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Diagnostic utility of candidate definitions for a positive MRI of the spine in patients with axial spondyloarthritis


Weber, Ulrich; Zhao, Zheng; Rufibach, Kaspar; Zubler, Veronika; Lambert, Robert G W; Chan, Stanley M; Ostergaard, Mikkel; Pedersen, Susanne J; Maksymowych, Walter P (2015). Diagnostic utility of candidate definitions for a positive MRI of the spine in patients with axial spondyloarthritis. Arthritis and Rheumatology, 67(4):924-933.

Abstract

Objective: A recent consensus statement suggested ≥3 corner inflammatory (CIL) or several corner fatty lesions (CFL) as candidate criteria for a positive spine MRI in axial spondyloarthritis. We aimed to evaluate the diagnostic utility of these cut-offs in non-radiographic axial spondyloarthritis (nr-axSpA) and ankylosing spondylitis (AS). Methods: 130 consecutive back pain patients ≤50 years newly referred to 2 university clinics (cohorts A/B) were classified according to rheumatologist expert opinion based on clinical examination and pelvic radiographs as having nr-axSpA (n=50), AS (n=33), or non-specific back pain (NSBP) (n=47). Cohort A also had 20 age-matched healthy controls. Four blinded readers assessed spine MRIs using the standardized Canada-Denmark module. Readers recorded CIL and CFL in 23 discovertebral units. We tested the diagnostic utility (mean sensitivity/specificity over 4 readers) of cut-off values for spinal MRI lesions as proposed in the literature (≥2/≥3 CIL; ≥6 CFL), and for possible thresholds from ≥1 to ≥10 CIL and CFL, for nr-axSpA and AS patients in both cohorts. Results: None of the spinal thresholds ≥2/≥3 CIL and ≥6 CFL showed clinically relevant diagnostic utility (range for positive likelihood ratios 1.38-2.36) when comparing nr-axSpA versus NSBP patients. A threshold of ≥6 CIL had moderate to substantial diagnostic utility (positive likelihood ratio 13.26/6.74) in nr-axSpA, while ≥4 CIL showed small diagnostic utility (3.83/2.72) but specificities >0.90. Conclusions: No previously proposed candidate criteria for a positive spinal MRI showed clinically relevant diagnostic utility in nr-axSpA. These findings question definitions of a positive MRI in spondyloarthritis based on spine MRI alone. This article is protected by copyright. All rights reserved.

Abstract

Objective: A recent consensus statement suggested ≥3 corner inflammatory (CIL) or several corner fatty lesions (CFL) as candidate criteria for a positive spine MRI in axial spondyloarthritis. We aimed to evaluate the diagnostic utility of these cut-offs in non-radiographic axial spondyloarthritis (nr-axSpA) and ankylosing spondylitis (AS). Methods: 130 consecutive back pain patients ≤50 years newly referred to 2 university clinics (cohorts A/B) were classified according to rheumatologist expert opinion based on clinical examination and pelvic radiographs as having nr-axSpA (n=50), AS (n=33), or non-specific back pain (NSBP) (n=47). Cohort A also had 20 age-matched healthy controls. Four blinded readers assessed spine MRIs using the standardized Canada-Denmark module. Readers recorded CIL and CFL in 23 discovertebral units. We tested the diagnostic utility (mean sensitivity/specificity over 4 readers) of cut-off values for spinal MRI lesions as proposed in the literature (≥2/≥3 CIL; ≥6 CFL), and for possible thresholds from ≥1 to ≥10 CIL and CFL, for nr-axSpA and AS patients in both cohorts. Results: None of the spinal thresholds ≥2/≥3 CIL and ≥6 CFL showed clinically relevant diagnostic utility (range for positive likelihood ratios 1.38-2.36) when comparing nr-axSpA versus NSBP patients. A threshold of ≥6 CIL had moderate to substantial diagnostic utility (positive likelihood ratio 13.26/6.74) in nr-axSpA, while ≥4 CIL showed small diagnostic utility (3.83/2.72) but specificities >0.90. Conclusions: No previously proposed candidate criteria for a positive spinal MRI showed clinically relevant diagnostic utility in nr-axSpA. These findings question definitions of a positive MRI in spondyloarthritis based on spine MRI alone. This article is protected by copyright. All rights reserved.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > Balgrist University Hospital, Swiss Spinal Cord Injury Center
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:2015
Deposited On:16 Jan 2015 13:37
Last Modified:13 May 2016 10:25
Publisher:Wiley-Blackwell Publishing, Inc.
ISSN:2326-5205
Free access at:Publisher DOI. An embargo period may apply.
Publisher DOI:https://doi.org/10.1002/art.39001
PubMed ID:25510605

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