Department of Medical, Surgical and Neuro Sciences, Diagnostic Imaging, University of Siena, Azienda Ospedaliera Universitaria Senese, Viale Bracci 10, 53100, Siena, Italy.
Rheumatology Unit, Research Center of Systemic Autoimmune and Autoinflammatory Diseases, University of Siena, Azienda Ospedaliera Universitaria Senese, Viale Bracci 10, 53100, Siena, Italy.
Radiol Med. 2019 Nov;124(11):1142-1150. doi: 10.1007/s11547-019-01016-w. Epub 2019 Mar 13.
Active sacroiliitis based on magnetic resonance imaging (MRI) without intravenous (I.V.) contrast material injection is considered sufficient for the diagnosis of spondyloarthritis (SpA), according to the Assessment of SpondyloArthritis International Society (ASAS) criteria. This work shows the added value of administering I.V. contrast material when evaluating the response to tumor necrosis factor (TNF) antagonists therapy, on the extension of bone marrow oedema (BMO) and pathological enhancement (osteitis/synovitis) in the sacroiliac joints (SIJs) on MRI.
Forty-three patients (25 females and 18 males, mean age of 54 ± 16.60 years, range 22-75 years) with a clinical diagnosis of SpA and active sacroiliitis at MRI with I.V. contrast material, were considered for a follow-up MRI after 6 months of TNF antagonists therapy. Disease activity was monitored by a Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) questionnaire. Descriptive statistics, Student's t test and Cohen's kappa were used. P < 0.05 was considered statistically significant.
Thirty-eight patients were finally included in the study; 36 of them showed an improvement on clinical assessment after therapy. Score's difference (improvement) after treatment was calculated in the MRI sequences both with and without contrast agent (respectively, mean value and range 3.18, 0-12 with contrast and 1.63, 0-7 without contrast). This improvement was statistically significant in each group (P value of 7.097e-08 with contrast and 6.741e-06 without contrast), and there was a significant difference between the two group too (P-value of 8.598e-07). Cohen's kappa for dichotomous variables showed a better agreement between the post-contrast MRI findings and BASDAI (K = 0.53, agreement = 92.11%, P = 0.0001) than MRI without contrast and BASDAI (K = 0.11, agreement = 57.89%, P = 0.06).
The evaluation of enhancement is a reliable tool for the assessment of the response to therapy in SIJs involvement in SpA, better than BMO; hence, it should be advised in the MRI of these patients.
根据评估脊柱关节炎国际学会（ASAS）标准，磁共振成像（MRI）显示活动性骶髂关节炎而无需静脉（IV）造影剂注射即可诊断脊柱关节炎（SpA）。本研究旨在探讨 IV 造影剂在评估肿瘤坏死因子（TNF）拮抗剂治疗反应中的价值，以及对 MRI 中骶髂关节（SIJ）骨髓水肿（BMO）和病理性强化（骨炎/滑膜炎）的扩展作用。
43 例（25 名女性和 18 名男性，平均年龄 54±16.60 岁，范围 22-75 岁）患者在 MRI 检查中发现有活动性骶髂关节炎且接受 IV 造影剂检查，在接受 TNF 拮抗剂治疗 6 个月后进行了随访 MRI。采用 Bath 强直性脊柱炎疾病活动指数（BASDAI）问卷监测疾病活动度。采用描述性统计、Student's t 检验和 Cohen's kappa 进行分析。P<0.05 为统计学差异显著。
最终有 38 例患者纳入研究，其中 36 例患者在治疗后临床评估有改善。治疗后 MRI 序列中（有或无造影剂）评分差值（改善）分别为 3.18（0-12）和 1.63（0-7）。两组评分均有显著差异（有对比剂组 P 值为 7.097e-08，无对比剂组 P 值为 6.741e-06），且两组之间有显著差异（P 值为 8.598e-07）。二项分类变量的 Cohen's kappa 显示，与 BASDAI 相比，增强 MRI 结果与 BASDAI 的一致性更好（K=0.53，一致性为 92.11%，P=0.0001），而与无造影剂的 MRI 结果与 BASDAI 的一致性较差（K=0.11，一致性为 57.89%，P=0.06）。
在评估脊柱关节炎 SIJ 受累患者的治疗反应时，强化评估是一种可靠的工具，优于 BMO，因此建议在这些患者的 MRI 检查中使用。
