P.F. Weiss, MD, MSCE, Department of Pediatrics, Division of Rheumatology and Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, and Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA;
T.G. Brandon, MPH, Department of Pediatrics, Division of Rheumatology and Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
J Rheumatol. 2023 Sep;50(9):1173-1177. doi: 10.3899/jrheum.2022-0890. Epub 2023 Apr 15.
Radiography is still used worldwide for the detection of sacroiliitis in juvenile spondyloarthritis (JSpA), despite its low sensitivity and reliability. We aimed to define unequivocal evidence of sacroiliitis on pelvic radiography in skeletally immature youth for use in classification criteria when magnetic resonance imaging (MRI) is unavailable.
Subjects were a retrospective cohort of juvenile patients with spondyloarthritis with a radiograph and MRI as part of a diagnostic evaluation for axial disease. Six musculoskeletal imaging experts underwent an iterative consensus process to define unequivocal sacroiliitis on radiography in skeletally immature youth. Radiographs were graded using the modified New York (mNY) criteria and the unequivocal sacroiliitis criteria. Interrater agreement was assessed with the Fleiss [Formula: see text] statistic. Specificity, area under the receiver operator characteristic curve (AUROC), and sensitivity of the 2 measures were tested using 2 MRI reference standards.
A total of 112 subjects, with a median age of 14.9 (range 6.7-20.1) years, were included. The Fleiss [Formula: see text] was fair for the mNY criteria (0.54, 95% CI 0.42-0.67) and the unequivocal sacroiliitis criteria (0.58, 95% CI 0.46-0.69). The unequivocal sacroiliitis criteria achieved > 90% specificity using both MRI reference standards. Sensitivity (59.26 and 57.14 vs 44.83 and 43.33) and AUROC (0.76 and 0.76 vs 0.71 and 0.71) were higher, for both reference standards, for the unequivocal sacroiliitis in youth definition than for the mNY criteria, respectively.
In this study, we propose the first consensus-derived definition to our knowledge of unequivocal sacroiliitis by radiography in skeletally immature youth. This definition achieved excellent specificity and had higher AUROC and sensitivity values than the mNY criteria using both MRI reference standards. This definition has applicability to the JSpA axial disease classification imaging criterion when MRI is unavailable.
尽管放射学在检测幼年脊柱关节炎（JSpA）的骶髂关节炎方面的敏感性和可靠性较低，但在全球范围内仍用于检测骶髂关节炎。我们旨在确定在缺乏磁共振成像（MRI）的情况下，用于分类标准的骨骼未成熟青少年的骨盆 X 线摄影中骶髂关节炎的明确证据。
本研究为回顾性队列研究，纳入了接受脊柱关节炎评估的幼年患者，这些患者的 X 线摄影和 MRI 作为轴向疾病诊断评估的一部分。六位肌肉骨骼影像学专家通过迭代共识过程来定义骨骼未成熟青少年 X 线上明确的骶髂关节炎。使用改良纽约（mNY）标准和明确的骶髂关节炎标准对 X 线片进行分级。采用 Fleiss [Formula: see text] 统计评估组间一致性。使用两种 MRI 参考标准测试这两种测量方法的特异性、接收者操作特征曲线（AUROC）下面积和敏感性。
共纳入 112 例患者，中位年龄为 14.9 岁（范围为 6.7-20.1 岁）。mNY 标准的 Fleiss [Formula: see text] 为中度（0.54，95%CI 0.42-0.67），明确的骶髂关节炎标准的 Fleiss [Formula: see text] 为中度（0.58，95%CI 0.46-0.69）。两种 MRI 参考标准均使用明确的骶髂关节炎标准时，特异性均>90%。在两种 MRI 参考标准下，与 mNY 标准相比，明确的骶髂关节炎在青少年定义中的敏感性（59.26 和 57.14 比 44.83 和 43.33）和 AUROC（0.76 和 0.76 比 0.71 和 0.71）更高。
在这项研究中，我们提出了骨骼未成熟青少年的 X 线摄影中明确的骶髂关节炎的第一个共识定义。与 mNY 标准相比，该定义使用两种 MRI 参考标准时，特异性更高，AUROC 和敏感性值更高。在 MRI 不可用时，该定义可应用于 JSpA 轴向疾病分类成像标准。
