Abstract
The aim of the study was to compare the diagnostic efficacy of the visual assessment of diffusion-weighted imaging (DWI) and dynamic contrast-enhanced (DCE) sequences compared to the STIR sequence in the diagnostics of active sacroiliitis in the course of axial spondyloarthritis (axSpA). The study group consisted of 49 patients who had undergone multiparametric magnetic resonance imaging of the sacroiliac joints (SIJs) due to clinical suspicion of axSpA. Two independent observers retrospectively assessed four quadrants of the SIJs for the presence of subchondral bone marrow oedema/osteitis with the use of modified SPARCC score in sequences: STIR, DWI (with ADC map) and DCE. Diagnostic efficiency parameters were calculated for DWI and DCE sequence separately, using STIR sequence as a reference. Inter-observer agreement was evaluated with the use of κ coefficient. Patients’ clinical symptoms were analysed to identify the group fulfilling the imaging arm of the ASAS criteria for axSpA. Overall, 46.9% (n = 23) of patients fulfilled the imaging arm of ASAS criteria for axial spondyloarthritis. DWI with ADC map: accuracy 95.6%, sensitivity 99.4%, specificity 54.0%. DCE sequence: accuracy 96.8%, sensitivity 98.4%, specificity 79.5%. The highest level of inter-observer agreement was achieved for STIR sequence (κ = 0.888), slightly lower for DCE sequence (κ = 0.773) and the lowest for DWI with ADC (κ = 0.674). Visual assessment of the DWI and DCE sequences has high accuracy and sensitivity of bone marrow oedema/osteitis detection, but the specificity and inter-observer agreement are poor, especially for the DWI sequence with ADC maps.
Highlights
The heterogeneous group of rheumatic diseases, known under the name of spondyloarthritis (SpA), has been divided into two categories: axial and peripheral spondyloarthritis [1]
If the active inflammatory lesion according to Assessment of SpondyloArthritis international Society (ASAS) criteria [13] was identified in at least one joint of the particular patient in the short tau inversion recovery (STIR) sequence, a patient was qualified to the group with ASAS positive sacroiliitis
If the particular patient belonged to an ASAS-positive sacroiliitis group and had at least one typical axial spondyloarthritis (axSpA) feature, according to ASAS criteria [2], in the step, this patient was included into ASAS axSpA imaging arm positive group
Summary
The heterogeneous group of rheumatic diseases, known under the name of spondyloarthritis (SpA), has been divided into two categories: axial (axSpA) and peripheral spondyloarthritis (pSpA) [1]. In 2009, magnetic resonance imaging (MRI) of sacroiliac joints (SIJs) was included into the Assessment of SpondyloArthritis international Society (ASAS) SpA diagnostic criteria. It resulted in the introduction of axSpA subdivision into two categories: radiographic and nonradiographic, where the inflammatory changes are only visible in the MRI or completely absent [2]. Thereafter, this decision turned out to be crucial, since further research assessed the prevalence of nonradiographic axSpA in the whole axSpA cohort oscillating between 20 and 80%, which is a substantial group,. The mean diagnostic delay of axSpA decreased from approximately 7 to 2 years [4], which has led to speeding up the introduction of proper therapy, before the occurrence of disabling structural changes in the SIJs and spine
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