Department of Radiology and Medical Imaging, Institut de Recherche Expérimentale et Clinique (IREC),Université Catholique de Louvain (UCL), Cliniques Universitaires Saint Luc, Avenue Hippocrate, 10/2942, B-1200, Brussels, Belgium.
EORTC, Head of the Statistics Unit, EORTC Headquarters, Brussels, Belgium.
Eur Radiol. 2018 Oct;28(10):4163-4173. doi: 10.1007/s00330-018-5377-3. Epub 2018 Apr 17.
To compare the diagnostic accuracy of DWI and STIR sequences in Whole body (WB) MRI of SpA patients.
Twenty consecutive patients with confirmed active SpA and 20 controls were investigated with identical WB MRI protocols, including DWI and STIR images. Two observers recorded 'lesions' (high signal intensity foci on STIR and high b-value DWI) in 17 anatomical areas, making a 17-point 'area score' and a 40-point 'lesion score'. ROC performance, inter-observer agreement, correlation with clinical parameters and spine and sacro-iliac joints (SIJ) MRI scores were assessed.
SpA patients had significantly higher lesion scores on DWI than on STIR (p<0.025). The lesion score area under the curve was significantly higher with DWI (99.9) than with STIR (95.8, p=0.02). DWI lesion score ≥5 had both sensitivity and specificity ≥85 %. With STIR the best threshold ≥3 yielded sensitivity ≥85 % and specificity ≥60 %. DWI area score ≥3 yielded sensitivity ≥85 % and specificity ≥80 %. With STIR the best threshold ≥4 yielded sensitivity ≥70 % and specificity ≥80 %. Inter-observer agreement was strong for both sequences. In patients, the lesion score was positively correlated with ASDAS-CRP, log(CRP), and local MRI scores.
DWI is a promising alternative to STIR in WB MRI to detect active SpA lesions.
• DWI is a robust alternative to STIR in WBMRI in SpA. • DWI might be superior in discriminating relevant inflammatory and degenerative changes. • Positive correlations exist between WB MRI, clinical, biological, local MRI data. • Distribution and frequency of abnormal MRI findings in SpA are highlighted.
比较 DWI 和 STIR 序列在脊柱关节炎（SpA）患者全身 MRI 中的诊断准确性。
连续纳入 20 例确诊为活动期 SpA 患者和 20 名对照者，行相同的全身 MRI 检查，包括 DWI 和 STIR 图像。两名观察者在 17 个解剖区域记录“病变”（STIR 上的高信号强度灶和高 b 值 DWI），得出 17 分“区域评分”和 40 分“病变评分”。评估了 ROC 性能、观察者间一致性、与临床参数及脊柱和骶髂关节（SIJ）MRI 评分的相关性。
SpA 患者的 DWI 病变评分显著高于 STIR（p<0.025）。DWI 的病变评分曲线下面积明显高于 STIR（99.9 比 95.8，p=0.02）。DWI 病变评分≥5 时，敏感性和特异性均≥85%。STIR 最佳阈值≥3 时，敏感性≥85%，特异性≥60%。DWI 区域评分≥3 时，敏感性≥85%，特异性≥80%。STIR 最佳阈值≥4 时，敏感性≥70%，特异性≥80%。两种序列的观察者间一致性均较强。在患者中，病变评分与 ASDAS-CRP、log(CRP)和局部 MRI 评分呈正相关。
DWI 是 STIR 检测活动性 SpA 病变的一种很有前途的全身 MRI 替代方法。
• DWI 是 SpA 全身 MRI 中替代 STIR 的可靠方法。• DWI 可能在鉴别相关炎症和退行性改变方面更有优势。• 全身 MRI、临床、生物学和局部 MRI 数据之间存在正相关。• 强调了 SpA 中异常 MRI 表现的分布和频率。
