Assessment of active spinal inflammatory changes in patients with axial spondyloarthritis: validation of whole body MRI against conventional MRI

Abstract

The Corresponding Author has the right to grant on behalf of all authors and does grant on behalf of all authors, an exclusive licence (or non exclusive for government employees) on a worldwide basis to the BMJ Publishing Group Ltd to permit this article (if accepted) to be published in ARD and any other BMJPGL products and sublicences such use and exploit all subsidiary rights, as set out in our licence (http://ARD.bmjjournals.com/ifora/licence.pdf). ABSTRACTObjective. To evaluate the performance of whole body (WB) MRI versus conventional (CON) MRI in assessing active inflammatory lesions of the entire spine in patients with established and clinically active axial spondyloarthritis (SpA) using the Spondyloarthritis Research Consortium of Canada (SPARCC) MRI index. Methods. 32 consecutive SpA patients fulfilling the modified New York criteria and with clinically active disease (BASDAI score ≥ 4) were scanned by sagittal WB and CON MRI of the spine. The MR images were scored independently in random order by 3 readers blinded to patient identifiers. Active inflammatory lesions of the spine were recorded on a web-based scoring form. Pearson correlation coefficient served to compare scores for WB and CON MRI for each rater whilst intra-class correlation coefficient (ICC) was used to assess inter-observer reliability.Results. The median percentage of inflammatory lesions recorded concordantly for both WB and CON MRI ranged from 83% to 91% for the 3 readers; 4% to 9% were only recorded by WB MRI, and 4% to 9% were recorded by CON MRI only. The Pearson correlation coefficient between WB and CON MRI per rater was 0.79, 0.89 and 0.81, respectively. The ICC(2, 1) for CON MRI was 0.75, 0.80 and 0.68 and for WB MRI 0.82, 0.83 and 0.93, respectively, for the 3 possible reader pairs. Conclusion. WB and CON MRI scores showed a high correlation and comparable high reliability for the detection of active inflammatory lesions in the spine of patients with clinically active SpA.

Detection of Active Sacroiliitis with Ankylosing Spondylitis through Intravoxel Incoherent Motion Diffusion-Weighted MR Imaging

“…Several studies have evaluated the activity of AS with MRI [6,7,[9][10][11][24][25][26][27]. The outcomes of those studies suggest that tissue perfusion and diffusion can be considered important biological parameters that might be used for the detection of disease or treatment response [28].…”

“…This study aimed to use IVIM DW-MRI at 1.5 T and measure the IVIM parameters obtained by the combination of ten b-values (0, 10,20,30,50,80,100,200, 400, and 800 s/mm 2 ) in sacroiliac joint lesions with AS. The objective was also to evaluate the ability of the IVIM parameters in differentiating the active group from the chronic and control groups.…”

“…In addition, a study has shown that up to 40 % of patients with AS in the active stage never have elevated CRP or ESR [7]. However, fast spin echo (FSE) sequence and fat suppression (FS) sequence have been recently used to detect the activity of AS, but short tau inversion recovery (STIR) sequences can also be used for this detection [8][9][10]. One study showed that dynamic contrast-enhanced MR imaging (DCE-MRI) is not routinely used in imaging of AS [11] because it can increase the risk of renal fibrosis.…”

Diagnostic Utility of MRI in Early Spondyloarthritis

“…Imaging of the lower extremities is an additional option that may be relevant for some patients with concomitant peripheral enthesitis, but this must be weighed against an additional examination time of 20 min. WBMRI of the SIJ and spine has been shown to correlate well and to demonstrate comparable reliability to conventional MRI for the detection of active inflammatory lesions in patients with established AS [13,14]. However, it depicts the SIJ in the coronal plane rather than the tilted coronal plane used in conventional MRI so that the images do not focus on the cartilaginous portion of the joint.…”

The impact of MRI on the clinical management of inflammatory arthritides

“…Imaging of the lower extremities is an additional option that may be relevant for some patients with concomitant peripheral enthesitis, but this has to be weighed against an additional examination time of 20 min. WB MRI of the SIJ and spine has been shown to correlate well and demonstrate comparable reliability to conventional MRI for the detection of active inflammatory lesions in patients with established AS [54,55]. However, it depicts the SIJ in the coronal plane rather than the tilted coronal plane used in conventional MRI so that the images do not focus on the cartilaginous portion of the joint.…”