Data-driven definitions for active and structural MRI lesions in the sacroiliac joint in spondyloarthritis and their predictive utility

Lara D. Veeken, vol. 60, pp. 4778–4789

Abstract

OBJECTIVES: To determine quantitative SI joint MRI lesion cut-offs that optimally define a positive MRI for inflammatory and structural lesions typical of axial SpA (axSpA) and that predict clinical diagnosis. METHODS: The Assessment of SpondyloArthritis international Society (ASAS) MRI group assessed MRIs from the ASAS Classification Cohort in two reading exercises where (A) 169 cases and 7 central readers; (B) 107 cases and 8 central readers. We calculated sensitivity/specificity for the number of SI joint quadrants or slices with bone marrow oedema (BME), erosion, fat lesion, where a majority of central readers had high confidence there was a definite active or structural lesion. Cut-offs with ≥95% specificity were analysed for their predictive utility for follow-up rheumatologist diagnosis of axSpA by calculating positive/negative predictive values (PPVs/NPVs) and selecting cut-offs with PPV ≥ 95%. RESULTS: Active or structural lesions typical of axSpA on MRI had PPVs ≥ 95% for clinical diagnosis of axSpA. Cut-offs that best reflected a definite active lesion typical of axSpA were either ≥4 SI joint quadrants with BME at any location or at the same location in ≥3 consecutive slices. For definite structural lesion, the optimal cut-offs were any one of ≥3 SI joint quadrants with erosion or ≥5 with fat lesions, erosion at the same location for ≥2 consecutive slices, fat lesions at the same location for ≥3 consecutive slices, or presence of a deep (i.e. >1 cm depth) fat lesion. CONCLUSION: We propose cut-offs for definite active and structural lesions typical of axSpA that have high PPVs for a long-term clinical diagnosis of axSpA for application in disease classification and clinical research.

Authors 15

1. Walter P. Maksymowych corresponding

   University of Alberta

   Affiliation as printed

   CARE Arthritis

   Department of Medicine, University of Alberta, Edmonton

2. Robert George William Lambert

   University of Alberta

   Affiliation as printed

   Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Canada

   Medical Imaging Consultants, Edmonton, Canada

3. Xenofon Baraliakos

   Rheumazentrum Ruhrgebiet · Ruhr University Bochum

   Affiliation as printed

   Rheumazentrum Ruhrgebiet Herne, Ruhr-University, Bochum, Germany

4. Ulrich Weber

   University of Southern Denmark · Sygehus Sønderjylland

   Affiliation as printed

   Department of Regional Health Research, University of Southern Denmark, Odense, Denmark

   Department of Rheumatology, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg

5. Pedro Machado

   University College London Hospitals NHS Foundation Trust · London North West Healthcare NHS Trust · Northwick Park Hospital · University College London

   Affiliation as printed

   Centre for Rheumatology and MRC Centre for Neuromuscular Diseases, University College London, London, UK

   Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust

   Department of Rheumatology, University College London Hospitals NHS Foundation Trust

6. Susanne Juhl Pedersen

   Glostrup Hospital · Rigshospitalet

   Affiliation as printed

   Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Copenhagen, Denmark

7. Manouk de Hooge

   Ghent University Hospital · Ghent University · VIB-UGent Center for Inflammation Research

   Affiliation as printed

   Rheumatology Department, Ghent University Hospital, Ghent, Belgium

   VIB Inflammation Research Center, Ghent University

8. Joachim Sieper

   German Rheumatism Research Centre · Charité - Universitätsmedizin Berlin

   Affiliation as printed

   Department of Rheumatology, Charité – Universitätsmedizin Berlin and German Rheumatism Research Centre, Berlin

9. Stephanie A. Wichuk

   University of Alberta

   Affiliation as printed

   Department of Medicine, University of Alberta, Edmonton

10. Denis Poddubnyy

    German Rheumatism Research Centre · Charité - Universitätsmedizin Berlin

    Affiliation as printed

    Department of Rheumatology, Charité – Universitätsmedizin Berlin and German Rheumatism Research Centre, Berlin

11. Martín Rudwaleit

    Klinikum Bielefeld · Charité - Universitätsmedizin Berlin

    Affiliation as printed

    Department of Rheumatology, Charité – Universitätsmedizin Berlin, Berlin, Germany

    Klinikum Bielefeld, Bielefeld

12. Désirée M F M van der Heijde Aachen

    Leiden University · Leiden University Medical Center

    Affiliation as printed

    Leiden University Medical Centre, Leiden

13. Robert Landewé

    Amsterdam UMC Location University of Amsterdam · Atrium Medisch Centrum Parkstad · University of Amsterdam

    Affiliation as printed

    Atrium Medical Center, Heerlen, the Netherlands

    Department of Rheumatology, Academic Medical Center, University of Amsterdam, Amsterdam

14. Iris Eshed

    Tel Aviv University · Sheba Medical Center

    Affiliation as printed

    Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel

15. Mikkel Østergaard

    University of Copenhagen · Glostrup Hospital · Rigshospitalet

    Affiliation as printed

    Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Copenhagen, Denmark

    Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark