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Sensitivity and specificity of spinal inflammatory lesions assessed by whole-body magnetic resonance imaging in patients with ankylosing spondylitis or recent-onset inflammatory back pain


Weber, U; Hodler, J; Kubik, R A; Rufibach, K; Lambert, R G W; Kissling, R O; Pfirrmann, C W A; Maksymowych, W P (2009). Sensitivity and specificity of spinal inflammatory lesions assessed by whole-body magnetic resonance imaging in patients with ankylosing spondylitis or recent-onset inflammatory back pain. Arthritis and Rheumatism, 61(7):900-908.

Abstract

OBJECTIVE: To determine the diagnostic utility of different spinal inflammatory lesions assessed by whole-body magnetic resonance imaging (MRI) in patients with ankylosing spondylitis (AS) or with recent-onset inflammatory back pain (IBP) compared with healthy controls. METHODS: We scanned 35 consecutive patients with AS fulfilling the modified New York criteria, 25 patients with IBP of <24 months' duration (both groups were age </=45 years and had a Bath Ankylosing Spondylitis Disease Activity Index score >/=4), and 35 healthy age- and sex-matched volunteers using whole-body MRI STIR sequences of the spine. MRIs were independently assessed in random order by 3 readers blinded to patient identity. Inflammatory spinal lesions were recorded consistent with definitions proposed by the Canada/Denmark International MRI Working Group: vertebral corner inflammatory lesions (CIL) and noncorner inflammatory lesions in central sagittal slices and lateral inflammatory lesions (LIL) in lateral slices. Concordantly scored lesions for the 3 possible reader pairs were used in the analysis of sensitivity, specificity, likelihood ratios (LRs), and areas under the curve for the entire spine and by spinal segment. RESULTS: Diagnostic utility was optimal when >/=2 CIL were recorded (for patients with AS, values for sensitivity, specificity, and positive LR were 69%, 94%, and 12, respectively, and for patients with IBP were 32%, 96%, and 8, respectively). LIL had high specificity (97%) but low sensitivity (31%). Nine controls had >/=1 CIL, but only 2 controls had >2 CIL. CONCLUSION: Diagnostic utility of STIR MRI for AS is optimal when >/=2 CIL are present. A single CIL can be found in up to 26% of healthy individuals.

OBJECTIVE: To determine the diagnostic utility of different spinal inflammatory lesions assessed by whole-body magnetic resonance imaging (MRI) in patients with ankylosing spondylitis (AS) or with recent-onset inflammatory back pain (IBP) compared with healthy controls. METHODS: We scanned 35 consecutive patients with AS fulfilling the modified New York criteria, 25 patients with IBP of <24 months' duration (both groups were age </=45 years and had a Bath Ankylosing Spondylitis Disease Activity Index score >/=4), and 35 healthy age- and sex-matched volunteers using whole-body MRI STIR sequences of the spine. MRIs were independently assessed in random order by 3 readers blinded to patient identity. Inflammatory spinal lesions were recorded consistent with definitions proposed by the Canada/Denmark International MRI Working Group: vertebral corner inflammatory lesions (CIL) and noncorner inflammatory lesions in central sagittal slices and lateral inflammatory lesions (LIL) in lateral slices. Concordantly scored lesions for the 3 possible reader pairs were used in the analysis of sensitivity, specificity, likelihood ratios (LRs), and areas under the curve for the entire spine and by spinal segment. RESULTS: Diagnostic utility was optimal when >/=2 CIL were recorded (for patients with AS, values for sensitivity, specificity, and positive LR were 69%, 94%, and 12, respectively, and for patients with IBP were 32%, 96%, and 8, respectively). LIL had high specificity (97%) but low sensitivity (31%). Nine controls had >/=1 CIL, but only 2 controls had >2 CIL. CONCLUSION: Diagnostic utility of STIR MRI for AS is optimal when >/=2 CIL are present. A single CIL can be found in up to 26% of healthy individuals.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > Epidemiology, Biostatistics and Prevention Institute (EBPI)
04 Faculty of Medicine > Balgrist University Hospital, Swiss Spinal Cord Injury Center
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:2009
Deposited On:17 Aug 2009 13:29
Last Modified:05 Apr 2016 13:19
Publisher:Wiley-Blackwell
ISSN:0004-3591
Additional Information:The definitive version is available at www.blackwell-synergy.com
Publisher DOI:https://doi.org/10.1002/art.24507
PubMed ID:19565558
Permanent URL: https://doi.org/10.5167/uzh-20175

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