1. Data-driven definitions for active and structural MRI lesions in the sacroiliac joint in spondyloarthritis and their predictive utility.
- Author
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Maksymowych WP, Lambert RG, Baraliakos X, Weber U, Machado PM, Pedersen SJ, Hooge M, Sieper J, Wichuk S, Poddubnyy D, Rudwaleit M, van der Heijde D, Landewe R, Eshed I, and Ostergaard M
- Subjects
- Adult, Bone Marrow Diseases diagnosis, Cohort Studies, Diagnosis, Differential, Edema diagnosis, Female, Humans, Magnetic Resonance Imaging methods, Male, Predictive Value of Tests, Reference Values, Rheumatology methods, Sensitivity and Specificity, Magnetic Resonance Imaging statistics & numerical data, Rheumatology statistics & numerical data, Sacroiliac Joint diagnostic imaging, Spondylarthritis diagnosis
- Abstract
Objectives: To determine quantitative SI joint MRI lesion cut-offs that optimally define a positive MRI for inflammatory and structural lesions typical of axial SpA (axSpA) and that predict clinical diagnosis., Methods: The Assessment of SpondyloArthritis international Society (ASAS) MRI group assessed MRIs from the ASAS Classification Cohort in two reading exercises where (A) 169 cases and 7 central readers; (B) 107 cases and 8 central readers. We calculated sensitivity/specificity for the number of SI joint quadrants or slices with bone marrow oedema (BME), erosion, fat lesion, where a majority of central readers had high confidence there was a definite active or structural lesion. Cut-offs with ≥95% specificity were analysed for their predictive utility for follow-up rheumatologist diagnosis of axSpA by calculating positive/negative predictive values (PPVs/NPVs) and selecting cut-offs with PPV ≥ 95%., Results: Active or structural lesions typical of axSpA on MRI had PPVs ≥ 95% for clinical diagnosis of axSpA. Cut-offs that best reflected a definite active lesion typical of axSpA were either ≥4 SI joint quadrants with BME at any location or at the same location in ≥3 consecutive slices. For definite structural lesion, the optimal cut-offs were any one of ≥3 SI joint quadrants with erosion or ≥5 with fat lesions, erosion at the same location for ≥2 consecutive slices, fat lesions at the same location for ≥3 consecutive slices, or presence of a deep (i.e. >1 cm depth) fat lesion., Conclusion: We propose cut-offs for definite active and structural lesions typical of axSpA that have high PPVs for a long-term clinical diagnosis of axSpA for application in disease classification and clinical research., (© The Author(s) 2021. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
- Published
- 2021
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