From the Institute of Health and Biomedical Innovation, Queensland University of Technology, Translational Research Institute, Princess Alexandra Hospital; University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital; Royal Brisbane and Women's Hospital; The University of Queensland, School of Medicine, Brisbane, Queensland, Australia.
L.A. Bradbury, MSc, MNPSt, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology at Translational Research Institute; K.A. Hollis, BScN, RN, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology at Translational Research Institute; B. Gautier, PhD, University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital; S. Shankaranarayana, MBBS, PhD, Princess Alexandra Hospital; P.C. Robinson, PhD, FRACP, Royal Brisbane and Women's Hospital; N. Saad, MD, FRANZCR, Princess Alexandra Hospital; K.A. Lê Cao, PhD, University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital; M.A. Brown, MD, PhD, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology at Translational Research Institute.
J Rheumatol. 2018 Jun;45(6):771-778. doi: 10.3899/jrheum.170312. Epub 2018 Feb 15.
We tested the discriminatory capacity of diffusion-weighted magnetic resonance imaging (DWI) and its potential as an objective measure of treatment response to tumor necrosis factor inhibition in ankylosing spondylitis (AS).
Three cohorts were studied prospectively: (1) 18 AS patients with Bath Ankylosing Spondylitis Disease Activity Index > 4, and erythrocyte sedimentation rate > 25 and/or C-reactive protein > 10 meeting the modified New York criteria for AS; (2) 20 cases of nonradiographic axial spondyloarthritis (nr-axSpA) as defined by the Assessment of Spondyloarthritis international Society (ASAS) criteria; and (3) 20 non-AS patients with chronic low back pain, aged between 18 and 45 years, who did not meet the imaging arm of the ASAS criteria for axSpA. Group 1 patients were studied prior to and following adalimumab treatment. Patients were assessed by DWI and conventional magnetic resonance imaging (MRI), and standard nonimaging measures.
At baseline, in contrast to standard nonimaging measures, DWI apparent diffusion coefficient (ADC) values showed good discriminatory performance [area under the curve (AUC) > 80% for Group 1 or 2 compared with Group 3]. DWI ADC values were significantly lower posttreatment (0.45 ± 0.433 before, 0.154 ± 0.23 after, p = 0.0017), but had modest discriminating capacity comparing pre- and posttreatment measures (AUC = 68%). This performance was similar to the manual Spondyloarthritis Research Consortium of Canada (SPARCC) scoring system.
DWI is informative for diagnosis of AS and nr-axSpA, and has moderate utility in assessment of disease activity or treatment response, with performance similar to that of the SPARCC MRI score.
我们测试了弥散加权磁共振成像（DWI）的鉴别能力及其作为肿瘤坏死因子抑制治疗反应的客观指标在强直性脊柱炎（AS）中的潜力。
前瞻性研究了三个队列：（1）18 例符合改良纽约 AS 标准的 AS 患者，Bath 强直性脊柱炎疾病活动指数（BASDAI）>4，红细胞沉降率（ESR）>25，C 反应蛋白（CRP）>10；（2）20 例非放射学中轴型脊柱关节炎（nr-axSpA）患者，符合 ASAS 标准；（3）20 例年龄在 18-45 岁之间的慢性下腰痛非 AS 患者，不符合 ASAS 轴性 SpA 的影像学标准。第 1 组患者在接受阿达木单抗治疗前后进行了研究。通过 DWI 和常规磁共振成像（MRI）以及标准影像学方法对患者进行评估。
与标准影像学方法相比，基线时 DWI 表观弥散系数（ADC）值具有良好的鉴别性能（曲线下面积（AUC）>80%，第 1 组或第 2 组与第 3 组相比）。治疗后 DWI ADC 值显著降低（治疗前为 0.45±0.433，治疗后为 0.154±0.23，p=0.0017），但治疗前后 ADC 值的鉴别能力适中（AUC=68%）。这种表现与手动加拿大脊柱关节炎研究协会（SPARCC）评分系统相似。
DWI 对 AS 和 nr-axSpA 的诊断具有信息性，在评估疾病活动度或治疗反应方面具有中等效用，与 SPARCC MRI 评分的性能相似。
