, University College London Hospitals NHS Foundation Trust, London, UK.,Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London.,Centre for Rheumatology and MRC Centre for Neuromuscular Diseases, University College London, London, UK
| |
Collapse
|
12
|
Resende GG, Meirelles EDS, Marques CDL, Chiereghin A, Lyrio AM, Ximenes AC, Saad CG, Gonçalves CR, Kohem CL, Schainberg CG, Campanholo CB, Bueno Filho JSDS, Pieruccetti LB, Keiserman MW, Yazbek MA, Palominos PE, Goncalves RSG, Lage RDC, Assad RL, Bonfiglioli R, Anti SMA, Carneiro S, Oliveira TL, Azevedo VF, Bianchi WA, Bernardo WM, Pinheiro MDM, Sampaio-Barros PD. The Brazilian Society of Rheumatology guidelines for axial spondyloarthritis - 2019. Adv Rheumatol 2020; 60:19. [PMID: 32171329 DOI: 10.1186/s42358-020-0116-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Accepted: 01/22/2020] [Indexed: 12/13/2022] Open
Abstract
Spondyloarthritis is a group of chronic inflammatory systemic diseases characterized by axial and/or peripheral joints inflammation, as well as extra-articular manifestations. The classification axial spondyloarthritis is adopted when the spine and/or the sacroiliac joints are predominantly involved. This version of recommendations replaces the previous guidelines published in May 2013.A systematic literature review was performed, and two hundred thirty-seven studies were selected and used to formulate 29 recommendations answering 15 clinical questions, which were divided into four sections: diagnosis, non-pharmacological therapy, conventional drug therapy and biological therapy. For each recommendation the level of evidence supporting (highest available), the strength grade according to Oxford, and the degree of expert agreement (inter-rater reliability) is informed.These guidelines bring evidence-based information on clinical management of axial SpA patients, including, diagnosis, treatment, and prognosis.
Collapse
Affiliation(s)
- Gustavo Gomes Resende
- Universidade Federal de Minas Gerais (UFMG), Alameda Álvaro Celso, 175 / 2° Andar. Santa Efigênia. CEP 30.150-260, Belo Horizonte, MG, Brazil.
| | | | | | | | - Andre Marun Lyrio
- Pontifície Universidade Católica (PUC) de Campinas, Campinas, Brazil
| | | | | | | | | | | | | | | | | | | | | | | | | | - Ricardo da Cruz Lage
- Universidade Federal de Minas Gerais (UFMG), Alameda Álvaro Celso, 175 / 2° Andar. Santa Efigênia. CEP 30.150-260, Belo Horizonte, MG, Brazil
| | | | | | | | - Sueli Carneiro
- Universidade Federal do Rio De Janeiro (UFRJ), Rio de Janeiro, Brazil
| | | | | | | | | | | | | |
Collapse
|
13
|
Seven S, Østergaard M, Morsel‐Carlsen L, Sørensen IJ, Bonde B, Thamsborg G, Lykkegaard JJ, Hendricks O, Jørgensen NR, Pedersen SJ. Magnetic Resonance Imaging of Lesions in the Sacroiliac Joints for Differentiation of Patients With Axial Spondyloarthritis From Control Subjects With or Without Pelvic or Buttock Pain: A Prospective, Cross‐Sectional Study of 204 Participants. Arthritis Rheumatol 2019; 71:2034-2046. [DOI: 10.1002/art.41037] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 07/05/2019] [Indexed: 12/29/2022]
Affiliation(s)
- Sengül Seven
- Rigshospitalet, Glostrup, Denmark, and University of Copenhagen Copenhagen Denmark
| | - Mikkel Østergaard
- Rigshospitalet, Glostrup, Denmark, and University of Copenhagen Copenhagen Denmark
| | | | | | - Birthe Bonde
- Birthe Bonde Clinic of Physioterapy Copenhagen Denmark
| | | | | | - Oliver Hendricks
- King Christian 10th Hospital for Rheumatic Diseases Gråsten Denmark
| | - Niklas Rye Jørgensen
- University of Southern Denmark, Odense, Denmark, and Rigshospitalet Glostrup Denmark
| | | |
Collapse
|
14
|
The role of imaging in the diagnosis and management of axial spondyloarthritis. Nat Rev Rheumatol 2019; 15:657-672. [DOI: 10.1038/s41584-019-0309-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2019] [Indexed: 12/15/2022]
|
15
|
Maksymowych WP, Lambert RG, Østergaard M, Pedersen SJ, Machado PM, Weber U, Bennett AN, Braun J, Burgos-Vargas R, de Hooge M, Deodhar AA, Eshed I, Jurik AG, Hermann KGA, Landewé RB, Marzo-Ortega H, Navarro-Compán V, Poddubnyy D, Reijnierse M, Rudwaleit M, Sieper J, Van den Bosch FE, van der Heijde D, van der Horst-Bruinsma IE, Wichuk S, Baraliakos X. MRI lesions in the sacroiliac joints of patients with spondyloarthritis: an update of definitions and validation by the ASAS MRI working group. Ann Rheum Dis 2019; 78:1550-1558. [PMID: 31422357 DOI: 10.1136/annrheumdis-2019-215589] [Citation(s) in RCA: 149] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 07/17/2019] [Accepted: 07/18/2019] [Indexed: 12/23/2022]
Abstract
OBJECTIVES The Assessment of SpondyloArthritis international Society (ASAS) MRI working group (WG) was convened to generate a consensus update on standardised definitions for MRI lesions in the sacroiliac joint (SIJ) of patients with spondyloarthritis (SpA), and to conduct preliminary validation. METHODS The literature pertaining to these MRI lesion definitions was discussed at three meetings of the group. 25 investigators (20 rheumatologists, 5 radiologists) determined which definitions should be retained or required revision, and which required a new definition. Lesion definitions were assessed in a multi-reader validation exercise using 278 MRI scans from the ASAS classification cohort by global assessment (lesion present/absent) and detailed scoring (inflammation and structural). Reliability of detection of lesions was analysed using kappa statistics and the intraclass correlation coefficient (ICC). RESULTS No revisions were made to the current ASAS definition of a positive SIJ MRI or definitions for subchondral inflammation and sclerosis. The following definitions were revised: capsulitis, enthesitis, fat lesion and erosion. New definitions were developed for joint space enhancement, joint space fluid, fat metaplasia in an erosion cavity, ankylosis and bone bud. The most frequently detected structural lesion, erosion, was detected almost as reliably as subchondral inflammation (κappa/ICC:0.61/0.54 and 0.60/0.83) . Fat metaplasia in an erosion cavity and ankylosis were also reliably detected despite their low frequency (κappa/ICC:0.50/0.37 and 0.58/0.97). CONCLUSION The ASAS-MRI WG concluded that several definitions required revision and some new definitions were necessary. Multi-reader validation demonstrated substantial reliability for the most frequently detected lesions and comparable reliability between active and structural lesions.
Collapse
Affiliation(s)
| | - Robert Gw Lambert
- Department of Radiology, University of Alberta, Edmonton, Alberta, Canada
| | - Mikkel Østergaard
- Center for Rheumatology and Spine Diseasesses, Rigshospitalet, Copenhagen, Denmark
| | | | - Pedro M Machado
- Department of Rheumatology, University College London Hospitals NHS Foundation Trust, London, UK.,Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK.,Centre for Rheumatology and MRC Centre for Neuromuscular Diseases, University College London, London, UK
| | - Ulrich Weber
- Danish Hospital for Rheumatic Diseases, University of Southern Denmark, Sønderborg, Denmark.,Hospital of Southern Jutland, University Hospital of the Region of Southern Denmark, Aabenraa, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Alexander N Bennett
- Academic Department of Military Rehabilitation, DMRC, and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Juergen Braun
- Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Herne, Germany
| | - Ruben Burgos-Vargas
- Department of Rheumatology, Hospital General de Mexico Dr Eduardo Liceaga and School of Medicine, Universidad Nacional Autonoma de Mexico, Mexico City, Mexico
| | - Manouk de Hooge
- VIB Inflammation Research Center, Ghent University, Gent, Belgium.,Rheumatology Department, Ghent University Hospital, Ghent, Belgium
| | - Atul A Deodhar
- Oregon Health and Science University, Portland, Oregon, USA
| | - Iris Eshed
- Department of Radiology, Radiology, Sheba Medical Center, affiliated to the Sackler School of Medicine, Tel Aviv, Israel
| | - Anne Grethe Jurik
- Department of Radiology, Aarhus University, Aarhus, Denmark.,Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Robert Bm Landewé
- Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Atrium Medical Center, Heerlen, The Netherlands
| | - Helena Marzo-Ortega
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | | | - Denis Poddubnyy
- Charité - Universitätsmedizin Berlin and German Rheumatism Research Centre, Berlin, Germany
| | - Monique Reijnierse
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Martin Rudwaleit
- Klinikum Bielefeld, Bielefeld, and Charité - Universitätsmedizin Berlin, Berlin, Bielefeld, Germany
| | - Joachim Sieper
- Charité - Universitätsmedizin Berlin and German Rheumatism Research Centre, Berlin, Germany
| | - Filip E Van den Bosch
- VIB Inflammation Research Center, Ghent University, Gent, Belgium.,Rheumatology Department, Ghent University Hospital, Ghent, Belgium
| | | | | | - Stephanie Wichuk
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | | |
Collapse
|
16
|
Bray TJP, Jones A, Bennett AN, Conaghan PG, Grainger A, Hodgson R, Hutchinson C, Leandro M, Mandl P, McGonagle D, O’Connor P, Sengupta R, Thomas M, Toms A, Winn N, Hall-Craggs MA, Marzo-Ortega H, Machado PM. Recommendations for acquisition and interpretation of MRI of the spine and sacroiliac joints in the diagnosis of axial spondyloarthritis in the UK. Rheumatology (Oxford) 2019; 58:1831-1838. [DOI: 10.1093/rheumatology/kez173] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 04/04/2019] [Indexed: 11/12/2022] Open
Abstract
Abstract
Objectives
To develop evidence-based recommendations on the use of MRI in the diagnosis of axial SpA (axSpA).
Methods
A working group comprising nine rheumatologists and nine musculoskeletal radiologists with an interest in axSpA was established, with support from the British Society of Spondyloarthritis (BRITSpA). Two meetings were held. In the first meeting, research questions were formulated. In the second meeting, the results of a systematic literature review designed to inform the recommendations were reviewed. An anonymized Delphi process was used to formulate the final set of recommendations. For each recommendation, the level of evidence and strength of recommendation was determined. The level of agreement was assessed using a 0–10 numerical rating scale.
Results
Two overarching principles were formulated, as follows: The diagnosis of axSpA is based on clinical, laboratory and imaging features (overarching principle 1), and patients with axSpA can have isolated inflammation of either the sacroiliac joints or the spine (overarching principle 2). Seven recommendations addressing the use of MRI in the assessment of patients with suspected axSpA were formulated, covering topics including recommended sequences, anatomical coverage, acquisition parameters and interpretation of active and structural MRI lesions. The level of agreement for each recommendation was very high (range 8.8–9.8).
Conclusion
A joint rheumatology and radiology consensus on the acquisition and interpretation of MRI in axSpA diagnosis was achieved, and a research agenda formulated. This consensus should help standardize practice around MRI and ensure a more informed, consistent approach to the diagnosis of axSpA.
Collapse
Affiliation(s)
| | - Alexis Jones
- Department of Rheumatology, University College London Hospitals NHS Foundation Trust, London
| | - Alexander N Bennett
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Stanford Hall, Nottinghamshire
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London
| | - Philip G Conaghan
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds
| | - Andrew Grainger
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds
| | - Richard Hodgson
- Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester
- NIHR Manchester Musculoskeletal Biomedical Research Unit, Manchester Academic Health Sciences Centre, Manchester
| | - Charles Hutchinson
- Department of Radiology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Maria Leandro
- Department of Rheumatology, University College London Hospitals NHS Foundation Trust, London
| | - Peter Mandl
- Department of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Denis McGonagle
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds
| | - Phill O’Connor
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds
| | - Raj Sengupta
- The Royal National Hospital for Rheumatic Diseases, Bath
| | | | - Andoni Toms
- Department of Radiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich
| | - Naomi Winn
- Department of Radiology, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry
| | | | - Helena Marzo-Ortega
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds
| | - Pedro M Machado
- Department of Rheumatology, University College London Hospitals NHS Foundation Trust, London
- Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London
- Centre for Rheumatology and MRC Centre for Neuromuscular Diseases, University College London, London, UK
| | | |
Collapse
|
17
|
Khmelinskii N, Regel A, Baraliakos X. The Role of Imaging in Diagnosing Axial Spondyloarthritis. Front Med (Lausanne) 2018; 5:106. [PMID: 29719835 PMCID: PMC5913283 DOI: 10.3389/fmed.2018.00106] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 03/29/2018] [Indexed: 01/12/2023] Open
Abstract
Imaging has a central role in the diagnosis, management, and follow-up of patients with axial spondyloarthritis (axSpA). For the early diagnosis of axSpA, magnetic resonance imaging is of utmost relevance. While no novel imaging techniques were developed during the past decade, improvements to the existing modalities have been introduced. This report provides an overview of the applications and limitations of the existing imaging modalities.
Collapse
Affiliation(s)
- Nikita Khmelinskii
- Rheumathology Department, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon Academic Medical Centre, Lisbon, Portugal
| | - Andrea Regel
- Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Herne, Germany
| | | |
Collapse
|
18
|
Ziegeler K, Eshkal H, Schorr C, Sieper J, Diekhoff T, Makowski MR, Hamm B, Hermann KGA. Age- and Sex-dependent Frequency of Fat Metaplasia and Other Structural Changes of the Sacroiliac Joints in Patients without Axial Spondyloarthritis: A Retrospective, Cross-sectional MRI Study. J Rheumatol 2018; 45:915-921. [PMID: 29657142 DOI: 10.3899/jrheum.170904] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2017] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To determine the prevalence of fat metaplasia and other structural lesions of the sacroiliac joints associated with axial spondyloarthritis in a nonrheumatological patient population. METHODS Magnetic resonance imaging examinations that included the pelvis and were performed in patients without known rheumatological disease were used for this retrospective cross-sectional study. These images were evaluated for sacroiliac fat metaplasia, sclerosis, osteophytes, and joint space alterations such as erosions or ankylosis. Patients were divided into 7 age groups (15-24 to ≥ 75 yrs). Prevalence of lesions across age groups was calculated. Possible clinical confounders (e.g., status post radiation, suspected inflammatory bowel disease) were investigated regarding their effect on lesion prevalence and extent, to exclude bias. RESULTS A total of 485 patients were enrolled. Fat metaplasia was very common and increased with age, from a prevalence of 50.6% in the age groups < 45, to 94.4% in patients ≥ 75 years. Erosions were uncommon: 0.6% of patients < 45, and 2.6% of the entire study population exhibited this feature, with no detectable age-dependent increase. Sclerosis and osteophytes were detected in 13.7% and 37.0% of patients, respectively. None of the investigated clinical confounders had a significant effect on lesion prevalence. CONCLUSION Our study shows a very high prevalence of fat metaplasia adjacent to the sacroiliac joint in asymptomatic patients, while erosions are extremely uncommon.
Collapse
Affiliation(s)
- Katharina Ziegeler
- From the Department of Radiology, and the Department of Rheumatology and Gastroenterology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,K. Ziegeler, MD, Department of Radiology, Charité Berlin; H. Eshkal, MD, Department of Radiology, Charité Berlin; C. Schorr, Department of Radiology, Charité Berlin; J. Sieper, MD, PhD, Department of Rheumatology and Gastroenterology, Charité Berlin; T. Diekhoff, MD, Department of Radiology, Charité Berlin; M.R. Makowski, MD, PhD, Department of Radiology, Charité Berlin; B. Hamm, MD, PhD, Professor of Radiology, Charité Berlin; K.G. Hermann, MD, PhD, Department of Radiology, Charité Berlin
| | - Hamama Eshkal
- From the Department of Radiology, and the Department of Rheumatology and Gastroenterology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,K. Ziegeler, MD, Department of Radiology, Charité Berlin; H. Eshkal, MD, Department of Radiology, Charité Berlin; C. Schorr, Department of Radiology, Charité Berlin; J. Sieper, MD, PhD, Department of Rheumatology and Gastroenterology, Charité Berlin; T. Diekhoff, MD, Department of Radiology, Charité Berlin; M.R. Makowski, MD, PhD, Department of Radiology, Charité Berlin; B. Hamm, MD, PhD, Professor of Radiology, Charité Berlin; K.G. Hermann, MD, PhD, Department of Radiology, Charité Berlin
| | - Claudia Schorr
- From the Department of Radiology, and the Department of Rheumatology and Gastroenterology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,K. Ziegeler, MD, Department of Radiology, Charité Berlin; H. Eshkal, MD, Department of Radiology, Charité Berlin; C. Schorr, Department of Radiology, Charité Berlin; J. Sieper, MD, PhD, Department of Rheumatology and Gastroenterology, Charité Berlin; T. Diekhoff, MD, Department of Radiology, Charité Berlin; M.R. Makowski, MD, PhD, Department of Radiology, Charité Berlin; B. Hamm, MD, PhD, Professor of Radiology, Charité Berlin; K.G. Hermann, MD, PhD, Department of Radiology, Charité Berlin
| | - Joachim Sieper
- From the Department of Radiology, and the Department of Rheumatology and Gastroenterology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,K. Ziegeler, MD, Department of Radiology, Charité Berlin; H. Eshkal, MD, Department of Radiology, Charité Berlin; C. Schorr, Department of Radiology, Charité Berlin; J. Sieper, MD, PhD, Department of Rheumatology and Gastroenterology, Charité Berlin; T. Diekhoff, MD, Department of Radiology, Charité Berlin; M.R. Makowski, MD, PhD, Department of Radiology, Charité Berlin; B. Hamm, MD, PhD, Professor of Radiology, Charité Berlin; K.G. Hermann, MD, PhD, Department of Radiology, Charité Berlin
| | - Torsten Diekhoff
- From the Department of Radiology, and the Department of Rheumatology and Gastroenterology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,K. Ziegeler, MD, Department of Radiology, Charité Berlin; H. Eshkal, MD, Department of Radiology, Charité Berlin; C. Schorr, Department of Radiology, Charité Berlin; J. Sieper, MD, PhD, Department of Rheumatology and Gastroenterology, Charité Berlin; T. Diekhoff, MD, Department of Radiology, Charité Berlin; M.R. Makowski, MD, PhD, Department of Radiology, Charité Berlin; B. Hamm, MD, PhD, Professor of Radiology, Charité Berlin; K.G. Hermann, MD, PhD, Department of Radiology, Charité Berlin
| | - Marcus R Makowski
- From the Department of Radiology, and the Department of Rheumatology and Gastroenterology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,K. Ziegeler, MD, Department of Radiology, Charité Berlin; H. Eshkal, MD, Department of Radiology, Charité Berlin; C. Schorr, Department of Radiology, Charité Berlin; J. Sieper, MD, PhD, Department of Rheumatology and Gastroenterology, Charité Berlin; T. Diekhoff, MD, Department of Radiology, Charité Berlin; M.R. Makowski, MD, PhD, Department of Radiology, Charité Berlin; B. Hamm, MD, PhD, Professor of Radiology, Charité Berlin; K.G. Hermann, MD, PhD, Department of Radiology, Charité Berlin
| | - Bernd Hamm
- From the Department of Radiology, and the Department of Rheumatology and Gastroenterology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,K. Ziegeler, MD, Department of Radiology, Charité Berlin; H. Eshkal, MD, Department of Radiology, Charité Berlin; C. Schorr, Department of Radiology, Charité Berlin; J. Sieper, MD, PhD, Department of Rheumatology and Gastroenterology, Charité Berlin; T. Diekhoff, MD, Department of Radiology, Charité Berlin; M.R. Makowski, MD, PhD, Department of Radiology, Charité Berlin; B. Hamm, MD, PhD, Professor of Radiology, Charité Berlin; K.G. Hermann, MD, PhD, Department of Radiology, Charité Berlin
| | - Kay-Geert A Hermann
- From the Department of Radiology, and the Department of Rheumatology and Gastroenterology, Charité - Universitätsmedizin Berlin, Berlin, Germany. .,K. Ziegeler, MD, Department of Radiology, Charité Berlin; H. Eshkal, MD, Department of Radiology, Charité Berlin; C. Schorr, Department of Radiology, Charité Berlin; J. Sieper, MD, PhD, Department of Rheumatology and Gastroenterology, Charité Berlin; T. Diekhoff, MD, Department of Radiology, Charité Berlin; M.R. Makowski, MD, PhD, Department of Radiology, Charité Berlin; B. Hamm, MD, PhD, Professor of Radiology, Charité Berlin; K.G. Hermann, MD, PhD, Department of Radiology, Charité Berlin.
| |
Collapse
|
19
|
Lukas C, Cyteval C, Dougados M, Weber U. MRI for diagnosis of axial spondyloarthritis: major advance with critical limitations 'Not everything that glisters is gold (standard)'. RMD Open 2018; 4:e000586. [PMID: 29479474 PMCID: PMC5822619 DOI: 10.1136/rmdopen-2017-000586] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 12/04/2017] [Accepted: 12/06/2017] [Indexed: 11/09/2022] Open
Abstract
Recognition of axial spondyloarthritis (SpA) remains challenging, as no unique reference standard is available to ascertain diagnosis. Imaging procedures have been used for long in the field, in particular pelvic radiography, to capture structural changes evocative of sacroiliitis, the key feature in SpA. The introduction of MRI of the sacroiliac joints (SIJs) has led to a major shift in recognition of the disorder. MRI has been shown to detect the initial inflammatory processes, in particular osteitis depicted by bone marrow oedema, even in patients having not yet developed structural lesions. In addition, MRI has revealed a previously under-recognised very early clinical phase of the disease where patients have symptomatic axial involvement, but no structural changes. However, what constitutes a ‘positive MRI’ in SpA remains controversial, since both sensitivity and specificity show limitations, and interpretation of MRI lesions in daily practice is critically dependent on the clinical context. There is growing evidence that integration of the assessment of structural changes on dedicated T1 weighted-sequences on MRI may enhance diagnostic utility. The performance of MRI in detecting structural lesions in the SIJs may even be superior to traditional evaluation by pelvic radiography. These findings launched a debate on imaging in SpA, whether MRI, which is advancing early recognition of disease and shows superiority to detect structural changes, should replace traditional conventional radiography of the SIJs.
Collapse
Affiliation(s)
- Cédric Lukas
- Department of Rheumatology, University Hospital Lapeyronie, Montpellier, France.,Montpellier University, Montpellier, France
| | - Catherine Cyteval
- Montpellier University, Montpellier, France.,Department of Radiology, University Hospital Lapeyronie, Montpellier, France
| | - Maxime Dougados
- Department of Rheumatology B, Cochin Hospital, Paris, France
| | - Ulrich Weber
- King Christian 10th Hospital for Rheumatic Diseases, Gråsten, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
20
|
Latourte A, Charlon S, Etcheto A, Feydy A, Allanore Y, Dougados M, Molto A. Imaging Findings Suggestive of Axial Spondyloarthritis in Diffuse Idiopathic Skeletal Hyperostosis. Arthritis Care Res (Hoboken) 2017; 70:145-152. [PMID: 28371491 DOI: 10.1002/acr.23244] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 03/21/2017] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To describe the magnetic resonance imaging (MRI) findings in diffuse idiopathic skeletal hyperostosis (DISH) patients and to assess the proportion of DISH patients whose MRI findings would fulfill the Assessment of Spondyloarthritis International Society (ASAS) criteria for a positive MRI of axial spondyloarthritis (SpA). METHODS This study involved all DISH patients who had a spine or sacroiliac (SI) joint MRI performed between January 2009 and December 2014. Sociodemographic and clinical data were collected. Available radiographs and MRI were analyzed and blindly scored by an experienced reader, using the Spondyloarthritis Research Consortium of Canada (SPARCC) scores for both spine and SI joint MRI. RESULTS A total of 53 symptomatic DISH patients was included in the analysis. The mean ± SD SPARCC score of the spine was 18.3 ± 23.4. Thirty-five patients (67.3%) had at least 1 fatty corner. Thirty patients (57.7%) met the ASAS definition of a spine MRI suggestive of axial SpA, but only 6 patients (15.8%) with an available SI joint MRI had sacroiliitis according to ASAS criteria. Only 1 patient (3.3%) had ≥3 erosions on the SI joint. CONCLUSION Inflammatory lesions of the spine are common on the MRI of symptomatic DISH patients, and more than half fulfilled the ASAS criteria for a spine MRI suggestive of axial SpA. However, only a few patients met the ASAS definition of active sacroiliitis, suggesting that MRI of the SI joint but not of the spine might allow the differential diagnosis of DISH versus axial SpA in the elderly.
Collapse
Affiliation(s)
- Augustin Latourte
- Paris Descartes University, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, INSERM (U1153), PRES Sorbonne Paris-Cité, Paris, France
| | - Stéphane Charlon
- Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris, France
| | - Adrien Etcheto
- Paris Descartes University, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, INSERM (U1153), PRES Sorbonne Paris-Cité, Paris, France
| | - Antoine Feydy
- Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris, France
| | - Yannick Allanore
- Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris, France
| | - Maxime Dougados
- Paris Descartes University, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, INSERM (U1153), PRES Sorbonne Paris-Cité, Paris, France
| | - Anna Molto
- Paris Descartes University, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, INSERM (U1153), PRES Sorbonne Paris-Cité, Paris, France
| |
Collapse
|
21
|
Guo RM, Lin WS, Liu WM, Zhou WY, Cao SE, Wang J, Li QL. Quantification of fat infiltration in the sacroiliac joints with ankylosing spondylitis using IDEAL sequence. Clin Radiol 2017; 73:231-236. [PMID: 29167015 DOI: 10.1016/j.crad.2017.10.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Revised: 10/06/2017] [Accepted: 10/20/2017] [Indexed: 11/16/2022]
Abstract
AIM To quantitatively assess fat infiltration in the sacroiliac joints (SIJs) of patients with ankylosing spondylitis (AS) by measuring the fat/water signal ratios of periarticular bone marrow with iterative decomposition of water and fat with echo asymmetry and least square estimation (IDEAL). MATERIALS AND METHODS Routine SIJ magnetic resonance imaging (MRI) and IDEAL were performed on 40 patients with AS and 30 healthy subjects. The fat infiltration regions (FIRs) and normal-appearing regions (NARs) of patients were measured based on the fat/water signal intensity on IDEAL. RESULTS AS patients had higher fat/water signal ratios on FIRs and NARs (65.4-85.4%, p<0.05, and 44.1-70.7%, p<0.05, respectively) compared to healthy controls (38.3-43.3%). After treatment, the fat/water signal ratios of FIRs and NARs decreased (42.1-53.7% and 41.5-50.3%, respectively), but they remained higher than in the healthy controls (p<0.05). The fat infiltration was detected more effectively with a fat fraction map of the IDEAL sequence (95%) than other sequences, including the T1-weighted sequence (65%), and the fat/water signal ratios of the sacrum and ilium between the left and right sides of SIJs were approximately the same. CONCLUSION The findings of this study suggest that IDEAL may be useful as a quantitative and objective method for evaluating the fat infiltration in the periarticular bone marrow of SIJs with AS; additionally, the sensitivity of IDEAL is better than that of routine sequences in detecting micro-fat infiltration of SIJs, and IDEAL can be used to quantitatively measure the adipose content and monitor patient follow-up after AS treatment.
Collapse
Affiliation(s)
- R-M Guo
- Department of Radiology, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - W-S Lin
- Department of Radiology, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - W-M Liu
- Department of Radiology, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - W-Y Zhou
- Department of Laboratory, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - S-E Cao
- Department of Radiology, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - J Wang
- Department of Radiology, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Q-L Li
- Department of VIP Medical Center, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
| |
Collapse
|
22
|
Chang EY, Chen KC, Huang BK, Kavanaugh A. Adult Inflammatory Arthritides: What the Radiologist Should Know. Radiographics 2017; 36:1849-1870. [PMID: 27726745 DOI: 10.1148/rg.2016160011] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Developments and improvements in knowledge are rapid and ongoing in both the radiologic and rheumatologic fields. During the past decade, the roles of imaging and the radiologist in the assessment and management of many inflammatory rheumatologic diseases have undergone several changes. To remain effective in patient care, the radiologist needs to be aware of these changes when recommending and interpreting imaging examinations for the referring physician. The goal of contemporary rheumatoid arthritis (RA) management is to redefine RA as a disease that is no longer characterized by erosions, which reflect established or long-standing untreated disease. Most cases of RA are now diagnosed clinically, but imaging increases diagnostic confidence, is superior to clinical examination for the detection of joint inflammation, and plays an important role in patient management. The concept of the seronegative spondyloarthritides has recently been redefined by the Assessment of SpondyloArthritis International Society (ASAS). This new set of ASAS classification criteria divides the spectrum of spondyloarthritis on the basis of predominantly axial skeletal clinical manifestations or predominantly peripheral skeletal clinical manifestations. For axial spondyloarthritis, magnetic resonance imaging and radiography play crucial roles for classification and diagnosis. For both peripheral spondyloarthritis and psoriatic arthritis, the radiologist can provide important information that influences classification and diagnosis, including documenting radiologic evidence of juxta-articular new bone formation, diagnosing sacroiliitis, or delineating the presence and extent of enthesitis and dactylitis. The radiologist's familiarity with recent classification criteria, in addition to the traditional diagnostic characteristics of the individual inflammatory arthritides, maximizes the productive interface between the radiologist and the rheumatologist. ©RSNA, 2016.
Collapse
Affiliation(s)
- Eric Y Chang
- From the Radiology Service, VA San Diego Healthcare System, 3350 La Jolla Village Dr, MC 114, San Diego, CA 92161 (E.Y.C., K.C.C.); and the Department of Radiology (E.Y.C., K.C.C., B.K.H.) and Division of Rheumatology, Allergy and Immunology, Department of Medicine (A.K.), University of California, San Diego Medical Center, San Diego, Calif
| | - Karen C Chen
- From the Radiology Service, VA San Diego Healthcare System, 3350 La Jolla Village Dr, MC 114, San Diego, CA 92161 (E.Y.C., K.C.C.); and the Department of Radiology (E.Y.C., K.C.C., B.K.H.) and Division of Rheumatology, Allergy and Immunology, Department of Medicine (A.K.), University of California, San Diego Medical Center, San Diego, Calif
| | - Brady K Huang
- From the Radiology Service, VA San Diego Healthcare System, 3350 La Jolla Village Dr, MC 114, San Diego, CA 92161 (E.Y.C., K.C.C.); and the Department of Radiology (E.Y.C., K.C.C., B.K.H.) and Division of Rheumatology, Allergy and Immunology, Department of Medicine (A.K.), University of California, San Diego Medical Center, San Diego, Calif
| | - Arthur Kavanaugh
- From the Radiology Service, VA San Diego Healthcare System, 3350 La Jolla Village Dr, MC 114, San Diego, CA 92161 (E.Y.C., K.C.C.); and the Department of Radiology (E.Y.C., K.C.C., B.K.H.) and Division of Rheumatology, Allergy and Immunology, Department of Medicine (A.K.), University of California, San Diego Medical Center, San Diego, Calif
| |
Collapse
|
23
|
Maksymowych WP, Wichuk S, Chiowchanwisawakit P, Lambert RG, Pedersen SJ. Fat metaplasia on MRI of the sacroiliac joints increases the propensity for disease progression in the spine of patients with spondyloarthritis. RMD Open 2017; 3:e000399. [PMID: 28469937 PMCID: PMC5387982 DOI: 10.1136/rmdopen-2016-000399] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Revised: 01/13/2017] [Accepted: 02/24/2017] [Indexed: 01/06/2023] Open
Abstract
Objective We tested the hypothesis that fat metaplasia on MRI of the sacroiliac joints (SIJ) increases the propensity for new bone formation in the spine of patients with spondyloarthritis. Methods We assessed baseline T1-weighted and short τ inversion recovery SIJ MRIs from patients in the Follow Up Research Cohort in Ankylosing Spondylitis (FORCAST). Radiographic progression was assessed using the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS). Structural and inflammatory lesions were scored using the Spondyloarthritis Research Consortium of Canada (SPARCC) SIJ structural and SPARCC SIJ inflammation scores, respectively. Radiographic progression was compared in cases with and without definite MRI lesions (score ≥2 or <2) and the extent of MRI lesions at baseline was compared in patients with and without radiographic progression. The predictive capacity of MRI SIJ lesions for radiographic progression in the spine was assessed in univariate and multivariate regression analyses. Results The extent of MRI structural lesions in the SIJ at baseline was significantly greater in those patients who had spinal radiographic progression on follow-up (p=0.003, 0.02, 0.003 for fat metaplasia, backfill and ankylosis, respectively). Also, radiographic progression was significantly greater in cases with definite baseline SIJ ankylosis (p=0.008). In multivariate regression that included all types of MRI lesions and was adjusted for age, sex, symptom duration, duration of follow-up, CRP, baseline mSASSS and treatment, the extent of SIJ fat metaplasia and ankylosis at baseline were independently associated with radiographic progression. Conclusions SIJ ankylosis and fat metaplasia but not inflammatory lesions increase the propensity for radiographic progression in the spine.
Collapse
Affiliation(s)
- W P Maksymowych
- Department of Medicine, Spondyloarthritis Research Consortium of Canada Center, University of Alberta, Edmonton, Alberta, Canada
| | - S Wichuk
- Department of Medicine, Spondyloarthritis Research Consortium of Canada Center, University of Alberta, Edmonton, Alberta, Canada
| | | | - R G Lambert
- Department of Radiology and Diagnostic Imaging, Spondyloarthritis Research Consortium of Canada Center, University of Alberta, Edmonton, Alberta, Canada
| | - S J Pedersen
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
24
|
Truong SL, Saad NF, Robinson PC, Cowderoy G, Lim I, Schachna L, Stebbings S, Stuckey S, Taylor AL, Whittle SL, Zochling J, Bird P, Brown MA. Consensus statements on the imaging of axial spondyloarthritis in Australia and New Zealand. J Med Imaging Radiat Oncol 2016; 61:58-69. [DOI: 10.1111/1754-9485.12573] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Accepted: 11/05/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Steven L Truong
- Department of Rheumatology; Auckland District Healthcare Board; Auckland New Zealand
- Translational Research Institute; Princess Alexandra Hospital; University of Queensland Diamantina Institute; Brisbane Queensland Australia
| | - Nivene F Saad
- Department of Radiology; Princess Alexandra Hospital; Woolloongabba Queensland Australia
- School of Medicine; University of Queensland; Herston Queensland Australia
| | - Philip C Robinson
- School of Medicine; University of Queensland; Herston Queensland Australia
| | - Greg Cowderoy
- Brisbane Private Imaging; Royal Brisbane and Womens’ Hospitals; Herston Queensland Australia
| | - Irwin Lim
- BJC Health; Sydney New South Wales Australia
| | | | - Simon Stebbings
- Department of Medicine; Dunedin School of Medicine; University of Otago; Dunedin New Zealand
- Department of Rheumatology; Dunedin Hospital; Dunedin New Zealand
| | - Stephen Stuckey
- Monash Imaging; Monash Health Departments of Medicine and Imaging; School of Clinical Studies at Monash Health; Monash University; Melbourne Victoria Australia
| | - Andrew L Taylor
- University of Western Australia; Perth Western Australia Australia
- Royal Perth Hospital; Perth Western Australia Australia
| | - Samuel L Whittle
- Rheumatology Unit; The Queen Elizabeth Hospital; Woodville South South Australia Australia
- The University of Adelaide; Adelaide South Australia Australia
| | - Jane Zochling
- Menzies Institute for Medical Research; University of Tasmania; Hobart Tasmania Australia
| | - Paul Bird
- University of New South Wales; Sydney New South Wales Australia
| | - Matthew A Brown
- Institute of Health and Biomedical Innovation; Translational Research Institute; Princess Alexandra Hospital; Queensland University of Technology; Brisbane Queensland Australia
| |
Collapse
|
25
|
Jacquemin C, Rubio Vargas R, van den Berg R, Thévenin F, Lenczner G, Reijnierse M, Ferkal S, Le Corvoisier P, Rahmouni A, Loeuille D, Feydy A, Dougados M, van der Heijde D, Claudepierre P. What is the reliability of non-trained investigators in recognising structural MRI lesions of sacroiliac joints in patients with recent inflammatory back pain? Results of the DESIR cohort. RMD Open 2016; 2:e000303. [PMID: 27933207 PMCID: PMC5133415 DOI: 10.1136/rmdopen-2016-000303] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 09/08/2016] [Accepted: 09/12/2016] [Indexed: 12/20/2022] Open
Abstract
Objective The objective of this study was to evaluate the reliability of recognising structural lesions on MRI (erosions, fatty lesions, ankylosis) of the sacroiliac joints (MRI-SIJ) in clinical practice compared to a central reading in patients with a possible recent axial spondyloarthritis (axSpA). Methods Patients aged 18–50 years, with recent (<3 years) and chronic (≥3 months) inflammatory back pain, suggestive of axSpA were included in the DEvenir des Spondyloarthrites Indifférenciées Récentes (DESIR) cohort. MRI-SIJ structural lesions were scored by non-trained local readers, and by two trained central readers. Local readers scored each SIJ as normal, doubtful or definite lesions. Central readers scored separately each type of lesion. The central reading (mean of the two central readers’ scores) was the external standard. Agreement (κ) was calculated first between local (3 definitions of a positive MRI-SIJ) and central readings (9 definitions), and then between the two central readers. Results 664/708 patients with complete available images were included. Agreements between local and central readings were overall ‘fair’, except when considering at least 2 or 3 fatty lesions and at least 3 erosions and/or fatty lesions where agreement was ‘moderate’. Agreement between central readers was similar. MRI-SIJ was positive for 52.6% of patients according to central reading (at least 1 structural lesion) and for 35.4% of patients according to local reading (at least unilateral ‘doubtful‘ or ‘definite’ structural lesions). Conclusions Agreement on a positive structural MRI-SIJ was fair to moderate between local and central readings, as well as between central readers. The reliability improved when fatty lesions were considered. Trial registration number NCTO 164 8907.
Collapse
Affiliation(s)
| | - Roxana Rubio Vargas
- Department of Rheumatology , Leiden University Medical Center , Leiden , The Netherlands
| | - Rosaline van den Berg
- Department of Rheumatology , Leiden University Medical Center , Leiden , The Netherlands
| | | | - Gregory Lenczner
- Department of Radiology , Clinique Hartmann , Neuilly-sur-Seine , France
| | - Monique Reijnierse
- Department of Radiology , Leiden University Medical Center , Leiden , The Netherlands
| | - Salah Ferkal
- Clinical Investigation Center 1430, AP-HP and Inserm, Hôpital Henri Mondor , Créteil , France
| | - Philippe Le Corvoisier
- Clinical Investigation Center 1430, AP-HP and Inserm, Hôpital Henri Mondor , Créteil , France
| | - Alain Rahmouni
- Department of Radiology , Hôpital Henri Mondor , Créteil , France
| | - Damien Loeuille
- Department of Rheumatology , Hôpital Brabois , Nancy , France
| | - Antoine Feydy
- Department of Radiology , Hôpital Cochin , Paris , France
| | - Maxime Dougados
- Department of Rheumatology , Hôpital Cochin , Paris , France
| | - Désirée van der Heijde
- Department of Rheumatology , Leiden University Medical Center , Leiden , The Netherlands
| | - Pascal Claudepierre
- Department of Rheumatology, Hôpital Henri Mondor, Créteil, France; Université Paris Est Créteil, EA 7379-EpidermE, F-94010, Créteil, France
| |
Collapse
|
26
|
|
27
|
Weber U, Jurik AG, Lambert RGW, Maksymowych WP. Imaging in Spondyloarthritis: Controversies in Recognition of Early Disease. Curr Rheumatol Rep 2016; 18:58. [DOI: 10.1007/s11926-016-0607-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
|
28
|
Maksymowych WP. The role of MRI in the evaluation of spondyloarthritis: a clinician's guide. Clin Rheumatol 2016; 35:1447-55. [PMID: 27094946 DOI: 10.1007/s10067-016-3265-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Revised: 03/28/2016] [Accepted: 03/29/2016] [Indexed: 01/17/2023]
Abstract
Plain radiography remains the benchmark for diagnostic evaluation of spondyloarthritis although MRI has much great sensitivity because it can detect a variety of inflammatory lesions as well as fat metaplasia. So, it is the imaging modality of choice when pelvic radiographs are equivocal and especially when important treatment decisions have to be made. Appropriate imaging includes the use of T1-weighted and short tau inversion recovery sequences of the sacroiliac joint in the tilted coronal plane. If there is localized spinal symptomatology, sagittal scans of the spine may also be helpful. However, routine spinal imaging is not recommended. Current consensus designates a positive MRI for classification purposes as requiring the presence of two definite subchondral inflammatory lesions on a single coronal slice or the presence of one such lesion on two consecutive coronal slices. However, such inflammatory lesions can occur in healthy individuals and in those with nonspecific back pain. Erosions are more specific, and their presence can enhance confidence in the diagnosis. MRI, together with CRP, can be helpful in selecting which patients without radiographic sacroiliitis are most likely to respond to tumor necrosis factor inhibitor therapy. The role of MRI in monitoring of patients with SpA remains unclear although it may be helpful in excluding other sources of back pain. A major unanswered question is whether MRI may be useful in predicting relapse following withdrawal of TNFi in patients who have achieved sustained remission.
Collapse
Affiliation(s)
- Walter P Maksymowych
- Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, AB, Canada.
| |
Collapse
|
29
|
Hu Z, Wang X, Qi J, Kong Q, Zhao M, Gu J. Backfill is a specific sign of axial spondyloarthritis seen on MRI. Joint Bone Spine 2015; 83:179-83. [PMID: 26709251 DOI: 10.1016/j.jbspin.2015.05.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 05/05/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To summarize the characteristics of backfill in patients with axial spondyloarthritis (SpA) and patients with non-specific back pain (NSBP) and healthy controls, and to assess the value of backfill in diagnosing axial SpA. METHODS Three readers blinded recorded backfill seen on T1SE MRI scans from 647 subjects: 297 patients with ankylosing spondylitis (AS), 126 patients with non-radiographic axial SpA (nr-axSpA), 147 patients with NSBP, and 77 healthy controls. The SPARCC SIJ Structural Score (SSS) method was used to assess backfill. The changes of backfill were evaluated by the follow-up MRI scans from 157 patients. We summarized the characteristics of backfill and calculated its sensitivity and specificity for diagnosing axial SpA. RESULTS Backfill was recorded in 78.8% AS patients, 11.1% nr-axSpA patients, 1.8% patients with NSBP, and no healthy control. Backfill affected more frequently at ilium bone, lower half of sacroiliac joints in axial SpA (both P<0.05). The SSS score of backfill was much higher in axial SpA than in patients with NSBP (both P<0.01) and it did not correlate with demographics and BASDAI, BASFI, and CRP (all P>0.05). The score of backfill only positively correlated with symptom duration in AS (r=0.251, P<0.01) and in nr-axSpA (r=0.743, P<0.01) patients. Only 8.9% patients had the change of backfill in an average follow-up time of 1.09 years. Backfill had high specificity (0.98) and moderate sensitivity (0.59) for diagnosing axial SpA. CONCLUSIONS We summarized the characteristics of backfill and found that backfill is a specific sign of axial SpA seen on T1SE MRI.
Collapse
Affiliation(s)
- Zaiying Hu
- Department of rheumatology, the third affiliated hospital, Sun Yat-Sen university, 600, Tianhe Road, 510630 Guangzhou, China
| | - Xiaohong Wang
- Department of radiology, the third affiliated hospital, Sun Yat-Sen university, 600, Tianhe Road, 510630 Guangzhou, China
| | - Jun Qi
- Department of rheumatology, the third affiliated hospital, Sun Yat-Sen university, 600, Tianhe Road, 510630 Guangzhou, China
| | - QingCong Kong
- Department of radiology, the third affiliated hospital, Sun Yat-Sen university, 600, Tianhe Road, 510630 Guangzhou, China
| | - Minjing Zhao
- Department of rheumatology, the third affiliated hospital, Sun Yat-Sen university, 600, Tianhe Road, 510630 Guangzhou, China
| | - Jieruo Gu
- Department of rheumatology, the third affiliated hospital, Sun Yat-Sen university, 600, Tianhe Road, 510630 Guangzhou, China.
| |
Collapse
|
30
|
Weiss BG, Bachmann LM, Pfirrmann CWA, Kissling RO, Zubler V. Whole Body Magnetic Resonance Imaging Features in Diffuse Idiopathic Skeletal Hyperostosis in Conjunction with Clinical Variables to Whole Body MRI and Clinical Variables in Ankylosing Spondylitis. J Rheumatol 2015; 43:335-42. [PMID: 26669910 DOI: 10.3899/jrheum.150162] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Discrimination of diffuse idiopathic skeletal hyperostosis (DISH) and ankylosing spondylitis (AS) can be challenging. Usefulness of whole-body magnetic resonance imaging (WB-MRI) in diagnosing spondyloarthritis has been recently proved. We assessed the value of clinical variables alone and in combination with WB-MRI to distinguish between DISH and AS. METHODS Diagnostic case-control study: 33 patients with AS and 15 patients with DISH were included. All patients underwent 1.5 Tesla WB-MRI scanning. MR scans were read by a blinded radiologist using the Canadian-Danish Working Group's recommendation. Imaging and clinical variables were identified using the bootstrap. The most important variables from MR and clinical history were assessed in a multivariate fashion resulting in 3 diagnostic models (MRI, clinical, and combined). The discriminative capacity was quantified using the area under the receiver-operating characteristic (ROC) curve. The strength of diagnostic variables was quantified with OR. RESULTS Forty-eight patients provided 1545 positive findings (193 DISH/1352 AS). The final MR model contained upper anterior corner fat infiltration (32 DISH/181 AS), ankylosis on the vertebral endplate (4 DISH/60 AS), facet joint ankylosis (4 DISH/49 AS), sacroiliac joint edema (11 DISH/91 AS), sacroiliac joint fat infiltration (2 DISH/114 AS), sacroiliac joint ankylosis (2 DISH/119 AS); area under the ROC curve was 0.71, 95% CI 0.64-0.78. The final clinical model contained patient's age and body mass index (area under the ROC curve 0.90, 95% CI 0.89-0.91). The full diagnostic model containing clinical and MR information had an area under the ROC curve of 0.93 (95% CI 0.92-0.95). CONCLUSION WB-MRI features can contribute to the correct diagnosis after a thorough conventional workup of patients with DISH and AS.
Collapse
Affiliation(s)
- Bettina G Weiss
- From the Department of Physical Medicine and Rheumatology, and Department of Radiology, Balgrist University Hospital; Medignition Inc. Research Consultants, Zurich, Switzerland.B.G. Weiss, MD, Department of Physical Medicine and Rheumatology, Balgrist University Hospital; L.M. Bachmann, MD, PhD, Professor, Medignition Inc. Research Consultants; C.W. Pfirrmann, MD, exec. MBA UZH, Department of Radiology, Balgrist University Hospital; R.O. Kissling, MD, Professor, Department of Physical Medicine and Rheumatology, Balgrist University Hospital; V. Zubler, MD, Department of Radiology, Balgrist University Hospital.
| | - Lucas M Bachmann
- From the Department of Physical Medicine and Rheumatology, and Department of Radiology, Balgrist University Hospital; Medignition Inc. Research Consultants, Zurich, Switzerland.B.G. Weiss, MD, Department of Physical Medicine and Rheumatology, Balgrist University Hospital; L.M. Bachmann, MD, PhD, Professor, Medignition Inc. Research Consultants; C.W. Pfirrmann, MD, exec. MBA UZH, Department of Radiology, Balgrist University Hospital; R.O. Kissling, MD, Professor, Department of Physical Medicine and Rheumatology, Balgrist University Hospital; V. Zubler, MD, Department of Radiology, Balgrist University Hospital
| | - Christian W A Pfirrmann
- From the Department of Physical Medicine and Rheumatology, and Department of Radiology, Balgrist University Hospital; Medignition Inc. Research Consultants, Zurich, Switzerland.B.G. Weiss, MD, Department of Physical Medicine and Rheumatology, Balgrist University Hospital; L.M. Bachmann, MD, PhD, Professor, Medignition Inc. Research Consultants; C.W. Pfirrmann, MD, exec. MBA UZH, Department of Radiology, Balgrist University Hospital; R.O. Kissling, MD, Professor, Department of Physical Medicine and Rheumatology, Balgrist University Hospital; V. Zubler, MD, Department of Radiology, Balgrist University Hospital
| | - Rudolf O Kissling
- From the Department of Physical Medicine and Rheumatology, and Department of Radiology, Balgrist University Hospital; Medignition Inc. Research Consultants, Zurich, Switzerland.B.G. Weiss, MD, Department of Physical Medicine and Rheumatology, Balgrist University Hospital; L.M. Bachmann, MD, PhD, Professor, Medignition Inc. Research Consultants; C.W. Pfirrmann, MD, exec. MBA UZH, Department of Radiology, Balgrist University Hospital; R.O. Kissling, MD, Professor, Department of Physical Medicine and Rheumatology, Balgrist University Hospital; V. Zubler, MD, Department of Radiology, Balgrist University Hospital
| | - Veronika Zubler
- From the Department of Physical Medicine and Rheumatology, and Department of Radiology, Balgrist University Hospital; Medignition Inc. Research Consultants, Zurich, Switzerland.B.G. Weiss, MD, Department of Physical Medicine and Rheumatology, Balgrist University Hospital; L.M. Bachmann, MD, PhD, Professor, Medignition Inc. Research Consultants; C.W. Pfirrmann, MD, exec. MBA UZH, Department of Radiology, Balgrist University Hospital; R.O. Kissling, MD, Professor, Department of Physical Medicine and Rheumatology, Balgrist University Hospital; V. Zubler, MD, Department of Radiology, Balgrist University Hospital
| |
Collapse
|
31
|
de Hooge M, van den Berg R, Navarro-Compán V, Reijnierse M, van Gaalen F, Fagerli K, Landewé R, van Oosterhout M, Ramonda R, Huizinga T, van der Heijde D. Patients with chronic back pain of short duration from the SPACE cohort: which MRI structural lesions in the sacroiliac joints and inflammatory and structural lesions in the spine are most specific for axial spondyloarthritis? Ann Rheum Dis 2015; 75:1308-14. [DOI: 10.1136/annrheumdis-2015-207823] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 07/19/2015] [Indexed: 12/22/2022]
|
32
|
Pedersen SJ, Maksymowych WP. Recent Advances in Imaging of the Axial Skeleton in Spondyloarthritis for Diagnosis, Assessment of Treatment Effect, and Prognostication. Curr Rheumatol Rep 2015; 17:60. [DOI: 10.1007/s11926-015-0531-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
|
33
|
Wendling D, Claudepierre P, Pham T, Loeuille D, Prati C. MRI in axial spondyloarthritis: From light to shadow? Joint Bone Spine 2015; 82:302-4. [PMID: 26047782 DOI: 10.1016/j.jbspin.2015.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2015] [Indexed: 01/02/2023]
Affiliation(s)
- Daniel Wendling
- Service de rhumatologie, CHRU de Besançon, université de Franche-Comté, 3, boulevard Fleming, 25030 Besançon, France.
| | | | - Thao Pham
- Service de rhumatologie, AP-HM, 13000 Marseille, France
| | | | - Clément Prati
- Service de rhumatologie, CHRU de Besançon, université de Franche-Comté, 3, boulevard Fleming, 25030 Besançon, France
| |
Collapse
|
34
|
Fat Metaplasia and Backfill Are Key Intermediaries in the Development of Sacroiliac Joint Ankylosis in Patients With Ankylosing Spondylitis. Arthritis Rheumatol 2014; 66:2958-67. [DOI: 10.1002/art.38792] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Accepted: 07/17/2014] [Indexed: 12/16/2022]
|
35
|
Maksymowych WP, Wichuk S, Chiowchanwisawakit P, Lambert RG, Pedersen SJ. Development and preliminary validation of the spondyloarthritis research consortium of Canada magnetic resonance imaging sacroiliac joint structural score. J Rheumatol 2014; 42:79-86. [PMID: 25320219 DOI: 10.3899/jrheum.140519] [Citation(s) in RCA: 105] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE There is an unmet need for reliable assessment of structural progression in the sacroiliac joints (SIJ) of patients with spondyloarthritis (SpA), but radiography is unreliable and lacks responsiveness. We aimed to develop and validate a new scoring method for structural lesions based on magnetic resonance imaging (MRI), the Spondyloarthritis Research Consortium of Canada (SPARCC) SIJ Structural Score (SSS). METHODS The SSS method for assessment of structural lesions is based on T1-weighted spin echo MRI, validated lesion definitions, slice selection according to well-defined anatomical principles, and dichotomous scoring (lesion present/absent) of 5 consecutive slices through the cartilaginous portion of the joint. Scoring ranges are fat metaplasia (0-40), erosion (0-40), backfill (0-20), and ankylosis (0-20). We progressively conducted 3 validation exercises with 2-4 readers on baseline, and either 2-year (exercises 1 and 2) or 1-year (exercise 3) scans from 147 patients with SpA assessed blinded to timepoint. Interobserver reliability was assessed by intraclass correlation coefficient (ICC) and smallest detectable change (SDC). RESULTS Interobserver reliability for status score was good to excellent for ankylosis (ICC 0.79-0.98), consistently good for fat metaplasia (ICC 0.71-0.78), moderate to good for erosion (ICC 0.58-0.62), and fair to good for backfill (ICC 0.35-0.66). Reliability for change scores was moderate to good for all structural lesions despite the relatively small changes in scores, and was highest for fat metaplasia when both ICC and SDC values were compared. CONCLUSION The new SPARCC MRI SSS method can detect structural changes in the SIJ with acceptable reliability over a 1-2-year timeframe, and should be further validated in patients with SpA.
Collapse
Affiliation(s)
- Walter P Maksymowych
- From the Department of Medicine; Department of Radiology and Diagnostic Imaging, Spondyloarthritis Research Consortium of Canada (SPARCC) Center, University of Alberta, Edmonton, Alberta, Canada; the Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand; the Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, University of Copenhagen, Denmark.W.P. Maksymowych, FRCP(C), Professor; S. Wichuk, BSc, Research Associate, Department of Medicine; R.G. Lambert, FRCP(C), Professor, Department of Radiology and Diagnostic Imaging, Spondyloarthritis Research Consortium of Canada Center, University of Alberta; P. Chiowchanwisawakit, MD, Department of Medicine, Siriraj Hospital, Mahidol University; S.J. Pedersen, MD, Rheumatologist, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, University of Copenhagen.
| | - Stephanie Wichuk
- From the Department of Medicine; Department of Radiology and Diagnostic Imaging, Spondyloarthritis Research Consortium of Canada (SPARCC) Center, University of Alberta, Edmonton, Alberta, Canada; the Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand; the Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, University of Copenhagen, Denmark.W.P. Maksymowych, FRCP(C), Professor; S. Wichuk, BSc, Research Associate, Department of Medicine; R.G. Lambert, FRCP(C), Professor, Department of Radiology and Diagnostic Imaging, Spondyloarthritis Research Consortium of Canada Center, University of Alberta; P. Chiowchanwisawakit, MD, Department of Medicine, Siriraj Hospital, Mahidol University; S.J. Pedersen, MD, Rheumatologist, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, University of Copenhagen
| | - Praveena Chiowchanwisawakit
- From the Department of Medicine; Department of Radiology and Diagnostic Imaging, Spondyloarthritis Research Consortium of Canada (SPARCC) Center, University of Alberta, Edmonton, Alberta, Canada; the Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand; the Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, University of Copenhagen, Denmark.W.P. Maksymowych, FRCP(C), Professor; S. Wichuk, BSc, Research Associate, Department of Medicine; R.G. Lambert, FRCP(C), Professor, Department of Radiology and Diagnostic Imaging, Spondyloarthritis Research Consortium of Canada Center, University of Alberta; P. Chiowchanwisawakit, MD, Department of Medicine, Siriraj Hospital, Mahidol University; S.J. Pedersen, MD, Rheumatologist, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, University of Copenhagen
| | - Robert G Lambert
- From the Department of Medicine; Department of Radiology and Diagnostic Imaging, Spondyloarthritis Research Consortium of Canada (SPARCC) Center, University of Alberta, Edmonton, Alberta, Canada; the Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand; the Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, University of Copenhagen, Denmark.W.P. Maksymowych, FRCP(C), Professor; S. Wichuk, BSc, Research Associate, Department of Medicine; R.G. Lambert, FRCP(C), Professor, Department of Radiology and Diagnostic Imaging, Spondyloarthritis Research Consortium of Canada Center, University of Alberta; P. Chiowchanwisawakit, MD, Department of Medicine, Siriraj Hospital, Mahidol University; S.J. Pedersen, MD, Rheumatologist, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, University of Copenhagen
| | - Susanne J Pedersen
- From the Department of Medicine; Department of Radiology and Diagnostic Imaging, Spondyloarthritis Research Consortium of Canada (SPARCC) Center, University of Alberta, Edmonton, Alberta, Canada; the Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand; the Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, University of Copenhagen, Denmark.W.P. Maksymowych, FRCP(C), Professor; S. Wichuk, BSc, Research Associate, Department of Medicine; R.G. Lambert, FRCP(C), Professor, Department of Radiology and Diagnostic Imaging, Spondyloarthritis Research Consortium of Canada Center, University of Alberta; P. Chiowchanwisawakit, MD, Department of Medicine, Siriraj Hospital, Mahidol University; S.J. Pedersen, MD, Rheumatologist, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, University of Copenhagen
| |
Collapse
|
36
|
Weber U, Østergaard M, Lambert RGW, Pedersen SJ, Chan SM, Zubler V, Rufibach K, Zhao Z, Maksymowych WP. Candidate lesion-based criteria for defining a positive sacroiliac joint MRI in two cohorts of patients with axial spondyloarthritis. Ann Rheum Dis 2014; 74:1976-82. [DOI: 10.1136/annrheumdis-2014-205408] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 05/25/2014] [Indexed: 01/14/2023]
|