Spoorenberg Anneke, de Vlam Kurt, van der Linden Sjef, Dougados Maxime, Mielants Herman, van de Tempel Hille, van der Heijde Désirée
University Hospital Maastricht, Maastricht, The Netherlands.
J Rheumatol. 2004 Jan;31(1):125-32.
To compare reliability and change over time of radiological scoring methods in ankylosing spondylitis (AS).
Two trained observers scored 217 sets of radiographs from baseline and from one and 2 years' followup. Sacroiliac (SI) joints were grade 0-4 by the New York method and Stoke Ankylosing Spondylitis Spine Score (SASSS). Hips and cervical and lumbar spine were graded 0-4 by Bath Ankylosing Spondylitis Radiology Index (BASRI). BASRI spinal scores and New York SI are combined into BASRI-spine (score 2-12) and with the addition of BASRI-hips into BASRI-total (2-16). Cervical and lumbar spine were also scored in detail (SASSS, 0-36 each) and were combined into SASSS-total or "modified" SASSS (both range 0-72). To assess change a smallest detectable difference (SDD) was estimated for data on a quasi-interval scale.
The SI scoring methods showed intra and interobserver kappa between 0.36 and 0.70. The BASRI-hip reached kappa between 0.59 and 0.84. Combined SASSS scores were most reliable, with intra and interobserver intraclass correlation coefficients (ICC) between 0.90 and 0.96. The ICC of the combined BASRI scores were also very good, ranging from 0.85 to 0.95. For SI New York, SI SASSS, and BASRI-hip, 0.3-1.2% of patients deteriorated 1 grade; 7.5% deteriorated 1 grade (6.3% of maximum score) in BASRI-spine and BASRI-total, and observers agreed in up to 48% of the cases that no change occurred. The SDD was lowest (7.5; 10% of maximum score) for "modified" SASSS. Only 0.8% of patients deteriorated more than the SDD and observers agreed in up to 92% of the cases that no change occurred.
Radiological scoring methods for AS are moderately to excellently reliable. Under the selected scoring conditions (concealed time order, average of 2 observers, SDD based on interobserver data, unselected patient population) there was too little change over 2 years to be detected reliably by the scoring methods.
比较强直性脊柱炎（AS）放射学评分方法的可靠性及随时间的变化情况。
两名经过培训的观察者对217套基线及随访1年和2年时的X线片进行评分。骶髂（SI）关节采用纽约方法和斯托克强直性脊柱炎脊柱评分（SASSS）进行0 - 4级分级。髋部以及颈椎和腰椎采用巴斯强直性脊柱炎放射学指数（BASRI）进行0 - 4级分级。BASRI脊柱评分和纽约SI评分合并为BASRI - 脊柱评分（2 - 12分），再加上BASRI - 髋部评分则为BASRI - 总分（2 - 16分）。颈椎和腰椎也进行详细评分（SASSS，各0 - 36分），并合并为SASSS - 总分或“改良”SASSS（范围均为0 - 72分）。为评估变化情况，对近似区间尺度的数据估计最小可检测差异（SDD）。
SI评分方法的观察者内和观察者间kappa值在0.36至0.70之间。BASRI - 髋部评分的kappa值在0.59至0.84之间。合并的SASSS评分最可靠，观察者内和观察者间组内相关系数（ICC）在0.90至0.96之间。合并的BASRI评分的ICC也非常好，范围为0.85至0.95。对于SI纽约评分、SI SASSS评分和BASRI - 髋部评分，0.3% - 1.2%的患者病情恶化1级；在BASRI - 脊柱评分和BASRI - 总分中，7.5%的患者病情恶化1级（占最高分的6.3%），观察者在高达48%的病例中一致认为病情无变化。“改良”SASSS的SDD最低（7.5；占最高分的10%）。只有0.8%的患者病情恶化超过SDD，观察者在高达92%的病例中一致认为病情无变化。
AS的放射学评分方法可靠性中等至优秀。在选定的评分条件下（时间顺序隐蔽、2名观察者平均、基于观察者间数据的SDD、未选择患者人群），2年内变化太小，评分方法无法可靠检测到。
