Abstract
BackgroundThe Back Pain Cohort of Southern Denmark (BaPa Cohort) was initiated with the aim of evaluating the clinical relevance of magnetic resonance imaging (MRI) in the diagnosis of early spondyloarthritis (SpA). In order to facilitate the collection of MRI data for this study, an electronic evaluation form was developed including both SpA-related and degenerative axial changes. The objective of the current study was to assess the intra- and inter-observer agreement of the MRI changes assessed.MethodsThree radiologists evaluated 48 MRI scans of the whole spine and the sacroiliac joints from a subsample of the BaPa Cohort, consisting of patients with non-specific low back pain and patients with different stages of SpA features. The spine was evaluated for SpA-related and degenerative MRI changes and the SIJ for SpA-related changes. Inter- and intra-observer agreements were calculated with kappa statistics. In the interpretation of the kappa coefficient, the standards for strength of agreement reported by Landis and Koch were followed.ResultsA total of 48 patients, 40% men and mean age of 31 years (range 18 – 40 years), were evaluated once by all three readers and re-evaluated by two of the readers after 4-12 weeks. For MRI changes in the spine, substantial to almost perfect observer agreement was found for the location and the size of vertebral signal changes and for disc degeneration and disc contour. For the sacroiliac joints, substantial or almost perfect observer agreement was found for the grading of bone marrow oedema and fatty marrow deposition, the depth of bone marrow oedema and for subchondral sclerosis. Global assessment of the SpA diagnosis had substantial to almost perfect observer agreements.ConclusionThe acceptable agreement for key MRI changes in the spine and sacroiliac joints makes it possible to use these MRI changes in the BaPa Cohort study and other studies investigating MRI changes in patients with non-specific low back pain and suspected SpA.
Highlights
The Back Pain Cohort of Southern Denmark (BaPa Cohort) was initiated with the aim of evaluating the clinical relevance of magnetic resonance imaging (MRI) in the diagnosis of early spondyloarthritis (SpA)
For ‘erosions’, ‘syndesmophytes or vertebral fusion’ and ‘Bone marrow oedema (BMO) at the apophyseal joint’, only single pairwise analyses of inter-observer agreement were possible because of too few positive ratings. These analyses showed a fair, moderate and moderate agreement, respectively (Table 4)
The inter- and intra-observer agreement for the evaluation of spondyloarthritis-related and degenerative MRI changes in the spine and spondyloarthritis-related changes in the sacroiliac joints were investigated in this study
Summary
The Back Pain Cohort of Southern Denmark (BaPa Cohort) was initiated with the aim of evaluating the clinical relevance of magnetic resonance imaging (MRI) in the diagnosis of early spondyloarthritis (SpA). Studies encompassing patients reflecting the target population and using a MRI protocol including both SpA-related and degenerative changes are needed to validate the utility of this new imaging modality for the diagnosis of SpA. On this basis, the Back Pain Cohort of Southern Denmark (BaPA Cohort) was initiated in 2011 at the Spine Centre of Southern Denmark with the aim of evaluating the clinical relevance of MRI in the diagnosis of early SpA.
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