Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
Ann Rheum Dis. 2017 Oct;76(10):1731-1736. doi: 10.1136/annrheumdis-2017-211486. Epub 2017 Jun 29.
To assess the prevalence of spinal inflammation on MRI in patients with chronic back pain (CBP) of maximally 3 years duration and to evaluate the yield of adding a positive MRI-spine as imaging criterion to the Assessment of SpondyloArthritis international Society (ASAS) classification criteria for axial spondyloarthritis (axSpA).
Baseline imaging of the sacroiliac joints (X-SI), MRI of the sacroiliac joints (MRI-SI) and MRI-spine were scored by ≥2 experienced central readers per modality in the SPondyloArthritis Caught Early (SPACE) and DEvenir des Spondylarthropathies Indifférenciées Récentes (DESIR) cohorts. Inflammation suggestive of axSpA was assessed in the entire spine. A positive MRI-spine was defined by the presence of ≥5 inflammatory lesions. Alternative less strict definitions were also tested.
In this study, 541 and 650 patients with CBP from the SPACE and DESIR cohorts were included. Sacroiliitis on X-SI and MRI-SI was found in 40/541 (7%) and 76/541 (14%) patients in SPACE, and in DESIR in 134/650 (21%) and 231/650 (36%) patients, respectively. In SPACE and DESIR, a positive MRI-spine was seen in 4/541 (1%) and 48/650 (7%) patients. Of the patients without sacroiliitis on imaging, 3/447 (1%) (SPACE) and 8/382 (2%) (DESIR) patients had a positive MRI-spine. Adding positive MRI-spine as imaging criterion led to new classification in only one patient in each cohort, as the other patients already fulfilled the clinical arm. Other definitions of a positive MRI-spine yielded similar results.
In two cohorts of patients with CBP with a maximum symptom duration of 3 years, a positive MRI-spine was rare in patients without sacroiliitis on MRI-SI and X-SI. Addition of MRI-spine as imaging criterion to the ASAS axSpA criteria had a low yield of newly classified patients and is therefore not recommended.
评估病程最长 3 年的慢性腰痛（CBP）患者的脊柱炎症在 MRI 上的发生率，并评估将阳性 MRI-脊柱作为影像学标准添加到评估脊柱关节炎国际学会（ASAS）轴性脊柱关节炎（axSpA）分类标准中的收益。
在 SPondyloArthritis Caught Early（SPACE）和 DEvenir des Spondylarthropathies Indifférenciées Récentes（DESIR）队列中，由至少 2 名经验丰富的中心读者对骶髂关节（X-SI）的基线影像学、骶髂关节 MRI（MRI-SI）和 MRI-脊柱进行评分。评估整个脊柱是否存在提示 axSpA 的炎症。阳性 MRI-脊柱的定义为存在≥5 个炎症性病变。还测试了其他不太严格的定义。
在这项研究中，纳入了 SPACE 和 DESIR 队列中 541 名和 650 名 CBP 患者。在 SPACE 中，X-SI 和 MRI-SI 上发现骶髂关节炎分别为 40/541（7%）和 76/541（14%），在 DESIR 中为 134/650（21%）和 231/650（36%）。在 SPACE 和 DESIR 中，4/541（1%）和 48/650（7%）患者的 MRI-脊柱为阳性。在影像学无骶髂关节炎的患者中，3/447（1%）（SPACE）和 8/382（2%）（DESIR）患者的 MRI-脊柱为阳性。仅在每个队列中增加阳性 MRI-脊柱作为影像学标准仅导致 1 名患者新分类，因为其他患者已经符合临床标准。其他阳性 MRI-脊柱的定义也得出了类似的结果。
在病程最长 3 年的 2 个 CBP 患者队列中，在 MRI-SI 和 X-SI 上无骶髂关节炎的患者中，阳性 MRI-脊柱较为少见。将 MRI-脊柱作为影像学标准添加到 ASAS axSpA 标准中，新分类患者的检出率较低，因此不推荐使用。
