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Assessment of structural lesions in sacroiliac joints enhances diagnostic utility of magnetic resonance imaging in early spondylarthritis
Author(s) -
Weber Ulrich,
Lambert Robert G. W.,
Pedersen Susanne J.,
Hodler Juerg,
Østergaard Mikkel,
Maksymowych Walter P.
Publication year - 2010
Publication title -
arthritis care and research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.032
H-Index - 163
eISSN - 2151-4658
pISSN - 2151-464X
DOI - 10.1002/acr.20312
Subject(s) - spondylarthritis , medicine , magnetic resonance imaging , radiology , lesion , ankylosing spondylitis , nuclear medicine , surgery
Objective To compare the diagnostic utility of T1‐weighted and STIR magnetic resonance imaging (MRI) sequences in early spondylarthritis (SpA) using a standardized approach to the evaluation of sacroiliac (SI) joints, and to test whether systematic calibration of readers directed at recognition of abnormalities on T1‐weighted MRI would enhance diagnostic utility. Methods Six readers independently assessed T1‐weighted and STIR MRI scans of the SI joints from 187 subjects: 75 ankylosing spondylitis (AS) and 27 preradiographic inflammatory back pain (IBP) patients, and 26 mechanical back pain and 59 healthy volunteer controls ages ≤45 years. The exercise was repeated 6 months later on a random selection of 30 AS patients and 34 controls after calibration directed at lesions visible on T1‐weighted MRI. Specific MRI lesions were recorded according to standardized definitions. In addition to deciding on the presence/absence of SpA, readers were asked which MRI sequence and which type of lesion was the primary basis for their diagnostic conclusion. Results Structural lesions were detected in 98% of AS patients and 64% of IBP patients. A diagnosis of SpA was based on T1‐weighted or combined T1‐weighted/STIR sequences in 82% of AS patients and 41% of IBP patients. Calibration enhanced the diagnostic utility of MRI in the majority of readers, especially those considered less experienced; the mean positive and negative likelihood ratios (of 6 readers) were 14.5 and 0.08 precalibration, respectively, and 22.2 and 0.02 postcalibration, respectively. Conclusion Recognition of structural lesions on T1‐weighted MRI contributes significantly to its diagnostic utility in early SpA. Rheumatologist training directed at detection of lesions visible on T1‐weighted MRI enhances diagnostic utility.