Shaye Kivity1,2,3,4, Shany Guly Gofrit5, Fadi Abu Baker6, Naama Leibushor7, Shahar Tavor8, Merav Lidar7,9, Iris Eshed9,10. 1. Department of Medicine A, Sheba Medical Center, Tel Hashomer, 52621, Ramat Gan, Israel. kivitys@gmail.com. 2. Rheumatology Unit, The Zabludowicz Center for Autoimmune Diseases, Tel-Hashomer, Ramat Gan, Israel. kivitys@gmail.com. 3. The Dr. Pinchas Borenstein Talpiot Medical Leadership Program 2013, Tel-Hashomer, Ramat Gan, Israel. kivitys@gmail.com. 4. Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel. kivitys@gmail.com. 5. Department of Medicine A, Sheba Medical Center, Tel Hashomer, 52621, Ramat Gan, Israel. 6. Gastroenterology and Hepatology Institute, Hillel Yaffe Medical Center, affiliated to the Ruth and Rappaport Faculty of Medicine, Haifa, Israel. 7. Rheumatology Unit, The Zabludowicz Center for Autoimmune Diseases, Tel-Hashomer, Ramat Gan, Israel. 8. Hebrew University, Jerusalem, Israel. 9. Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel. 10. Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.
Abstract
OBJECTIVES: To evaluate the association between inflammatory back pain (IBP) features, acute and structural MRI findings suggestive of sacroiliitis, and diagnosis of spondyloarthritis (SpA). METHODS: Data from 224 patients who underwent MRI for suspected sacroiliitis (2005-2015) was retrospectively reviewed by an expert rheumatologist for the presence of IBP features and for clinical standard of reference diagnosis. A telephone questionnaire was performed in cases of missing data. Acute and structural MRI parameters were scored by an experienced radiologist for the presence of sacroiliitis using the Assessment of Spondyloarthritis International Society (ASAS) criteria, Berlin score, and observer's global impression (GI) scores. Association between IBP features and MRI scores, and odds ratio for SpA diagnosis, were calculated. RESULTS: One hundred ninety-three subjects were included (119 F:74 M, mean age 39.7 ± 15.6, mean follow-up 49 ± 18 months). Fifty-two (26.9%) subjects were diagnosed with SpA. IBP scores were significantly higher in SpA patients (p < 0.001). IBP, ASAS, and GI MRI scores were significantly associated with the SpA diagnosis (p < 0.001 for all). The presence of night pain and morning stiffness was significantly associated with sacroiliac-joints' bone marrow edema (BME, p < 0.05). Sensitivity for diagnosis of SpA was high for IBP (96%) and low for the MRI parameters (26.9-57.4%), and specificity was low for IBP (32%) and high for the MRI parameters (88.3-94.3%). CONCLUSIONS: The presence of IBP features is highly associated with diagnosis of SpA and correlates with MRI BME, all probably reflect inflammation. The combination of IBP and MRI should be the cornerstone in the clinician's final diagnosis of SpA.
OBJECTIVES: To evaluate the association between inflammatory back pain (IBP) features, acute and structural MRI findings suggestive of sacroiliitis, and diagnosis of spondyloarthritis (SpA). METHODS: Data from 224 patients who underwent MRI for suspected sacroiliitis (2005-2015) was retrospectively reviewed by an expert rheumatologist for the presence of IBP features and for clinical standard of reference diagnosis. A telephone questionnaire was performed in cases of missing data. Acute and structural MRI parameters were scored by an experienced radiologist for the presence of sacroiliitis using the Assessment of Spondyloarthritis International Society (ASAS) criteria, Berlin score, and observer's global impression (GI) scores. Association between IBP features and MRI scores, and odds ratio for SpA diagnosis, were calculated. RESULTS: One hundred ninety-three subjects were included (119 F:74 M, mean age 39.7 ± 15.6, mean follow-up 49 ± 18 months). Fifty-two (26.9%) subjects were diagnosed with SpA. IBP scores were significantly higher in SpA patients (p < 0.001). IBP, ASAS, and GI MRI scores were significantly associated with the SpA diagnosis (p < 0.001 for all). The presence of night pain and morning stiffness was significantly associated with sacroiliac-joints' bone marrow edema (BME, p < 0.05). Sensitivity for diagnosis of SpA was high for IBP (96%) and low for the MRI parameters (26.9-57.4%), and specificity was low for IBP (32%) and high for the MRI parameters (88.3-94.3%). CONCLUSIONS: The presence of IBP features is highly associated with diagnosis of SpA and correlates with MRI BME, all probably reflect inflammation. The combination of IBP and MRI should be the cornerstone in the clinician's final diagnosis of SpA.
Entities:
Keywords:
Axial spondyloarthropathy; Inflammatory back pain; MRI; Sacroiliitis
Authors: Luca Saba; Massimo De Filippo; Francesco Saba; Federica Fellini; Pierre-Yves Marcy; Robert Dagan; Philippe Voituriez; Jacques Aelvoet; Gérard Klotz; Roland Bernard; Valérie Salinesi; Serge Agostini Journal: Indian J Radiol Imaging Date: 2019-12-31