根据 DESIR 队列中当地风湿病学家或放射科医生的阳性影像学（骶髂关节的 X 线片和/或 MRI）和中央培训读者对轴性 SpA 的分类。
Classification of axial SpA based on positive imaging (radiographs and/or MRI of the sacroiliac joints) by local rheumatologists or radiologists versus central trained readers in the DESIR cohort.
机构信息
Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
Radiology Department, Clinique Hartmann, Neuilly Sur Seine, France.
出版信息
Ann Rheum Dis. 2015 Nov;74(11):2016-21. doi: 10.1136/annrheumdis-2014-205432. Epub 2014 Jun 24.
OBJECTIVE
Investigating changes in patient classification (ASAS (Assessment of SpondyloArthritis international Society) axSpA criteria) based on evaluation of images of the sacro-iliac joints (MRI-SI and X-SI) by local and central readers.
METHODS
The DESIR cohort included patients with inflammatory back pain (IBP; ≥3 months, but <3 years), suggestive of axSpA. Local radiologists/rheumatologists (local-reading) and two central readers (central-reading) evaluated baseline images. Agreement regarding positive MRI (pos-MRI) between central readers and between local-reading and central-reading was calculated (κs). Number of patients classified differently (ASAS criteria) by using local-reading instead of central-reading was calculated.
RESULTS
Inter-reader agreement between the two central readers and between local-reading and central-reading was substantial (κ=0.73 and κ=0.70, respectively). In 89/663 MRI-SIs (13.4%) local-reading and central-reading disagreed; 38/223 patients (17.0%) with pos-MRI (local-reading) were negative by central-reading; 51/440 patients (11.6%) with neg-MRI (local-reading) were positive by central-reading.In 163/582 patients eligible for applying ASAS criteria (28.0%), local-reading and central-reading disagreed on positive imaging (MRI-SI and/or X-SI; κ=0.68). In 46/582 patients (7.9%) a different evaluation resulted in a different classification; 18/582 patients (3.1%) classified no-SpA (central-reading) were axSpA by local-reading; 28/582 patients (4.8%) classified axSpA (central-reading) were no-SpA by local-reading. Among axSpA patients (central-reading), 16/419 patients (3.8%) fulfilling imaging-arm by central-reading fulfilled clinical-arm by local-reading; 29/419 patients (6.9%) fulfilling clinical-arm by central-reading fulfilled also imaging-arm by local-reading.
CONCLUSIONS
In patients with recent onset IBP, trained readers and local rheumatologists/radiologists agree well on recognising a pos-MRI. While disagreeing in 28% of the patients on positive imaging (MRI-SI and/or X-SI), classification of only 7.9% of the patients changed based on a different evaluation of images, showing the ASAS axSpA criteria's robustness.
目的
通过当地和中央读者对骶髂关节（MRI-SI 和 X-SI）图像的评估，研究患者分类（ASAS（强直性脊柱炎国际评估协会）axSpA 标准）的变化。
方法
DESIR 队列包括炎症性背痛（IBP；≥3 个月，但<3 年）、疑似 axSpA 的患者。当地放射科医生/风湿病学家（本地阅读）和两位中央读者（中央阅读）评估基线图像。计算中央读者之间以及本地阅读和中央阅读之间阳性 MRI（pos-MRI）的一致性（κs）。计算使用本地阅读而不是中央阅读时，分类不同（ASAS 标准）的患者数量。
结果
两位中央读者之间以及本地阅读和中央阅读之间的读者间一致性为中等（κ=0.73 和 κ=0.70）。在 663 例 MRI-SI 中，89 例（13.4%）本地阅读和中央阅读存在分歧；223 例 pos-MRI（本地阅读）患者中，38 例（17.0%）为阴性；440 例 neg-MRI（本地阅读）患者中，51 例（11.6%）为阳性。在 582 例符合 ASAS 标准（28.0%）的患者中，本地阅读和中央阅读对阳性影像学（MRI-SI 和/或 X-SI）的评估存在分歧（κ=0.68）。在 582 例患者中，46 例（7.9%）不同的评估导致不同的分类；582 例患者中，18 例（3.1%）中央阅读为非 SpA（axSpA），而本地阅读为 SpA；28 例（4.8%）中央阅读为 axSpA，而本地阅读为非 SpA。在 axSpA 患者中（中央阅读），419 例患者中，16 例（3.8%）符合中央阅读的影像学标准，符合本地阅读的临床标准；419 例患者中，29 例（6.9%）符合中央阅读的临床标准，也符合本地阅读的影像学标准。
结论
在近期出现 IBP 的患者中，经过培训的读者和当地的风湿病学家/放射科医生在识别阳性 MRI 方面非常一致。虽然在 28%的患者中对阳性影像学（MRI-SI 和/或 X-SI）存在分歧，但只有 7.9%的患者的分类因图像评估的不同而改变，这表明 ASAS axSpA 标准具有稳健性。
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