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Ann Rheum Dis. Jun 2003; 62(6): 519–525.
PMCID: PMC1754576

Radiographic assessment of sacroiliitis by radiologists and rheumatologists: does training improve quality?

Abstract

Objective: To assess performance of radiologists and rheumatologists in detecting sacroiliitis

Methods: 100 rheumatologists and 23 radiologists participated. One set of films was used for each assessment, another for training, and the third for confidence judgment. Films of HLA-B27+ patients with AS were used to assess sensitivity. For specificity films of healthy HLA-B27- relatives were included. Plain sacroiliac (SI) films with simultaneously taken computed tomographic scans (CTs) were used for confidence judgment. Three months after reading the training set, sensitivity and specificity assessments were repeated. Next, participants attended a workshop. They also rated 26 SI radiographs and 26 CTs for their trust in each judgment. Three months later final assessments were done.

Results: Sensitivity (84.3%/79.8%) and specificity (70.6%/74.7%) for radiologists and rheumatologists were comparable. Rheumatologists showed 6.3% decrease in sensitivity after self education (p=0.001), but 3.0% better specificity (p=0.008). The decrease in sensitivity reversed after the workshop. Difference in sensitivity three months after the workshop and baseline was only 0.5%. Sensitivity <50% occurred in 13% of participants. Only a few participants showed changes of >5% in both sensitivity and specificity. Intraobserver agreement for sacroiliitis grade 1 or 2 ranged from 65% to 100%. Sensitivity for CT (86%) was higher than for plain films (72%) (p<0.001) with the same specificity (84%). Confidence ratings for correctly diagnosing presence (7.7) or absence (8.3) of sacroiliitis were somewhat higher than incorrectly diagnosing the presence (6.6) or absence (7.4) of sacroiliitis (p<0.001).

Conclusion: Radiologists and rheumatologists show modest sensitivity and specificity for sacroiliitis and sizeable intraobserver variation. Overall, neither individual training nor workshops improved performance.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Hollingsworth PN, Cheah PS, Dawkins RL, Owen ET, Calin A, Wood PH. Observer variation in grading sacroiliac radiographs in HLA-B27 positive individuals. J Rheumatol. 1983 Apr;10(2):247–254. [PubMed]
  • Yazici H, Turunç M, Ozdoğan H, Yurdakul S, Akinci A, Barnes CG. Observer variation in grading sacroiliac radiographs might be a cause of 'sacroiliitis' reported in certain disease states. Ann Rheum Dis. 1987 Feb;46(2):139–145. [PMC free article] [PubMed]
  • Taylor HG, Wardle T, Beswick EJ, Dawes PT. The relationship of clinical and laboratory measurements to radiological change in ankylosing spondylitis. Br J Rheumatol. 1991 Oct;30(5):330–335. [PubMed]
  • van der Linden SM, Khan MA, Rentsch HU, Gerber N, Cats A, Valkenburg HA, Tugwell PX. Chest pain without radiographic sacroiliitis in relatives of patients with ankylosing spondylitis. J Rheumatol. 1988;15(5):836–839. [PubMed]
  • van der Linden S, Valkenburg HA, Cats A. Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum. 1984 Apr;27(4):361–368. [PubMed]
  • Braun J, Bollow M, Sieper J. Radiologic diagnosis and pathology of the spondyloarthropathies. Rheum Dis Clin North Am. 1998 Nov;24(4):697–735. [PubMed]
  • Ryan LM, Carrera GF, Lightfoot RW, Jr, Hoffman RG, Kozin F. The radiographic diagnosis of sacroiliitis. A comparison of different views with computed tomograms of the sacroiliac joint. Arthritis Rheum. 1983 Jun;26(6):760–763. [PubMed]
  • Docherty P, Mitchell MJ, MacMillan L, Mosher D, Barnes DC, Hanly JG. Magnetic resonance imaging in the detection of sacroiliitis. J Rheumatol. 1992 Mar;19(3):393–401. [PubMed]
  • Battafarano DF, West SG, Rak KM, Fortenbery EJ, Chantelois AE. Comparison of bone scan, computed tomography, and magnetic resonance imaging in the diagnosis of active sacroiliitis. Semin Arthritis Rheum. 1993 Dec;23(3):161–176. [PubMed]
  • Braun J, Bollow M, Eggens U, König H, Distler A, Sieper J. Use of dynamic magnetic resonance imaging with fast imaging in the detection of early and advanced sacroiliitis in spondylarthropathy patients. Arthritis Rheum. 1994 Jul;37(7):1039–1045. [PubMed]
  • Blum U, Buitrago-Tellez C, Mundinger A, Krause T, Laubenberger J, Vaith P, Peter HH, Langer M. Magnetic resonance imaging (MRI) for detection of active sacroiliitis--a prospective study comparing conventional radiography, scintigraphy, and contrast enhanced MRI. J Rheumatol. 1996 Dec;23(12):2107–2115. [PubMed]
  • Yu W, Feng F, Dion E, Yang H, Jiang M, Genant HK. Comparison of radiography, computed tomography and magnetic resonance imaging in the detection of sacroiliitis accompanying ankylosing spondylitis. Skeletal Radiol. 1998 Jun;27(6):311–320. [PubMed]
  • Murphey MD, Wetzel LH, Bramble JM, Levine E, Simpson KM, Lindsley HB. Sacroiliitis: MR imaging findings. Radiology. 1991 Jul;180(1):239–244. [PubMed]
  • Fenton P. Magnetic resonance imaging of the sacroiliac joints: worth the cost? J Rheumatol. 1996 Dec;23(12):2020–2021. [PubMed]
  • Braun J, Sieper J, Bollow M. Imaging of sacroiliitis. Clin Rheumatol. 2000;19(1):51–57. [PubMed]
  • Khan MA, van der Linden SM, Kushner I, Valkenburg HA, Cats A. Spondylitic disease without radiologic evidence of sacroiliitis in relatives of HLA-B27 positive ankylosing spondylitis patients. Arthritis Rheum. 1985 Jan;28(1):40–43. [PubMed]
  • Gorter S, van der Linden S, Brauer J, van der Heijde D, Houben H, Rethans JJ, Scherpbier A, van der Vleuten C, Boonen A, Dinant H, et al. Rhemulatologists' performance in dailiy practice. Arthritis Rheum. 2001 Feb;45(1):16–27. [PubMed]

Figures and Tables

Figure 1
Flow chart of participants and examinations.

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