在轴向脊柱关节炎中，前后位腰椎与常规骨盆 X 线片评估放射性骶髂关节炎。

Assessment of radiographic sacroiliitis in anteroposterior lumbar vs conventional pelvic radiographs in axial spondyloarthritis.

机构信息

Gastroenterology, Infectious Diseases and Rheumatology Department, Charité Universitätsmedizin Berlin.

Clinical Research Unit, Berlin Institute of Health (BIH), Berlin.

出版信息

Rheumatology (Oxford). 2021 Jan 5;60(1):269-276. doi: 10.1093/rheumatology/keaa260.

DOI:10.1093/rheumatology/keaa260

PMID:32710108

Abstract

OBJECTIVE

The aim was to investigate the reliability and validity of radiographic sacroiliitis assessment in anteroposterior (AP) lumbar radiographs compared with conventional pelvic radiographs in patients with axial spondyloarthritis (axSpA).

METHODS

Patients from the German Spondyloarthritis Inception Cohort were selected based on the availability of pelvic and AP lumbar radiographs with visible SI joints at baseline and year 2. Two readers scored the images independently in a random order according to the modified New York criteria. The sacroiliitis sum score was calculated as the mean of both readers. Patients were classified as radiographic (r-)axSpA if radiographic sacroiliitis of grade ≥2 bilaterally or grade ≥3 unilaterally was present in the opinion of both readers and as non-radiographic (nr-)axSpA otherwise. The reliability and validity of sacroiliitis assessment in AP lumbar radiographs was assessed using intraclass correlation coefficients (ICCs), absolute agreement and κ statistics.

RESULTS

A total of 226 sets of radiographs were scored from 113 patients included in the study. The ICC for the sacroiliitis sum score was 0.91 at both baseline and year 2. A total of 62 (54.9%) and 55 (48.7%) patients were classified as r-axSpA at baseline and 65 (57.5%) and 60 (53.1%) patients at year 2 based on evaluation of pelvic and AP lumbar radiographs, respectively. The absolute agreement between the methods on the classification was 84.9 and 85.0% at baseline and year 2, respectively, with the κ of 0.70 at both time points.

CONCLUSION

Radiographic sacroiliitis can be assessed in AP lumbar radiographs with a similar reliability to conventional pelvic radiographs.

摘要

目的

本研究旨在评估与传统骨盆 X 线相比，前后位（AP）腰椎 X 线在评估轴性脊柱关节炎（axSpA）患者的骶髂关节炎方面的可靠性和有效性。

方法

本研究从德国脊柱关节炎起始队列中选择患者，纳入标准为基线和第 2 年均有可见骶髂关节的骨盆和 AP 腰椎 X 线。两名阅片者按照改良纽约标准，以随机顺序独立阅片。骶髂关节炎总分（SS）为两位阅片者评分的平均值。如果两位阅片者均认为双侧骶髂关节炎≥2 级或单侧≥3 级存在放射学骶髂关节炎，则患者被归类为放射学（r-）axSpA，否则为非放射学（nr-）axSpA。使用组内相关系数（ICC）、绝对一致性和κ 统计量评估 AP 腰椎 X 线评估骶髂关节炎的可靠性和有效性。

结果

本研究共纳入 113 例患者的 226 套 X 线片。在基线和第 2 年，骶髂关节炎总分的 ICC 分别为 0.91。根据骨盆和 AP 腰椎 X 线片的评估，分别有 62 例（54.9%）和 55 例（48.7%）患者在基线时被归类为 r-axSpA，分别有 65 例（57.5%）和 60 例（53.1%）患者在第 2 年被归类为 r-axSpA。两种方法在分类上的绝对一致性分别为 84.9%和 85.0%，在两个时间点的κ 值均为 0.70。