Department of Radiology, Jagiellonian University Medical College, 19 Kopernika Street, 31-501, Krakow, Poland.
Department of General and Interventional Radiology and Neuroradiology, Wroclaw Medical University, 213 Borowska Street, 50-556, Wroclaw, Poland.
Rheumatol Int. 2019 Sep;39(9):1559-1565. doi: 10.1007/s00296-019-04373-x. Epub 2019 Jul 10.
The aim of the study was to compare the diagnostic efficacy of the visual assessment of diffusion-weighted imaging (DWI) and dynamic contrast-enhanced (DCE) sequences compared to the STIR sequence in the diagnostics of active sacroiliitis in the course of axial spondyloarthritis (axSpA). The study group consisted of 49 patients who had undergone multiparametric magnetic resonance imaging of the sacroiliac joints (SIJs) due to clinical suspicion of axSpA. Two independent observers retrospectively assessed four quadrants of the SIJs for the presence of subchondral bone marrow oedema/osteitis with the use of modified SPARCC score in sequences: STIR, DWI (with ADC map) and DCE. Diagnostic efficiency parameters were calculated for DWI and DCE sequence separately, using STIR sequence as a reference. Inter-observer agreement was evaluated with the use of κ coefficient. Patients' clinical symptoms were analysed to identify the group fulfilling the imaging arm of the ASAS criteria for axSpA. Overall, 46.9% (n = 23) of patients fulfilled the imaging arm of ASAS criteria for axial spondyloarthritis. DWI with ADC map: accuracy 95.6%, sensitivity 99.4%, specificity 54.0%. DCE sequence: accuracy 96.8%, sensitivity 98.4%, specificity 79.5%. The highest level of inter-observer agreement was achieved for STIR sequence (κ = 0.888), slightly lower for DCE sequence (κ = 0.773) and the lowest for DWI with ADC (κ = 0.674). Visual assessment of the DWI and DCE sequences has high accuracy and sensitivity of bone marrow oedema/osteitis detection, but the specificity and inter-observer agreement are poor, especially for the DWI sequence with ADC maps.
本研究旨在比较扩散加权成像（DWI）和动态对比增强（DCE）序列与 STIR 序列在诊断轴性脊柱关节炎（axSpA）过程中活动性骶髂关节炎中的诊断效能。研究组纳入了 49 例因临床怀疑 axSpA 而行骶髂关节多参数磁共振成像的患者。两名独立观察者使用改良 SPARCC 评分，对 SIJ 的四个象限进行骨髓水肿/骨炎的存在情况进行回顾性评估，评估序列包括：STIR、DWI（ADC 图）和 DCE。单独计算 DWI 和 DCE 序列的诊断效率参数，并以 STIR 序列作为参考。使用κ系数评估观察者间的一致性。分析患者的临床症状，以确定符合 ASAS 轴性脊柱关节炎影像学标准的患者。总的来说，46.9%（n=23）的患者符合 ASAS 轴性脊柱关节炎的影像学标准。DWI 与 ADC 图：准确性 95.6%，敏感度 99.4%，特异度 54.0%。DCE 序列：准确性 96.8%，敏感度 98.4%，特异度 79.5%。STIR 序列的观察者间一致性最高（κ=0.888），DCE 序列稍低（κ=0.773），DWI 与 ADC 序列最低（κ=0.674）。DWI 和 DCE 序列的视觉评估具有高准确性和高骨髓水肿/骨炎检测敏感度，但特异性和观察者间一致性较差，特别是 DWI 序列的 ADC 图。
