Centre for Medical Imaging, University College London, London.
Department of Rheumatology, University College London Hospitals NHS Foundation Trust, London.
Rheumatology (Oxford). 2019 Oct 1;58(10):1831-1838. doi: 10.1093/rheumatology/kez173.
To develop evidence-based recommendations on the use of MRI in the diagnosis of axial SpA (axSpA).
A working group comprising nine rheumatologists and nine musculoskeletal radiologists with an interest in axSpA was established, with support from the British Society of Spondyloarthritis (BRITSpA). Two meetings were held. In the first meeting, research questions were formulated. In the second meeting, the results of a systematic literature review designed to inform the recommendations were reviewed. An anonymized Delphi process was used to formulate the final set of recommendations. For each recommendation, the level of evidence and strength of recommendation was determined. The level of agreement was assessed using a 0-10 numerical rating scale.
Two overarching principles were formulated, as follows: The diagnosis of axSpA is based on clinical, laboratory and imaging features (overarching principle 1), and patients with axSpA can have isolated inflammation of either the sacroiliac joints or the spine (overarching principle 2). Seven recommendations addressing the use of MRI in the assessment of patients with suspected axSpA were formulated, covering topics including recommended sequences, anatomical coverage, acquisition parameters and interpretation of active and structural MRI lesions. The level of agreement for each recommendation was very high (range 8.8-9.8).
A joint rheumatology and radiology consensus on the acquisition and interpretation of MRI in axSpA diagnosis was achieved, and a research agenda formulated. This consensus should help standardize practice around MRI and ensure a more informed, consistent approach to the diagnosis of axSpA.
针对轴性脊柱关节炎（axSpA）的诊断，制定基于循证医学的 MRI 使用建议。
成立了一个由 9 名风湿病学家和 9 名对 axSpA 有兴趣的肌肉骨骼放射科医生组成的工作组，该工作组得到了英国脊柱关节炎协会（BRITSpA）的支持。召开了两次会议。在第一次会议上，制定了研究问题。在第二次会议上，回顾了旨在为建议提供信息的系统文献综述的结果。使用匿名 Delphi 过程制定了最终建议。对于每一项建议，都确定了证据水平和推荐强度。使用 0-10 的数字评分量表评估了一致性程度。
制定了两项总体原则，如下所示：axSpA 的诊断基于临床、实验室和影像学特征（总则 1），axSpA 患者的骶髂关节或脊柱可能仅存在炎症（总则 2）。制定了 7 项关于 MRI 在疑似 axSpA 患者评估中的使用建议，涵盖了推荐序列、解剖学覆盖范围、采集参数以及活动性和结构性 MRI 病变的解读等主题。每项建议的一致性程度都非常高（范围为 8.8-9.8）。
在 axSpA 诊断中 MRI 的采集和解读方面达成了风湿病学和放射学的共识，并制定了研究议程。这一共识应有助于规范 MRI 实践，并确保对 axSpA 的诊断采取更明智、一致的方法。
