Department of Rheumatology, CHU Nancy Brabois, 1 rue du Morvan, 54511 Vandoeuvre-les-Nancy cedex, France.
Department of Radiology, University Hospital of Hadassah, Hasayeret Hayerushalmit 17/7, Jerusalem, Israel.
Eur J Radiol. 2017 Oct;95:169-176. doi: 10.1016/j.ejrad.2017.08.004. Epub 2017 Aug 7.
To assess the performance of pelvic plain radiograph (radiography), abdominal CT and sacroiliac joint MRI (MRI) compared with sacroiliac joints CT (SI joint CT) for the diagnosis of structural sacroiliitis in a population suffering from spondyloarthritis (SpA) meeting the New York or ASAS criteria.
All SpA patients eligible for biologic treatment who received a pre-therapeutic check-up including the four imaging techniques in the same year were selected from 2005 to 2012. An assessment of sacroiliitis was based independently by a rheumatologist and a radiologist on radiography according to the modified New York criteria and on abdominal CT, MRI and SI Joint CT depending on the presence of erosion on at least two consecutive slices. A final diagnosis was established for conflicting exams.
Of the 58 selected patients, sacroiliitis was diagnosed on radiography, abdominal CT, MRI and SI Joint CT in 32, 26, 34 and 35 patients, respectively. Inter-reader agreements for the grade of sacroiliitis were substantial with a weighted Kappa that varied between 0.60 and 0.76 and they were moderate for the diagnosis of sacroiliitis with a Kappa that varied between 0.45 and 0.55 for the four imaging modalities. The sensitivities of radiography, abdominal CT and MRI were 82.8%, 71.4% and 85.7% respectively and the specificities were 86.9%, 100% and 82.6% respectively with excellent accuracy and positive predictive value and good negative predictive value.
This study demonstrates the relevance of MRI and abdominal CT for the diagnosis of structural sacroiliitis with good sensitivities and excellent specificities. These imaging modalities may also contribute for the diagnosis of structural sacroiliitis.
评估骨盆平片（X 线）、腹部 CT 和骶髂关节 MRI（MRI）与骶髂关节 CT（SI 关节 CT）在符合纽约或 ASAS 标准的脊柱关节炎（SpA）患者中诊断结构骶髂关节炎方面的表现。
从 2005 年至 2012 年，选择了所有符合生物治疗条件且在同一年接受包括这四种影像学技术的治疗前检查的 SpA 患者。根据改良纽约标准，由风湿病学家和放射科医生分别对 X 线片和腹部 CT、MRI 和 SI 关节 CT 进行评估，以评估骶髂关节炎，根据至少两个连续层面的侵蚀存在来诊断骶髂关节炎。对于有冲突的检查，建立了最终诊断。
在 58 名入选的患者中，分别有 32 例、26 例、34 例和 35 例患者在 X 线片、腹部 CT、MRI 和 SI 关节 CT 上诊断为骶髂关节炎。读者之间对骶髂关节炎严重程度的一致性为中等，加权 Kappa 值在 0.45 至 0.55 之间，对骶髂关节炎的诊断一致性为中等，Kappa 值在 0.45 至 0.55 之间。X 线片、腹部 CT 和 MRI 的敏感性分别为 82.8%、71.4%和 85.7%，特异性分别为 86.9%、100%和 82.6%，准确性、阳性预测值均较高，阴性预测值较好。
本研究表明 MRI 和腹部 CT 对结构骶髂关节炎的诊断具有相关性，敏感性和特异性均较好。这些影像学方法也可能有助于诊断结构骶髂关节炎。
