Jyoti Panwar1,2, Shirley M L Tse3,4, Lillian Lim3,4, Mirkamal A Tolend3,4, Shilpa Radhakrishnan3,4, Muayad Salman3,4, Rahim Moineddin3,4, Andrea S Doria3,4, Jennifer Stimec3,4. 1. From the Joint Department of Medical Imaging, University Health Network, University of Toronto; Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto; Division of Pediatric Rheumatology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario; Division of Pediatric Rheumatology, Department of Pediatrics, The University of Alberta, Edmonton, Alberta; Kanchi Kamakoti CHILDS Trust Hospital, Chennai; Department of Radiology, Christian Medical College, Vellore, India; Makassed Hospital, Jerusalem, Israel; Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada. drjyoticmch@gmail.com Jyoti.panwar@sickkids.ca. 2. J. Panwar, MD, FRCR, Joint Department of Medical Imaging, University Health Network, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, and Department of Radiology, Christian Medical College; S.M. Tse, MD, Division of Pediatric Rheumatology, The Hospital for Sick Children, University of Toronto; L. Lim, MD, FRCPC, Division of Pediatric Rheumatology, Department of Pediatrics, The University of Alberta; M.A. Tolend, Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto; S. Radhakrishnan, MD, Kanchi Kamakoti CHILDS Trust Hospital; M. Salman, MD, Makassed Hospital; R. Moineddin, PhD, Department of Family and Community Medicine, University of Toronto; A.S. Doria, MD, PhD, MSc, Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto; J. Stimec, MD, Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto. drjyoticmch@gmail.com Jyoti.panwar@sickkids.ca. 3. From the Joint Department of Medical Imaging, University Health Network, University of Toronto; Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto; Division of Pediatric Rheumatology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario; Division of Pediatric Rheumatology, Department of Pediatrics, The University of Alberta, Edmonton, Alberta; Kanchi Kamakoti CHILDS Trust Hospital, Chennai; Department of Radiology, Christian Medical College, Vellore, India; Makassed Hospital, Jerusalem, Israel; Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada. 4. J. Panwar, MD, FRCR, Joint Department of Medical Imaging, University Health Network, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, and Department of Radiology, Christian Medical College; S.M. Tse, MD, Division of Pediatric Rheumatology, The Hospital for Sick Children, University of Toronto; L. Lim, MD, FRCPC, Division of Pediatric Rheumatology, Department of Pediatrics, The University of Alberta; M.A. Tolend, Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto; S. Radhakrishnan, MD, Kanchi Kamakoti CHILDS Trust Hospital; M. Salman, MD, Makassed Hospital; R. Moineddin, PhD, Department of Family and Community Medicine, University of Toronto; A.S. Doria, MD, PhD, MSc, Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto; J. Stimec, MD, Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto.
Abstract
OBJECTIVE: Intra- and interreader reliability, construct validity, and responsiveness of the Spondyloarthritis Research Consortium of Canada (SPARCC) magnetic resonance imaging (MRI) scoring system were investigated for scoring sacroiliitis in patients with juvenile spondyloarthritis (JSpA)/enthesitis-related arthritis (ERA) who have received biologic and/or nonbiologic treatment. METHODS: Ninety whole-body MRI examinations with dedicated oblique coronal planes of the sacroiliac joints in 46 patients were independently reviewed and scored by 2 pediatric musculoskeletal radiologists, blinded to clinical details, using the SPARCC system. Intra- and interreader reliability was assessed by intraclass correlation coefficients (ICC). Construct validity testing was done by (1) correlating the SPARCC MRI scores of sacroiliitis with clinical disease activity indicators (cross-sectional validity), and (2) correlating the change in the MRI score with the change in clinical indicators before and after treatment (longitudinal validity). Responsiveness of the MRI and clinical indicators was also evaluated, grouped by biologic and nonbiologic treatment. RESULTS: When applied in children with JSpA/ERA, the SPARCC showed almost perfect intra- and interreader reliability (ICC 0.79-1.00). There was poor cross-sectional and longitudinal correlation between clinical assessment indicators and MRI scoring. SPARCC scores showed higher responsiveness to treatment-related change than most clinical outcome measures. Three clinical outcome measures correlated longitudinally with SPARCC score in nonbiologic treatment: active joint count (r = 0.72, p < 0.001), FABER (Flexion, Abduction, External Rotation) test (r = 0.58, p = 0.012), and physician's global assessment (r = 0.61, p = 0.034). CONCLUSION: The SPARCC MRI scoring system is a reliable tool with relatively higher responsiveness than clinical indicators and is suitable for objective quantification of sacroiliitis when applied to pediatric patients with JSpA/ERA.
OBJECTIVE: Intra- and interreader reliability, construct validity, and responsiveness of the Spondyloarthritis Research Consortium of Canada (SPARCC) magnetic resonance imaging (MRI) scoring system were investigated for scoring sacroiliitis in patients with juvenile spondyloarthritis (JSpA)/enthesitis-related arthritis (ERA) who have received biologic and/or nonbiologic treatment. METHODS: Ninety whole-body MRI examinations with dedicated oblique coronal planes of the sacroiliac joints in 46 patients were independently reviewed and scored by 2 pediatric musculoskeletal radiologists, blinded to clinical details, using the SPARCC system. Intra- and interreader reliability was assessed by intraclass correlation coefficients (ICC). Construct validity testing was done by (1) correlating the SPARCC MRI scores of sacroiliitis with clinical disease activity indicators (cross-sectional validity), and (2) correlating the change in the MRI score with the change in clinical indicators before and after treatment (longitudinal validity). Responsiveness of the MRI and clinical indicators was also evaluated, grouped by biologic and nonbiologic treatment. RESULTS: When applied in children with JSpA/ERA, the SPARCC showed almost perfect intra- and interreader reliability (ICC 0.79-1.00). There was poor cross-sectional and longitudinal correlation between clinical assessment indicators and MRI scoring. SPARCC scores showed higher responsiveness to treatment-related change than most clinical outcome measures. Three clinical outcome measures correlated longitudinally with SPARCC score in nonbiologic treatment: active joint count (r = 0.72, p < 0.001), FABER (Flexion, Abduction, External Rotation) test (r = 0.58, p = 0.012), and physician's global assessment (r = 0.61, p = 0.034). CONCLUSION: The SPARCC MRI scoring system is a reliable tool with relatively higher responsiveness than clinical indicators and is suitable for objective quantification of sacroiliitis when applied to pediatric patients with JSpA/ERA.
Entities:
Keywords:
ENTHESITIS-RELATED ARTHRITIS; JUVENILE SPONDYLOARTHRITIS; MAGNETIC RESONANCE IMAGING; SACROILIITIS; SCORING SYSTEM; SPONDYLOARTHRITIS RESEARCH CONSORTIUM OF CANADA
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