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Ann Rheum Dis. 2015 Jun;74(6):985-92. doi: 10.1136/annrheumdis-2013-203887. Epub 2014 Jan 22.

Does spinal MRI add incremental diagnostic value to MRI of the sacroiliac joints alone in patients with non-radiographic axial spondyloarthritis?

Author information

1
Department of Medicine, University of Alberta, Edmonton, Alberta, Canada Department of Rheumatology, Balgrist University Hospital, Zurich, Switzerland.
2
Department of Radiology, Balgrist University Hospital, Zurich, Switzerland.
3
Department of Rheumatology, PLA General Hospital, Beijing, China.
4
Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada.
5
Department of Ophthalmology, University of Alberta, Edmonton, Alberta, Canada.
6
Copenhagen Center for Arthritis Research, Center for Rheumatology and Spinal Diseases, University of Copenhagen, Copenhagen, Denmark.
7
Rufibach rePROstat, Biostatistical Consulting and Training, Basel, Switzerland.
8
Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.

Abstract

OBJECTIVE:

To assess the incremental diagnostic value of spine MRI evaluated separately from and combined with sacroiliac joint (SIJ) MRI in non-radiographic axial spondyloarthritis (nr-axSpA) compared with SIJ MRI alone.

METHODS:

The study sample comprised two independent cohorts A/B of 130 consecutive patients aged ≤50 years with back pain, newly referred to two university clinics, and 20 healthy controls. Patients were classified according to clinical examination and pelvic radiographs as having nr-axSpA (n=50), ankylosing spondylitis (n=33), or non-specific back pain (n=47). Four readers assessed SIJ and spine MRI separately 6 months apart, and 1-12 months later both scans simultaneously using standardised modules. Readers recorded presence/absence of SpA and their level of confidence in this conclusion on a 0-10 scale (0=definitely not; 10=definite). We analysed differences between SIJ MRI versus spine MRI alone, and SIJ MRI alone versus combined MRI, descriptively by the number/percentage of subjects according to the mean of four readers.

RESULTS:

In cohorts A/B, 15.8%/24.2% of patients with nr-axSpA having a negative SIJ MRI were reclassified as being positive for SpA by global evaluation of combined scans. However, 26.8%/11.4% of non-specific back pain controls and 17.5% of healthy volunteers with a negative SIJ MRI were falsely reclassified as having SpA by combined MRI. Low confidence in a diagnosis of SpA by SIJ MRI increased to high confidence by combined MRI in 6.6%/7.3% of patients with nr-axSpA.

CONCLUSIONS:

Combined spine and SIJ MRI added little incremental value compared with SIJ MRI alone for diagnosing patients with nr-axSpA and enhancing confidence in this diagnosis.

KEYWORDS:

Ankylosing Spondylitis; Magnetic Resonance Imaging; Spondyloarthritis

PMID:
24451240
DOI:
10.1136/annrheumdis-2013-203887
[Indexed for MEDLINE]
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