Assessment of structural lesions in sacroiliac joints enhances diagnostic utility of magnetic resonance imaging in early spondylarthritis

Ulrich Weber; Robert G W Lambert; Susanne J Pedersen; Juerg Hodler; Mikkel Østergaard; Walter P Maksymowych

doi:http://dx.doi.org/10.1002/acr.20312

Assessment of structural lesions in sacroiliac joints enhances diagnostic utility of magnetic resonance imaging in early spondylarthritis

Ulrich Weber, Robert G W Lambert, Susanne J Pedersen, Juerg Hodler, Mikkel Østergaard, Walter P Maksymowych

92 Citationer (Scopus)

Abstract

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. 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. 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. 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.

Originalsprog	Engelsk
Tidsskrift	Arthritis Care and Research
Vol/bind	62
Udgave nummer	12
Sider (fra-til)	1763-71
Antal sider	9
ISSN	0893-7524
DOI	https://doi.org/10.1002/acr.20312
Status	Udgivet - 1 dec. 2010

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http://dx.doi.org/10.1002/acr.20312

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title = "Assessment of structural lesions in sacroiliac joints enhances diagnostic utility of magnetic resonance imaging in early spondylarthritis",

abstract = "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. 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. 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. 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.",

author = "Ulrich Weber and Lambert, {Robert G W} and Pedersen, {Susanne J} and Juerg Hodler and Mikkel {\O}stergaard and Maksymowych, {Walter P}",

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T1 - Assessment of structural lesions in sacroiliac joints enhances diagnostic utility of magnetic resonance imaging in early spondylarthritis

AU - Weber, Ulrich

AU - Lambert, Robert G W

AU - Pedersen, Susanne J

AU - Hodler, Juerg

AU - Østergaard, Mikkel

AU - Maksymowych, Walter P

PY - 2010/12/1

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N2 - 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. 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. 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. 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.

AB - 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. 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. 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. 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.

U2 - http://dx.doi.org/10.1002/acr.20312

DO - http://dx.doi.org/10.1002/acr.20312

M3 - Journal article

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SP - 1763

EP - 1771

JO - Arthritis care and research : the official journal of the Arthritis Health Professions Association

JF - Arthritis care and research : the official journal of the Arthritis Health Professions Association

IS - 12

ER -

Assessment of structural lesions in sacroiliac joints enhances diagnostic utility of magnetic resonance imaging in early spondylarthritis

Abstract

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