| 1. Taurog JD, Chhabra A, Colbert RA. Ankylosing Spondylitis and Axial Spondyloarthritis. N Engl J Med 2016;374:2563-74. |
Review/Other-Dx |
N/A |
To enhance awareness and understanding of axial spondyloarthritis and ankylosing spondylitis — and the relationship between the two — in order to facilitate prompt and accurate diagnosis and proper treatment. |
No results stated in abstract. |
4 |
| 2. Reveille JD, Witter JP, Weisman MH. Prevalence of axial spondylarthritis in the United States: estimates from a cross-sectional survey. Arthritis Care Res (Hoboken) 2012;64:905-10. |
Review/Other-Dx |
Representative sample of 5,013 |
To provide contemporary US national prevalence estimates for SpA using the Amor and ESSG classification criteria. |
The overall age-adjusted prevalence of definite and probable SpA by the Amor criteria was 0.9% (95% confidence interval [95% CI] 0.7–1.1%), corresponding to an estimated 1.7 million persons (95% CI 1.4–2.1 million persons). The age-adjusted prevalence of SpA by the ESSG criteria was 1.4% (95% CI 1.0–1.9%), corresponding to an estimated 2.7 million persons (95% CI 1.9–3.7 million persons). There were no statistically significant sex differences in SpA prevalence. The SpA prevalence among non-Hispanic white persons was 1.0% (95% CI 0.7–1.5%) by the Amor criteria and 1.5% (95% CI 1.0–2.3%) by the ESSG criteria. |
4 |
| 3. Sieper J, Poddubnyy D. Axial spondyloarthritis. [Review]. Lancet. 390(10089):73-84, 2017 07 01. |
Review/Other-Dx |
N/A |
To provide an overview of axial spondyloarthritis.Axial spondyloarthritis |
No results stated in abstract. |
4 |
| 4. Sieper J, van der Heijde D, Landewe R, et al. New criteria for inflammatory back pain in patients with chronic back pain: a real patient exercise by experts from the Assessment of SpondyloArthritis international Society (ASAS). Ann Rheum Dis. 2009;68(6):784-788. |
Observational-Dx |
20 patients |
To discuss a new approach for the development of IBP classification criteria. |
5 parameters best explained IBP according to the experts. These were: (1) improvement with exercise (OR 23.1); (2) pain at night (OR 20.4); (3) insidious onset (OR 12.7); (4) age at onset <40 years (OR 9.9); and (5) no improvement with rest (OR 7.7). If at least 4 out of these 5 parameters were fulfilled, the criteria had a sensitivity of 77.0% and specificity of 91.7% in the patients participating in the workshop, and 79.6% and 72.4%, respectively, in the validation cohort. |
2 |
| 5. Weisman MH, Witter JP, Reveille JD. The prevalence of inflammatory back pain: population-based estimates from the US National Health and Nutrition Examination Survey, 2009-10. Ann Rheum Dis 2013;72:369-73. |
Review/Other-Dx |
5103 patients |
To estimate the current US inflammatory back pain (IBP) prevalence using four published case definitions. |
Age-adjusted US prevalence of IBP by Calin criteria was 5.0% (95% CI 4.2% to 5.8%). Prevalence of IBP was 5.6% (95% CI 4.7% to 6.5%) by ESSG criteria, and 5.8% (95% CI 5.2% to 6.4%) and 6.0% (95% CI 4.9% to 7.1%) by Berlin Criteria 8a and 7b, respectively. IBP prevalence did not differ significantly by age groups or between men and women. IBP prevalence was significantly lower among non-Hispanic black persons compared with non-Hispanic white persons for the Calin and ESSG IBP criteria. For the ESSG and Berlin 7b criteria, non-Hispanic white persons had significantly higher IBP prevalences compared with Mexican Americans. |
4 |
| 6. Underwood MR, Dawes P. Inflammatory back pain in primary care. Br J Rheumatol. 1995;34(11):1074-1077. |
Review/Other-Dx |
313 patients |
To review IBP in primary care in patients. |
313 back pain sufferers completed a screening questionnaire for IBP. This was positive in 46 (15%), who were invited for a further examination. Only 2 of these patients had definite AS. 18 of them (39%) had other features associated with spondyloarthropathy. It is suggested that up to 5% of back pain sufferers may have a mild form of AS that may never progress to definite ankylosis, but for whom treatment as if they had AS may be of benefit. |
4 |
| 7. Masson Behar V, Dougados M, Etcheto A, et al. Diagnostic delay in axial spondyloarthritis: A cross-sectional study of 432 patients. Joint Bone Spine. 84(4):467-471, 2017 Jul. |
Review/Other-Dx |
432 patients were analyzed |
To quantify the diagnostic delay in patients with axSpA in France and to explore its associated factors. |
The mean age at diagnosis was 34.2 (standard deviation, 12.5) years, the mean disease duration at the time of the assessment was 11.4 (10.4) years. In all, 66.7% were HLA B27 positive, and 70.2% had radiographic sacroiliitis. The mean diagnostic delay was 4.9 (6.3) years, with a median of 2.0 years (interquartile range, 1–7; range: 0–43). In multivariable analysis, factors independently associated with a longer diagnostic delay were: higher age at diagnosis (beta = 0.13; P < 0.001), less frequent peripheral arthritis or dactylitis (beta = -1.69; P = 0.005), and more frequent entheseal pain (beta = 1.46; P = 0.015). |
4 |
| 8. Jadon DR, Sengupta R, Nightingale A, et al. Axial Disease in Psoriatic Arthritis study: defining the clinical and radiographic phenotype of psoriatic spondyloarthritis. Annals of the Rheumatic Diseases. 76(4):701-707, 2017 04. |
Review/Other-Dx |
402 cases |
To compare the prevalence, clinical and radiographic characteristics of psoriatic spondyloarthritis (PsSpA) in psoriatic arthritis (PsA), with ankylosing spondylitis (AS). |
A significant proportion of patients with radiographic axial disease had PsSpA (118/275; 42.91%), and often had symptomatically silent axial disease (30/118; 25.42%). Modified New York criteria for AS were fulfilled by 48/201 (23.88%) PsA cases, and Classification of Psoriatic Arthritis criteria by 49/201 (24.38%) AS cases. pPsA compared with PsSpA cases had a lower frequency of HLA-B*27 (OR 0.12; 95% CI 0.05 to 0.25). Disease activity, metrology and disability were comparable in PsSpA and AS. A significant proportion of PsSpA cases had spondylitis without sacroiliitis (39/118; 33.05%); they less frequently carried HLA-B*27 (OR 0.11; 95% CI 0.04 to 0.33). Sacroiliac joint complete ankylosis (adjusted OR, ORadj 2.96; 95% CI 1.42 to 6.15) and bridging syndesmophytes (ORadj 2.78; 95% CI 1.49 to 5.18) were more likely in AS than PsSpA. Radiographic axial disease was more severe in AS than PsSpA (Psoriatic Arthritis Spondylitis Radiology Index Score: adjusted incidence risk ratio 1.13; 95% CI 1.09 to 1.19). |
4 |
| 9. Baraliakos X, Hermann KG, Landewe R, et al. Assessment of acute spinal inflammation in patients with ankylosing spondylitis by magnetic resonance imaging: a comparison between contrast enhanced T1 and short tau inversion recovery (STIR) sequences. Ann Rheum Dis. 2005;64(8):1141-1144. |
Observational-Dx |
38 patients |
To compare the performance of 2 different MRI sequences-T1-weighted, fat saturated, spin echo after application of contrast medium, and STIR sequences-to detect spinal inflammation in patients with AS. |
Intraclass correlation coefficients were excellent 0.91 and 0.86 for the Gd-DTPA and STIR sequences, respectively. The overall correlation of the single MRI scores for both sequences was also good (r = 0.84, P=0.01). The intrarater variance was 6.71 and 9.41 and the interrater variance was 13.16 and 19.04 for the Gd-DTPA and STIR sequences, respectively. The smallest detectable distance was 4.7 and 5.6 for the Gd-DTPA and STIR sequences, respectively. The concordance rate for both sequences was 83.5% (range 80.5%–87.7% in the 3 spinal segments). Inflammatory spinal lesions were found in 10.1% of the vertebral units in the STIR sequence but not in the T1/Gd-DTPA sequence, while the T1/Gd-DTPA sequence showed inflammatory lesions in 6.4% of the vertebral units that were found normal by STIR. |
2 |
| 10. Bennett AN, Rehman A, Hensor EM, Marzo-Ortega H, Emery P, McGonagle D. Evaluation of the diagnostic utility of spinal magnetic resonance imaging in axial spondylarthritis. Arthritis Rheum. 2009;60(5):1331-1341. |
Observational-Dx |
174 patients; 11 controls |
To compare MRI patterns of disease in active SpA, degenerative arthritis, and malignancy. |
The physician diagnosis was SpA in 64 subjects, degenerative arthritis in 45 subjects, malignancy in 45 subjects, other diagnoses in 20 subjects, and normal in 11 subjects. There was 72% agreement between the imaging diagnosis and physician diagnosis. End-plate edema, degenerative discs, and Romanus lesions were frequently observed in patients with any of the 3 major diagnoses. Single Romanus lesions were of low diagnostic utility for SpA, but =3 Romanus lesions (LR 12.4) and severe Romanus lesions (LR infinite) in younger subjects were highly diagnostic of SpA. Posterior element BMO lesions of mild or moderate grade were also highly diagnostic of SpA (LR 14.5). The most common diagnostic confusion was between SpA and degenerative arthritis, since both had Romanus lesions present and the presence/absence of degenerative discs did not change the diagnostic assessment. |
2 |
| 11. Bennett AN, Rehman A, Hensor EM, Marzo-Ortega H, Emery P, McGonagle D. The fatty Romanus lesion: a non-inflammatory spinal MRI lesion specific for axial spondyloarthropathy. Ann Rheum Dis. 2010;69(5):891-894. |
Observational-Dx |
174 patients with back pain and 11 controls |
To assess the diagnostic utility of fatty Romanus lesions for SpA in a population with chronic back pain. |
29 patients had fatty Romanus lesions: 31% (20/64) of patients with spondyloarthropathy, 13% (6/45) with degenerative arthritis, 4% (2/45) with spinal malignancy, 5% (1/20) with ‘other’ diagnoses; none of 11 normal subjects had fatty Romanus lesions. The majority of the fatty Romanus lesions in SpA 60% (135/226) were present in the thoracic spine. The diagnostic utility of fatty Romanus lesions for SpA (LR = 4.7) was significantly (P<0.05) greater than for other diagnoses and increased further (LR = 12.6, P<0.05) when more than 5 fatty Romanus lesions were present. Of note 5/20 (25%) patients with SpA with fatty Romanus lesions had no diagnostic bone-oedema lesions on fat-suppressed MRI, suggesting that fatty Romanus lesions may be useful diagnostically in axial-SpA. |
3 |
| 12. Kim NR, Choi JY, Hong SH, et al. "MR corner sign": value for predicting presence of ankylosing spondylitis. AJR Am J Roentgenol 2008;191:124-8. |
Observational-Dx |
52 patients with ankylosing spondylitis and 52 age- and sex-matched control subjects. |
To evaluate the MRI features of the "MR corner sign" and to determine its diagnostic usefulness in ankylosing spondylitis. |
The MR corner sign was defined as a triangular and sharply marginated corner abnormality in a vertebral body unassociated with osteophytes or Schmorl's node. MR corner lesions were significantly more common in the ankylosing spondylitis group than in the control group (Fisher's exact test, p < 0.001). The sensitivity, specificity, and positive and negative predictive values of the MR corner sign were 44%, 96%, 92%, and 63%, respectively. The most frequent feature of signal intensity was a Modic type II change (77%). In patients with ankylosing spondylitis, the MR corner sign was fre quently seen at the thoracolumbar junction, whereas degenerative corner lesions were commonly seen in the lower lumbar spine. |
3 |
| 13. Weber U, Hodler J, Jurik AG, et al. Assessment of active spinal inflammatory changes in patients with axial spondyloarthritis: validation of whole body MRI against conventional MRI. Ann Rheum Dis 2010;69:648-53. |
Observational-Dx |
32 patients |
To evaluate the performance of whole body (WB) MRI versus conventional (CON) MRI in assessing active inflammatory lesions of the entire spine in patients with established and clinically active axial spondyloarthritis (SpA) using the Spondyloarthritis Research Consortium of Canada (SPARCC) MRI index. |
The median percentage of inflammatory lesions recorded concordantly for both WB MRI and CON MRI ranged from 83% to 91% for the three readers; 4-9% were only recorded by WB MRI and 4-9% were recorded by CON MRI only. The Pearson correlation coefficients between WB and CON MRI per rater were 0.79, 0.89 and 0.81, respectively. The ICC(2, 1) were 0.75, 0.80 and 0.68 for CON MRI and 0.82, 0.83 and 0.93 for WB MRI for the three possible reader pairs. |
2 |
| 14. Jacobson JA, Roberts CC, Bencardino JT, et al. ACR Appropriateness Criteria® Chronic Extremity Joint Pain-Suspected Inflammatory Arthritis. J Am Coll Radiol 2017;14:S81-S89. |
Review/Other-Dx |
N/A |
Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for chronic extremity joint pain. |
No results stated in abstract. |
4 |
| 15. van der Linden S, Valkenburg HA, Cats A. Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum. 1984;27(4):361-368. |
Review/Other-Dx |
N/A |
To evaluate the New York and the Rome diagnostic criteria for AS and the clinical history screening test for AS. |
The New York criterion of pain in the (dorso) lumbar spine lacks specificity, and the chest expansion criterion is too insensitive. The Rome criterion of low back pain for more than 3 months is very useful. Our study showed the clinical history screening test for AS to be moderately sensitive, but it might be better in clinical practice. As a modification of the New York criteria, substitution of the Rome pain criterion for the New York pain criterion is proposed. |
4 |
| 16. Mau W, Zeidler H, Mau R, et al. Clinical features and prognosis of patients with possible ankylosing spondylitis. Results of a 10-year followup. J Rheumatol 1988;15:1109-14. |
Review/Other-Dx |
88 patients |
To report the prognosis of patients with possible ankylosing spondylitis. |
After 5 years' followup, 24, and after 10 years 32 patients (59% of the 54 finally available, 36% of the 88 original patients) had definite AS. In 12 individuals, AS could be excluded. Of the 10 remaining patients, 6 still had possible, and 4 had undifferentiated spondyloarthropathy. A comparison between HLA-B27 positive and negative patients showed a significantly increased frequency of definite AS or possible and undifferentiated spondyloarthropathy (p less than 0.05) in the group of HLA-B27 positive patients. |
4 |
| 17. Rudwaleit M, Landewe R, van der Heijde D, et al. The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part I): classification of paper patients by expert opinion including uncertainty appraisal. Ann Rheum Dis. 2009;68(6):770-776. |
Observational-Dx |
71 patients |
To develop candidate classification criteria for axial SpA that includes patients with but also without radiographic sacroiliitis. |
Active sacroiliitis on MRI (OR 45, 95% CI, 5.3 to 383; P<0.001) was strongly associated with the classification of axial SpA. The knowledge of MRI findings led to a change in the classification of 21.1% of patients. According to the first set of candidate criteria (sensitivity 97.1%; specificity 94.7%) a patient with chronic back pain is classified as axial SpA in the presence of sacroiliitis by MRI or x-rays in conjunction with 1 SpA feature or, if sacroiliitis is absent, in the presence of at least 3 SpA features. In a second set of candidate criteria, IBP is obligatory in the clinical arm (sensitivity 86.1%; specificity 94.7%). |
3 |
| 18. Khan MA, van der Linden SM, Kushner I, Valkenburg HA, Cats A. Spondylitic disease without radiologic evidence of sacroiliitis in relatives of HLA-B27 positive ankylosing spondylitis patients. Arthritis Rheum 1985;28:40-3. |
Review/Other-Dx |
201 relatives |
To report 2 independently-conducted family studies of HLA-B27 positive probands with ankylosing spondylitis (AS |
In the Cleveland study of 100 relatives of 30 B27 positive AS probands, 9 relatives did not show radiologic abnormalities of the sacroiliac joints or the spine but had symptoms of chronic inflammatory back pain previously reported to be characteristic of AS. These 9 relatives were all subsequently found to possess B27, in contrast with only 27 of 60 asymptomatic relatives (P < 0.01). In the Leiden study of 101 relatives of 20 randomly chosen B27 positive AS probands, 13 of 86 relatives without radiographic evidence of sacroiliitis reported “thoracic pain and stiffness,” as defined in the Rome criteria for AS. Twelve of these 13 symptomatic relatives were B27 positive. In contrast, among the remaining 73 relatives, only 33 were B27 positive (P < 0.01). |
4 |
| 19. Rudwaleit M, van der Heijde D, Landewe R, et al. The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): validation and final selection. Ann Rheum Dis. 2009;68(6):777-783. |
Observational-Dx |
649 patients from 25 centers |
To validate and refine 2 sets of candidate criteria for the classification/diagnosis of SpA. |
Upon diagnostic workup, axial SpA was diagnosed in 60.2% of the cohort. Of these, 70% did not fulfil modified New York criteria and, therefore, were classified as having “nonradiographic” axial SpA. Refinement of the candidate criteria resulted in new ASAS classification criteria that are defined as: the presence of sacroiliitis by radiography or by MRI plus at least 1 SpA feature (“imaging arm”) or the presence of HLA-B27 plus at least 2 SpA features (“clinical arm”). The sensitivity and specificity of the entire set of the new criteria were 82.9% and 84.4%, and for the imaging arm alone 66.2% and 97.3%, respectively. The specificity of the new criteria was much better than that of the European Spondylarthropathy Study Group criteria modified for MRI (sensitivity 85.1%, specificity 65.1%) and slightly better than that of the modified Amor criteria (sensitivity 82.9%, specificity 77.5%). |
3 |
| 20. Costantino F, Zeboulon N, Said-Nahal R, Breban M. Radiographic sacroiliitis develops predictably over time in a cohort of familial spondyloarthritis followed longitudinally. Rheumatology (Oxford). 56(5):811-817, 2017 05 01. |
Review/Other-Dx |
953 patients |
To investigate factors associated with the presence of radiographic sacroiliitis at baseline and the predictors of progression to AS in a family cohort of SpA. |
Factors independently associated with radiographic sacroiliitis at inclusion were male sex, younger age at disease onset, longer disease duration, inflammatory back pain, uveitis and lack of enthesitis. During the follow-up, 27.3% of the patients with axial SpA developed definite sacroiliitis, whereas there was no progression in patients with peripheral SpA. After 15 years of follow-up, a Kaplan-Meier estimate of the proportion of patients with definite radiographic sacroiliitis reached 68.5%. Factors associated with progression to definite sacroiliitis were a low-grade radiographic sacroiliitis at inclusion, occurrence of buttock pain and the absence of peripheral arthritis during the follow-up period. |
4 |
| 21. Ghosh N, Ruderman EM. Nonradiographic axial spondyloarthritis: clinical and therapeutic relevance. Arthritis Res Ther 2017;19:286. |
Review/Other-Tx |
N/A |
To review various aspects of axial spondyloarthritis, with a strong focus on nr-axSpA and its current classification in the field of rheumatology. |
No results stated in abstract. |
4 |
| 22. Mandl P, Navarro-Compan V, Terslev L, et al. EULAR recommendations for the use of imaging in the diagnosis and management of spondyloarthritis in clinical practice. Ann Rheum Dis 2015;74:1327-39. |
Review/Other-Dx |
N/A |
To formulate key clinical questions relating to the role of imaging in SpA, to identify and critically appraise the available evidence, and to generate recommendations based on both evidence and expert opinion. |
No results stated in abstract. |
4 |
| 23. Poddubnyy D, Sieper J. Similarities and differences between nonradiographic and radiographic axial spondyloarthritis: a clinical, epidemiological and therapeutic assessment. Curr Opin Rheumatol 2014;26:377-83. |
Review/Other-Dx |
N/A |
To summarise recent data on similarities and differences (and their possible explanations) between nonradiographic axial spondyloarthritis and radiographic axial spondyloarthritis (ankylosing spondylitis). |
No results stated in abstract. |
4 |
| 24. Law L, Beckman Rehnman J, Deminger A, Klingberg E, Jacobsson LTH, Forsblad-d'Elia H. Factors related to health-related quality of life in ankylosing spondylitis, overall and stratified by sex. Arthritis Res Ther. 20(1):284, 2018 12 27. |
Observational-Dx |
210 patients |
To assess HRQoL using the Short Form-36 (SF-36) in a cohort of patients with AS compared with controls and to examine associations between SF-36 scores and spinal radiographic changes, physical function, disease activity and demographic data overall and stratified by sex. |
atients with AS scored significantly lower (p < 0.001) compared to controls in all SF-36 domains and component summaries; PCS 42.4 (14.5) in AS versus 52.4 (11.8) in controls and MCS 47.9 (20.0) in AS versus 54.1 (10.1) in controls. Both men and women scored significantly lower in PCS compared with MCS. Multivariable logistic regression analyses revealed that living without a partner (OR 2.38, 95% CI 1.00-5.67), long symptom duration (year in decade OR 1.66, 95% CI 1.16-2.37), higher BASFI (OR 1.98, 95% CI 1.46-2.70) and ASDAS = 2.1 (OR 3.32, 95% CI 1.45-7.62) were associated with worse PCS, while living without a partner (OR 3.04, 95% CI 1.34-6.91), fatigue (visual analogue scale for global fatigue greater than the median (OR 6.36, 95% CI 3.06-13.19) and ASDAS = 2.1 (OR 2.97, 95% CI 1.41-6.25) with worse MCS. |
3 |
| 25. Lopez-Medina C, Garrido-Castro JL, Castro-Jimenez J, et al. Evaluation of quality of life in patients with axial spondyloarthritis and its association with disease activity, functionality, mobility, and structural damage. Clin Rheumatol. 37(6):1581-1588, 2018 Jun. |
Review/Other-Dx |
100 patients |
To evaluate quality of life (QoL) in patients with axial spondyloarthritis (axSpA) and its association with disease activity, functionality, structural damage, and spinal mobility, using patient-reported outcomes. |
Mean ASQoL score in all patients was 4.02 ± 2.81, with statistically significant differences between male and female (3.61 ± 2.80 vs. 4.83 ± 2.70). Patients with high disease activity (measured by the ASAS-endorsed Disease Activity Score, ASDAS > 2.1) showed higher mean score in ASQoL than those with low disease activity (ASDAS = 2.1) (3.21 ± 0.74 vs. 1.43 ± 0.43, p < 0.001). ASQoL presented a significant linear correlation with BASDAI, BASFI, and ASDAS (r > 0.60). However, disease duration was not significantly correlated with ASQoL. Finally, the 68.9% of the ASQoL variability (R2 = 0.689) was determined by BASDAI, BASFI, and mSASSS, presenting mSASSS a negative regression coefficient (- 0.035). |
4 |
| 26. van Lunteren M, Ez-Zaitouni Z, de Koning A, et al. In Early Axial Spondyloarthritis, Increasing Disease Activity Is Associated with Worsening of Health-related Quality of Life over Time. J Rheumatol. 45(6):779-784, 2018 06. |
Observational-Dx |
161 patients |
To assess and quantify the association between change in Ankylosing Spondylitis Disease Activity Score (ASDAS) and HRQOL over time in early axSpA. |
There were 161 patients with axSpA [53% male, mean (± SD) age 29.7 (± 7.5) yrs, symptom duration 13.6 (± 7.2) months, HLA-B27-positive 91%, radiographic sacroiliitis 22%] who had ASDAS of 2.5 (± 1.0) and 2.0 (± 0.8), PCS of 28.4 (± 14.3) and 36.9 (± 13.1), and MCS of 48.2 (± 13.8) and 49.3 (± 12.0) at baseline and 1 year, respectively. Per unit increase in ASDAS between baseline and 1 year, PCS worsened by 9.5 points. |
3 |
| 27. Landewe R, Dougados M, Mielants H, van der Tempel H, van der Heijde D. Physical function in ankylosing spondylitis is independently determined by both disease activity and radiographic damage of the spine. Ann Rheum Dis 2009;68:863-7. |
Review/Other-Dx |
217 patients |
To study the relationship between disease activity, radiographic damage and physical function in patients with ankylosing spondylitis (AS). |
mSASSS correlated moderately well with BASFI (Spearman's r = 0.45) and DFI (r = 0.38). BASDAI correlated well with BASFI (r = 0.66) and DFI (r = 0.59). Correlation coefficients for mSASSS versus BASFI and DFI decreased by increasing levels of BASDAI, being zero at the highest quintile of BASDAI. GEE showed that both BASDAI and mSASSS independently and significantly helped to explain either BASFI or DFI. |
4 |
| 28. Ramiro S, van der Heijde D, van Tubergen A, et al. Higher disease activity leads to more structural damage in the spine in ankylosing spondylitis: 12-year longitudinal data from the OASIS cohort. Ann Rheum Dis 2014;73:1455-61. |
Observational-Dx |
184 patients |
To analyse the long-term relationship between disease activity and radiographic damage in the spine in patients with ankylosing spondylitis (AS). |
Disease activity measures were significantly longitudinally associated with radiographic progression. Neither medication nor the presence of extra-articular manifestations confounded this relationship. The models with ASDAS as disease activity measure fitted the data better than models with BASDAI, CRP or BASDAI+CRP. An increase of one ASDAS unit led to an increase of 0.72 mSASSS units/2 years. A 'very high disease activity state' (ie, ASDAS >3.5) compared with 'inactive disease' (ie, ASDAS <1.3) resulted in an additional 2-year progression of 2.31 mSASSS units. The effect of ASDAS on mSASSS was higher in males versus females (0.98 vs -0.06 mSASSS units per ASDAS unit) and in patients with <18 years vs =18 years symptom duration (0.84 vs 0.16 mSASSS units per ASDAS unit). |
2 |
| 29. van der Heijde D, Braun J, Deodhar A, et al. Modified stoke ankylosing spondylitis spinal score as an outcome measure to assess the impact of treatment on structural progression in ankylosing spondylitis. [Review]. Rheumatology (Oxford). 58(3):388-400, 2019 03 01. |
Review/Other-Dx |
N/A |
To update evidence-based recommendations for the treatment of patients with ankylosing spondylitis (AS) and nonradiographic axial spondyloarthritis (SpA). |
No results stated in abstract. |
4 |
| 30. Ward MM, Deodhar A, Gensler LS, et al. 2019 Update of the American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network Recommendations for the Treatment of Ankylosing Spondylitis and Nonradiographic Axial Spondyloarthritis. Arthritis Care Res (Hoboken). 71(10):1285-1299, 2019 Oct. |
Review/Other-Tx |
N/A |
To update evidence-based recommendations for the treatment of patients with ankylosing spondylitis (AS ) and nonradiographic axial spondyloarthritis (SpA). |
No results stated in abstract. |
4 |
| 31. Campagna R, Pessis E, Feydy A, et al. Fractures of the ankylosed spine: MDCT and MRI with emphasis on individual anatomic spinal structures. AJR Am J Roentgenol. 2009;192(4):987-995. |
Review/Other-Dx |
N/A |
To illustrate the spectrum of MDCT and MRI appearances of spinal fractures in AS and DISH. |
Spinal fractures associated with AS and DISH usually involve the 3 columns of the spine, and injury to the posterior osteoligamentous component is the hallmark of these fractures. Osseous and ligamentous injuries can be accurately visualized and analyzed with MDCT with multiplanar reformation and with MRI. |
4 |
| 32. Rustagi T, Drazin D, Oner C, et al. Fractures in Spinal Ankylosing Disorders: A Narrative Review of Disease and Injury Types, Treatment Techniques, and Outcomes. [Review]. Journal of Orthopaedic Trauma. 31 Suppl 4:S57-S74, 2017 Sep. |
Review/Other-Dx |
21 articles |
To discuss fractures in Spinal ankylosing disorders |
No results stated in abstract. |
4 |
| 33. Westerveld LA, Verlaan JJ, Oner FC. Spinal fractures in patients with ankylosing spinal disorders: a systematic review of the literature on treatment, neurological status and complications. Eur Spine J. 2009;18(2):145-156. |
Review/Other-Dx |
93 articles |
A systematic review aims to increase the knowledge on treatment, neurological status and complications of trauma patients with ankylosed spines (due to AS or DISH) and admitted with spine fractures, by pooling data previously published in the literature. |
93 articles were included, representing 345 AS patients and 55 DISH patients. Most fractures were localized in the cervical spine and resulted from low energy impact. Delayed diagnosis often occurred due to patient and doctor related factors. On admission 67.2% of the AS patients and 40.0% of the DISH patients demonstrated neurologic deficits, while secondary neurological deterioration occurred frequently. Surgical or nonoperative treatment did not alter the neurological prospective for most patients. The complication rate was 51.1% in AS patients and 32.7% in DISH patients. The overall mortality within 3 months after injury was 17.7% in AS and 20.0% in DISH. |
4 |
| 34. Wang YF, Teng MM, Chang CY, Wu HT, Wang ST. Imaging manifestations of spinal fractures in ankylosing spondylitis. AJNR Am J Neuroradiol. 2005;26(8):2067-2076. |
Observational-Dx |
12 cases |
To characterize spinal fractures and determine the value of different imaging modalities in AS. |
Fractures were found in the cervical spine in 3 patients and in the thoracolumbar spine in 9. The 3 columns of the spine were involved in 11 patients. A routine 4-mm axial CT was not enough to demonstrate all fractures and ligament tears. The sensitivities of 3D-CT scans for demonstration of the following problems were similar to that of MRI and were better than that of conventional radiographs: tearing of the posterior longitudinal ligament, the thoracic spinous process fracture, and the facet fracture. MRI depicted these following findings that usually were not shown on conventional radiographs or 3D-CT scans: cord deformity, soft tissue disruption, and ligament tears in the posterior column. MRI also showed avascular necrosis and occult fractures better than conventional radiographs or CT scans. |
3 |
| 35. Caron T, Bransford R, Nguyen Q, Agel J, Chapman J, Bellabarba C. Spine fractures in patients with ankylosing spinal disorders. Spine (Phila Pa 1976). 2010;35(11):E458-464. |
Observational-Dx |
112 patients |
To describe the spine fracture characteristics, current treatments, and their results in patients with ankylosing spinal disorders, such as AS and DISH, with the hypothesis that complication and mortality rates are high. |
Of the 122 spine fractures in 112 consecutive patients with ankylosing spinal disorders, the majority were transdiscal extension injuries, most commonly affecting C6-C7. 81% of the patients had at least 1 major medical comorbidity. Spinal cord injury was present in 58% of the patients, 34% of whom improved by at least 1 American Spinal Injury Association grade. 19% of patients had delayed diagnosis of their spine fracture, 81% of whom had resulting neurologic compromise. Surgery was performed on 67% of patients, consisting primarily of multilevel posterior instrumentation 3 levels above and below the injury. 84% of all patients had at least 1 complication. Mortality was 32% and correlated with age =70 (P<0.0001), number of comorbidities (P<0.0001), and low-energy mechanism of injury (P=0.009). AS patients were younger (P=0.03) and had a higher risk of delayed fracture diagnosis (P=0.012), but were otherwise similar to DISH patients. |
4 |
| 36. Bennett AN, McGonagle D, O'Connor P, et al. Severity of baseline magnetic resonance imaging-evident sacroiliitis and HLA-B27 status in early inflammatory back pain predict radiographically evident ankylosing spondylitis at eight years. Arthritis Rheum. 2008;58(11):3413-3418. |
Observational-Dx |
40 patients |
To investigate what proportion of patients with MRI-evident sacroiliitis develop AS in the long term and whether there are predictors of outcome. |
50 patients were assessed at the beginning of the study, and 40 patients were followed up after a mean of 7.7 years. Of these 40 patients, 58% were HLA-B27 positive, and 98% met the European Spondylarthropathy Study Group criteria. At baseline, 33 (83%) of the 40 patients followed up had MRI-evident sacroiliitis, and 6 (12%) had unequivocal AS according to the modified New York criteria. At follow-up, despite significant improvements in clinical outcomes, 13/39 patients (33.3%) had AS according to the modified New York criteria. The combination of severe sacroiliitis seen on MRI with HLA-B27 positivity was an excellent predictor of future AS (LR 8.0, specificity 92%), while mild or no sacroiliitis, regardless of HLA-B27 status, was a predictor of not having AS (LR 0.4, specificity 38%). |
2 |
| 37. Oostveen J, Prevo R, den Boer J, van de Laar M. Early detection of sacroiliitis on magnetic resonance imaging and subsequent development of sacroiliitis on plain radiography. A prospective, longitudinal study. J Rheumatol 1999;26:1953-8. |
Observational-Dx |
25 patients |
To investigate the diagnostic value of magnetic resonance imaging (MRI) in the detection of early sacroiliitis. |
At study entry > or = grade 2 sacroiliitis was found on MRI in 36 of 50 SI joints. Edema was found in 20 of 50 SI joints. After 3 years > or = grade 2 sacroiliitis was found on PR in 21 of 44 SI joints. The positive predictive value of > or = grade 2 sacroiliitis on MRI for the development of > or = grade 2 sacroiliitis on PR after 3 years was 60%; sensitivity was 85% and specificity 47%. |
2 |
| 38. Sieper J, Rudwaleit M, Baraliakos X, et al. The Assessment of SpondyloArthritis international Society (ASAS) handbook: a guide to assess spondyloarthritis. Ann Rheum Dis. 2009;68 Suppl 2:ii1-44. |
Review/Other-Dx |
N/A |
To provide a comprehensive handbook on the most relevant aspects for the assessments of spondyloarthritis, covering classification criteria, MRI and x-rays for SIJs and the spine, a complete set of all measurements relevant for clinical trials and international recommendations for the management of SpA. |
n/a |
4 |
| 39. Battistone MJ, Manaster BJ, Reda DJ, Clegg DO. Radiographic diagnosis of sacroiliitis--are sacroiliac views really better? J Rheumatol. 1998;25(12):2395-2401. |
Review/Other-Dx |
445 right SIJ and 442 left SIJ |
To determine whether detailed oblique radiographs of the SIJs provide significant diagnostic advantage to a single AP projection of the pelvis in establishing the presence and severity of sacroiliitis. |
Analysis of these data showed an agreement rate between AP views and SI views of 89.7% for the right SIJ radiographs and 86.4% for the left SIJ. There was no instance in which a patient with “unequivocal abnormalities” of the SIJ on the AP pelvis was read as having “normal” SI views. Similarly, there were no cases in which “normal” SIJ on AP pelvis films were read as having unequivocal abnormalities on SI views. |
4 |
| 40. Omar A, Sari I, Bedaiwi M, Salonen D, Haroon N, Inman RD. Analysis of dedicated sacroiliac views to improve reliability of conventional pelvic radiographs. Rheumatology (Oxford). 56(10):1740-1745, 2017 10 01. |
Observational-Dx |
266 radiographs were read from 109 patients |
To compare the antero-posterior (AP) pelvis view with the Ferguson view of the SI joint in order to resolve whether one modality has a clear advantage for grading of sacroiliitis. |
Intra-observer reliability of the observers showed similar ICC scores; this was also reflected in the kappa for diagnosis of AS fulfilling modified NY criteria between the observers. The inter-rater agreement showed similar kappa values between the two modalities. When separately evaluating SI joints with score grading of 0-2, grade 2 showed the lowest kappa, reaching a low of 0.1 and 0.19 for the right SI joint for Ferguson and AP pelvis views, respectively. Both modalities were concordant diagnostically; reclassification from AS to non-AS and vice versa was in the range 5-11%. |
2 |
| 41. Blum U, Buitrago-Tellez C, Mundinger A, et al. Magnetic resonance imaging (MRI) for detection of active sacroiliitis--a prospective study comparing conventional radiography, scintigraphy, and contrast enhanced MRI. J Rheumatol 1996;23:2107-15. |
Observational-Dx |
44 patients and 20 controls. |
To determine the diagnostic value of MRI compared to conventional radiography and scintigraphy in patients with clinical signs of active sacroiliitis. |
MRI was most sensitive (95%) and superior to quantitative SI scintigraphy (48%) or conventional radiography (19%) for the detection and confirmation of active sacroiliitis. For the assessment of inflammatory signs, MRI had higher specificity (100%) than scintigraphy (97%) or plain radiography (47%). |
2 |
| 42. Inanc N, Atagunduz P, Sen F, Biren T, Turoglu HT, Direskeneli H. The investigation of sacroiliitis with different imaging techniques in spondyloarthropathies. Rheumatol Int. 2005;25(8):591-594. |
Observational-Dx |
54 patients |
To compare the value of different imaging techniques in SpA patients with inflammatory low back pain. |
The sensitivities of plain radiography, quantitative SI scintigraphy, and MRI were 61%, 55%, and 89%, respectively, among the patients with SpA. MRI and quantitative SI scintigraphy detected sacroiliitis in 97% and 49% of group A, respectively. In group B, these results were 76% and 66%, respectively. |
2 |
| 43. van Tubergen A, Heuft-Dorenbosch L, Schulpen G, et al. Radiographic assessment of sacroiliitis by radiologists and rheumatologists: does training improve quality? Ann Rheum Dis 2003;62:519-25. |
Observational-Dx |
100 rheumatologists and 23 radiologists participated. |
To assess performance of radiologists and rheumatologists in detecting sacroiliitis. |
Sensitivity (84.3%/79.8%) and specificity (70.6%/74.7%) for radiologists and rheumatologists were comparable. Rheumatologists showed 6.3% decrease in sensitivity after self education (p=0.001), but 3.0% better specificity (p=0.008). The decrease in sensitivity reversed after the workshop. Difference in sensitivity three months after the workshop and baseline was only 0.5%. Sensitivity <50% occurred in 13% of participants. Only a few participants showed changes of >5% in both sensitivity and specificity. Intraobserver agreement for sacroiliitis grade 1 or 2 ranged from 65% to 100%. Sensitivity for CT (86%) was higher than for plain films (72%) (p<0.001) with the same specificity (84%). Confidence ratings for correctly diagnosing presence (7.7) or absence (8.3) of sacroiliitis were somewhat higher than incorrectly diagnosing the presence (6.6) or absence (7.4) of sacroiliitis (p<0.001). |
2 |
| 44. Geijer M, Gothlin GG, Gothlin JH. The clinical utility of computed tomography compared to conventional radiography in diagnosing sacroiliitis. A retrospective study on 910 patients and literature review. J Rheumatol 2007;34:1561-5. |
Observational-Dx |
910 patients |
To assess the utility of CT reports compared to radiography reports in everyday clinical practice in a large number of patients with AS. |
The agreement between radiography and CT data was only fair, with a kappa value of 0.2418. There were 35.0% false-positive radiography reports, 22.5% false-negative radiography reports, and 86.0% false-equivocal radiography reports. In total, 41.3% of all radiological reports gave a false answer. |
3 |
| 45. Diekhoff T, Hermann KG, Greese J, et al. Comparison of MRI with radiography for detecting structural lesions of the sacroiliac joint using CT as standard of reference: results from the SIMACT study. Ann Rheum Dis. 76(9):1502-1508, 2017 09. |
Observational-Dx |
110 patients |
To address the question how the T1-weighted MRI (T1w MRI) sequence compares with radiography for SI joints' structural lesions using low-dose CT as the standard of reference. |
Using low-dose CT as the standard of reference, T1w MRI showed markedly better sensitivity with significantly more correct imaging findings compared with radiography for erosions (79% vs 42%; p=0.002), joint space changes (75% vs 41%; p=0.002) and overall positivity (85% vs 48%; p=0.001), respectively, while there were no differences between X-rays and MRI-T1 sequence regarding specificity (>80% for all scores). Only for sclerosis, MRI-T1 was inferior to radiography (sensitivity 30% vs 70%, respectively), however, not statistically significant (p=0.663). |
2 |
| 46. Christiansen AA, Hendricks O, Kuettel D, et al. Limited Reliability of Radiographic Assessment of Sacroiliac Joints in Patients with Suspected Early Spondyloarthritis. J Rheumatol. 44(1):70-77, 2017 01. |
Observational-Dx |
104 patients |
To determine the reproducibility of evaluation of sacroiliac joint (SIJ) radiographs among readers with varying levels of experience, and to identify potential drivers of disagreement in classification among 5 predefined radiographic lesion types. |
Mean ? values (percent concordance) were 0.39 (84.1%) for mNY classification over 21 reader pairs, 0.46 (79.8%) between 2 musculoskeletal radiologists, and 0.55 (86.5%) and 0.36 (77.9%) between the most experienced rheumatologist and the 2 radiologists. Erosion showed the lowest agreement (25%) among patients with discordant classification and gave the highest OR of 13.5 for disagreement. |
3 |
| 47. Devauchelle-Pensec V, D'Agostino MA, Marion J, et al. Computed tomography scanning facilitates the diagnosis of sacroiliitis in patients with suspected spondylarthritis: results of a prospective multicenter French cohort study. Arthritis Rheum. 2012;64(5):1412-1419. |
Observational-Dx |
489 patients |
To assess the performance of CT scanning for ascertaining sacroiliitis in patients with suspected SpA. |
After training, interreader reliability was moderate for sacroiliitis grading on radiographs (kappa = 0.59), excellent on CT scans (kappa = 0.91), and excellent for ascertaining sacroiliitis on both radiographs (kappa = 1) and CT scans (kappa = 0.96). The first and second readers considered the quality of imaging to be excellent in 66% and 67%, respectively, of the radiographs (kappa = 0.88) and in 93% and 92%, respectively, of the CT scans (kappa = 0.93). Concordance between radiographs and CT scans was low for sacroiliitis grading (kappa = 0.08) or ascertainment (kappa = 0.16). Definite sacroiliitis was ascertained on radiographs in 6 patients (3.5%) (confirmed by CT scans in 4 patients) and on CT scans in 32 patients (18.5%). A history of uveitis was associated with definite sacroiliitis on radiographs (P=0.04) and CT scans (P<0.0001). |
2 |
| 48. Agreement between clinical practice and trained central reading in reading of sacroiliac joints on plain pelvic radiographs. Results from the DESIR cohort. |
Observational-Dx |
688 patients |
To investigate the degree of agreement between local rheumatologists/radiologists and central trained readers (external standard) on the presence/absence of sacroiliitis on radiographs of the sacroiliac (SI) joints. |
Interreader agreement between the central readers was moderate (? = 0.54); 108 of 688 radiographs (15.7%) were adjudicated. According to local reading ("at least unilateral obvious sacroiliitis"), 183 of the 688 patients (26.6%) had sacroiliitis, whereas according to central reading, 145 of 688 patients (21.1%) had sacroiliitis. Agreement between local reading and central reading was also moderate (? = 0.55); 76 of 183 patients (41.5%) with "at least unilateral obvious sacroiliitis" (positive by local reading) and 32 of 109 patients (29.4%) with "bilateral obvious sacroiliitis" or "at least unilateral fusion" (positive by local reading) were rated as "negative" by central reading, and 38 of 505 patients (7.5%) and 68 of 579 patients (11.7%), respectively, without sacroiliitis (negative by local reading) were interpreted as "positive" by central reading. |
2 |
| 49. Tan S, Ward MM. Computed tomography in axial spondyloarthritis. [Review]. Curr Opin Rheumatol. 30(4):334-339, 2018 07. |
Review/Other-Dx |
N/A |
To review new insights to diagnosis and evaluation revealed by the use of CT. |
No results stated in abstract. |
4 |
| 50. Song IH, Brandt H, Rudwaleit M, Sieper J. Limited diagnostic value of unilateral sacroiliitis in scintigraphy in assessing axial spondyloarthritis. J Rheumatol 2010;37:1200-2. |
Observational-Dx |
207 patients |
To assess the diagnostic value for axial spondyloarthritis (SpA) of unilateral sacroiliitis in scintigraphy in daily clinical practice. |
Sensitivities of scintigraphy for any (unilateral or bilateral), bilateral, and isolated unilateral sacroiliitis were 64.9%, 40.2%, and 24.7%, respectively. Respective specificities were 50.5%, 57.7%, and 92.8%, resulting in likelihood ratios of 1.3, 1.0, and 3.4. |
3 |
| 51. Jacobsson H, Larsson SA, Vesterskold L, Lindvall N. The application of single photon emission computed tomography to the diagnosis of ankylosing spondylitis of the spine. Br J Radiol 1984;57:133-40. |
Review/Other-Dx |
3 patients |
To describe the application of bone scintigraphy in the detection and diagnosis of ankylosing spondylitis. |
Sites of increased uptake of 99Tcm-MDP were observed in three of the eleven patients examined so far. By carefully optimising the SPECT system (rotating gamma camera), as well as the examination procedure, with respect to high spatial resolution, it was possible to relate these sites precisely to anatomical sites in sectional images of the spine. The advantages of SPECT are demonstrated in all three cases in which the areas of increased uptake in sagittal and transverse sections can be related to specific anatomical sites of the spine characteristically affected by AS. |
4 |
| 52. Kim YI, Suh M, Kim YK, Lee HY, Shin K. The usefulness of bone SPECT/CT imaging with volume of interest analysis in early axial spondyloarthritis. BMC Musculoskelet Disord 2015;16:9. |
Observational-Dx |
20 patients and 13 controls |
To investigate the usefulness of bone SPECT/CT with volume of interest (VOI) analysis in early axial SpA patients. |
The SIS ratio of early axial SpA patients vs. control subjects was significantly increased in bone SPECT/CT (p < 0.001). However, no significant difference was detected in bone scintigraphy. ROC curve analysis showed a significant difference in the area under curve (AUC) of bone SPECT/CT vs. bone scintigraphy (0.862 vs. 0.523, respectively; p < 0.001). With a cut-off SIS ratio of 1.50, ROC curve analysis showed a sensitivity of 80.0% and specificity of 84.6% in bone SPECT/CT. The SIS ratio measured in SPECT/CT, but not that measured in bone scintigraphy, was significantly increased with a higher grade of SI joint changes in plain radiography (p = 0.014). |
2 |
| 53. Parghane RV, Singh B, Sharma A, Singh H, Singh P, Bhattacharya A. Role of 99mTc-Methylene Diphosphonate SPECT/CT in the Detection of Sacroiliitis in Patients with Spondyloarthropathy: Comparison with Clinical Markers and MRI. J Nucl Med Technol. 45(4):280-284, 2017 Dec. |
Observational-Dx |
155 patients |
To evaluate the role of 99mTc-methylene diphosphonate (99mTc-MDP) SPECT/CT for the detection of sacroiliitis in spondyloarthropathies by comparing it with clinical markers and MRI findings. |
The sensitivity, specificity, accuracy, and positive and negative predictive values of 99mTc-MDP SPECT/CT were 90.0%, 80.0%, 87.0%, 92.0%, and 75.0%, respectively. The accuracy of SPECT/CT (87%) was better than that of ESR (58.1%), CRP (32.9%), BASDAI scoring (77%), and planar bone scintigraphy (53%). Similar results were found for sensitivity and negative predictive value. Regarding specificity, SPECT/CT (80%) was lower than BASDAI scoring (88.6%) and equal to planar bone scintigraphy (80%). Regarding positive predictive value, SPECT/CT (92%) was a bit lower than BASDAI scoring (93.6%). ?-values for planar 99mTc-MDP bone scanning and SPECT/CT were 0.167 and 0.673, respectively, indicating poor agreement for planar bone scanning and good agreement for SPECT/CT. A significant (P < 0.001) correlation (r = 0.659) was observed between SPECT/CT and MRI findings. |
2 |
| 54. Navallas M, Ares J, Beltran B, Lisbona MP, Maymo J, Solano A. Sacroiliitis associated with axial spondyloarthropathy: new concepts and latest trends. Radiographics. 2013;33(4):933-956. |
Review/Other-Dx |
N/A |
To review new concepts and trends of imaging patients with sacroiliitis. |
MR imaging has become an integral part of managing patients with sacroiliitis. MR imaging can serve as a biomarker of disease activity, allows monitoring, and can provide guidance for the treatment of affected patients, and it will likely become even more central to the care of these patients. Familiarity with the anatomy, anatomic variants, and physiologic changes of the sacroiliac joints is important for correctly interpreting findings and avoiding misdiagnosis. |
4 |
| 55. Lee YH, Hwang JY, Lee SW, Lee J. The clinical usefulness of multidetector computed tomography of the sacroiliac joint for evaluating spondyloarthropathies. Korean J Intern Med. 2007;22(3):171-177. |
Observational-Dx |
37 patients |
To investigate the diagnostic value of performing MDCT of the SIJ in the evaluation of AS patients. |
MDCT detected more bilateral sacroiliitis as compared to the plain radiography (86.5% vs 75.7%, respectively), and MDCT yielded a higher grade of disease in 32.4% (right SIJ) and 24.3% (left SIJ) of the patients. More patients satisfied the modified New York criteria with using MDCT as compared with that when using the plain radiography (81.1% vs 54.1%, respectively, P=0.002). |
2 |
| 56. Wu H, Zhang G, Shi L, et al. Axial Spondyloarthritis: Dual-Energy Virtual Noncalcium CT in the Detection of Bone Marrow Edema in the Sacroiliac Joints. Radiology. 290(1):157-164, 2019 01. |
Observational-Dx |
47 patients |
To determine the diagnostic performance of dual-energy virtual noncalcium (VNCa) CT in the detection of bone marrow edema in study participants with sacroiliitis associated with axial spondyloarthritis. |
Sensitivity, specificity, and accuracy of readers 1 and 2, respectively, in the identification of bone edema at CT were 87% and 93% (48 and 51 of 55), 94% and 91% (32 and 31 of 34), and 90% and 92% (80 and 82 of 89). Interobserver agreement was excellent (? = 0.81). CT numbers from VNCa images increased from no edema to severe edema (P < .001). The area under the receiver operating characteristic curve was 0.93 for reader 1 and 0.91 for reader 2 in differentiation of the presence of bone marrow edema from no edema. A cutoff value of -33 HU derived from reader 1 yielded overall sensitivity, specificity, and accuracy of 90% (49 of 55), 83% (28 of 34), and 87% (77 of 89) in the detection of any extent of edema in the sacroiliac joints. |
1 |
| 57. Zhang P, Yu KH, Guo RM, et al. Comparing the diagnostic utility of sacroiliac spectral CT and MRI in axial spondyloarthritis. British Journal of Radiology. 89(1059):20150196, 2016. |
Observational-Dx |
137 patients |
To compare the clinical value of sacroiliac spectral CT and MRI in diagnosing axial spondyloarthritis (SpA). |
Spectral CT is comparable with MRI for the detection of bone marrow oedema, and it is superior to MRI for detection of osseous sclerosis and erosions. MRI is superior to spectral CT in detecting enthesitis and synovitis. There were statistically significant differences in STIR signal intensity, water concentration and calcium concentration ratios as well as CT values between nLBP and patients with axial SpA (p < 0.05) in the ilium. There was a statistically significant but weak correlation between ratios of water concentration and STIR signal intensity in both the ilium and sacrum (p < 0.05). Overall, the iliac water concentration was most sensitive for detection of patients with SpA. The positive likelihood ratio of the STIR signal intensity ratio was the highest. The diagnostic odds ratio of the calcium concentration ratio was the highest, and its negative likelihood ratio was the lowest. |
3 |
| 58. de Koning A, de Bruin F, van den Berg R, et al. Low-dose CT detects more progression of bone formation in comparison to conventional radiography in patients with ankylosing spondylitis: results from the SIAS cohort. Ann Rheum Dis. 77(2):293-299, 2018 02. |
Observational-Dx |
87 patients |
To compare the CT Syndesmophyte Score (CTSS) for low-dose CT (ldCT) with the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS) for conventional radiographs (CR) in patients with ankylosing spondylitis (AS). |
50 patients were included in the syndesmophyte analysis and 37 in the total score analysis. Mean (SD) status scores for mSASSS (range 0–72) and CTSS (range 0–552) at baseline were 17.9 (13.8) and 161.6 (126.6), and mean progression was 2.4 (3.8) and 17.9 (22.1). Three times as many patients showed new or growing syndesmophytes at =3 quadrants on ldCT compared with =3 corners on CR for individual readers; for consensus this increased to five times. In 50 patients, 36 new or growing syndesmophytes are seen on CR compared with 151 on ldCT, most being found in the thoracic spine. |
3 |
| 59. Althoff CE, Sieper J, Song IH, et al. Active inflammation and structural change in early active axial spondyloarthritis as detected by whole-body MRI. Ann Rheum Dis. 2013;72(6):967-973. |
Observational-Dx |
75 patients |
To evaluate active inflammatory lesions and structural changes in patients with active nonradiographic SpA compared with patients with AS on whole-body MRI. |
92% of patients with AS showed active inflammation in the SIJ, 53% in the spine and 94% and 39%, respectively, in the nonradiographic SpA group. There was a nonsignificant trend towards more inflammation in patients with AS compared with patients with nonradiographic SpA in SIJs and spine. Peripheral enthesitis/osteitis was more common in patients with AS (n=22) than in those with nonradiographic SpA (n=12) (P=0.05). Structural changes were more common in patients with AS than in those with nonradiographic SpA, with significantly higher scores for SIJ fatty bone marrow deposition in patients with AS (4.8+/-3.2) compared with those with nonradiographic SpA (2.4+/-2.7; P=0.001) and more frequent bone proliferation in the spine and the SIJ (P=0.02 and P=0.005, respectively). SIJ erosions were more common in AS (score 4.2+/-2.3) than in nonradiographic SpA (score 3.8+/-1.8) patients (not significant). |
4 |
| 60. Ez-Zaitouni Z, Bakker PA, van Lunteren M, et al. The yield of a positive MRI of the spine as imaging criterion in the ASAS classification criteria for axial spondyloarthritis: results from the SPACE and DESIR cohorts. Ann Rheum Dis. 76(10):1731-1736, 2017 Oct. |
Observational-Dx |
541 and 650 patients with CBP from the SPACE and DESIR cohorts were included. |
To assess the prevalence of spinal inflammation on MRI in patients with chronic back pain (CBP) of maximally 3 years duration and to evaluate the yield of adding a positive MRI-spine as imaging criterion to the Assessment of SpondyloArthritis international Society (ASAS) classification criteria for axial spondyloarthritis (axSpA). |
Sacroiliitis on X-SI and MRI-SI was found in 40/541 (7%) and 76/541 (14%) patients in SPACE, and in DESIR in 134/650 (21%) and 231/650 (36%) patients, respectively. In SPACE and DESIR, a positive MRI-spine was seen in 4/541 (1%) and 48/650 (7%) patients. Of the patients without sacroiliitis on imaging, 3/447 (1%) (SPACE) and 8/382 (2%) (DESIR) patients had a positive MRI-spine. Adding positive MRI-spine as imaging criterion led to new classification in only one patient in each cohort, as the other patients already fulfilled the clinical arm. |
4 |
| 61. Larbi A, Fourneret B, Lukas C, et al. Prevalence and topographic distribution of spinal inflammation on MR imaging in patients recently diagnosed with axial spondyloarthritis. Diagn Interv Imaging. 98(4):347-353, 2017 Apr. |
Review/Other-Dx |
112 HLA-B27 positive patients |
To determine the prevalence and topographic distribution of spinal lesions in lower thoracic and lumbar spine on magnetic resonance imaging (MRI) in patients with recently diagnosed with spondyloarthritis. |
Thirty-six patients (32.1%) showed spinal patterns of spondyloarthritis, including 16 patients (14.3%) with no associated inflammatory sacroiliitis. Posterior inflammatory lesions were present in 20.5% of patients. Posterior spinal inflammatory lesions were significantly associated with vertebral corner inflammatory lesions (P = 0.03). |
4 |
| 62. Lorenzin M, Ortolan A, Frallonardo P, et al. Spine and sacroiliac joints on magnetic resonance imaging in patients with early axial spondyloarthritis: prevalence of lesions and association with clinical and disease activity indices from the Italian group of the SPACE study. Reumatismo. 68(2):72-82, 2016 Sep 09. |
Review/Other-Dx |
60 patients |
To determine the prevalence of spine and sacroiliac joint (SIJ) lesions on magnetic resonance imaging (MRI) in patients with early axial spondyloarthritis (axSpA) and their correlation with disease activity indices. |
51.6% of patients showed bone marrow edema (BME) in spine-MRI and 56.7% of patients in SIJ-MRI. Signs of enthesitis were found in 55% of patients in the thoracic district. Of the 55% of patients with BME on spine-MRI, 15% presented presented a negative SIJMRI. There was a significant difference between these cohorts with regard to the prevalence of radiographic sacroiliitis, active sacroiliitis on MRI and SPARCC SIJ score. |
4 |
| 63. Rudwaleit M, Schwarzlose S, Hilgert ES, Listing J, Braun J, Sieper J. MRI in predicting a major clinical response to anti-tumour necrosis factor treatment in ankylosing spondylitis. Ann Rheum Dis. 2008;67(9):1276-1281. |
Observational-Dx |
62 patients |
To evaluate the role of MRI in predicting a Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) improvement of at least 50% (BASDAI 50) upon anti-TNF therapy of active AS. |
The Berlin MRI spine score (OR 1.16, 95% CI, 1.02 to 1.33) and disease duration (OR 0.9, 95% CI, 0.63 to 0.97) were statistically significant predictors of a BASDAI 50 response using regression analysis while there was only a trend for C-reactive protein. The LR for achievement of BASDAI 50 was increased in patients with a Berlin MRI spine score =11 (LR 6.7), disease duration <10 years (LR 4.2) and C-reactive protein =40 mg/L (LR 3.4). All patients with 2 or 3 of these predictors improved clinically (as assessed by BASDAI) by at least 45%. Disease duration >20 years, normal C-reactive protein and no active inflammatory lesion in the spine were highly predictive of not achieving BASDAI 50. A trend was only found for the MRI score of SIJ to be predictive. |
3 |
| 64. Bruijnen ST, van der Weijden MA, Klein JP, et al. Bone formation rather than inflammation reflects ankylosing spondylitis activity on PET-CT: a pilot study. Arthritis Res Ther. 2012;14(2):R71. |
Observational-Dx |
12 patients |
To investigate the potential of PET/CT for imaging AS activity by the investigation of 3 different tracers in a stepwise approach with MRI and conventional radiographs as references for PET/CT data. |
No increased FDG and [11C](R)PK11195 uptake was noticed on PET/CT scans of the first 10 patients. In contrast, MRI demonstrated a total of 5 bone edema lesions in 3 out of 10 patients. In the 2 additional AS patients scanned with 18F-fluoride PET/CT, 18F-fluoride depicted 17 regions with increased uptake in both vertebral column and SIJs. In contrast, FDG depicted only 3 lesions, with an uptake of 5 times lower compared to 18F-fluoride, and again no [11C](R)PK11195 positive lesions were found. In these 2 patients, MRI detected 9 lesions and 6 out of 9 matched with the anatomical position of 18F-fluoride uptake. Conventional radiographs showed structural bony changes in 11 out of 17 18F-fluoride PET positive lesions. |
3 |
| 65. Bruijnen STG, Verweij NJF, van Duivenvoorde LM, et al. Bone formation in ankylosing spondylitis during anti-tumour necrosis factor therapy imaged by 18F-fluoride positron emission tomography. Rheumatology (Oxford). 57(4):631-638, 2018 04 01. |
Observational-Dx |
12 anti-TNF-naïve AS patients |
To assess whether 18F-fluoride uptake in clinically active AS patients is related to focal bone formation in spine biopsies and is sensitive to change during anti-TNF treatment. |
PET-positive lesions were found in the costovertebral joints (43%), facet joints (23%), bridging syndesmophytes (20%) and non-bridging vertebral lesions (14%) and in SI joints (75%). After 12 weeks of anti-TNF treatment, 18F-fluoride uptake in clinical responders decreased significantly in the costovertebral (mean SUVAUC -1.0; P < 0.001) and SI joints (mean SUVAUC -1.2; P = 0.03) in contrast to non-responders. |
1 |
| 66. Idolazzi L, Salgarello M, Gatti D, et al. 18F-fluoride PET/CT for detection of axial involvement in ankylosing spondylitis: correlation with disease activity. Ann Nucl Med. 30(6):430-4, 2016 Jul. |
Observational-Dx |
29 patients |
To evaluate the relationships between the findings of 18F-fluoride PET/CT (F-PET/CT) reflecting osteo-proliferative processes and the clinical indexes related to the disease activity. |
The number of F-PET/CT positive sites was significantly higher in patients with severe functional impairment and higher disease activity and it was positively related to both BASDAI (r = 0.336; P = 0.036) and ASDAS (r = 0.408; P = 0.014) while the number of degenerative features (osteoarthritis) was related neither with functional impact nor with disease activity. |
3 |
| 67. Raynal M, Bouderraoui F, Ouichka R, et al. Performance of 18F-sodium fluoride positron emission tomography with computed tomography to assess inflammatory and structural sacroiliitis on magnetic resonance imaging and computed tomography, respectively, in axial spondyloarthritis. Arthritis Res Ther. 21(1):119, 2019 May 14. |
Experimental-Dx |
23 patients with spondyloarthritis (SpA). |
To assess increased sacroiliac joint (SIJ) uptake on 18F-NaF PET/CT and to compare with MRI for inflammation and with CT scan for structural damages in a population of 23 patients with spondyloarthritis (SpA). |
Structural sacroiliitis was observed on 7 radiographs and 10 CT scans; 10 MRIs showed inflammatory sacroiliitis, and 20 patients had a positive PET. The inter-reader reliability was good for the PET activity score and good to excellent for the SUVmax. A positive PET was not correlated with a positive MRI or with a structural sacroiliitis on CT scan. The PET-activity score and SUVmax were correlated with the SPARCC inflammation score but not with erosion or ankylosis scores on CT scan. |
1 |
| 68. Buchbender C, Ostendorf B, Ruhlmann V, et al. Hybrid 18F-labeled Fluoride Positron Emission Tomography/Magnetic Resonance (MR) Imaging of the Sacroiliac Joints and the Spine in Patients with Axial Spondyloarthritis: A Pilot Study Exploring the Link of MR Bone Pathologies and Increased Osteoblastic Activity. J Rheumatol 2015;42:1631-7. |
Observational-Dx |
13 patients with active ankylosing spondylitis |
To examine whether inflammatory or chronic changes on magnetic resonance imaging (MRI) in the sacroiliac joints (SIJ) and the spines of patients with active ankylosing spondylitis (AS) are linked to osteoblastic activity, assessed by PET/MRI. |
A total of 104 SQ and 1196 VQ were examined. In SIJ, bone marrow edema (BME) was seen in 44.2%, fat deposition (FD) in 42.3%, and 18F-F in 46.2% SQ. BME alone was associated with 18F-F in 78.6% and FD alone in only 7.7% SQ, while the combination BME/FD was associated with 18F-F in 72.2% SQ. Erosions, sclerosis, and ankylosis alone were rarely associated with 18F-F. In the spine, BME alone was seen in 9.9%, FD in 18.2%, and 18F-F in 5.4% VQ. BME alone was associated with 18F-F in 14.3% and FD alone in 8.7% VQ, while the combination BME/FD was associated with 18F-F in 40.6% VQ. |
2 |
| 69. Fischer DR, Pfirrmann CW, Zubler V, et al. High bone turnover assessed by 18F-fluoride PET/CT in the spine and sacroiliac joints of patients with ankylosing spondylitis: comparison with inflammatory lesions detected by whole body MRI. EJNMMI Res 2012;2:38. |
Observational-Dx |
10 patients with active AS |
To compare the frequency and distribution of increased activity on 18?F-fluoride PET/CT with the presence of bone marrow edema on whole-body MR imaging in the spine and sacroiliac joints (SIJ) of patients with active ankylosing spondylitis (AS). |
Analysis of interobserver agreement for PET/CT yielded a kappa value of 0.68 for spinal lesions and of 0.88 for SIJ lesions. The corresponding kappa values for the MRI modality were 0.64 and 0.93, respectively. More spinal lesions were detected by MRI in comparison to PET/CT (68 vs. 38), whereas a similar number of SIJ quadrants scored positive in both modalities (19 vs. 17). Analysis of agreement of lesion detection between both imaging modalities yielded a kappa value of only 0.25 for spinal lesions and of 0.64 for SIJ lesions. |
2 |
| 70. Ouichka R, Bouderraoui F, Raynal M, et al. Performance of 18F-sodium fluoride positron emission tomography with computed tomography to assess inflammatory and structural sacroiliitis on magnetic resonance imaging in axial spondyloarthritis. Clin Exp Rheumatol. 37(1):19-25, 2019 Jan-Feb. |
Observational-Dx |
23 patients with active spondyloarthritis |
To assess increased sacroiliac joint (SIJ) uptake on 18F-NaF PET/CT according to a qualitative and quantitative approach and to compare with MRI SIJ assessments for structural and inflammatory sacroiliitis in a population of 23 patients with spondyloarthritis (SpA) |
Structural sacroiliitis was observed on 7 radiographs and 15 MRIs. 10 MRIs showed inflammatory sacroiliitis (mean SPARCC 18.7). Twenty patients had a positive PET with a mean PET-activity score of 18.2 (±8.7). The mean SUVmax for a positive PET was 1.78 vs. 1.45 for a negative one. The inter-reader reliability was good for the PET activity score (ICC= 0.56 [IC-95: 0.32; 0.76]) and good to excellent for the SUVmax (ICC=0.70-0.90 [IC-95: 0.41; 0.96]). According to a binary approach, a positive PET was not correlated with a positive MRI for structural sacroiliitis. The PET-activity score (r=0.61, p=0.001) and SUVmax (r=0.56, p=0.004) were correlated with the SPARCC inflammation score but not with structural sacroiliitis or for SPARCC structural lesions. |
2 |
| 71. Sawicki LM, Lutje S, Baraliakos X, et al. Dual-phase hybrid 18 F-Fluoride Positron emission tomography/MRI in ankylosing spondylitis: Investigating the link between MRI bone changes, regional hyperaemia and increased osteoblastic activity. J Med Imaging Radiat Oncol. 62(3):313-319, 2018 Jun. |
Review/Other-Dx |
13 patients with active ankylosing spondylitis |
To investigate the link between regional hyperaemia and osteoblastic activity in inflammatory and chronic lesions of ankylosing spondylitis (AS) of the sacroiliac joints (SIJ) using dual-phase 18 F-Fluoride PET/MRI. |
Of 104 SQ, there were 63.4% SQ with FD, 42.3% SQ with BME, 26.9% SQ with erosions, 26% SQ with sclerosis and 10.6% SQ with ankylosis. BME alone was associated with focal 18 F-Fluoride uptake in 63.6% SQ on blood-pool phase and 90.9% SQ on mineralization phase 18 F-Fluoride PET/MRI. Instead, FD, erosion, sclerosis, ankylosis were not associated with focal 18 F-Fluoride uptake on either blood-pool or mineralization phase 18 F-Fluoride PET/MRI. SQ showing BME alone or a combination of BME and chronic AS lesions had a significantly higher percentage of focal 18 F-Fluoride uptake on blood-pool phase and mineralization phase PET/MRI than SQ showing AS lesions without BME (P < 0.001). Both 18 F-Fluoride PET datasets provided high IQ, albeit IQ of mineralization phase PET was superior to blood-pool phase PET (P < 0.001). |
4 |
| 72. Toussirot E, Caoduro C, Ungureanu C, Michel F, Runge M, Boulahdour H. 18F- fluoride PET/CT assessment in patients fulfilling the clinical arm of the ASAS criteria for axial spondyloarthritis. A comparative study with ankylosing spondylitis. Clin Exp Rheumatol 2015;33:588. |
Observational-Dx |
15 patients |
To evaluate the utility of 18F-fluoride PET-CT in patients with non Rx Ax SpA compared to patients with ankylosing spondylitis (AS). |
In AS patients, the number of areas with increased radionuclide uptake ranged from 2 to 33. The mean SIJ/sacrum standard uptake value (SIJ/S SUV) ratio was 2.02±0.6. For SIJ, there was a good concordance betweenactive inflammatory areas depicted on 18Ffluoride PET-CT and MRI. Conversely, for spinal lesions, the number of fluoride lesions on PET-CT scans largely exceeded those detected by spinal MRI (33 vs. 4). There was also a relationship between SIJ MRI score and SIJ/S SUV ratio. Finally, the level of confidence of the clinicians for the diagnosis of non Rx Ax SpA using a visual analog scale (0–10) was 7.3±0.9 before and 5.8±1.3 after 18F- fluoride PET-CT analysis. |
4 |
| 73. Strobel K, Fischer DR, Tamborrini G, et al. 18F-fluoride PET/CT for detection of sacroiliitis in ankylosing spondylitis. Eur J Nucl Med Mol Imaging. 2010;37(9):1760-1765. |
Observational-Dx |
15 patients with AS; 13 patients with mechanical low back pain |
To evaluate the performance of 18F-fluoride PET/CT for the diagnosis of SIJ arthritis in patients with active AS. |
The mean SIJ/S ratio of 30 quantified joints in the AS group was 1.66 (range 1.10–3.07) with PET/CT, and the mean SIJ/S ratio of 26 quantified joints in the mechanical low back pain group was 1.12 (range 0.71–1.52). The area under the receiver operating characteristic curve for SIJ arthritis was 0.84. With plain radiography as the gold standard and taking an SIJ/S ratio of >1.3 as the threshold, the sensitivity, specificity and accuracy on a per patient basis were 80%, 77% and 79%, respectively. On a per SIJ basis, the greatest sensitivity (94%) was found in grade 3 sacroiliitis (n = 16). |
3 |
| 74. Carmona R, Harish S, Linda DD, Ioannidis G, Matsos M, Khalidi NA. MR imaging of the spine and sacroiliac joints for spondyloarthritis: influence on clinical diagnostic confidence and patient management. Radiology 2013;269:208-15. |
Observational-Dx |
55 patients |
To quantify the effect of magnetic resonance (MR) imaging of the spine and sacroiliac joints on clinical diagnostic confidence and to determine if MR imaging affects treatment of patients with axial spondyloarthritis. |
Diagnostic confidence for specific clinical features improved significantly after MR imaging for inflammatory back pain (14% vs 76%, before vs after; P < .001), mechanical back pain (4% vs 49%, P < .001), spondylitis (7% vs 76%, P < .001) and sacroiliitis (9% vs 87%, P < .001). Confidence for overall diagnoses also improved significantly after MR imaging for ankylosing spondylitis (29% vs 80%, P < .001), undifferentiated spondyloarthritis (58% vs 93%, P < .001) and osteoarthritis (29% vs 64%, P < .001). Of the 23 patients for whom tumor necrosis factor-a inhibitor (TNFi) therapy was recommended before MR imaging, 12 (52%) were prescribed TNFi therapy after MR imaging. Of the 32 patients for whom TNFi therapy was not recommended before MR imaging, 10 (31%) patients were prescribed TNFi therapy after MR imaging. Overall, 22 (40%) patients had a change in treatment recommendation regarding TNFi therapy after MR imaging. |
2 |
| 75. Maksymowych WP, Chiowchanwisawakit P, Clare T, Pedersen SJ, Ostergaard M, Lambert RG. Inflammatory lesions of the spine on magnetic resonance imaging predict the development of new syndesmophytes in ankylosing spondylitis: evidence of a relationship between inflammation and new bone formation. Arthritis Rheum. 2009;60(1):93-102. |
Review/Other-Dx |
29 patients |
To determine whether a vertebral corner that demonstrates an active corner inflammatory lesion on MRI in patients with AS is more likely to evolve into a de novo syndesmophyte visible on plain radiography than is a vertebral corner that demonstrates no active inflammation on MRI. |
New syndesmophytes developed significantly more frequently in vertebral corners with inflammation (20%) than in those without inflammation (5.1%) seen on baseline MRI (P=0.008 for all reader pairs). They also developed more frequently in vertebral corners where inflammation had resolved than in those where inflammation persisted after anti-TNF treatment. This was confirmed in the analysis of the prospective cohort, in which significantly more vertebral corners with inflammation (14.3%) compared with those without inflammation (2.9%) seen on baseline MRI developed new syndesmophytes (P=0.003 for all reader pairs). |
4 |
| 76. Sepriano A, Ramiro S, Landewe R, Dougados M, van der Heijde D, Rudwaleit M. Is active sacroiliitis on MRI associated with radiographic damage in axial spondyloarthritis? Real-life data from the ASAS and DESIR cohorts. Rheumatology (Oxford). 58(5):798-802, 2019 May 01. |
Observational-Dx |
125 (ASAS-cohort) and 415 (DESIR-cohort) patients |
To assess any association between bone marrow oedema on MRI of the sacroiliac joints (MRI-SIJ) according to local readings in daily practice and the development of structural damage on radiographs of the SIJ (X-SIJ) in axial spondyloarthritis (axSpA). |
According to local readings, progression and ‘improvement’ in X-SIJ was seen in both the ASAS- and DESIR-cohort, yielding a net progression that was higher in the former than in the latter (19.2% and 6.3%). In multivariable analysis, baseline bone marrow oedema on MRI-SIJ was strongly associated with X-SIJ structural progression in both ASAS (odds ratio = 3.2 [95% CI: 1.3; 7.9]), and DESIR (odds ratio = 7.6 [95% CI: 4.3; 13.2]). |
3 |
| 77. Maksymowych WP, Lambert RG, Ostergaard M, et al. MRI lesions in the sacroiliac joints of patients with spondyloarthritis: an update of definitions and validation by the ASAS MRI working group. Ann Rheum Dis. 78(11):1550-1558, 2019 Nov. |
Review/Other-Dx |
N/A |
To generate a consensus update on standardised definitions for MRI lesions in the sacroiliac joint (SIJ) of patients with spondyloarthritis (SpA), and to conduct preliminary validation. |
No results stated in abstract. |
4 |
| 78. Puhakka KB, Jurik AG, Egund N, et al. Imaging of sacroiliitis in early seronegative spondylarthropathy. Assessment of abnormalities by MR in comparison with radiography and CT. Acta Radiol. 2003;44(2):218-229. |
Review/Other-Dx |
41 patients |
To analyze the type and frequency of abnormalities of the SIJ in early SpA by MRI in comparison with CT and radiography, assess the most appropriate MRI sequences to be used, and introduce a new way of grading MRI abnormalities of the SIJ. |
MRI and CT had equal efficacy superior to radiography in staging of erosions and osseous sclerosis. Only MRI allowed visualization and grading of active inflammatory changes in the subchondral bone and surrounding ligaments in addition to bone marrow fatty accumulations. T2-weighted sequences did not contribute to assessment of sacroiliitis. |
4 |
| 79. Rudwaleit M, Jurik AG, Hermann KG, et al. Defining active sacroiliitis on magnetic resonance imaging (MRI) for classification of axial spondyloarthritis: a consensual approach by the ASAS/OMERACT MRI group. Ann Rheum Dis. 2009;68(10):1520-1527. |
Review/Other-Dx |
10 doctors |
To identify and describe MRI findings in sacroiliitis and to reach consensus on which MRI findings are essential for the definition of sacroiliitis. |
Active inflammatory lesions such as BMO/osteitis, synovitis, enthesitis and capsulitis associated with SpA can be detected by MRI. Among these, the clear presence of BMO/osteitis was considered essential for defining active sacroiliitis. Structural damage lesions such as sclerosis, erosions, fat deposition and ankylosis can also be detected by MRI. At present, however, the exact place of structural damage lesions for diagnosis and classification is less clear, particularly if these findings are minor. The ASAS group formally approved these proposals by voting at the annual assembly. |
4 |
| 80. Aydin SZ, Maksymowych WP, Bennett AN, McGonagle D, Emery P, Marzo-Ortega H. Validation of the ASAS criteria and definition of a positive MRI of the sacroiliac joint in an inception cohort of axial spondyloarthritis followed up for 8 years. Ann Rheum Dis. 2012;71(1):56-60. |
Observational-Dx |
29 patients |
To test the diagnostic and predictive value of the ASAS criteria and definition of a ‘positive’ MRI. |
All patients were classified as having axial SpA, with more patients fulfilling the imaging arm (83%, n=24/29) than the human leucocyte antigen B27 arm (62%, n=18/29). Concordant reader data showed that the baseline MRI had high diagnostic utility for SpA according to global assessment (sensitivity/specificity: 66%/94%, LR+ 11.8, LR- 0.4) and ASAS definition (sensitivity/specificity: 79%/89%, LR+ 7.1, LR- 0.2). Likewise, a positive baseline MRI had 100% sensitivity for subsequent radiographic sacroiliitis by either assessment, although specificity was lower (56% for global assessment and 33% for ASAS definition). |
3 |
| 81. Agten CA, Zubler V, Zanetti M, et al. Postpartum Bone Marrow Edema at the Sacroiliac Joints May Mimic Sacroiliitis of Axial Spondyloarthritis on MRI. AJR Am J Roentgenol. 211(6):1306-1312, 2018 12. |
Experimental-Dx |
30 healthy women and 30 age-matched women with known a axial spondyloarthritis |
To compare MRI findings in the sacroiliac joints of postpartum women (as a model of mechanical changes) and women with known axial spondyloarthritis (as an inflammatory model). |
In the postpartum group, 63.3% (19/30) of women showed BME around the sacroiliac joints compared with 86.7% (26/30) of women in the spondyloarthritis group (based on ASAS criteria). Erosions were uncommon in the postpartum group (10.0% [3/30] postpartum vs 56.7% [17/30] spondyloarthritis). Fatty bone marrow replacement, backfill, and ankylosis were not seen in the postpartum group. In subjects with positive MRI findings for sacroiliitis based on ASAS criteria, the SPARCC MRI index (mean ± SD, 13.6 ± 14.5 vs 13.0 ± 10.7; p = 0.818) and Berlin method (4.5 ± 3.0 and 5.5 ± 3.5, p = 0.378) were not different between the postpartum and spondyloarthritis groups. Scores were not different between birth modalities. |
1 |
| 82. Arnbak B, Grethe Jurik A, Horslev-Petersen K, et al. Associations Between Spondyloarthritis Features and Magnetic Resonance Imaging Findings: A Cross-Sectional Analysis of 1,020 Patients With Persistent Low Back Pain. Arthritis & Rheumatology. 68(4):892-900, 2016 Apr. |
Review/Other-Dx |
1,020 patients |
To 1) estimate the prevalence of magnetic resonance imaging (MRI) findings and clinical features included in the ASAS criteria for SpA and 2) to explore the associations between MRI findings and clinical features. |
537 (53%) had at least 1 of the clinical features included in the ASAS criteria for SpA. Three clinical features were common-inflammatory back pain according to the ASAS criteria, a good response to nonsteroidal antiinflammatory drugs (NSAIDs), and family history of SpA. The prevalence of these features ranged from 15% to 17%. Sacroiliitis on MRI according to the ASAS definition was present in 217 patients (21%). Of those 217 patients, 91 (42%) had the minimum amount of bone marrow edema required according to the ASAS definition (a low bone marrow edema score). The presence of HLA-B27, peripheral arthritis, a good response to NSAIDs, and preceding infection were independently positively associated with MRI findings in the SI joints (odds ratios [ORs] of 1.9-9.0). The remaining 8 clinical features were not positively associated with MRI findings. Importantly, only age was independently associated with low bone marrow edema score at the SI joints (OR of 1.1 per year). |
4 |
| 83. Weber U, Lambert RG, Ostergaard M, Hodler J, Pedersen SJ, Maksymowych WP. The diagnostic utility of magnetic resonance imaging in spondylarthritis: an international multicenter evaluation of one hundred eighty-seven subjects. Arthritis Rheum. 2010;62(10):3048-3058. |
Observational-Dx |
187 subjects |
To systematically assess the diagnostic utility of MRI to differentiate patients with SpA from patients with nonspecific back pain and healthy volunteers, using a standardized evaluation of MRIs of the SIJs. |
Diagnostic utility was high for all 5 readers, both for patients with AS (sensitivity 0.90, specificity 0.97, positive LR 44.6) and for patients with preradiographic IBP (sensitivity 0.51, specificity 0.97, positive LR 26.0). Diagnostic utility based solely on detection of BMO enhanced sensitivity (67%) for patients with IBP but reduced specificity (88%); detection of erosions in addition to BMO further enhanced sensitivity (81%) without changing specificity. A single lesion of the SIJ on MRI was observed in up to 27% of control subjects. |
2 |
| 84. Weber U, Jurik AG, Zejden A, et al. Frequency and Anatomic Distribution of Magnetic Resonance Imaging Features in the Sacroiliac Joints of Young Athletes: Exploring "Background Noise" Toward a Data-Driven Definition of Sacroiliitis in Early Spondyloarthritis. Arthritis rheumatol.. 70(5):736-745, 2018 05. |
Observational-Dx |
42 patients |
To explore the frequency and anatomic distribution of SI joint MRI lesions in recreational and elite athletes. |
In recreational runners before and after running, the mean ± SD number of SI joint quadrants showing BME (MRI readings pooled over 3 readers) was 3.1 ± 4.2 and 3.1 ± 4.5, respectively, while in elite ice hockey players, it was 3.6 ± 3.0. The posterior lower ilium was the single most affected SI joint region, followed by the anterior upper sacrum. |
3 |
| 85. Weber U, Zubler V, Pedersen SJ, et al. Development and validation of a magnetic resonance imaging reference criterion for defining a positive sacroiliac joint magnetic resonance imaging finding in spondyloarthritis. Arthritis Care Res (Hoboken) 2013;65:977-85. |
Observational-Dx |
157 patients with back pain and 20 age-matched healthy controls. |
To validate a magnetic resonance imaging (MRI) reference criterion for a positive sacroiliac (SI) joint MRI finding based on the level of confidence in the classification of spondyloarthritis (SpA) by expert MRI readers. |
In cohorts A and B, 76.4% and 71.6% of subjects met the MRI criterion, respectively. The kappa values for interreader agreement were 0.76 for cohort A and 0.80 for cohort B and between MRI-based and clinical assessment were 0.93 for cohort A and 0.57 for cohort B. Using this MRI reference criterion, the cutoff for the number of affected SI joint quadrants needed to reach a predefined specificity of =0.90 was =2 for bone marrow edema (BME) in both cohorts and =1 for erosion in both cohorts, and the BME and/or erosion lesions increased sensitivity without reducing specificity. |
1 |
| 86. de Winter J, de Hooge M, van de Sande M, et al. Magnetic Resonance Imaging of the Sacroiliac Joints Indicating Sacroiliitis According to the Assessment of SpondyloArthritis international Society Definition in Healthy Individuals, Runners, and Women With Postpartum Back Pain. Arthritis rheumatol.. 70(7):1042-1048, 2018 07. |
Review/Other-Dx |
172 subjects |
To compare magnetic resonance images (MRIs) of the sacroiliac (SI) joints of healthy subjects and individuals with known mechanical strain acting upon the SI joints to those of patients with axial spondyloarthritis (SpA) and patients with chronic back pain. |
Of the 47 healthy volunteers, 11 (23.4%) had an MRI positive for sacroiliitis, compared to 43 (91.5%) of 47 axial SpA patients and 3 (6.4%) of 47 patients with chronic back pain. Three (12.5%) of the 24 runners and 4 (57.1%) of the 7 women with postpartum back pain had a positive MRI. Using a SPARCC cutoff of =2 for positivity, 12 (25.5%) of 47 healthy volunteers, 46 (97.9%) of 47 positive axial SpA patients, 5 (10.6%) of 47 controls with chronic back pain, 4 (16.7%) of 24 runners, and 4 (57.1%) of 7 women with postpartum back pain had positive MRIs. Deep bone marrow edema (BME) lesions were not found in healthy volunteers, patients with chronic back pain, or runners, but were found in 42 (89.4%) of 47 positive axial SpA patients and in 1 (14.3%) of 7 women with postpartum back pain. |
4 |
| 87. Weber U, Lambert RG, Pedersen SJ, Hodler J, Ostergaard M, Maksymowych WP. Assessment of structural lesions in sacroiliac joints enhances diagnostic utility of magnetic resonance imaging in early spondylarthritis. Arthritis Care Res (Hoboken) 2010;62:1763-71. |
Observational-Dx |
187 subjects |
To compare the diagnostic utility of T1-weighted and STIR magnetic resonance imaging (MRI) sequences in early spondylarthritis (SpA) using a standardized approach to the evaluation of sacroiliac (SI) joints, and to test whether systematic calibration of readers directed at recognition of abnormalities on T1-weighted MRI would enhance diagnostic utility. |
Structural lesions were detected in 98% of AS patients and 64% of IBP patients. A diagnosis of SpA was based on T1-weighted or combined T1-weighted/STIR sequences in 82% of AS patients and 41% of IBP patients. Calibration enhanced the diagnostic utility of MRI in the majority of readers, especially those considered less experienced; the mean positive and negative likelihood ratios (of 6 readers) were 14.5 and 0.08 precalibration, respectively, and 22.2 and 0.02 postcalibration, respectively. |
3 |
| 88. Weber U, Ostergaard M, Lambert RG, et al. Candidate lesion-based criteria for defining a positive sacroiliac joint MRI in two cohorts of patients with axial spondyloarthritis. Ann Rheum Dis 2015;74:1976-82. |
Observational-Dx |
157 patients |
To determine candidate lesion-based criteria for a positive sacroiliac joint (SIJ) MRI based on bone marrow oedema (BMO) and/or erosion in non-radiographic axial spondyloarthritis (nr-axSpA); to compare the performance of lesion-based criteria with global evaluation by expert readers. |
For both cohorts A/B, global assessment showed high specificity (0.95/0.83) compared with the Assessment in SpondyloArthritis international Society (ASAS) definition (0.76/0.74). BMO =3 (0.89/0.84) or =4 (0.92/0.87) showed comparably high specificity to global assessment. Erosion =2 and/or BMO =3 or =4 were associated with comparably high sensitivity to global assessment without affecting specificity. These combined criteria showed both higher sensitivity and specificity than the ASAS definition. |
2 |
| 89. de Hooge M, van den Berg R, Navarro-Compan V, et al. Patients with chronic back pain of short duration from the SPACE cohort: which MRI structural lesions in the sacroiliac joints and inflammatory and structural lesions in the spine are most specific for axial spondyloarthritis?. Ann Rheum Dis. 75(7):1308-14, 2016 07. |
Observational-Dx |
287 patients |
To investigate the extent and performance of MRI lesions in the sacroiliac joint (MRI-SI) and spine (MRI-spine) in patients with suspected axial spondyloarthritis (axSpA). |
In total 126 patients were ASAS criteria positive (73 imaging-arm+ (22 by modified New York criteria (mNY)+; 51 by MRI+mNY-); 53 clinical-arm+) and 161 were ASAS criteria negative (89 possible axSpA and 72 no SpA). On MRI-SI (n=287), at least three fatty lesions (or at least three erosions) were seen in 45.5 (63.6)% of mNY+ patients, 15.7 (47.1)% of MRI+mNY- patients and 15.1 (13.2)% of clinical-arm+ patients versus 3.4 (6.7)% of possible axSpA patients and 2.8 (4.2)% of no SpA patients. A combined rule (at least five fatty lesions and/or erosions) performed equally well. Sclerosis and ankylosis were too rare to analyse. On MRI-spine (n=284), at least five inflammatory lesions (or at least five fatty lesions) were seen in 27.3 (18.2)% of mNY+ patients, 13.7 (21.6)% of MRI+mNY- patients and 3.8 (1.9)% of clinical-arm+ patients versus 4.5 (6.7)% of possible SpA patients and 2.9 (4.3)% of no SpA patients. |
3 |
| 90. Hu Z, Wang X, Qi J, Kong Q, Zhao M, Gu J. Backfill is a specific sign of axial spondyloarthritis seen on MRI. Joint Bone Spine. 83(2):179-83, 2016 Mar. |
Observational-Dx |
297 patients with ankylosing spondylitis (AS), 126 patients with non-radiographic axial SpA (nr-axSpA), 147 patients with NSBP, 77 healthy controls. |
To summarize the characteristics of backfill in patients with axial spondyloarthritis (SpA) and patients with non-specific back pain (NSBP) and healthy controls, and to assess the value of backfill in diagnosing axial SpA. |
Backfill was recorded in 78.8% AS patients, 11.1% nr-axSpA patients, 1.8% patients with NSBP, and no healthy control. Backfill affected more frequently at ilium bone, lower half of sacroiliac joints in axial SpA (both P<0.05). The SSS score of backfill was much higher in axial SpA than in patients with NSBP (both P<0.01) and it did not correlate with demographics and BASDAI, BASFI, and CRP (all P>0.05). The score of backfill only positively correlated with symptom duration in AS (r=0.251, P<0.01) and in nr-axSpA (r=0.743, P<0.01) patients. Only 8.9% patients had the change of backfill in an average follow-up time of 1.09 years. Backfill had high specificity (0.98) and moderate sensitivity (0.59) for diagnosing axial SpA. |
2 |
| 91. Laloo F, Herregods N, Jaremko JL, Verstraete K, Jans L. MRI of the sacroiliac joints in spondyloarthritis: the added value of intra-articular signal changes for a 'positive MRI'. Skeletal Radiol. 47(5):683-693, 2018 May. |
Observational-Dx |
363 patients |
To determine if intra-articular signal changes at the sacroiliac joint space on MRI have added diagnostic value for spondyloarthritis, when compared to bone marrow edema (BME). |
BME had SN of 68.9%, SP of 74.0% and LR+ of 2.6 for diagnosis of spondyloarthritis. BME in absence of intra-articular signal changes had a lower SN and LR+ for spondyloarthritis (SN = 20.5%, LR+ 1.4). Concomitant BME and high T1 signal (SP = 97.2%, LR + = 10.5), BME and fluid signal (SP = 98.6%, LR + = 10.3) or BME and ankylosis (SP = 100%) had higher SP and LR+ for spondyloarthritis. Concomitant BME and VP had low LR+ for spondyloarthritis (SP = 91%, LR + =0.9). When BME was absent, intra-articular signal changes were less prevalent, but remained highly specific for spondyloarthritis. |
2 |
| 92. Laloo F, Herregods N, Varkas G, et al. MR signal in the sacroiliac joint space in spondyloarthritis: a new sign. Eur Radiol. 27(5):2024-2030, 2017 May. |
Observational-Dx |
363 patients |
To determine the diagnostic value of MR signal within the sacroiliac (SI) joint space in spondyloarthritis (SpA). |
Presence of intra-articular high T1 signal, fluid signal and ankylosis had a specificity of 95.8 %, 95.3 % and 99.5 % for SpA. High T1 signal, fluid signal and ankylosis were present in 38.4 %, 19.2 % and 17.9 % of SpA patients and in 4.2 %, 4.7 % and 0.5 % of patients without SpA, resulting in LR+ of 9.0, 4.1 and 37.9, respectively. VP was present in 13.2 % of SpA patients and in 20.8 % of patients without SpA, resulting in an LR+ of 0.6. |
2 |
| 93. Baraliakos X, Hoffmann F, Deng X, Wang YY, Huang F, Braun J. Detection of Erosions in Sacroiliac Joints of Patients with Axial Spondyloarthritis Using the Magnetic Resonance Imaging Volumetric Interpolated Breath-hold Examination. J Rheumatol. 2019 Feb 15. |
Observational-Dx |
109 patients |
To evaluate the ability of VIBE to detect erosions in sacroiliac joints (SIJ) of patients with axial spondyloarthritis (axSpA) compared to the established T1-weighted MRI sequence and computed tomography (CT). |
Erosions were less frequently detected by CT (153 SQ) than by T1-weighted MRI (182 SQ; p = 0.008) and VIBE-MRI (199 SQ; p < 0.001 vs CT and p = 0.031 vs T1-weighted MRI). Taking CT as the gold standard, the sensitivity of VIBE-MRI (71.2%) was higher than that for T1-weighted MRI (63.4%), with similar specificity (87.3% vs 88%, respectively). In linear regression analysis, younger age was significantly associated with occurrence of erosions independently in VIBE-MRI (ß = 0.384, p < 0.001) and T1-weighted MRI (ß = 0.369, p < 0.001) compared to CT. |
2 |
| 94. Diekhoff T, Greese J, Sieper J, Poddubnyy D, Hamm B, Hermann KA. Improved detection of erosions in the sacroiliac joints on MRI with volumetric interpolated breath-hold examination (VIBE): results from the SIMACT study. Ann Rheum Dis. 77(11):1585-1589, 2018 11. |
Observational-Dx |
100 patients |
To compare the performance of a new three-dimensional MRI sequence (volumetric interpolated breath-hold examination; MR-VIBE) with a conventional T1-weighted sequence (MR-T1) for the detection of erosions in the sacroiliac joints (SIJs) using low-dose CT (ldCT) as reference. |
MR-VIBE had a higher sensitivity than MR-T1 (95% vs 79%, respectively) without a decrease in specificity (93% each). MR-VIBE compared with MR-T1 identified 16% more patients with erosions (36 vs 30 of 38 patients with positive ldCT findings). The erosion sum score was also higher for MR-VIBE (8.1±9.3) than MR-T1 (6.7±8.4), p=0.003. The agreement on erosion detection was also higher for MR-VIBE (?=0.71) compared with MRI-T1 (?=0.56). |
2 |
| 95. Beltran LS, Samim M, Gyftopoulos S, Bruno MT, Petchprapa CN. Does the Addition of DWI to Fluid-Sensitive Conventional MRI of the Sacroiliac Joints Improve the Diagnosis of Sacroiliitis?. AJR Am J Roentgenol. 210(6):1309-1316, 2018 Jun. |
Observational-Dx |
63 patients |
To determine whether adding DWI to conventional MRI of the sacroiliac joints improves the diagnostic performance of MRI readers in the detection of sacroiliitis. |
The accuracy, sensitivity, and specificity of MRI without DWI were 68.3%, 69.0%, and 67.6% and for MRI with DWI were 74.6%, 69.0%, and 79.4% (accuracy and sensitivity, p > 0.100; specificity, p = 0.039). The mean confidence score for MRI without DWI was 3.60 and for MRI with DWI was 3.67 (p = 0.270). The kappa coefficient for MRI without DWI was 0.28 and for MRI with DWI was 0.46 (p = 0.041). The nADCmean in patients with sacroiliitis was 3.86 and in patients without sacroiliitis was 1.6 (p = 0.001). The nADCmean AUC was 0.758 (95% CI, 0.67-0.83). |
3 |
| 96. Boy FN, Kayhan A, Karakas HM, Unlu-Ozkan F, Silte D, Aktas I. The role of multi-parametric MR imaging in the detection of early inflammatory sacroiliitis according to ASAS criteria. Eur J Radiol 2014;83:989-96. |
Observational-Dx |
45 patients |
To retrospectively evaluate the accuracy of multi-parametric magnetic resonance (MR) imaging including fat saturated (FS) T2-weighted, short-tau inversion recovery (STIR), diffusion-weighted (DW-MR), and dynamic-contrast-enhanced MR (DCE-MR) imaging techniques in the diagnosis of early inflammatory sacroiliitis and determine the additional value of DW-MR and DCE-MR images according to recently defined 'Assessment in SpondyloArthritis international Society' criteria. |
Of the 45 patients, 31 had inflammatory back pain. Of 31, 28 (90.3%) patients had inflammatory sacroiliitis diagnosed by clinical and laboratory analysis. FS T2-weighted MR images had the highest sensitivity (42.8% for both radiologists) for detecting osteitis in patients with inflammaory sacroiliitis when compared to other imaging sequences. For specificity, PPV, NPV, accuracy, and AUC levels there were no statistically significant difference between image viewing settings. However, adding STIR, DW-MR and DCE-MR images to the FS T2-weighted MR images did not improve the above stated indices. |
3 |
| 97. Bozgeyik Z, Ozgocmen S, Kocakoc E. Role of diffusion-weighted MRI in the detection of early active sacroiliitis. AJR Am J Roentgenol 2008;191:980-6. |
Observational-Dx |
42 patients with chronic low back |
To evaluate the value of diffusion-weighted MRI (DWI) to detect active inflammatory changes in the sacroiliac joints of patients with early axial spondyloarthritis (also spelled spondylarthritis). |
ADC values measured from the lesions at b values of 1,000 and 600 s/mm(2) in patients with sacroiliitis (n = 13) were significantly higher than values measured from iliac and sacral bones in patients with low back pain of mechanical origin (n = 29). DWI showed sensitivity for detecting acute lesions in early sacroiliitis similar to that of T1-weighted gadolinium images (area under the curve, 0.843-0.971). Intra- and interrater reliability of DWI was acceptable. |
2 |
| 98. Bradbury LA, Hollis KA, Gautier B, et al. Diffusion-weighted Imaging Is a Sensitive and Specific Magnetic Resonance Sequence in the Diagnosis of Ankylosing Spondylitis. J Rheumatol. 45(6):771-778, 2018 06. |
Observational-Dx |
18 AS patients, 20 cases of nonradiographic axial spondyloarthritis, and 20 non-AS patients with chronic low back pain |
To test the discriminatory capacity of diffusion-weighted magnetic resonance imaging (DWI) and its potential as an objective measure of treatment response to tumor necrosis factor inhibition in ankylosing spondylitis (AS). |
At baseline, in contrast to standard nonimaging measures, DWI apparent diffusion coefficient (ADC) values showed good discriminatory performance [area under the curve (AUC) > 80% for Group 1 or 2 compared with Group 3]. DWI ADC values were significantly lower posttreatment (0.45 ± 0.433 before, 0.154 ± 0.23 after, p = 0.0017), but had modest discriminating capacity comparing pre– and posttreatment measures (AUC = 68%). |
3 |
| 99. J P Bray T, Vendhan K, Ambrose N, et al. Diffusion-weighted imaging is a sensitive biomarker of response to biologic therapy in enthesitis-related arthritis. Rheumatology. 56(3):399-407, 2017 03 01. |
Observational-Dx |
22 adolescents with enthesitis-related arthropathy. |
To evaluate diffusion-weighted imaging (DWI) as a tool for measuring treatment response in adolescents with enthesitis-related arthropathy (ERA). |
For both radiological and clinical definitions of response, reductions in ADC and nADC after treatment were greater in responders than in non-responders (for radiological response: ADC: P < 0.01; nADC: P = 0.055; for clinical response: ADC: P = 0.33; nADC: P = 0.089). ADC and nADC could predict radiological response with a high level of sensitivity and specificity and were moderately sensitive and specific predictors of clinical response (the area under the receiver operating characteristic curves were as follows: ADC: 0.97, nADC: 0.82 for radiological response; and ADC: 0.67, nADC: 0.78 for clinical response). |
2 |
| 100. Chan CWS, Tsang HHL, Li PH, et al. Diffusion-weighted imaging versus short tau inversion recovery sequence: Usefulness in detection of active sacroiliitis and early diagnosis of axial spondyloarthritis. PLoS ONE. 13(8):e0201040, 2018. |
Observational-Dx |
305 patients with chronic back pain |
To compare the utility of Diffusion weighted imaging (DWI) with short tau inversion recovery (STIR) sequence in the diagnosis of early axial spondyloarthritis (SpA). |
When compared to STIR sequence, DWI had similar sensitivity (STIR 0.29, DWI 0.30) and specificity (STIR 0.97, DWI 0.92) in diagnosing sacroiliitis. However, STIR sequence had better reliability (STIR 0.78, DWI 0.61). In early disease group, DWI was not better than STIR sequence in detecting active sacroiliitis (sensitivity DWI vs STIR: 0.34 vs 0.36; specificity DWI vs STIR: 0.93 vs 0.93; positive predictive value DWI vs STIR: 0.92 vs 0.92; negative predictive value DWI vs STIR: 0.36 vs 0.37). Using the Assessment in SpondyloArthritis international Society (ASAS) classification criteria, 67/98 patients with early disease (sensitivity 0.91 specificity 0.90) and 221/305 overall (sensitivity 0.90; specificity 0.92) were classified as axial SpA. Among the expert diagnosed axial SpA patients who did not meet the ASAS criteria, only 2 had positive DWI. |
2 |
| 101. Chung HY, Xu X, Lau VW, et al. Comparing diffusion weighted imaging with clinical and blood parameters, and with short tau inversion recovery sequence in detecting spinal and sacroiliac joint inflammation in axial spondyloarthritis. Clin Exp Rheumatol. 35(2):262-269, 2017 Mar-Apr. |
Observational-Dx |
110 axial spondyloarthritis patients. |
To investigate the usefulness of diffusion weighted imaging (DWI) by comparing with clinical features, blood parameters and traditional short tau inversion recovery (STIR) sequence in detecting spinal and sacroiliac (SI) joint inflammation in axial spondyloarthritis (axSpA) patients. |
DWI did not correlate with clinical parameters or blood parameters. It also had lowered sensitivity. When compared with STIR sequence, it correlated well with STIR sequence at the SI joint level (CC 0.76, p<0.001), but weakly at the spinal level (CC 0.23, p=0.02). At the SI joint level, the presence of inflammation on both STIR sequence and DWI was associated with an increase in maximum (B=0.24, p=0.02 in STIR; B=0.37, p<0.001 in DWI) and mean ADC values (B=0.17, p=0.003 in STIR; B=0.15, p=0.01 in DWI). Maximum (B=0.19, p=0.04) and mean spinal ADC values (B=0.18, p=0.01) were also positively associated with DWI detected spinal inflammation. Presence of Modic lesions showed positive correlation with STIR sequence (B=7.12, p=0.01) but not spinal ADC values. |
2 |
| 102. Gaspersic N, Sersa I, Jevtic V, Tomsic M, Praprotnik S. Monitoring ankylosing spondylitis therapy by dynamic contrast-enhanced and diffusion-weighted magnetic resonance imaging. Skeletal Radiol 2008;37:123-31. |
Observational-Dx |
30 patients with active spondylitis or bilateral sacroiliitis |
To assess the role of quantitative MRI in the evaluation of AS treatment efficacy. |
Clinical and quantitative MRI parameters diminished significantly with regression of the inflammatory activity. The improvement in AS was most pronounced in patients treated with infliximab; after 12 months the ADC diminished from an average of 1.31 to 0.88 x 10(-3) mm(2)/s, f(enh) from 1.85 to 0.60, and g(enh) from 3.09 to 1.40 %/s. |
3 |
| 103. Gezmis E, Donmez FY, Agildere M. Diagnosis of early sacroiliitis in seronegative spondyloarthropathies by DWI and correlation of clinical and laboratory findings with ADC values. Eur J Radiol 2013;82:2316-21. |
Review/Other-Dx |
62 patients with inflammatory low back pain and 40 subjects in the control group. |
To show the signal characteristics of the sacral and iliac surfaces by DWI which may contribute in early diagnosis of sacroiliitis and investigate the correlation between ADC values and clinical and laboratory parameters. |
ADC values on both surfaces of the both sacroiliac joints were found 0.23 × 10(-3)mm(2)/sn in the control group. In the patient group, mean ADC value of 0.48 × 10(-3)mm(2)/sn was obtained (p<0.001), which was statistically significant, compatible with the increased diffusion due to medullary edema in early sacroiliitis. There was a slight correlation between CRP and ADC values; presumed to be showing the relation between the activity of the disease and the active inflammation on DWI. There was no correlation between arthritis and enthesitis and the ADC values (p>0.001). |
4 |
| 104. Kucybala I, Ciuk S, Urbanik A, Wojciechowski W. The usefulness of diffusion-weighted imaging (DWI) and dynamic contrast-enhanced (DCE) sequences visual assessment in the early diagnosis of axial spondyloarthritis. Rheumatol Int. 39(9):1559-1565, 2019 Sep. |
Observational-Dx |
49 patients |
To compare the diagnostic efficacy of the visual assessment of diffusion-weighted imaging (DWI) and dynamic contrast-enhanced (DCE) sequences compared to the STIR sequence in the diagnostics of active sacroiliitis in the course of axial spondyloarthritis (axSpA). |
Overall, 46.9% (n=23) of patients fulflled the imaging arm of ASAS criteria for axial spondyloarthritis. DWI with ADC map: accuracy 95.6%, sensitivity 99.4%, specifcity 54.0%. DCE sequence: accuracy 96.8%, sensitivity 98.4%, specifcity 79.5%. The highest level of inter-observer agreement was achieved for STIR sequence (?=0.888), slightly lower for DCE sequence (?=0.773) and the lowest for DWI with ADC (?=0.674). |
2 |
| 105. Shi Z, Han J, Qin J, Zhang Y. Clinical application of diffusion-weighted imaging and dynamic contrast-enhanced MRI in assessing the clinical curative effect of early ankylosing spondylitis. Medicine (Baltimore). 98(20):e15227, 2019 May. |
Review/Other-Dx |
48 patients |
To demonstrate the clinical application value of diffusion-weighted imaging (DWI) and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in assessing a clinical curative effect of early ankylosing spondylitis (AS). |
The mean ADC value of the subarticular surface bone marrow of patients and after clinical treatment was (5.05 ± 1.10) × 10 and (4.34 ± 0.55) × 10 mm/s in ilium and (4.63 ± 0.79) × 10 and (3.96 ± 0.23) × 10 mm/s in sacrum, respectively. 2. In the DCE-MRI follow-up treatment imaging of 48 patients with AS (192 parts), the TIC curve type recorded was as follows: 43.75% (84/192) of type II, 56.25% (108/192) of type III, and type I curve was not seen. The number of type II curve was significantly reduced for pre treatment group (84 cases) compared with that post treatment group (124 cases). The Fenh, Senh, and TTP values were respective (113.38 ± 44.71)%, (60.94 ± 38.56)% min, (129.52 ± 42.66) s in ilium and (83.03 ± 20.39)%, (44.91 ± 15.19)% min, (123.44 ± 28.50) s in sacrum before clinical treatment. After the treatment, the Fenh, Senh, and TTP values were respective (75.90 ± 17.97)%, (33.96 ± 11.36)% min, (138.67 ± 26.60) s in ilium and (73.28 ± 15.67)%, (31.92 ± 8.15)% min, (140.19 ± 19.88) s in sacrum. |
4 |
| 106. Zhang M, Zhou L, Huang N, Zeng H, Liu S, Liu L. Assessment of active and inactive sacroiliitis in patients with ankylosing spondylitis using quantitative dynamic contrast-enhanced MRI. J Magn Reson Imaging. 46(1):71-78, 2017 07. |
Observational-Dx |
42 patients with ankylosing spondylitis |
To investigate the feasibility of using quantitative dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) to differentiate the active and inactive stage of sacroiliitis and the correlation between quantitative parameters and disease activity as measured by clinical scores. |
Ktrans , Kep , Ve , time to peak (TTP), max concentration (MAX Conc), and area under the curve (AUC) of the active group were significantly higher than those of the inactive stage group (P < 0.05). There were significant correlations between all parameters and BASDAI (P < 0.05). AUC of the receiver operator characteristics curve (AUCR ) of different parameters were not statistically different (P >0.05), except between AUC and MAX Conc (P = 0.0012). |
3 |
| 107. Althoff CE, Feist E, Burova E, et al. Magnetic resonance imaging of active sacroiliitis: do we really need gadolinium? Eur J Radiol. 2009;71(2):232-236. |
Observational-Dx |
105 patients |
To compare short tau inversion recovery (STIR) sequences and fatsaturated T1-weighted fast spin-echo (FSE) sequences in terms of diagnosis, diagnostic confidence, and quantification of inflammatory changes. |
Active sacroiliitis was diagnosed in 46 patients and ruled out in 34 using STIR, whereas findings were inconclusive in 25 patients. The corresponding numbers for T1/Gd were 47, 44, and 14. Diagnostic confidence was significantly lower for STIR (7.3+/-2.6) compared with T1/Gd (8.7+/-1.9) (P<0.001). The sum scores were 2.5 (+/-3.3) for STIR and 2.2 (+/-3.2) for T1/Gd for the right SIJ and 2.2 (+/-2.9) (STIR) and 1.9 (+/-3.1) (T1/Gd) for the left SIJ. Agreement was high with intraclass correlation coefficient values of 0.86 for the right SIJ and 0.90 for the left SIJ and positive correlation (r=0.62 right, 0.60 left). |
2 |
| 108. de Hooge M, van den Berg R, Navarro-Compan V, et al. Magnetic resonance imaging of the sacroiliac joints in the early detection of spondyloarthritis: no added value of gadolinium compared with short tau inversion recovery sequence. Rheumatology (Oxford). 2013;52(7):1220-1224. |
Review/Other-Dx |
127 patients |
To investigate the additional value of T1/Gd compared with T1 and STIR sequence in detecting active lesions of the SIJ typical of SpA in a prospective cohort study, the SpondyloArthritis Caught Early (SPACE) cohort, and to assess its influence on final MRI diagnosis of the SIJ (MRI-SIJ) based on the ASAS definition of active sacroiliitis. |
A total of 127 patients received an MRI-SIJ at baseline and 67 patients also received an MRI-SIJ at 3 months follow-up since the Gd protocol was added some months after the start of the SPACE project. 25/127 patients (19.7%) with a baseline MRI-SIJ and 14/67 patients (20.6%) with a follow-up MRI-SIJ presented BMO on the STIR sequence sufficient to fulfill the ASAS definition for a positive MRI-SIJ. In 8 patients, additional synovitis and/or capsulitis/enthesitis was observed; however, no additional BMO was visualized on T1/Gd. One patient, without clinical diagnosis of axSpA, showed synovitis as an isolated finding. |
4 |
| 109. Giraudo C, Weber M, Puchner A, Grisar J, Kainberger F, Schueller-Weidekamm C. Which MR sequences should we use for the reliable detection and localization of bone marrow edema in spondyloarthritis?. Radiol Med (Torino). 122(10):752-760, 2017 Oct. |
Observational-Dx |
74 patients |
To evaluate the diagnostic confidence in detecting and localizing BME in patients with clinical findings suggestive of SpA, using para-coronal STIR alone, and comparing it with the diagnostic confidence using a multiplanar method without contrast application, which included para-coronal STIR and para-axial proton density fat-saturated sequences, and with a multiplanar contrast-enhanced method. |
Both multiplanar methods increased the diagnostic confidence in detection (p < 0.001) and localization (p < 0.001) of sacroiliitis; no significant difference occurred between the multiplanar unenhanced and enhanced methods (p = 0.405 and p = 1.00, respectively, for detection and localization). A statistically significant difference between the distributions of certain and uncertain rating for detection based on the size and signal intensity of each lesion emerged (p = 0.006 and p < 0.001, respectively), whereas no statistically significant difference occurred for the confidence of localization (p = 0.452 and p = 0.694, respectively). |
3 |
| 110. Madsen KB, Egund N, Jurik AG. Grading of inflammatory disease activity in the sacroiliac joints with magnetic resonance imaging: comparison between short-tau inversion recovery and gadolinium contrast-enhanced sequences. J Rheumatol. 2010;37(2):393-400. |
Observational-Dx |
40 patients |
To investigate the potential concordance of 2 different MRI sequences, STIR and fat-saturated T1/Gd contrast medium to detect active bone marrow abnormalities at the SIJs in patients with SpA. |
There was a significant positive correlation between the activity scores obtained by STIR and Gd-enhanced sequences (P<0.0001). Agreement in the detection of bone marrow abnormalities occurred in 60 of the 80 joints, 35 with and 25 without signs of active disease. Discordance with STIR-positive marrow activity scores occurred in only 11 joints; Gd-enhanced positive scores in 9 joints. The STIR sequence detected remnants of marrow activity in the periphery of chronic fatty replacement not seen or partly obscured on the Gd sequence. Small subchondral enhancing lesions may not be scored on the STIR sequence, mostly because of reduced image resolution. |
3 |
| 111. Sung S, Kim HS, Kwon JW. MRI assessment of sacroiliitis for the diagnosis of axial spondyloarthropathy: comparison of fat-saturated T2, STIR and contrast-enhanced sequences. British Journal of Radiology. 90(1078):20170090, 2017 Oct. |
Observational-Dx |
92 patients. |
To evaluate whether there are significant differences between contrast-enhanced fat-saturated T1 weighted imaging and non-enhanced fat-suppression imaging for diagnosing sacroiliitis in patients with inflammatory back pain. |
Cohen’s kappa coefficients for sacroiliitis positivity between the two observers were 0.978 and 0.956, and Cohen’s kappa coefficients between the two image sets for each observer were 0.892 and 0.870, respectively. |
2 |
| 112. Bennett AN, Marzo-Ortega H, Kaur-Papadakis D, Rehman A, BRITSpA. The Use of Magnetic Resonance Imaging in Axial Spondyloarthritis: Time to Bridge the Gap Between Radiologists and Rheumatologists. J Rheumatol. 44(6):780-785, 2017 06. |
Review/Other-Dx |
269 radiologists |
To describe current practice in the use of MRI for assessment of axSpA by UK radiologists. |
Twenty-nine radiologists (11%) used contrast as standard, 256 (91%) used T1 and short-tau inversion recovery, and 172 (64%) also used T2 sequences. Five percent scanned only SIJ, 33% scanned SIJ and lumbar spine, 29% scanned SIJ and thoracolumbar spine, and 30% scanned SIJ and the whole spine. Mean scan time was 34 min. Eighteen percent did not use the subchondral bone marrow edema of the SIJ to help diagnose axSpA and 18% did not use the inflammatory vertebral corner lesions to assist diagnosis. Awareness of axSpA was reported by 75% of radiologists, and awareness of definitions for positive MRI of SIJ and spine by 31% and 25%, respectively. |
4 |
| 113. Weber U, Zubler V, Zhao Z, et al. Does spinal MRI add incremental diagnostic value to MRI of the sacroiliac joints alone in patients with non-radiographic axial spondyloarthritis?. Ann Rheum Dis. 74(6):985-92, 2015 Jun. |
Observational-Dx |
130 with back pain and 20 healthy controls |
To assess: (1) the incremental diagnostic value of spine MRI evaluated independently from SIJ MRI and then simultaneously with SIJ MRI in two SpA inception cohorts compared with the diagnostic value of SIJ MRI alone; (2) the frequency of false positive classification as SpA in NSBP and healthy controls according to spine MRI alone and combined MRI; (3) which MRI spinal lesion type had the highest impact on correct/incorrect classification. |
In cohorts A/B, 15.8%/24.2% of patients with nr-axSpA having a negative SIJ MRI were reclassified as being positive for SpA by global evaluation of combined scans. However, 26.8%/11.4% of non-specific back pain controls and 17.5% of healthy volunteers with a negative SIJ MRI were falsely reclassified as having SpA by combined MRI. Low confidence in a diagnosis of SpA by SIJ MRI increased to high confidence by combined MRI in 6.6%/7.3% of patients with nr-axSpA. |
2 |
| 114. Chung HY, Yiu RSW, Chan SCW, Lee KH, Lau CS. Fatty corner lesions in T1-weighted magnetic resonance imaging as an alternative to sacroiliitis for diagnosis of axial spondyloarthritis. BMC Rheumatol.. 3:17, 2019. |
Observational-Dx |
238 axSpA patients and 62 non-axSpA patients with back pain |
To systematically evaluate the diagnostic accuracy of fatty corner lesions in tertiary centre patients with chronic back pain. |
FCLs of the anterior whole spine (AUC 0.62; p = 0.003) and anterior thoracic spine (AUC 0.64; p = 0.001) had diagnostic significance. Incorporating at least 5 whole spine FCLs into the imaging criteria of the Assessment of SpondyloArthritis international Society (ASAS) criteria for axSpA yielded a sensitivity of 91.6% and specificity of 91.9%. Similarly, applying at least 3 anterior thoracic FCLs to the imaging criteria of the ASAS axial SpA criteria yielded a sensitivity of 92.0% and specificity of 93.5%. |
1 |
| 115. van der Heijde D, Sieper J, Maksymowych WP, et al. Spinal inflammation in the absence of sacroiliac joint inflammation on magnetic resonance imaging in patients with active nonradiographic axial spondyloarthritis. Arthritis Rheumatol 2014;66:667-73. |
Review/Other-Dx |
185 patients |
To evaluate the presence of spinal inflammation with and without sacroiliac (SI) joint inflammation on magnetic resonance imaging (MRI) in patients with active nonradiographic axial spondyloarthritis (SpA), and to compare the disease characteristics of these subgroups. |
Among patients with baseline SPARCC scores, 40% had an SI joint score of =2 and 52% had a spine score of =2. Forty-nine percent of patients with baseline SI joint scores of <2, and 58% of those with baseline SI joint scores of =2, had a spine score of =2. Comparison of baseline disease characteristics by baseline SI joint and spine scores showed that a greater proportion of patients in the subgroup with a baseline SPARCC score of =2 for both SI joints and spine were male, and patients with spine and SI joint scores of <2 were younger and had shorter symptom duration. |
4 |
| 116. Marzo-Ortega H, McGonagle D, O'Connor P, et al. Baseline and 1-year magnetic resonance imaging of the sacroiliac joint and lumbar spine in very early inflammatory back pain. Relationship between symptoms, HLA-B27 and disease extent and persistence. Ann Rheum Dis. 2009;68(11):1721-1727. |
Observational-Dx |
54 patients; 22 controls |
To use MRI to study the SIJ and lumbar spine and explore the relationship between sites and extent of inflammation and HLA-B27 status over 12 months. |
At baseline 46/54 (85%) patients had BMO (SIJs and lumbar spine) compared with 40% in the control group. The majority of affected patients had inflammation at the SIJ level (96% (n = 44); 23.5% (n = 12) lumbar spine) and 28.3% (n = 13) at both sites simultaneously. The SIJ activity score confirmed more severe inflammation (BMO grade 2 or 3: 52.2%) in the IBP group (controls = BMO grade 1: 100%; P<0.001). HLA-B27 was associated with both the severity (P=0.009) and number of baseline SIJ lesions (P=0.045) and with persistence (SIJ or lumbar spine) at 1 year (P=0.02). 90% of reattenders fulfilled European Spondyloarthropathy Study Group criteria; 73.5% showed MRI inflammation despite clinical improvement (median BASDAI 5.65 to 3.05; P<0.009). |
3 |
| 117. Blachier M, Coutanceau B, Dougados M, et al. Does the site of magnetic resonance imaging abnormalities match the site of recent-onset inflammatory back pain? The DESIR cohort. Ann Rheum Dis. 2013;72(6):979-985. |
Review/Other-Dx |
648 patients |
To assess whether the site of axial pain (thoracic spine, lumbar spine or buttock(s)) was associated with the site of MRI lesions in patients with recent IBP suggesting spondyloarthritis. |
Of the 648 patients with complete data, 61% had thoracic pain, 91.6% lumbar pain and 79.2% buttock pain. MRI inflammation was seen in 19%, 21% and 46% of patients at the thoracic, lumbar and SIJ sites, respectively. By multivariate analysis, pain was significantly associated with MRI inflammation only at the same site (adjusted OR thoracic pain 1.71; 95% CI, 1.09 to 2.67; P=0.02; adjusted OR lumbar pain 2.53; 95% CI, 1.03 to 6.20; P=0.04; adjusted OR buttock pain 2.86; 95% CI, 1.84 to 4.46; P<0.0001). Pain site was not significantly associated with the site of structural MRI changes, except for buttock pain and SIJ structural MRI changes (adjusted OR buttock pain 1.89; 95% CI, 1.22 to 2.90; P=0.004). The association between pain site and site of MRI inflammation persisted in the subgroups with normal or doubtful SIJ radiographs or with ASAS international Society criteria for SpA. |
4 |
| 118. Bochkova AG, Levshakova AV, Bunchuk NV, Braun J. Spinal inflammation lesions as detected by magnetic resonance imaging in patients with early ankylosing spondylitis are more often observed in posterior structures of the spine. Rheumatology (Oxford). 2010;49(4):749-755. |
Observational-Dx |
29 patients |
To study the localization and extent of spinal inflammation in patients with AS in detail. |
Consecutive patients with AS (n = 29), who fulfilled the modified New York criteria, were examined by MRI: 67% male, 93% HLA-B27-positive, median age 27.5 (18–49) years, median disease duration 7.5 (1.5–24) years. IBP, median duration 36 (1–240) months, with a mean intensity of 40 mm on a visual analogue scale (20–100) was present in 26 patients (89.7%), and the BASDAI was >40 in 21 patients (72.4%). MRI evidence of spinal inflammation at any site was found in 27 patients (96.5%), whereas radiographic changes were only seen in 6.9% (P<0.05). Patients with a short history of IBP (n = 11) had significantly more lesions in posterior spinal structures than in vertebral bodies: 90.9% vs 27.2%, respectively (P<0.003). Isolated changes in posterior spinal structures were seen in 8 of these patients (72.7%), whereas, in contrast, patients with a longer history of IBP (n = 18) had significantly more inflammation in vertebral bodies: 88.9% vs 27.2%, respectively (P<0.01). |
2 |
| 119. de Hooge M, de Bruin F, de Beer L, et al. Is the Site of Back Pain Related to the Location of Magnetic Resonance Imaging Lesions in Patients With Chronic Back Pain? Results From the Spondyloarthritis Caught Early Cohort. Arthritis Care Res (Hoboken). 69(5):717-723, 2017 05. |
Review/Other-Dx |
348 patients |
To determine associations between magnetic resonance imaging (MRI) lesions originating from either axial spondyloarthritis (SpA) or from degeneration and pain in patients with chronic back pain of <2 years duration. |
Pain was localized in the thoracic spine (35.9%), the lumbar spine (82.5%), or in the buttock(s) (57.8%). Inflammatory lesions of the SI joint (odds ratio [OR] 1.06; P = 0.04) and erosions of the SI joint in patients <25 years (OR 1.16; P = 0.04) were associated with buttock pain. Axial SpA spinal lesions were not associated with pain. Modic type 1 lesions in patients >35 years (OR 5.19; P = 0.001), high-intensity zone lesions in females not fulfilling ASAS criteria (OR 5.09; P = 0.001), and herniation in various subgroups (OR range 2.07-4.66) were associated with pain. |
4 |
| 120. Weber U, Hodler J, Kubik RA, et al. Sensitivity and specificity of spinal inflammatory lesions assessed by whole-body magnetic resonance imaging in patients with ankylosing spondylitis or recent-onset inflammatory back pain. Arthritis Rheum 2009;61:900-8. |
Observational-Dx |
35 patients with ankylosing spondylitis, 25 patients with recent-onset inflammatory back pain, and 35 healthy age- and sex-matched volunteers. |
To determine the diagnostic utility of different spinal inflammatory lesions assessed by whole-body magnetic resonance imaging (MRI) in patients with ankylosing spondylitis (AS) or with recent-onset inflammatory back pain (IBP) compared with healthy controls. |
Diagnostic utility was optimal when > or =2 CIL were recorded (for patients with AS, values for sensitivity, specificity, and positive LR were 69%, 94%, and 12, respectively, and for patients with IBP were 32%, 96%, and 8, respectively). LIL had high specificity (97%) but low sensitivity (31%). Nine controls had > or =1 CIL, but only 2 controls had >2 CIL. |
2 |
| 121. Weber U, Zhao Z, Rufibach K, et al. Diagnostic utility of candidate definitions for demonstrating axial spondyloarthritis on magnetic resonance imaging of the spine. Arthritis Rheumatol 2015;67:924-33. |
Observational-Dx |
130 patients and 20 age‐matched healthy controls. |
To evaluate the diagnostic utility of these cutoffs in nonradiographic axial SpA and ankylosing spondylitis (AS). |
None of the spinal thresholds (=2 or =3 CILs and =6 CFLs) showed clinically relevant diagnostic utility (positive likelihood ratio [LR] range 1.38–2.36) when comparing patients with nonradiographic axial SpA to patients with nonspecific back pain. A threshold of =6 CILs had moderate to substantial diagnostic utility (positive LR 13.26 and 6.74 in cohorts A and B, respectively) in nonradiographic axial SpA, while =4 CILs showed small diagnostic utility (positive LR 3.83 and 2.72 in cohorts A and B, respectively) but specificities of >0.90. |
2 |
| 122. Weiss BG, Bachmann LM, Pfirrmann CW, Kissling RO, Zubler V. Whole Body Magnetic Resonance Imaging Features in Diffuse Idiopathic Skeletal Hyperostosis in Conjunction with Clinical Variables to Whole Body MRI and Clinical Variables in Ankylosing Spondylitis. Journal of Rheumatology. 43(2):335-42, 2016 Feb. |
Observational-Dx |
33 patients with ankylosing spondylitis and 15 patients with diffuse idiopathic skeletal hyperostosis |
To assess the value of clinical variables alone and in combination with WB-MRI to distinguish between DISH and AS. |
Forty-eight patients provided 1545 positive findings (193 DISH/1352 AS). The final MR model contained upper anterior corner fat infiltration (32 DISH/181 AS), ankylosis on the vertebral endplate (4 DISH/60 AS), facet joint ankylosis (4 DISH/49 AS), sacroiliac joint edema (11 DISH/91 AS), sacroiliac joint fat infiltration (2 DISH/114 AS), sacroiliac joint ankylosis (2 DISH/119 AS); area under the ROC curve was 0.71, 95% CI 0.64-0.78. The final clinical model contained patient's age and body mass index (area under the ROC curve 0.90, 95% CI 0.89-0.91). The full diagnostic model containing clinical and MR information had an area under the ROC curve of 0.93 (95% CI 0.92-0.95). |
3 |
| 123. Hermann KG, Baraliakos X, van der Heijde DM, et al. Descriptions of spinal MRI lesions and definition of a positive MRI of the spine in axial spondyloarthritis: a consensual approach by the ASAS/OMERACT MRI study group. Ann Rheum Dis. 71(8):1278-88, 2012 Aug. |
Review/Other-Dx |
N/A |
To define characteristic MRI findings in the spine of patients with SpA and provide a definition of a positive spinal MRI for inflammation and structural changes. |
A total of 6 different types of lesions were described for inflammation—AP spondylitis, spondylodiscitis, arthritis of costovertebral joints, arthritis of zygoapophyseal joints and enthesitis of spinal ligaments—and another 4 for structural changes—fatty deposition, erosions, syndesmophytes and ankylosis. In the literature review, 4 relevant papers were identified. AP spondylitis and fat depositions at vertebral edges were considered as the most typical findings in SpA. Based on expert consensus and taking the literature review into consideration, a positive spinal MRI for inflammation was defined as the presence of AP spondylitis in =3 sites. Evidence of fatty deposition at several vertebral corners was found to be suggestive of axial SpA, especially in younger adults. ASAS members (n=56) approved these definitions by voting in January 2010. |
4 |
| 124. de Bruin F, ter Horst S, Bloem HL, et al. Prevalence of degenerative changes of the spine on magnetic resonance images and radiographs in patients aged 16-45 years with chronic back pain of short duration in the Spondyloarthritis Caught Early (SPACE) cohort. Rheumatology (Oxford). 55(1):56-65, 2016 Jan. |
Review/Other-Dx |
274 patients |
To determine the prevalence of degenerative changes (DCs) in the spine of young patients with back pain without axial spondyloarthritis (no-axSpA), with possible axSpA (poss-axSpA) and with definite axSpA (axSpA), as shown on MRI and radiographs. |
Two hundred and forty-five (89%) patients had DCs on MRI [21/25 (84%) no-axSpA, 121/134 (90%) poss-axSpA, 103/115 (90%) axSpA, P = 0.792], range 1-29 (median 5.5), and 121 (44%) patients had DCs on radiographs [13/25 (52%) no-axSpA, 62/134 (46%) poss-axSpA, 48/115 (42%) axSpA, P = 0.261], range 1-11 (median 2). |
4 |
| 125. Baraliakos X, Landewe R, Hermann KG, et al. Inflammation in ankylosing spondylitis: a systematic description of the extent and frequency of acute spinal changes using magnetic resonance imaging. Ann Rheum Dis 2005;64:730-4. |
Observational-Dx |
38 patients with active AS |
To assess the presence and extent of inflammation in all three spinal segments in patients with AS by T1 weighted, fat saturated, post-Gd-DTPA and STIR MRI sequences, and to compare the differential involvement of the three spinal segments. |
A greater number of inflammatory spinal lesions were found by the STIR sequence than by Gd-DTPA: inflammation was present in 30.6% of the VUs as assessed by STIR, compared with 26.8% of the same VUs assessed by T(1)/Gd-DTPA. Inflammation was found more commonly in the thoracic spine (TS) than in the cervical (CS) or the lumbar spine (LS) with both techniques. When STIR was used, spinal inflammation in the CS, the TS, and LS was detected in 10/38 (26%), 28/38 (74%), and 9/38 (24%) patients, respectively. The VU T7/8 was found to be the VU most often affected by both techniques (27.8% by T(1)/Gd-DTPA and 34.5% by STIR). |
3 |
| 126. Braun J, Baraliakos X, Golder W, et al. Magnetic resonance imaging examinations of the spine in patients with ankylosing spondylitis, before and after successful therapy with infliximab: evaluation of a new scoring system. Arthritis Rheum 2003;48:1126-36. |
Observational-Dx |
20 patients with AS |
To evaluate a magnetic resonance imaging (MRI) scoring system for the assessment of spinal inflammation in patients with ankylosing spondylitis (AS) who participated in a randomized, placebo-controlled trial of infliximab, and to examine whether infliximab is also effective for the reduction of MRI-proven spinal inflammation. |
Active spinal lesions were detected in 15 of 20 patients (75%); the frequency as determined by STIR was equal in the 2 groups. At baseline, the total MRI scores determined using Gd-DTPA, STIR, and T1 were 112.5, 156, and 253.5, respectively. The interrater variance and intrarater variance were, respectively, 6.4 and 7.7 for the active lesion score as determined by Gd-DTPA, 15.7 and 5.3 for the active lesion score as determined by STIR sequence, and 167.3 and 75.5 for the chronic lesion score as determined by T1 sequence. Based on the means of the scores assigned by the 2 readers, the active lesion score as determined by Gd-DTPA improved by 40% in the infliximab group compared with 6% in the placebo group, the active lesion score as determined by STIR improved by 60% in the infliximab group but deteriorated by 21% in the placebo group, and the chronic lesion score as determined by T1 improved by 7% in the infliximab group but worsened by 35% in the placebo group. Five patients in the infliximab group and 2 in the placebo group were clinical responders. |
3 |
| 127. Hermann KG, Landewe RB, Braun J, van der Heijde DM. Magnetic resonance imaging of inflammatory lesions in the spine in ankylosing spondylitis clinical trials: is paramagnetic contrast medium necessary? J Rheumatol 2005;32:2056-60. |
Observational-Dx |
48 patients with ankylosing spondylitis |
To investigate whether Gd-enhanced sequences add relevant information compared to STIR imaging alone in the detection of active spinal lesions. |
The ASspiMRI-a scoring method was used, in which 23 vertebral units are graded for inflammation from 0 to 6 (total score 0 to 138). Mean scorings of both techniques within readers were in the same range (reader 1: STIR 7.8, T1/Gd 7.7; reader 2: STIR 4.4, T1/Gd 4.7). Intraclass correlation coefficients comparing STIR and T1/Gd where high for both status scores (reader 1: 0.88; reader 2: 0.90) and change scores (both readers: 0.88). Bland and Altman analysis for both sequences showed homogeneous interreader variability along the entire spectrum of scorings, for both status scores and change scores. Smallest detectable change for status scores was 6.2 for STIR and 6.7 for T1/Gd, and for change scores 6.5 and 6.3, respectively. Standardized response means were comparable for both methods (range: 0.80-1.09). |
2 |
| 128. Rudwaleit M, Baraliakos X, Listing J, Brandt J, Sieper J, Braun J. Magnetic resonance imaging of the spine and the sacroiliac joints in ankylosing spondylitis and undifferentiated spondyloarthritis during treatment with etanercept. Ann Rheum Dis 2005;64:1305-10. |
Observational-Tx |
18 patients with active ankylosing spondylitis and 7 with active undifferentiated spondyloarthritis. |
To assess the changes in inflammatory lesions of the spine and the sacroiliac (SI) joints as detected by magnetic resonance imaging (MRI) in patients with ankylosing spondylitis (AS) and undifferentiated spondyloarthritis (uSpA) with predominant axial symptoms during treatment with etanercept. |
By use of the definite STIR sequence, significant regression of spinal inflammation was already seen already after 6 weeks in the patients treated with etanercept (mean (SD) 11.2 (13.8) at TP0 v 6.8 (7.9) at TP1; p = 0.023) but not in patients treated with placebo. Continuous treatment with etanercept for 24 weeks reduced active spinal changes by 69% (p = 0.012). T1/Gd-DTPA sequences gave similar results. There was only a trend for a decrease of active inflammatory lesions of the SI joints. |
2 |
| 129. Wang YX, Griffith JF, Deng M, et al. Vertebral body corner oedema vs gadolinium enhancement as biomarkers of active spinal inflammation in ankylosing spondylitis. Br J Radiol. 2012;85(1017):e702-708. |
Observational-Dx |
32 patients |
To investigate the relative performance of T2-weighted STIR and fat-suppressed T1-weighted Gd contrast-enhanced sequences in depicting active inflammatory lesions in AS. |
For the pretreatment lesion status, the intraclass correlation coefficients comparing STIR readings and contrast-enhanced readings were 0.69+/-0.23 for Reader 1 and 0.65+/-0.21 for Reader 2. At baseline, the mean ASspiMRI-a score was 15.4% and 17.7% higher for contrast-enhanced images than for STIR images for Reader 1 and Reader 2, respectively. After infliximab treatment, Reader 1 rated an ASspiMRI-a score reduction of 50.8+/-33.6% and 25.3+/-35.3% for STIR images and contrast-enhanced images, respectively, whereas Reader 2 rated an ASspiMRI-a score reduction of 42.4+/-50.4% and 32.9+/-35.6% for STIR images and contrast-enhanced images, respectively. |
2 |
| 130. Arslan H, Sakarya ME, Adak B, Unal O, Sayarlioglu M. Duplex and color Doppler sonographic findings in active sacroiliitis. AJR Am J Roentgenol. 1999;173(3):677-680. |
Observational-Dx |
38 patients |
To describe the duplex and color Doppler US findings in active sacroiliitis. |
Vascularization around the posterior portions of SIJs was seen in 41 joints of the 21 patients with active sacroiliitis, 9 joints of 6 patients with osteoarthritis, and 13 joints of 8 volunteers. The mean RI values were 0.62 +/- 0.13, 0.91 +/- 0.09, and 0.97 +/- 0.03, respectively. In the patients with active sacroiliitis, the mean RI value was 0.91 +/- 0.07 after therapy. The RI values for the patients with active sacroiliitis were significantly different from those of the patients with osteoarthritis (P<.001) and of the volunteers (P<.001). In addition, the RI values were significantly different before and after treatment in the patients with active sacroiliitis (P<.001). |
3 |
| 131. Ghosh A, Mondal S, Sinha D, Nag A, Chakraborty S. Ultrasonography as a useful modality for documenting sacroiliitis in radiographically negative inflammatory back pain: a comparative evaluation with MRI. Rheumatology (Oxford). 53(11):2030-4, 2014 Nov. |
Observational-Dx |
29 patients with inflammatory low back pain |
To identify and characterize features of sacroiliitis in patients with non-radiographic inflammatory low back pain by ultrasonography (USG) and to correlate the findings with that of MRI. |
Receiver operating characteristic analysis revealed cut-off values for flow signals and RI of 3 and 0.605, respectively. There was a significant difference in the number of flow signals, RI and echogenicity of the SI joint between MRI-proven cases and controls. The Cohen's ? for flow signals, RI and hyperechogenicity when compared with MRI were 0.816 (95% CI 0.676, 0.937) and 0.821 (95% CI 0.662, 0.965) and 0.403 (95% CI 0.108, 0.695). Taking both flow signals and RI parameters as criteria for determining sacroiliitis, comparison with MRI returned a ? of 0.816 (95% CI 0.601, 0.963). |
2 |
| 132. Unlu E, Pamuk ON, Cakir N. Color and duplex Doppler sonography to detect sacroiliitis and spinal inflammation in ankylosing spondylitis. Can this method reveal response to anti-tumor necrosis factor therapy? J Rheumatol. 2007;34(1):110-116. |
Observational-Dx |
39 patients with AS and 14 healthy controls |
To investigate the role of color and duplex Doppler US in the detection of SIJ and spinal inflammation, as well as response to anti-TNF therapy in patients with AS. |
In patients with AS, RI values of SIJ and of lumbar vertebral and thoracal vertebral areas were lower than in controls (all P=0.01). In AS patients with active disease according to BASDAI, RI values of thoracal vertebral (P=0.0013) and lumbar vertebral (P=0.027) were significantly lower than in the inactive group. In the group with active AS, SIJ RI was nonsignificant lower (P=0.16). After anti-TNF therapy, there were significant increases in mean SIJ RI (P=0.028) and lumbar vertebral RI (P=0.039), and a nonsignificant increase in thoracal vertebral RI (P>0.05). |
3 |
| 133. Mohammadi A, Ghasemi-rad M, Aghdashi M, Mladkova N, Baradaransafa P. Evaluation of disease activity in ankylosing spondylitis; diagnostic value of color Doppler ultrasonography. Skeletal Radiol. 2013;42(2):219-224. |
Observational-Dx |
51 patients with AS and sacroiliitis and 30 control subjects |
To assess color Doppler US as a potential diagnostic tool in suspected sacroiliitis in comparison with MRI representing the gold standard. |
MRI demonstrated active disease in 27 and inactive disease in 24 patients. Color Doppler US detected pulsatile monophasic wave spectral waveform flow in 22 patients with the active disease, and triphasic in 7 patients with inactive disease and in 8 control patients. The sensitivity, specificity, positive predictive value and negative predictive value for active sacroiliitis detection with color Doppler US were 82% (95% CI, 68%–91 %), 92% (95% CI, 85%–96%), 91% (95% CI, 84%–96 %), and 84% (95% CI, 70%–92%), respectively, for pulsatile monophasic wave spectral waveform Doppler US. MRI of SIJ was negative in all 30 (60 SIJ) control participants. |
2 |
| 134. Klauser A, Halpern EJ, Frauscher F, et al. Inflammatory low back pain: high negative predictive value of contrast-enhanced color Doppler ultrasound in the detection of inflamed sacroiliac joints. Arthritis Rheum 2005;53:440-4. |
Observational-Dx |
103 patients and 30 controls without low back pain. |
To determine the value of microbubble contrast agents for color Doppler ultrasound (CDUS) compared with magnetic resonance imaging (MRI) in the detection of active sacroiliitis. |
Forty-three patients (41%) with 70 of 206 SI joints (34%) and none of the controls nor the 60 control SI joints demonstrated active sacroiliitis on MRI. Unenhanced CDUS showed a sensitivity of 17%, a specificity of 96%, a PPV of 65%, and an NPV of 72%; contrast-enhanced CDUS showed a sensitivity of 94%, a specificity of 86%, a PPV of 78%, and an NPV of 97%. Detection of vascularity in the SI joint was increased by contrast administration (P < 0.0001). Clustered receiver operating curve analysis demonstrated that enhanced CDUS (A(z) = 0.89) was significantly better than unenhanced CDUS (A(z) = 0.61) for the diagnosis of active sacroiliitis verified by MRI (P < 0.0001; 2-sided test). |
1 |
| 135. Klauser AS, De Zordo T, Bellmann-Weiler R, et al. Feasibility of second-generation ultrasound contrast media in the detection of active sacroiliitis. Arthritis Rheum 2009;61:909-16. |
Observational-Dx |
42 patients and 21 controls |
To determine whether a recently available contrast-enhanced ultrasound (CEUS) technique using second-generation microbubbles allows for the detection of active sacroiliitis, and to measure CEUS enhancement depth at the dorsocaudal part of the sacroiliac (SI) joints in healthy volunteers compared with patients with sacroiliitis. |
CEUS detected enhancement in all clinically active SI joints, showing an enhancement depth into the dorsal SI joint cleft of 18.5 mm (range 16-22.1), which was significantly higher compared with both inactive joints of patients (3.6 mm, range 0-12; P < 0.001) and healthy controls (3.1 mm, range 0-7.8; P < 0.001). All inactive joints were correctly classified based on a lack of deep enhancement in patients with sacroiliitis and controls (42 of 42, 100% sensitivity, 100% specificity; Cohen's kappa = 1) |
2 |
| 136. Gutierrez M, Rodriguez S, Soto-Fajardo C, et al. Ultrasound of sacroiliac joints in spondyloarthritis: a systematic review. Rheumatol Int. 38(10):1791-1805, 2018 Oct. |
Meta-analysis |
13 studies were included |
To analyse the available evidence about the use of US as a diagnostic tool in sacroiliitis in patients with SpA, by a systemic review of the literature fulfilling OMERACT criteria. |
In most articles (76.9%), the main US finding compatible with sacroiliitis evaluated was the presence of vascularisation (Doppler signals) with measurements of the resistive index (RI). The sensitivity and specificity analysis were performed in seven studies (58.8%) and were good, with a median of 90 and 89.2%, respectively. The studies showed a positive to moderate a strong correlation between the US and the gold standard but this was optimal only in four studies. In general, the agreement was good in all studies (= 0.80). |
Good |
| 137. Madsen KB, Jurik AG. Magnetic resonance imaging grading system for active and chronic spondylarthritis changes in the sacroiliac joint. Arthritis Care Res (Hoboken) 2010;62:11-8. |
Observational-Dx |
37 patients |
To develop a new grading method to quantify activity and chronic spondylarthritis (SpA) changes in the sacroiliac (SI) joints identified by magnetic resonance imaging (MRI), taking into account the complex joint anatomy, and to compare the findings with radiographic changes. |
Inter- and intraobserver agreements for grading activity and chronic changes were good, with kappa values between 0.72 and 0.86 and between 0.83 and 0.90, respectively. Nearly half of the disease activity changes were due to inflammation in the ligamentous joint portion, which was significantly related to ankylosing spondylitis (AS). |
2 |
| 138. Maksymowych WP, Inman RD, Salonen D, et al. Spondyloarthritis research Consortium of Canada magnetic resonance imaging index for assessment of sacroiliac joint inflammation in ankylosing spondylitis. Arthritis Rheum 2005;53:703-9. |
Review/Other-Dx |
11 patients with AS with clinically active disease and 11 additional patients randomized to the trial of infliximab therapy. |
To develop a feasible magnetic resonance imaging (MRI)-based scoring system for sacroiliac joint inflammation in patients with ankylosing spondylitis (AS) that requires minimal scan time, does not require contrast enhancement, evaluates lesions separately at each articular surface, and limits the number of sacroiliac images that are scored. |
ICC for total sacroiliac joint STIR score ranged from 0.90 to 0.98 (P < 0.00001) and interobserver ICC for combined readers from the 2 sites was 0.84 (P < 0.0001). ICC for change scores was lower for STIR (ICC 0.53) than for Gd-DTPA-enhanced sequences (ICC 0.79). |
4 |
| 139. Lukas C, Braun J, van der Heijde D, et al. Scoring inflammatory activity of the spine by magnetic resonance imaging in ankylosing spondylitis: a multireader experiment. J Rheumatol 2007;34:862-70. |
Observational-Dx |
Thirty sets of MRI |
To investigate feasibility, inter-reader reliability, sensitivity to change, and discriminatory ability of 3 different scoring methods for MRI activity and change in activity of the spine in patients with AS. |
The mean time to score one set of MRI was shortest for the Berlin method. SDC was lowest for the Berlin method and highest for SPARCC. Overall inter-reader ICC per method were between 0.49 and 0.77 for scoring activity status, and between 0.46 and 0.72 for scoring activity change. ICC for all possible reader pairs showed much more fluctuation per method, with lowest observed values of about 0.05 (very low agreement) and highest observed values over 0.90 (excellent agreement). In general, ICC for SPARCC were consistently higher than for other systems. Sensitivity to change differed per reader, and was more consistent with SPARCC than with the other methods, but was in general excellent for all 3 methods. Discrimination between groups (TNF-blocker vs placebo) assessed by Z-scores was good and comparable among methods. |
3 |
| 140. Maksymowych WP, Inman RD, Salonen D, et al. Spondyloarthritis Research Consortium of Canada magnetic resonance imaging index for assessment of spinal inflammation in ankylosing spondylitis. Arthritis Rheum 2005;53:502-9. |
Observational-Dx |
11 patients with ankylosing spondylitis and 20 additional patients randomized to a 24‐week trial of either infliximab or placebo. |
To develop a feasible magnetic resonance imaging (MRI)-based scoring system for spinal inflammation in patients with spondylarthropathy that requires minimal scan time, does not require contrast enhancement, evaluates the extent of lesions in 3 dimensional planes, and limits the number of vertebral levels that are scored because MRI demonstrates characteristic inflammatory lesions in the spine of patients with ankylosing spondylitis (AS) prior to the development of typical features on plain radiographic. |
An initial analysis of all discovertebral units (DVUs) in the spine of 11 patients demonstrated a mean of 3.2 (95% confidence interval 3.2, 5.2) affected units, while limiting the scoring to a maximum of 6 units captured most of the affected units. We scanned 11 patients with AS with clinically active disease and 20 additional patients randomized to a 24-week trial of either infliximab or placebo. Intraobserver reproducibility for the 6-DVU STIR score ranged from 0.93 to 0.98 (P < 0.0001). Interobserver reproducibility of scores by readers from both sites was 0.79 (P < 0.0001) for status score and 0.82 (P < 0.0001) for change score. Analysis of pretreatment and posttreatment scores for all 20 patients randomized to infliximab/placebo showed a large degree of responsiveness (standardized response mean = 0.87). |
2 |
| 141. Dougados M, Demattei C, van den Berg R, et al. Rate and Predisposing Factors for Sacroiliac Joint Radiographic Progression After a Two-Year Follow-up Period in Recent-Onset Spondyloarthritis. Arthritis rheumatol.. 68(8):1904-13, 2016 08. |
Observational-Dx |
708 patients |
To evaluate the rate of radiographic structural progression in the sacroiliac (SI) joints in patients with radiographic or nonradiographic axial spondyloarthritis (SpA), and to determine factors predisposing to such progression, over 2 years. |
Of the 708 patients enrolled, 449 had baseline and 2-year pelvic radiographs. Of these patients, 47% were men. Their mean ± SD age was 34 ± 9 years, 61% were B27 positive, and 37% had inflammation of the SI joints on MRI. The percentages of patients who switched from nonradiographic to radiographic axial SpA (4.9% [16 of 326]) and from radiographic to nonradiographic axial SpA (5.7% [7 of 123]) were low. The mean ± SD change in the total SI joint score (range 0-8) was small (0.1 ± 0.8) but highly significant (P < 0.001). The potential baseline predisposing factors for meeting the modified New York criteria in the multivariate analysis were current smoking, HLA-B27 positivity, and inflammation of the SI joints on MRI, with odds ratios of 3.3 (95% confidence interval [95% CI] 1.0-11.5], 12.6 (95% CI 2.3-274), and 48.8 (95% CI 9.3-904), respectively. |
4 |
| 142. Dougados M, Sepriano A, Molto A, et al. Sacroiliac radiographic progression in recent onset axial spondyloarthritis: the 5-year data of the DESIR cohort. Ann Rheum Dis. 76(11):1823-1828, 2017 Nov. |
Review/Other-Dx |
416 patients |
To estimate sacroiliac joint radiographic (X-SIJ) progression in patients with axial spondyloarthritis (axSpA) and to evaluate the effects of inflammation on MRI (MRI-SIJ) on X-SIJ progression. |
In 416 patients with pairs of baseline and 5-year X-SIJ present, net progression occurred in 5.1% (1), 13.0% (2) and 10.3% (3) respectively, regarding a shift from nr-axSpA to r-axSpA (1), a change of at least one grade (2) or a change of at least one grade but ignoring a change from grade 0 to 1 (3). Baseline MRI-SIJ predicted structural damage after 5 years in human leukocyte antigen-B27 (HLA-B27) positive (OR 5.39 (95% CI 3.25 to 8.94)) and in HLA-B27 negative (OR 2.16 (95% CI 1.04 to 4.51)) patients. |
4 |
| 143. Ibrahim A, Gladman DD, Thavaneswaran A, et al. Sensitivity and Specificity of Radiographic Scoring Instruments for Detecting Change in Axial Psoriatic Arthritis. Arthritis Care Res (Hoboken). 69(11):1700-1705, 2017 11. |
Observational-Dx |
105 patients with axial psoriatic arthritis. |
To determine the sensitivity to change of the Bath Ankylosing Spondylitis Radiology Index for the spine (BASRI-s), the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS), the Radiographic Ankylosing Spondylitis Spine Score (RASSS), and the PsA Spondylitis Radiology Index (PASRI) in axial PsA. |
Of the patients studied, 25 (24%) showed progression, as determined by the independent expert. The respective sensitivity and specificity values for an increase in score to detect true change were as follows: 0.48 and 0.78 (BASRI-s), 0.52 and 0.84 (mSASSS), 0.44 and 0.84 (RASSS), and 0.52 and 0.74 (PASRI). Logistic regression analyses showed that an increase of 1 point in the respective scores was associated with the following odds ratios for identifying true progression: BASRI-s 3.0, mSASSS 5.27, RASSS 3.70, and PASRI 3.06. |
2 |
| 144. Poddubnyy D, Rudwaleit M, Haibel H, et al. Rates and predictors of radiographic sacroiliitis progression over 2 years in patients with axial spondyloarthritis. Ann Rheum Dis 2011;70:1369-74. |
Observational-Dx |
210 patients |
To assess the progression of radiographic sacroiliitis in a cohort of patients with early axial spondyloarthritis over a period of 2 years and to explore predictors of progression. |
115 patients (54.8%) fulfilled the modified New York criteria for AS in their radiographic part in the opinion of both readers at baseline, while 95 patients (45.2%) were classified as non-radiographic axial spondyloarthritis. More patients with non-radiographic spondyloarthritis (10.5%) compared with AS (4.4%) showed an estimated 'true' progression by at least one grade according to both readers, although the difference between the two groups was statistically non-significant. The rate of progression from non-radiographic axial spondyloarthritis to AS was 11.6% over 2 years. An elevated level of C-reactive protein (CRP) at baseline was a strong positive predictor of radiographic sacroiliitis progression in non-radiographic axial spondyloarthritis and AS (OR 3.65 and 5.08, respectively, p<0.05). |
2 |
| 145. Sepriano A, Rudwaleit M, Sieper J, van den Berg R, Landewe R, van der Heijde D. Five-year follow-up of radiographic sacroiliitis: progression as well as improvement? Ann Rheum Dis 2016;75:1262-3. |
Observational-Dx |
357 patients |
The aim of this study was therefore to assess positive and negative changes on plain pelvic radiographs (X-SI) over time in the Assessment of Spondylo Arthritis international Society (ASAS) cohort, in which X-SI judgements have been provided by single local readers from many centres worldwide. |
357 patients had paired X-SI available. Of these, 17.4% (62/357) fulfilled the criteria for r-axSpA. At follow-up, this proportion has raised to 22.4% (80/357) suggesting a net progression of 5%. Cross-tabulation, however, revealed that more than half (36/62) considered mNY-positive at baseline were assessed mNY-negative at follow-up. If true, this would mean that radiographic sacroiliitis would have regressed in 58% of the cases. Conversely, only 54/295 patients (18.3%) became positive at follow-up. |
4 |
| 146. Wang R, Gabriel SE, Ward MM. Progression of Nonradiographic Axial Spondyloarthritis to Ankylosing Spondylitis: A Population-Based Cohort Study. Arthritis Rheumatol 2016;68:1415-21. |
Review/Other-Dx |
83 subjects with new-onset non-radiographic axial spondyloarthritis |
To examine the progression to AS in a population-based inception cohort of patients with nonradiographic axial SpA. |
Over a mean follow-up of 10.6 years, 16 subjects progressed to AS. The probabilities of remaining as nr-axSpA at 5, 10, and 15 years were 93.6%, 82.7%, and 73.6%, respectively. Subjects in the imaging arm (n=18) progressed more frequently and rapidly than those in the clinical arm (n=65) (28% versus 17%; hazard ratio 3.50, 95% CI 1.15–10.6, p=0.02). |
4 |
| 147. Dougados M, Maksymowych WP, Landewe RBM, et al. Evaluation of the change in structural radiographic sacroiliac joint damage after 2 years of etanercept therapy (EMBARK trial) in comparison to a contemporary control cohort (DESIR cohort) in recent onset axial spondyloarthritis. Ann Rheum Dis. 77(2):221-227, 2018 02. |
Observational-Tx |
355 patients |
To compare 2 years of radiographic sacroiliac joint (SIJ) changes in patients with recent onset axial spondyloarthritis (axSpA) receiving etanercept in a clinical trial (EMBARK) to similar patients not receiving biologics in a cohort study (DESIR). |
At 104 weeks, total SIJ score improved in the etanercept group (n=154, adjusted least-squares mean change: -0.14) and worsened in the control group (n=182, change: 0.08). The adjusted difference between groups (etanercept minus control) was -0.22 (95% CI -0.38 to -0.06), p=0.008. The net percentage of patients with progression was significantly lower in the etanercept versus the control group for two of three binary endpoints: -1.9% versus 1.6% (adjusted difference for etanercept minus control: -4.7%,95% CI -9.9 to 0.5, p=0.07) for change in mNY criteria; -1.9% versus 7.8% (adjusted difference: -18.2%,95% CI -30.9 to -5.6, p=0.005) for change =1 grade in =1 SIJ; and -0.6% versus 6.7% (adjusted difference: -16.4%,95% CI -27.9 to -5.0, p=0.005) for change =1 grade in =1 SIJ, with shift from 0 to 1 or 1 to 0 considered no change. |
1 |
| 148. Rios Rodriguez V, Hermann KG, Weis A, et al. Progression of Structural Damage in the Sacroiliac Joints in Patients With Early Axial Spondyloarthritis During Long-Term Anti-Tumor Necrosis Factor Treatment: Six-Year Results of Continuous Treatment With Etanercept. Arthritis rheumatol.. 71(5):722-728, 2019 05. |
Review/Other-Dx |
42 patients |
To evaluate radiographic progression in the sacroiliac (SI) joints and to identify its predictors during long-term treatment (up to 6 years) with the tumor necrosis factor (TNF) inhibitor etanercept in patients with early axial spondyloarthritis (SpA). |
The mean ± SD change in the sacroiliitis sum score was 0.13 ± 0.73, -0.27 ± 0.76, and -0.09 ± 0.68, in the time intervals baseline to year 2, year 2 to year 4, and year 4 to year 6, respectively. In the longitudinal mixed model analysis, elevated C-reactive protein level (ß = 0.58 [95% confidence interval 0.24, 0.91]) and MRI SI joint osteitis score (ß = 0.06 [95% confidence interval 0.03, 0.10]) were independently associated with progression of the sacroiliitis sum score. |
4 |
| 149. Zong HX, Xu SQ, Tong H, Wang XR, Pan MJ, Teng YZ. Effect of anti-tumor necrosis factor alpha treatment on radiographic progression in patient with ankylosing spondylitis: A systematic review and meta-analysis. Mod Rheumatol. 29(3):503-509, 2019 May. |
Meta-analysis |
14 studies including 3186 patients |
To review the literature about the effect of TNF a inhibitor on radiographic progression and disease activity in patient with AS. |
We included 14 studies of low to moderate risk of bias with 3,186 patients, compared with control group, there was no effect of mSASSS changes (SMD = -0.12, 95% CI: -1.17-0.93, p value = .82, I2 = 95%) and follow-up (SMD = 0.03, 95% CI: 0.21-0.26, p value = .82, I2 = 36%) estimation in anti-TNF a group. However anti-TNF a agent treatment led to remarkable improvements on both Bath AS disease activity index (BASDAI) (SMD = 1.06, 95% CI: 0.22-1.89, p value = .01, I2 = 96%) and Bath AS functional index (BASFI) (SMD = 0.93, 95% CI: 0.24-1.92, p value = .01, I2 = 97%) scores at 12 weeks. |
Good |
| 150. MacKay K, Mack C, Brophy S, Calin A. The Bath Ankylosing Spondylitis Radiology Index (BASRI): a new, validated approach to disease assessment. Arthritis Rheum 1998;41:2263-70. |
Observational-Dx |
470 patients |
To develop a reproducible and simple radiologic scoring system for the spine in patients with ankylosing spondylitis (AS): the Bath Ankylosing Spondylitis Radiology Index for the spine (BASRI-s). |
Intra- and interobserver variation showed 75-86% and 73-79% complete agreement at all sites, respectively. Specificities of 0.83-0.89 suggested that the lumbar and cervical spine BASRI scores were disease specific. Sensitivity to change became apparent at 2 years (P < 0.001). Using a lateral view and an anteroposterior view of the lumbar spine was more sensitive than using a lateral view alone. Grading a set of radiographs (sacroiliac joints, lumbar spine, and cervical spine) took 30 seconds. |
2 |
| 151. Maas F, Arends S, Brouwer E, et al. Reduction in Spinal Radiographic Progression in Ankylosing Spondylitis Patients Receiving Prolonged Treatment With Tumor Necrosis Factor Inhibitors. Arthritis Care Res (Hoboken). 69(7):1011-1019, 2017 07. |
Observational-Dx |
210 patients |
To evaluate the course of spinal radiographic progression for up to 8 years of followup in a large cohort of ankylosing spondylitis (AS) patients treated with tumor necrosis factor (TNF) inhibitors. |
At baseline, median mSASSS of 210 included AS patients was 2.8 (interquartile range 0.0-12.0), mean ± SD mSASSS 10.0 ± 15.5. During the first 4 years, radiographic progression followed a linear course (estimated mean progression rate was 1.7 for 0-2 and 2-4 years). A deflection from a linear course was found in patients with complete and imputed data over 6 and 8 years. The estimated mean 2-year progression rate reduced from 2.3 to 0.8 in patients with complete 8-year data. The same pattern was found after adjustment for baseline mSASSS scores, presence of syndesmophytes, sex, HLA-B27 status, age, symptom duration, smoking duration, body mass index, disease activity, and nonsteroidal antiinflammatory drug use. |
3 |
| 152. Poddubnyy D, Haibel H, Listing J, et al. Baseline radiographic damage, elevated acute-phase reactant levels, and cigarette smoking status predict spinal radiographic progression in early axial spondylarthritis. Arthritis Rheum 2012;64:1388-98. |
Observational-Dx |
210 patients |
To assess prospectively the rates and to explore predictors of spinal radiographic progression over 2 years in a cohort of patients with early axial spondylarthritis (SpA). |
Among the patients with axial SpA, 14.3% showed spinal radiographic progression after 2 years (20% of those with AS and 7.4% of those with nonradiographic axial SpA). The following parameters were independently associated with spinal radiographic progression: presence of syndesmophytes at baseline (odds ratio [OR] 6.29, P < 0.001), elevated levels of markers of systemic inflammation (for the erythrocyte sedimentation rate, OR 4.04, P = 0.001; for C-reactive protein level time-averaged over 2 years, OR 3.81, P = 0.001), and cigarette smoking (OR 2.75, P = 0.012). These associations were confirmed by multivariate logistic regression analysis. No clear association with spinal radiographic progression was observed for HLA-B27 status, sex, age, disease duration, Bath Ankylosing Spondylitis Disease Activity Index, Bath Ankylosing Spondylitis Functional Index, presence of peripheral arthritis, enthesitis, psoriasis, treatment with nonsteroidal antiinflammatory drugs, or treatment with disease-modifying antirheumatic drugs at baseline. |
2 |
| 153. Ramiro S, Stolwijk C, van Tubergen A, et al. Evolution of radiographic damage in ankylosing spondylitis: a 12 year prospective follow-up of the OASIS study. Ann Rheum Dis 2015;74:52-9. |
Review/Other-Dx |
809 radiographs from 186 patients. |
To describe the evolution of radiographic abnormalities of the spine in patients with ankylosing spondylitis (AS). |
Mean mSASSS at baseline was 11.6 (16.2). While the course of progression in individual patients was highly variable, and still occurred in patients with decades of symptom duration, mean 2 year progression was 2.0 (3.5) mSASSS units. Over the entire follow-up, at least one new syndesmophyte was found in 55% (R1) and 63% (R2) of patients (38% (R1) and 39% (R2) of all intervals). In 24% of patients (39% of intervals), there was no progression. A progression =5 mSASSS units occurred in 22% of patients (or in 12% of intervals). At the group level, a linear time course model fitted the data best, with a constant rate over the entire 12 year interval of 0.98 mSASSS units/year. Radiographic progression occurred significantly faster in men, in HLA-B27 positive patients and in patients with a baseline mSASSS=10. |
4 |
| 154. Jeong H, Eun YH, Kim IY, et al. Effect of tumor necrosis factor alpha inhibitors on spinal radiographic progression in patients with ankylosing spondylitis. Int J Rheum Dis. 21(5):1098-1105, 2018 May. |
Observational-Tx |
151 patients |
To evaluate the effect of tumor necrosis factor a inhibitors (TNFi) on spinal radiographic progression in patients with ankylosing spondylitis (AS). |
Mean X-ray follow-up duration was 102.9 ± 54.9 months. Mean time from symptom onset to start of TNFi use was 104.8 ± 83.6 months (median 84 months) and mean TNFi index was 42.9 ± 23.8% (median 40.9%). In multivariable analysis, initial mSASSS, initial C-reactive protein, body mass index, current smoker, and delayed start of TNFi use were associated with radiographic progression. Presence of peripheral arthritis and the TNFi index were negatively associated with radiographic progression. |
2 |
| 155. Molnar C, Scherer A, Baraliakos X, et al. TNF blockers inhibit spinal radiographic progression in ankylosing spondylitis by reducing disease activity: results from the Swiss Clinical Quality Management cohort. Ann Rheum Dis. 77(1):63-69, 2018 Jan. |
Observational-Dx |
432 patients |
To analyse the impact of tumour necrosis factor inhibitors (TNFis) on spinal radiographic progression in ankylosing spondylitis (AS). |
Mean (SD) mSASSS increase was 0.9 (2.6) units in 2 years. Prior use of TNFi reduced the odds of progression by 50% (OR 0.50, 95% CI 0.28 to 0.88) in the multivariable analysis. While no direct effect of TNFi on progression was present in an analysis including time-varying ASDAS (OR 0.61, 95% CI 0.34 to 1.08), the indirect effect, via a reduction in ASDAS, was statistically significant (OR 0.75, 95% CI 0.59 to 0.97). |
2 |
| 156. Park JW, Kim MJ, Lee JS, et al. Impact of Tumor Necrosis Factor Inhibitor Versus Nonsteroidal Antiinflammatory Drug Treatment on Radiographic Progression in Early Ankylosing Spondylitis: Its Relationship to Inflammation Control During Treatment. Arthritis rheumatol.. 71(1):82-90, 2019 01. |
Observational-Dx |
215 patients |
To investigate the impact of tumor necrosis factor inhibitor (TNFi) treatment and inflammation control on radiographic progression in early ankylosing spondylitis (AS) over 4 years. |
The TNFi group had longer disease duration, a higher baseline CRP level, and a higher Bath Ankylosing Spondylitis Disease Activity Index than did controls. The time-averaged CRP level over radiographic intervals was lower with TNFi treatment than with NSAID treatment (mean ± SD 0.27 ± 0.30 mg/dl versus 0.61 ± 0.68 mg/dl; P < 0.001). Overall, mean ± SD mSASSS change over the 2-year interval was 1.30 ± 2.97 units. In the multivariable model adjusted for age, smoking status, baseline CRP level, and the presence of syndesmophytes at baseline, the TNFi group showed less mSASSS change over the 2-year interval (ß = -0.90 [95% confidence interval {95% CI} -1.51, -0.29]). However, when a time-averaged CRP level was additionally included, it significantly influenced the mSASSS change (ß = 1.02 [95% CI 0.32, 1.71]), decreasing the estimated group difference (ß = -0.52 [95% CI -1.17, 0.14]). |
2 |
| 157. Creemers MC, Franssen MJ, van't Hof MA, Gribnau FW, van de Putte LB, van Riel PL. Assessment of outcome in ankylosing spondylitis: an extended radiographic scoring system. Ann Rheum Dis 2005;64:127-9. |
Observational-Dx |
57 patients |
To develop and validate an extensive radiographic scoring system for ankylosing spondylitis (AS). |
Interobserver correlations of the lumbar and cervical spine scores were good (r>0.95). The interobserver duplicate error was 0.55 in a range from 0 to 36. The mean change in the cervical and lumbar spine scores between weeks 0 and 48 of all patients was 1.45 (range 0-6.0) and 1.06 (0-5.0), respectively (paired t testing, p<0.001). Change in radiological score was seen in 36/57 (63%) patients (lumbar and cervical spine 11, cervical spine 12, lumbar spine 13 patients). |
2 |
| 158. Hu Z, Xu M, Wang Q, Qi J, Lv Q, Gu J. Colour Doppler ultrasonography can be used to detect the changes of sacroiliitis and peripheral enthesitis in patients with ankylosing spondylitis during adalimumab treatment. Clin Exp Rheumatol 2015;33:844-50. |
Observational-Dx |
41 patients |
To investigate whether colour Doppler ultrasonography (CDUS) can be used to detect the effect of adalimumab on sacroiliitis and peripheral enthesitis in patients with ankylosing spondylitis (AS). |
Significant reduction in mean CDUS score of SIJs and peripheral enthesitis and increase in mean RI value were observed in AS patients treated with adalimumab for 12 weeks and 24 weeks as compared with baseline (all p<0.05). The CDUS scores of SIJs and peripheral enthesitis positively related with clinical assessments (including BASDAI, BASFI, and CRP), while the RI value negatively related with them at all visits (all p<0.05). The results of CDUS also correlated well with the MRI data (all p<0.05) during adalimumab treatment in AS patients. |
3 |
| 159. Jiang Y, Chen L, Zhu J, et al. Power Doppler ultrasonography in the evaluation of infliximab treatment for sacroiliitis in patients with ankylosing spondylitis. Rheumatol Int 2013;33:2025-9. |
Review/Other-Dx |
110 sacroiliac joints in 55 patients |
To evaluate the feasibility of using power Doppler ultrasound (PDUS) to detect changes in the sacroiliac joint regions after infliximab (an anti-TNF-a blocker) treatment in active axial ankylosing spondylitis (AS) patients. |
The color flow signals inside the sacroiliac joints were observed, and the resistance index (RI) was measured. The clinical condition of the AS patients was improved compared with their condition before the infliximab treatment. Before the treatment, color flow signals were observed in 103 joints, and the mean RI value was 0.56 ± 0.06. Three months after the first infliximab treatment, color flow signals were observed in 50 joints, and the mean RI value was 0.87 ± 0.11. There were more blood flow signals in the sacroiliac joints before the infliximab treatment in patients with active AS (p < 0.01), and the mean RI value was higher after the infliximab treatment (p < 0.01). The blood flow signals in the sacroiliac joints became weaker or even disappeared and the RI values increased in patients with active sacroiliitis after infliximab treatment. |
4 |
| 160. Koivikko MP, Koskinen SK. MRI of cervical spine injuries complicating ankylosing spondylitis. Skeletal Radiol. 37(9):813-9, 2008 Sep. |
Review/Other-Dx |
20 patients |
To study characteristic MRI findings in cervical spine fractures complicating ankylosing spondylitis (AS). |
On MRI, of these 20 patients, 19 had a total of 29 cervical and upper thoracic spine fractures. Of 20 transverse fractures traversing both anterior and posterior columns, 7 were transdiskal and exhibited less bone marrow edema than did those traversing vertebral bodies. One Jefferson's, 1 atlas posterior arch (Jefferson's on MDCT), 2 odontoid process, and 5 non-contiguous spinous process fractures were detectable. MRI showed 2 fractures that were undetected by MDCT, and conversely, MDCT detected 6 fractures not seen on MRI; 16 patients had spinal cord findings ranging from impingement and contusion to complete transection. |
4 |
| 161. Nakstad PH, Server A, Josefsen R. Traumatic cervical injuries in ankylosing spondylitis. Acta Radiol 2004;45:222-6. |
Observational-Dx |
11 patients with advanced ankylosing spondylitis |
To demonstrate the importance of magnetic resonance (MR) and computed tomography (CT) in the evaluation of cervical traumas in patients suffering from ankylosing spondylitis. |
CT with reformation sagittal and coronal plane was superior to plain X-ray films in demonstrating fractures and dislocations. MR was considered mandatory when evaluating changes in medulla and epidural hematomas, which were detected in 4 patients. |
4 |
| 162. Beckmann NM, West OC, Nunez D, Jr., et al. ACR Appropriateness Criteria® Suspected Spine Trauma. J Am Coll Radiol 2019;16:S264-S85. |
Review/Other-Dx |
N/A |
Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for suspected spine trauma. |
No results stated in abstract. |
4 |
| 163. American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: https://www.acr.org/-/media/ACR/Files/Appropriateness-Criteria/RadiationDoseAssessmentIntro.pdf. |
Review/Other-Dx |
N/A |
To provide evidence-based guidelines on exposure of patients to ionizing radiation. |
No abstract available. |
4 |
