Diffusion-weighted Imaging Is a Sensitive and Specific Magnetic Resonance Sequence in the Diagnosis of Ankylosing Spondylitis

Bradbury, L.; Hollis, Kelly; Gautier, Benoît; Shankaranarayana, Sateesh; Robinson, Philip C; Saad, Nivene; Cao, Kim‐Anh Lê; Brown, Matthew A.

doi:10.3899/jrheum.170312

Cited by 39 publications

(40 citation statements)

References 27 publications

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“…Bone marrow edema in AS patients is related to inflammation, which leads to increased water in extracellular spaces 19 and may indicate that the increase of disease activity states causes an increase in the diffusion of local water molecules, resulting in higher ADC mean values. 20 Previous studies have reported that low bone marrow density is correlated with high disease activity in AS patients with increased ADC values, which is in agreement with our results. [21][22][23] Our results showed that the higher percentiles (50th, 75th, and 90th) had a greater ability to differentiate between active, inactive, and control groups and different disease activity states.…”

Section: Discussionsupporting

confidence: 93%

“…In addition, the ADC mean , which was higher than the SPARCC MRI index, was positively correlated with disease activity states. Bone marrow edema in AS patients is related to inflammation, which leads to increased water in extracellular spaces and may indicate that the increase of disease activity states causes an increase in the diffusion of local water molecules, resulting in higher ADC mean values . Previous studies have reported that low bone marrow density is correlated with high disease activity in AS patients with increased ADC values, which is in agreement with our results …”

Section: Discussionsupporting

confidence: 92%

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Whole‐lesion ADC histogram analysis and the spondyloarthritis research consortium of canada (SPARCC) MRI index in evaluating the disease activity of ankylosing spondylitis

Wang

Chu

Zhu

et al. 2018

Magnetic Resonance Imaging

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Background Conventional MRI is limited in quantitative evaluation of ankylosing spondylitis (AS) activity states. A comparison of the effectiveness of the whole‐lesion apparent diffusion coefficient (ADC) histogram analysis with the Spondyloarthritis Research Consortium of Canada (SPARCC) MRI index in evaluating the disease activity of AS might aid in this assessment. Purpose To compare the effectiveness of the whole‐lesion ADC histogram analysis with the SPARCC MRI index in evaluating the disease activity states of AS. Study Type Prospective. Population A total of 57 AS patients and 27 healthy matched volunteers were included. Field Strength/Sequence 3.0T MR including a diffusion‐weighted imaging (DWI) sequence (b = 0, 1000 s/mm2). Statistical Tests One‐way analysis of variance (ANOVA) and Scheffe's post‐hoc was used to compare the parameters among different groups. A receiver operating characteristic (ROC) analysis and the Spearman rank correlation were performed to test the diagnostic performance of all parameters in distinguishing different disease activity states and determining the correlations between them. Assessment AS disease activity states was evaluated according to the Ankylosing Spondylitis Disease Activity Score (ASDAS). Initial DWI images and corresponding ADC maps were imported into our in‐house software. Regions of interest (ROIs) were drawn in all slices and the relevant parameters were derived simultaneously. The SPARCC MRI index scores were counted artificially based on T2‐PDW‐SPAIR images. Results The ADCmean, ADC percentiles, and SPARCC MRI index of the active group were significantly higher than the inactive and control groups (all P < 0.001). The 90th percentile could differentiate the inactive from the control group and the low disease activity group from the inactive group (P = 0.011 and 0.006, respectively). The 50th percentile of the high disease activity group was significantly higher than the low group (P = 0.004), while the SPARCC MRI index of the very high disease activity group was higher than the high group (P < 0.001). Data Conclusion The whole‐volume ADC histogram analysis was superior to the SPARCC MRI index in assessing AS activity states. Level of Evidence: 1 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;50:114–126.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 92%

Whole‐lesion ADC histogram analysis and the spondyloarthritis research consortium of canada (SPARCC) MRI index in evaluating the disease activity of ankylosing spondylitis

Wang

Chu

Zhu

et al. 2018

Magnetic Resonance Imaging

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“…Although ldCT and radiography can identify structural damage, MRI of SIJ has evolved as the most suitable imaging modality for diagnosis and classification of early axSpA including early AS [2], because of its ability to detect inflammatory changes in and around the joints prior to any structural change developing [9]. MRI modalities employed include SPAIR, a T2 fat suppressed technique [10], and diffusionweighted imaging [11]. A standardized definition of structural lesions likely to reflect previous SIJ inflammation was defined by the Canada-Denmark MRI Working Group, employing T1-weighted MRI sequences [2].…”

Section: Introductionmentioning

confidence: 99%

MRI compared with low-dose CT scanning in the diagnosis of axial spondyloarthritis

Liu

Xiao

et al. 2019

Clin Rheumatol

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Objectives To compare the performance of conventional radiography, ldCT, and MRI in the diagnosis of sacroiliitis in suspected axial spondyloarthritis (axSpA). Methods Patients presenting with > 3 months chronic back pain were assessed by axSpA-experienced rheumatologists and diagnosed as axSpA or not; axSpA patients were then considered nr-axSpA or AS using plain radiography. Non-axSpA patients were recruited as controls, and divided into non-inflammatory and inflammatory groups on the basis of inflammatory back pain and/or CRP/ESR elevation. Clinical variables, pelvic radiography, sacroiliac joint (SIJ) ldCT, and SIJ MRI were obtained. Results A total of 121 patients were included and had SIJ radiography and ldCT, of whom 71 additionally had an SIJ MRI. These included 23 non-inflammatory controls, 21 inflammatory controls, 32 nr-axSpA cases, and 45 AS cases. Fourteen of 32 (44%) nr-axSpA patients had positive ldCT scans, 21/24 (88%) had MRI-BMO, and 11/24 (46%) had MRI-structural lesions. ldCT had high specificity with only 1/23 (4%) non-inflammatory controls being positive. MRI-BMO had the highest sensitivity for nr-axSpA, but compared with ldCT lower specificity, with 5/15 (33%) of non-inflammatory controls being positive, and similar sensitivity for AS (20/22 (91%) vs 44/44 for ldCT). Conclusions ldCT identifies evidence of radiographic change in a significant proportion of nr-axSpA cases and is highly specific for axSpA. MRI-BMO lesions are more sensitive than either conventional radiography or MRI-structural assessment for axSpA. The relative position of these imaging modalities in screening for axSpA needs to be reconsidered, also taking into account the costs involved. Key Points • ldCT is more sensitive for erosions or sclerosis in axSpA than plain radiography, with 44% of patients with nr-axSpA having evidence of AS-related sacroiliac joint changes on ldCT. • MRI-structural lesions are no more sensitive but are less specific for AS than ldCT. • MRI-BMO is the most sensitive test for nr-axSpA of the modalities tested but is less specific for axSpA than for ldCT. Keywords axSpA. Conventional radiography. Diagnostics. ldCT. Imaging procedures. MRI Matthew A. Brown and Dan Chen contributed equally to this work.

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“…Regarding the SIJ MRI in the same cohort (SPACE), the use of an IV MRI contrast agent (gadolinium), which is essential for the detection of synovitis and/or capsulitis, failed to increase the sensitivity of the test compared with STIR alone, because these acute lesions were only observed in patients who also presented bone marrow edema (visible on STIR) [20] (2B). In addition, the acquisition of diffusionweighted images (DWI) is an alternative to the use of contrast agents, reducing the risk of nephrotoxicity, albeit without showing better performance than STIR imaging analyses [21,22] (2B).…”

Section: (2b)mentioning

confidence: 99%

The Brazilian Society of Rheumatology guidelines for axial spondyloarthritis – 2019

et al. 2020

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Spondyloarthritis is a group of chronic inflammatory systemic diseases characterized by axial and/or peripheral joints inflammation, as well as extra-articular manifestations. The classification axial spondyloarthritis is adopted when the spine and/or the sacroiliac joints are predominantly involved. This version of recommendations replaces the previous guidelines published in May 2013. A systematic literature review was performed, and two hundred thirty-seven studies were selected and used to formulate 29 recommendations answering 15 clinical questions, which were divided into four sections: diagnosis, non-pharmacological therapy, conventional drug therapy and biological therapy. For each recommendation the level of evidence supporting (highest available), the strength grade according to Oxford, and the degree of expert agreement (inter-rater reliability) is informed. These guidelines bring evidence-based information on clinical management of axial SpA patients, including, diagnosis, treatment, and prognosis. The purpose of these guidelines is to bring evidencebased information on clinical management of axial SpA patients, including, diagnosis, treatment and prognosis, for rheumatologists, general physicians, allied-specialists (dermatology, ophthalmology and gastroenterology), and other allied-professionals, such as physiotherapists. This version replaces the previous guidelines published on May 26, 2013 [3] and should be updated every 4 years. Methods A systematic literature review was performed, with external review of an specialized group of the Brazilian

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Diffusion-weighted Imaging Is a Sensitive and Specific Magnetic Resonance Sequence in the Diagnosis of Ankylosing Spondylitis

Abstract: DWI is informative for diagnosis of AS and nr-axSpA, and has moderate utility in assessment of disease activity or treatment response, with performance similar to that of the SPARCC MRI score.

Cited by 39 publications

References 27 publications

Whole‐lesion ADC histogram analysis and the spondyloarthritis research consortium of canada (SPARCC) MRI index in evaluating the disease activity of ankylosing spondylitis

Whole‐lesion ADC histogram analysis and the spondyloarthritis research consortium of canada (SPARCC) MRI index in evaluating the disease activity of ankylosing spondylitis

MRI compared with low-dose CT scanning in the diagnosis of axial spondyloarthritis

The Brazilian Society of Rheumatology guidelines for axial spondyloarthritis – 2019

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