Abstract
ObjectiveTo compare the utility of Diffusion weighted imaging (DWI) with short tau inversion recovery (STIR) sequence in the diagnosis of early axial spondyloarthritis (SpA).MethodsThree hundred and five patients with chronic back pain were recruited consecutively from 3 rheumatology centers. Clinical, radiological and blood parameters were recorded. Patients with back pain duration no more than 3 years were classified as having early disease. STIR sequence and DWI of the sacroiliac joints were obtained and assessed using the Spondyloarthritis Research Consortium of Canada (SPARCC) method. The Assessment in Spondyloarthritis international Society definition was used to define positive STIR and DWI. Results were compared to expert diagnosed axial SpA.ResultsWhen compared to STIR sequence, DWI had similar sensitivity (STIR 0.29, DWI 0.30) and specificity (STIR 0.97, DWI 0.92) in diagnosing sacroiliitis. However, STIR sequence had better reliability (STIR 0.78, DWI 0.61). In early disease group, DWI was not better than STIR sequence in detecting active sacroiliitis (sensitivity DWI vs STIR: 0.34 vs 0.36; specificity DWI vs STIR: 0.93 vs 0.93; positive predictive value DWI vs STIR: 0.92 vs 0.92; negative predictive value DWI vs STIR: 0.36 vs 0.37). Using the Assessment in SpondyloArthritis international Society (ASAS) classification criteria, 67/98 patients with early disease (sensitivity 0.91 specificity 0.90) and 221/305 overall (sensitivity 0.90; specificity 0.92) were classified as axial SpA. Among the expert diagnosed axial SpA patients who did not meet the ASAS criteria, only 2 had positive DWI.ConclusionDWI and STIR have similar sensitivity in diagnosing axSpA in early disease. However, the use of DWI is limited by poorer reliability when compared with STIR.
Highlights
The use of Diffusion weighted imaging (DWI) is limited by poorer reliability when compared with short tau inversion recovery (STIR)
Axial spondyloarthritis (SpA) describes a spectrum of chronic rheumatic diseases characterized by axial joint inflammation and ankylosis, of which ankylosing spondylitis (AS) is the prototype
By comparing with traditional STIR sequence, we aimed to evaluate whether DWI had better sensitivity in detecting sacroiliac (SI) joint inflammation in early axial SpA
Summary
Axial spondyloarthritis (SpA) describes a spectrum of chronic rheumatic diseases characterized by axial joint inflammation and ankylosis, of which ankylosing spondylitis (AS) is the prototype. It has significant social and psychiatric impacts [1, 2] and affects quality-of-life [3,4,5]. It is associated with increased cardiovascular events [6, 7]. Disease diagnosis is becoming more important as it will facilitate early therapeutic interventions. Magnetic Resonance Imaging (MRI) can detect axial inflammation before radiographic changes, and has been widely used to diagnose axial SpA at an earlier stage
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