Inès Herrada1, Hervé Devilliers2, Christine Fayolle1, Grégoire Attané3, Romaric Loffroy3, Frank Verhoeven4, Paul Ornetti5, André Ramon6. 1. Rheumatology department, CHU Dijon-Burgundy, Dijon, France. 2. Department of internal medicine and systemic diseases, Dijon-Burgundy university hospital, Dijon, France; Centre d'Investigation Clinique, Inserm, CIC 1432, university of Bourgogne-Franche Comté, Dijon, France. 3. Diagnostic and therapeutic radiology department, Dijon-Burgundy university hospital, Dijon, France. 4. Rheumatology Department, CHU Besançon, EA 4267 PEPITE, FHU INCREASE, University of Bourgogne-Franche Comté, Besançon, France. 5. Rheumatology department, CHU Dijon-Burgundy, Dijon, France; Inserm UMR1093-CAPS, université Bourgogne, UFR des Sciences du Sport, Dijon, France; CIC-P, Plurithematic Module, Technological Investigation Platform, Dijon-Burgundy university hospital, Dijon, France. 6. Rheumatology department, CHU Dijon-Burgundy, Dijon, France; Inserm EFS BFC, UMR1098, university of Bourgogne-Franche Comté, Dijon, France. Electronic address: andre.ramon@chu-dijon.fr.
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.
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.
Authors: Steven L Truong; Tim McEwan; Paul Bird; Irwin Lim; Nivene F Saad; Lionel Schachna; Andrew L Taylor; Philip C Robinson Journal: Rheumatol Ther Date: 2021-12-28