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Anterior chest wall inflammation by whole body MRI in patients with spondyloarthritis: lack of association between clinical and imaging findings in a cross-sectional study


Weber, U; Lambert, R G; Rufibach, K; Maksymowych, W P; Hodler, J; Zejden, A; Duewell, S; Kissling, R O; Filipow, P L; Jurik, A G (2012). Anterior chest wall inflammation by whole body MRI in patients with spondyloarthritis: lack of association between clinical and imaging findings in a cross-sectional study. Arthritis Research & Therapy, 14(1):R3.

Abstract

INTRODUCTION: Inflammatory involvement of the anterior chest wall (ACW) impacts the quality of life in patients with spondyloarthritis (SpA) although involvement of the ACW is often neglected on clinical and imaging evaluation. Whole body (WB) MRI is an imaging method to assess the ACW in addition to the sacroiliac joints and spine without additional inconvenience for patients. The goals of this study were to describe the distribution of ACW inflammation by WB MRI in both early and established SpA and associations between clinical and imaging findings indicative of inflammation. METHODS: The ACW of 122 consecutive SpA patients (95 with ankylosing spondylitis (AS) and 27 with non-radiographic SpA (nrSpA)) and 75 healthy controls was scanned by sagittal and coronal WB MRI. The MR images were scored independently in random order by 7 readers blinded to patient identifiers. Active and structural inflammatory lesions of the ACW were recorded on a web-based data entry form. ACW pain by patient self-report, ACW tenderness on physical examination according to the Maastricht ankylosing spondylitis enthesitis score (MASES) and MRI lesions were analyzed descriptively. Kappa statistics served to assess the agreement between clinical and imaging findings. RESULTS: ACW pain or tenderness was present in 26% with little difference between AS and nrSpA patients. Bone marrow edema (BME), erosion and fat infiltration were recorded in 44.3%, 34.4% and 27.0% of SpA patients and in 9.3%, 12.0% and 5.3% of controls. MRI lesions occurred more frequently in AS patients (BME, erosion and fat infiltration in 49.5%, 36.8%, and 33.7%, respectively) compared with nrSpA patients (25.9%, 25.9%, and 3.7%, respectively). The most frequently affected joint by MRI lesions was the manubriosternal joint. The kappa values between clinical assessments and MRI inflammation ranged from -0.10 to only 0.33 for both AS and nrSpA patients. CONCLUSIONS: 26% of SpA patients showed clinical involvement of the ACW. WB MRI signs of ACW inflammation occurred in a substantial proportion of patients with AS (49.5%) and nrSpA (25.9%). There was no association between clinical assessments of ACW, including the MASES, and MRI features.

INTRODUCTION: Inflammatory involvement of the anterior chest wall (ACW) impacts the quality of life in patients with spondyloarthritis (SpA) although involvement of the ACW is often neglected on clinical and imaging evaluation. Whole body (WB) MRI is an imaging method to assess the ACW in addition to the sacroiliac joints and spine without additional inconvenience for patients. The goals of this study were to describe the distribution of ACW inflammation by WB MRI in both early and established SpA and associations between clinical and imaging findings indicative of inflammation. METHODS: The ACW of 122 consecutive SpA patients (95 with ankylosing spondylitis (AS) and 27 with non-radiographic SpA (nrSpA)) and 75 healthy controls was scanned by sagittal and coronal WB MRI. The MR images were scored independently in random order by 7 readers blinded to patient identifiers. Active and structural inflammatory lesions of the ACW were recorded on a web-based data entry form. ACW pain by patient self-report, ACW tenderness on physical examination according to the Maastricht ankylosing spondylitis enthesitis score (MASES) and MRI lesions were analyzed descriptively. Kappa statistics served to assess the agreement between clinical and imaging findings. RESULTS: ACW pain or tenderness was present in 26% with little difference between AS and nrSpA patients. Bone marrow edema (BME), erosion and fat infiltration were recorded in 44.3%, 34.4% and 27.0% of SpA patients and in 9.3%, 12.0% and 5.3% of controls. MRI lesions occurred more frequently in AS patients (BME, erosion and fat infiltration in 49.5%, 36.8%, and 33.7%, respectively) compared with nrSpA patients (25.9%, 25.9%, and 3.7%, respectively). The most frequently affected joint by MRI lesions was the manubriosternal joint. The kappa values between clinical assessments and MRI inflammation ranged from -0.10 to only 0.33 for both AS and nrSpA patients. CONCLUSIONS: 26% of SpA patients showed clinical involvement of the ACW. WB MRI signs of ACW inflammation occurred in a substantial proportion of patients with AS (49.5%) and nrSpA (25.9%). There was no association between clinical assessments of ACW, including the MASES, and MRI features.

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Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Diagnostic and Interventional Radiology
04 Faculty of Medicine > Balgrist University Hospital, Swiss Spinal Cord Injury Center
04 Faculty of Medicine > Epidemiology, Biostatistics and Prevention Institute (EBPI)
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:2012
Deposited On:28 Mar 2012 22:10
Last Modified:21 Nov 2016 15:36
Publisher:BioMed Central
ISSN:1478-6354
Free access at:Publisher DOI. An embargo period may apply.
Publisher DOI:https://doi.org/10.1186/ar3551
PubMed ID:22226453
Permanent URL: https://doi.org/10.5167/uzh-55540

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