Shengli Clinical Medical College of Fujian Medical University, Fujian, Fuzhou, China.
Department of Radiology, Fujian Provincial Hospital, Fujian, Fuzhou, China.
Front Immunol. 2023 Jul 3;14:1136925. doi: 10.3389/fimmu.2023.1136925. eCollection 2023.
Disease activity is relevant to the treatment and prognosis of axSpA, and methods to quantitatively assess disease activity and efficacy of axSpA are still being explored.
The purpose of this study was to find an optimal quantitative indicator for evaluating disease activity and curative effect of axSpA, using multi-b-values-fitting RESOLVE DWI.
The prospective study included 106 patients divided into axSpA group (n=89) and no-axSpA group (n=17) by Assessment of Spondyloarthritis international Society (ASAS) criteria. The axSpA group were divided into active group and inactive group according to ASDAS-CRP. The active group treated with systematic tumour necrosis factor inhibitors (TNFi) was selected as treatment group (n=20). All patients underwent MRI examination of sacroiliac joints (SIJs), including RESOLVE DWI. The ADC values of subchondral bone marrow in SIJs were measured (ADC was b=50,500s/mm fitting, ADC was b=50,700s/mm fitting, and ADC was b=50,500,700s/mm fitting). By comparing the ADC values between different groups, a relatively optimal b-values-fitting sequence was obtained, further evaluating curative effect of the treatment group.
The ADC values of axSpA group, inactive group and active group SIJs were all higher than those of no-axSpA group. The ADC values of active group SIJs were all higher than those of inactive group. ADC had the largest AUC, relative higher sensitivity and specificity while taking account of the image quality than ADC and ADC between different groups. In the treatment group, there was no significant difference in ADC values between pre-treatment and 3 weeks, 3 weeks and 6 weeks, 6 weeks and 12 weeks (all P>0.0083, Bonferroni-corrected threshold), while the decreased ADC values in the interval of 6 weeks or more were statistically significant (all P<0.0083, Bonferroni-corrected threshold).
Multi-b-values-fitting (b=50,500,700s/mm) RESOLVE DWI has a certain advantage in evaluating disease activity of axSpA. It was worth noting that short-term review (3 weeks or less) of RESOLVE DWI was unsatisfactory and review at 6 weeks or later would help to evaluate curative effect of axSpA.
疾病活动度与 axSpA 的治疗和预后相关，目前仍在探索用于定量评估 axSpA 疾病活动度和疗效的方法。
本研究旨在通过多 b 值拟合 RESOLVE DWI 找到评估 axSpA 疾病活动度和疗效的最佳定量指标。
前瞻性研究纳入了 106 例患者，根据 ASAS 标准分为 axSpA 组（n=89）和非 axSpA 组（n=17）。根据 ASDAS-CRP，axSpA 组分为活动组和非活动组。活动组接受系统肿瘤坏死因子抑制剂（TNFi）治疗，作为治疗组（n=20）。所有患者均接受了骶髂关节（SIJ）磁共振成像（MRI）检查，包括 RESOLVE DWI。测量 SIJ 软骨下骨髓的 ADC 值（b=50、500、700s/mm 拟合的 ADC 值）。通过比较不同组间的 ADC 值，获得相对最佳的 b 值拟合序列，进一步评估治疗组的疗效。
axSpA 组、非活动组和活动组 SIJ 的 ADC 值均高于非 axSpA 组。活动组 SIJ 的 ADC 值均高于非活动组。考虑到图像质量，ADC 值的 AUC 最大，相对敏感性和特异性均较高。在治疗组中，治疗前与治疗后 3 周、3 周与治疗后 6 周、6 周与治疗后 12 周时的 ADC 值差异均无统计学意义（均 P>0.0083，Bonferroni 校正阈值），而 6 周或更长时间间隔的 ADC 值降低具有统计学意义（均 P<0.0083，Bonferroni 校正阈值）。
多 b 值拟合（b=50、500、700s/mm）RESOLVE DWI 在评估 axSpA 疾病活动度方面具有一定优势。值得注意的是，RESOLVE DWI 的短期（3 周以内）复查效果不佳，6 周或更长时间的复查有助于评估 axSpA 的疗效。
