Rheumatology Clinic, Università Politecnica delle Marche, Dipartimento Di Scienze Cliniche e Molecolari, Ospedale Carlo Urbani, Jesi, Italy.
U.O. di Radiologia, Ospedale degli Infermi, Azienda AUSL della Romagna, Faenza, Italy.
Clin Exp Rheumatol. 2022 Jul;40(7):1385-1392. doi: 10.55563/clinexprheumatol/e3b8c9. Epub 2021 Sep 28.
To demonstrate a possible basis for a quantitative magnetic resonance imaging (MRI) approach that uses histographic analysis to determine bone marrow oedema (BME) and fat metaplasia at sacroiliac joints (SIJs) level in patients with axial spondyloarthritis (axSpA).
In this prospective, cross-sectional study, consecutive axSpA patients with inflammatory low back pain underwent 1.5-T MRI. MRI images were scored on a 4-point (0-3) scoring system both for BME and fat metaplasia by two radiologists. A region-of-interest based histographic quantitative analysis was used to assess MRI images. Using the area under the receiver operating characteristic curve (AUC-ROC) approach was tested the diagnostic accuracy of histographic analysis for detecting BME vs. BME and fat metaplasia on MRI images.
17 of the 43 patients (39.5%) included only had a BME lesion, while the remaining 26 patients (60.5%) had both BME and fat metaplasia at the SIJ level. Inter-rater agreement between readers was good (weighted kappa 0.643). On MRI images, BME and BME+fat metaplasia showed significant difference in histographic analysis (p<0.001), with an AUC-ROC of 0.898, and an optimal cut-off point of 311 at histographic analysis in the distinction of BME vs. fat metaplasia.
Histographic analysis could represent a method for quantifying BME on MRI images of SIJs in patients with axSpA. This type analysis can provide important prognostic information and guide the choice of treatment in patients with sacroiliitis.
展示一种基于组织学分析的定量磁共振成像（MRI）方法的可能性，该方法用于确定中轴型脊柱关节炎（axSpA）患者骶髂关节（SIJ）水平的骨髓水肿（BME）和脂肪化生。
在这项前瞻性、横断面研究中，连续纳入患有炎症性下腰痛的 axSpA 患者进行 1.5-T MRI 检查。两位放射科医生对 BME 和脂肪化生分别进行 4 分（0-3 分）评分系统的 MRI 图像评分。采用基于感兴趣区的组织学定量分析来评估 MRI 图像。使用受试者工作特征曲线下面积（AUC-ROC）方法来测试组织学分析检测 MRI 图像上 BME 与 BME 和脂肪化生的诊断准确性。
43 名患者中有 17 名（39.5%）仅存在 BME 病变，而其余 26 名患者（60.5%）在 SIJ 水平上同时存在 BME 和脂肪化生。两位读者之间的组内一致性较好（加权kappa 0.643）。在 MRI 图像上，BME 和 BME+脂肪化生在组织学分析上有显著差异（p<0.001），AUC-ROC 为 0.898，在组织学分析中区分 BME 与脂肪化生的最佳截断点为 311。
组织学分析可以代表一种用于量化 axSpA 患者 SIJ MRI 图像上 BME 的方法。这种类型的分析可以提供重要的预后信息，并指导骶髂关节炎患者的治疗选择。
