Pastor Maxime, Lukas Cedric, Ramos-Pascual Sonia, Saffarini Mo, Wantz William, Cyteval Catherine
Osteoarticular Medical Imaging Section, Department of Medical Imaging, Montpellier University Hospital, 34295, Montpellier, France.
Department of Rheumatology, Montpellier University Hospital, 34295, Montpellier, France.
Eur Radiol. 2023 Dec;33(12):8645-8655. doi: 10.1007/s00330-023-09969-3. Epub 2023 Jul 27.
To compare sacroiliac joint (SIJ) lesions on MRI in women with versus without axial spondyloarthritis (ax-SpA) and establish an algorithm to determine whether such lesions are due to ax-SpA.
This retrospective comparative study assessed bone marrow edema (BME), sclerosis, erosions, osteophytes, and ankylosis at the SIJ in two groups of women, one with and another without ax-SpA. Sensitivity and specificity were calculated for combinations/characteristics of lesions, using rheumatologists' assessment with assessment of spondyloarthritis international society (ASAS) criteria as the gold standard for diagnosis of ax-SpA.
Compared to women without ax-SpA, women with ax-SpA had more BME (61% vs 17%, p < 0.001), sclerosis (40% vs 22%, p < 0.001), erosions (35% vs 5%, p < 0.001), and ankylosis (2% vs 0%, p = 0.007), but less osteophytes (5% vs 33%, p < 0.001). The ASAS MRI criteria yielded 59% sensitivity and 88% specificity, while a new algorithm achieved 56% sensitivity and 95% specificity using the following criteria: no osteophytes at the SIJ and either (i) BME at the SIJ with at least one dimension ≥ 8 mm or (ii) at least one erosion at the SIJ.
We recommend the following pragmatic algorithm for MRI diagnosis of ax-SpA in women: no osteophytes at the SIJ and either (i) BME at the SIJ with at least one dimension ≥ 8 mm or (ii) at least one erosion at the SIJ. The false positive rate when using the new algorithm (3.3%) is less than half than when using the ASAS MRI criteria (7.7%); thus, its application in clinical practice could reduce overdiagnosis and prevent overtreatment of ax-SpA.
The developed algorithm has a false-positive rate that is less than half than when using the ASAS MRI criteria (3.3% vs 7.7%), thus its application in clinical practice could reduce overdiagnosis and prevent overtreatment of axial spondyloarthritis.
• Compared to women without axial spondyloarthritis (ax-SpA), women with ax-SpA had a significantly higher prevalence of bone marrow edema (BME), sclerosis, erosions, and ankylosis, but a significantly lower prevalence of osteophytes. • A new algorithm for positive ax-SpA based on sacroiliac joint MRI was developed: no osteophytes at the sacroiliac joint (SIJ) and either (i) BME at the SIJ with at least one dimension ≥ 8 mm or (ii) at least one erosion at the SIJ. • We recommend this new algorithm for diagnosis of ax-SpA in women, as it has a significantly better specificity than the assessment of spondyloarthritis international society (ASAS) MRI criteria and less than half the false positive rate; thus, its application in clinical practice could reduce overdiagnosis and prevent overtreatment of ax-SpA.
比较有与没有轴性脊柱关节炎（ax-SpA）的女性骶髂关节（SIJ）在MRI上的病变情况，并建立一种算法以确定此类病变是否由ax-SpA所致。
这项回顾性比较研究评估了两组女性SIJ处的骨髓水肿（BME）、骨质硬化、侵蚀、骨赘和关节强直情况，一组患有ax-SpA，另一组未患。以风湿病学家依据脊柱关节炎国际协会（ASAS）标准进行的评估作为诊断ax-SpA的金标准，计算病变组合/特征的敏感性和特异性。
与没有ax-SpA的女性相比，患有ax-SpA的女性有更多的BME（61%对17%，p＜0.001）、骨质硬化（40%对22%，p＜0.001）、侵蚀（35%对5%，p＜0.001）和关节强直（2%对0%，p = 0.007），但骨赘较少（5%对33%，p＜0.001）。ASAS MRI标准的敏感性为59%，特异性为88%，而一种新算法使用以下标准时敏感性为56%，特异性为95%：SIJ处无骨赘且要么（i）SIJ处BME至少有一个维度≥8 mm，要么（ii）SIJ处至少有一处侵蚀。
我们推荐以下用于女性ax-SpA的MRI诊断实用算法：SIJ处无骨赘且要么（i）SIJ处BME至少有一个维度≥8 mm，要么（ii）SIJ处至少有一处侵蚀。使用新算法时的假阳性率（3.3%）不到使用ASAS MRI标准时（7.7%）的一半；因此，其在临床实践中的应用可减少ax-SpA的过度诊断并避免过度治疗。
所开发的算法假阳性率不到使用ASAS MRI标准时的一半（3.3%对7.7%），因此其在临床实践中的应用可减少轴性脊柱关节炎的过度诊断并避免过度治疗。
• 与没有轴性脊柱关节炎（ax-SpA）的女性相比，患有ax-SpA的女性骨髓水肿（BME）、骨质硬化、侵蚀和关节强直的患病率显著更高，但骨赘的患病率显著更低。• 基于骶髂关节MRI制定了一种新的ax-SpA阳性诊断算法：骶髂关节（SIJ）处无骨赘且要么（i）SIJ处BME至少有一个维度≥8 mm，要么（ii）SIJ处至少有一处侵蚀。• 我们推荐这种用于女性ax-SpA诊断的新算法，因为它的特异性明显优于脊柱关节炎国际协会（ASAS）MRI标准，且假阳性率不到其一半；因此，其在临床实践中的应用可减少ax-SpA的过度诊断并避免过度治疗。
