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OP0047 EROSIONS ON MRI OF THE SACROILIAC JOINTS IN PATIENTS WITH ANKYLOSING SPONDYLITIS: CAN THEY BE RELIABLY DETECTED? U. Weber 1, 2,*, S. J. Pedersen 3, M. Ostergaard 3, K. Rufibach 4, R. G. Lambert 5, W. P. Maksymowych 1 1Rheumatology, University of Alberta, Edmonton, Canada, 2Rheumatology, Balgrist University Hospital, Zurich, Switzerland, 3Rheumatology, Copenhagen University Hospital, Copenhagen, Denmark, 4Biostatistics, University of Zurich, Zurich, Switzerland, 5Radiology, University of Alberta, Edmonton, Canada Background: Erosions of the sacroiliac joints (SIJ) on pelvic radiographs represent a postinflammatory structural lesion in ankylosing spondylitis (AS) and are the most important feature of the modified New York classification criteria. Recent studies have shown that erosions can be detected also on magnetic resonance imaging (MRI) of the SIJ early in the disease course before they can be seen on radiography (1). Erosions may extend across major portions of the iliac and sacral subchondral bone (extended erosion (EE)). We have also recently observed a novel appearance of erosions on MRI where tissue metaplasia re-fills the excavated erosion and have termed this phenomenon “backfilling” (BP). However, data on the reliability of detection of erosions and these related features on MRI are scarce. Objectives: To assess the reproducibility of erosions, EE and BP in the SIJ detected by MRI in 30 patients with established AS and in 30 controls using the Spondyloarthritis Research Consortium of Canada (SPARCC) MRI standardized methodology. Methods: 30 patients with AS meeting the modified New York criteria (15 patients each with symptom duration of ≤5 and ≥5/≤10 years) and 30 controls (15 healthy volunteers and 15 patients with mechanical back pain (MBP)) underwent an MRI with STIR and T1 spin echo sequences of the SIJ. The 60 subjects were randomly selected from a larger study population (1). The MR images were assessed in randomized order and independently by 4 readers blinded to subject identifiers. A standardized erosion definition was applied and lesion reference images served to calibrate the readers. Erosions in all 8 quadrants on each slice of the SIJ, EE and BP were scored on an internet-based reading program of the SPARCC method. The frequency of erosions was analyzed descriptively by concordant observations of the 6 possible reader pairs. Kappa statistics (erosions as binary variable on a patient level) and intraclass correlation coefficients (ICC3, 1 and ICC2, 1) (erosion sum scores per patient) for all readers jointly were used to assess the reproducibility of erosions. Results: In this randomly selected study population, erosions on SIJ MRI were detected in all 30 AS patients by ≥2 readers, whereas 5 MBP patients and 1 healthy control also showed lesions meeting the definition of erosion. EE and BP were recorded in 22 and 19 AS patients, respectively. The kappa value for all 60 subjects showed an agreement for erosions between the 4 readers of 0.70 (95% confidence interval (CI) 0.56-0.81), for EE of 0.73 (CI 0.59-0.85) and for BP of 0.63 (CI 0.47-0.77). For all 4 observers, the ICC(3, 1) and ICC(2, 1) values for the erosion score were 0.76 and 0.72, for EE 0.72 and 0.71, and for BP 0.55 and 0.55, respectively. For comparison, the kappa and ICC values for bone marrow edema (BME) were 0.61, 0.89 and 0.87, respectively. Conclusions: In 30 AS patients and in 30 controls, the agreement between 4 readers regarding erosions on SIJ MRI as a binary variable on a patient level was substantial and comparable to BME. References: 1Weber U et al. Arthritis Rheum 2010;62:3048 |
验证MRI检测AS病人骶髂关节骨侵蚀、扩展侵蚀和回填 Weber U, et al. EULAR 2011. Present No:OP0047. 背景：骨盆平片证实的骶髂关节(SIJ)侵蚀病变代表了强直性脊柱炎(AS)病人炎症后结构损害，是纽约修订版分类标准的最重要特征。近来有研究显示核磁共振（MRI）可以发现早期病程SIJ侵蚀病灶，而此时放射学检查为阴性[1]。侵蚀可能会扩展到大部分髂骨和骶骨的软骨下骨（扩展侵蚀[EE]）。我们最近也观察到增生组织重新填充骨质缺失的侵蚀灶，我们将该现象命名为“回填（backfilling，BP）”。然而，有关MRI发现侵蚀病变的可信度以及相关影像学特点还不是很清楚。 目的：利用脊柱关节炎研究协会（SPARCC）标化MRI评估法对30例确诊AS和30例对照进行研究已评价MRI检测侵蚀、EE和BP的可重复性。 方法：30例AS病人符合纽约修订版分类标准（病程≤5年以及≥5 /≤10年的病人分别有15例），另设30例对照（15例健康志愿者，15例机械性腰背痛(MBP)患者）。对这些受试者进行骶髂关节炎MRI检查，所用序列包括STIR、T1自旋回波。这60例受试者来自一个更大的研究人群[1]。所有MRI摄片均随机排序并遮蔽病人信息，由4位读片师分别独立地评估。为了校准不同读片师的判读差异，本研究对侵蚀病变进行了标准化定义并提供影像学病变参考图谱。采用基于因特网的SPARCC读片程序，读片师对每张SIJ摄片中8个象限的侵蚀、EE和BP进行评分。4位读片师共有6种可能的配对组合，侵蚀的最终判定是根据这6种组合的判读一致性来决定的。对所有读片结果计算Kappa统计量(每个病人的侵蚀被判为有或无)和同类相关系数(ICC3, 1以及ICC2, 1)，从而评价侵蚀病变检测的可重复性。 结果：在这个随机选取的研究人群中，所有30例病人均有骶髂关节MRI侵蚀病变，侵蚀病变是由至少2个读片师一致判定的。而5例MBP患者和1例健康对照也有符合定义的侵蚀病变。EE和BP分别见于22例和19例AS患者。4位读片师对所有60例受试者是否有侵蚀病变进行判定的Kappa值为0.704（95％可信区间（CI）: 0.56-0.81），EE为0.73（CI: 0.59-0.85），BP为0.63（CI: 0.47- 0.77）。所有4个读片师的组内相关系数分析显示，侵蚀评分的ICC(3,1)和ICC(2,1)分别为0.76和0.72，EE为0.72和0.71，BP为0.55和0.55。骨髓水肿（BME）的Kappa和ICC值分别为0.61、0.89和0.87。 结论: 在30 AS病人和30例对照中，在病人水平将侵蚀设为有或无，则4位读片师对于骶髂关节MRI侵蚀病变的判读一致性是显著的，堪比对骨髓水肿(BME)的判读。 |