Christiansen Alice Ashouri, Hendricks Oliver, Kuettel Dorota, Hørslev-Petersen Kim, Jurik Anne Grethe, Nielsen Steen, Rufibach Kaspar, Loft Anne Gitte, Pedersen Susanne Juhl, Hermansen Louise Thuesen, Østergaard Mikkel, Arnbak Bodil, Manniche Claus, Weber Ulrich
From the King Christian 10th Hospital for Rheumatic Diseases, Gråsten; Hospital of Southern Jutland, Aabenraa; Institute of Regional Health Research, University of Southern Denmark, Odense; Department of Radiology, and Department of Rheumatology, Aarhus University Hospital, Aarhus; Research Department, Spine Centre of Southern Denmark, Hospital Lillebaelt Middelfart, Middelfart; Department of Internal Medicine, Hospital Lillebaelt Vejle, Vejle; Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, Glostrup; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Rufibach rePROstat, Biostatistical Consulting and Training, Basel, Switzerland.
A.A. Christiansen, MD, King Christian 10th Hospital for Rheumatic Diseases, and Hospital of Southern Jutland, and Institute of Regional Health Research, University of Southern Denmark; O. Hendricks, MD, PhD, King Christian 10th Hospital for Rheumatic Diseases, and Hospital of Southern Jutland, and Institute of Regional Health Research, University of Southern Denmark; D. Kuettel, MD, King Christian 10th Hospital for Rheumatic Diseases, and Hospital of Southern Jutland; K. Hørslev-Petersen, MD, DMSc, King Christian 10th Hospital for Rheumatic Diseases, and Hospital of Southern Jutland, and Institute of Regional Health Research, University of Southern Denmark; A.G. Jurik, MD, DMSc, Institute of Regional Health Research, University of Southern Denmark, and Department of Radiology, Aarhus University Hospital, and Research Department, Spine Centre of Southern Denmark, Hospital Lillebaelt Middelfart; S. Nielsen, MD, King Christian 10th Hospital for Rheumatic Diseases, and Hospital of Southern Jutland; K. Rufibach, PhD, Rufibach rePROstat, Biostatistical Consulting and Training; A.G. Loft, MD, DMSc, Department of Internal Medicine, Hospital Lillebaelt Vejle, and Department of Rheumatology, Aarhus University Hospital; S.J. Pedersen, MD, PhD, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, and Department of Clinical Medicine, University of Copenhagen; L.T. Hermansen, MSc, King Christian 10th Hospital for Rheumatic Diseases, and Hospital of Southern Jutland; M. Østergaard, MD, PhD, DMSc, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, and Department of Clinical Medicine, University of Copenhagen; B. Arnbak, MSc, PhD, Institute of Regional Health Research, University of Southern Denmark, and Research Department, Spine Centre of Southern Denmark, Hospital Lillebaelt Middelfart; C. Manniche, MD, DMSc, Institute of Regional Health Research, University of Southern Denmark, and Research Department, Spine Centre of Southern Denmark, Hospital Lillebaelt Middelfart; U. Weber, MD, King Christian 10th Hospital for Rheumatic Diseases, and Hospital of Southern Jutland, and Institute of Regional Health Research, University of Southern Denmark.
J Rheumatol. 2017 Jan;44(1):70-77. doi: 10.3899/jrheum.160079. Epub 2016 Oct 15.
To determine the reproducibility of evaluation of sacroiliac joint (SIJ) radiographs among readers with varying levels of experience, and to identify potential drivers of disagreement in classification among 5 predefined radiographic lesion types.
The study sample consisted of 104 consecutive patients aged 18-40 with low back pain ≥ 3 months of duration who met the Assessment of SpondyloArthritis international Society (ASAS) definition for a positive SIJ magnetic resonance image, or were HLA-B27-positive and had ≥ 1 spondyloarthritis (SpA)-related clinical/laboratory feature according to the ASAS classification criteria for axial SpA. Seven blinded readers (2 musculoskeletal radiologists, 5 rheumatologists) classified pelvic radiographs according to the modified New York criteria (mNY) and recorded presence/absence of 5 lesion types in both SIJ: erosion, sclerosis, ankylosis, joint space widening, and joint space narrowing. Reproducibility of mNY classification among 21 reader pairs was assessed and potential drivers of disagreement were identified among 5 lesion types. A generalized linear mixed logistic regression model served to analyze to what extent discordance in lesion type was associated with discrepant mNY classification.
Mean κ values (percent concordance) were 0.39 (84.1%) for mNY classification over 21 reader pairs, 0.46 (79.8%) between 2 musculoskeletal radiologists, and 0.55 (86.5%) and 0.36 (77.9%) between the most experienced rheumatologist and the 2 radiologists. Erosion showed the lowest agreement (25%) among patients with discordant classification and gave the highest OR of 13.5 for disagreement.
Reproducibility of radiographic SIJ classification in an SpA inception cohort was only fair to at best moderate among 7 readers with varying levels of experience, questioning the applicability of mNY in early SpA.
确定不同经验水平的阅片者对骶髂关节（SIJ）X线片评估的可重复性，并识别5种预定义的X线病变类型在分类中存在分歧的潜在驱动因素。
研究样本包括104例年龄在18 - 40岁、腰痛持续≥3个月的连续患者，这些患者符合国际脊柱关节炎评估协会（ASAS）关于SIJ磁共振成像阳性的定义，或根据ASAS轴性脊柱关节炎（SpA）分类标准为HLA - B27阳性且具有≥1项SpA相关临床/实验室特征。7名盲法阅片者（2名肌肉骨骼放射科医生、5名风湿病学家）根据改良纽约标准（mNY）对骨盆X线片进行分类，并记录双侧SIJ中5种病变类型的存在与否：侵蚀、硬化、强直、关节间隙增宽和关节间隙变窄。评估21对阅片者之间mNY分类的可重复性，并在5种病变类型中识别分歧的潜在驱动因素。采用广义线性混合逻辑回归模型分析病变类型的不一致与mNY分类差异的相关程度。
21对阅片者之间mNY分类的平均κ值（一致百分比）为0.39（84.1%），2名肌肉骨骼放射科医生之间为0.46（79.8%），经验最丰富的风湿病学家与2名放射科医生之间分别为0.55（86.5%）和0.36（77.9%）。在分类不一致的患者中，侵蚀的一致性最低（25%），且分歧的最高比值比为13.5。
在一个SpA起始队列中，7名不同经验水平的阅片者对X线SIJ分类的可重复性充其量仅为中等，这对mNY在早期SpA中的适用性提出了质疑。
