使用定量成像生物标志物测量中轴型脊柱关节炎的治疗反应：一项前瞻性观察队列研究。
Measuring response to treatment in axial spondyloarthritis using quantitative imaging biomarkers: a prospective observational cohort study.
机构信息
Department of Rheumatology, University College London Hospitals NHS Foundation Trust, London, UK.
Centre for Medical Imaging, University College London, London, UK.
出版信息
Br J Radiol. 2023 Dec;96(1152):20220530. doi: 10.1259/bjr.20220530. Epub 2023 Oct 25.
OBJECTIVE
Objective assessments of disease activity and response to treatment in axial spondyloarthritis (axSpA) remain a challenge; quantitative imaging biomarkers (QIBs) of inflammation could enhance assessments of disease activity and therapeutic response. We aimed to determine the responsiveness of QIBs obtained from diffusion-weighted imaging (DW-MRI) and chemical shift-encoded MRI (CSE-MRI) using the partially automated Bone Edema and Adiposity Characterisation with Histograms (BEACH) software tool in axSpA patients undergoing biologic therapy.
METHODS
We conducted a prospective longitudinal cohort study, including 30 patients with axSpA undergoing biologic therapy. Patients were scanned before and after biologic therapy using conventional MRI, DWI and CSE-MRI at 3T. Apparent diffusion coefficient (ADC) and proton density fat fraction (PDFF) were assessed using the BEACH tool (https://github.com/TJPBray/BEACH), and conventional MR images were assessed using established visual scoring methods by expert radiologists. Responsiveness - the ability of the MRI measurements to capture changes in disease occurring as a result of biologic therapy - was assessed using the standardized response mean (SRM). Inter-reader reliability of the ADC and PDFF maps was assessed using Bland-Altman limits of agreement analysis and the intraclass correlation coefficient.
RESULTS
Responsiveness to therapy was moderate for ADC-based parameters (SRM 0.50) and comparable to established visual scoring methods for bone marrow oedema (SRM 0.53). Interobserver variability was lower for QIBs compared with conventional visual scores methods.
CONCLUSIONS
QIBs measured using the BEACH tool are sensitive to changes in inflammation in axSpA following biologic therapy, with similar responsiveness and lower interobserver variability to visual scoring by expert radiologists.
ADVANCES IN KNOWLEDGE
QIBs measured using the partially automated BEACH tool offer an objective measure of response to biologic therapy in axSpA.
目的
在中轴型脊柱关节炎（axSpA）中，疾病活动度和治疗反应的客观评估仍然具有挑战性；炎症的定量成像生物标志物（QIBs）可以增强对疾病活动度和治疗反应的评估。我们旨在确定在接受生物治疗的 axSpA 患者中，使用部分自动化的骨水肿和脂肪特征直方图（BEACH）软件工具从扩散加权成像（DWI）和化学位移编码 MRI（CSE-MRI）获得的 QIBs 的反应性。
方法
我们进行了一项前瞻性纵向队列研究，纳入 30 名接受生物治疗的 axSpA 患者。患者在接受生物治疗前后在 3T 上进行常规 MRI、DWI 和 CSE-MRI 扫描。使用 BEACH 工具（https://github.com/TJPBray/BEACH）评估表观扩散系数（ADC）和质子密度脂肪分数（PDFF），并由专家放射科医生使用既定的视觉评分方法评估常规 MR 图像。使用标准化反应均值（SRM）评估 MRI 测量值捕捉生物治疗引起的疾病变化的能力-即反应性。使用 Bland-Altman 协议界限分析和组内相关系数评估 ADC 和 PDFF 图的读者间可靠性。
结果
基于 ADC 的参数的治疗反应性为中度（SRM 0.50），与骨髓水肿的既定视觉评分方法相当（SRM 0.53）。与传统的视觉评分方法相比，QIBs 的观察者间变异性较低。
结论
使用 BEACH 工具测量的 QIBs 对 axSpA 中生物治疗后炎症的变化敏感，与专家放射科医生的视觉评分具有相似的反应性和较低的观察者间变异性。
知识进步
使用部分自动化的 BEACH 工具测量的 QIBs 为 axSpA 对生物治疗的反应提供了客观的衡量标准。
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