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Diagnostic Utility of Candidate Definitions for Demonstrating Axial Spondyloarthritis on Magnetic Resonance Imaging of the Spine

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Zeitschriftentitel: Arthritis & Rheumatology
Personen und Körperschaften: Weber, Ulrich, Zhao, Zheng, Rufibach, Kaspar, Zubler, Veronika, Lambert, Robert G. W., Chan, Stanley M., Østergaard, Mikkel, Pedersen, Susanne J., Maksymowych, Walter P.
In: Arthritis & Rheumatology, 67, 2015, 4, S. 924-933
Medientyp: E-Article
Sprache: Englisch
veröffentlicht:
Wiley
Schlagwörter:
author_facet Weber, Ulrich
Zhao, Zheng
Rufibach, Kaspar
Zubler, Veronika
Lambert, Robert G. W.
Chan, Stanley M.
Østergaard, Mikkel
Pedersen, Susanne J.
Maksymowych, Walter P.
Weber, Ulrich
Zhao, Zheng
Rufibach, Kaspar
Zubler, Veronika
Lambert, Robert G. W.
Chan, Stanley M.
Østergaard, Mikkel
Pedersen, Susanne J.
Maksymowych, Walter P.
author Weber, Ulrich
Zhao, Zheng
Rufibach, Kaspar
Zubler, Veronika
Lambert, Robert G. W.
Chan, Stanley M.
Østergaard, Mikkel
Pedersen, Susanne J.
Maksymowych, Walter P.
spellingShingle Weber, Ulrich
Zhao, Zheng
Rufibach, Kaspar
Zubler, Veronika
Lambert, Robert G. W.
Chan, Stanley M.
Østergaard, Mikkel
Pedersen, Susanne J.
Maksymowych, Walter P.
Arthritis & Rheumatology
Diagnostic Utility of Candidate Definitions for Demonstrating Axial Spondyloarthritis on Magnetic Resonance Imaging of the Spine
Immunology
Rheumatology
Immunology and Allergy
author_sort weber, ulrich
spelling Weber, Ulrich Zhao, Zheng Rufibach, Kaspar Zubler, Veronika Lambert, Robert G. W. Chan, Stanley M. Østergaard, Mikkel Pedersen, Susanne J. Maksymowych, Walter P. 2326-5191 2326-5205 Wiley Immunology Rheumatology Immunology and Allergy http://dx.doi.org/10.1002/art.39001 <jats:sec><jats:title>Objective</jats:title><jats:p>A recent consensus statement has suggested ≥3 corner inflammatory lesions (CILs) or several corner fatty lesions (CFLs) as candidate criteria indicative of axial spondyloarthritis (SpA) on magnetic resonance imaging (MRI) of the spine. The aim of this study was to evaluate the diagnostic utility of these cutoffs in nonradiographic axial SpA and ankylosing spondylitis (AS).</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>One hundred thirty consecutive patients with back pain who were ≤50 years of age and newly referred to 2 university clinics (cohorts A and B) were classified according to rheumatologist expert opinion based on results of clinical examination and pelvic radiography as having nonradiographic axial SpA (n = 50), AS (n = 33), or nonspecific back pain (n = 47). Cohort A also included 20 age‐matched healthy controls. Four blinded readers assessed MRIs of the spine using the standardized Canada–Denmark module. Readers recorded CILs and CFLs in 23 discovertebral units. We tested the diagnostic utility (mean sensitivity and specificity over 4 readers) of the cutoff for the number of lesions on spinal MRI as proposed in the literature (≥2 or ≥3 CILs and ≥6 CFLs), and we tested for possible thresholds (from ≥1 CIL or CFL to ≥10 CILs or CFLs) for nonradiographic axial SpA and AS patients in both cohorts.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>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 &gt;0.90.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>None of the previously proposed candidate criteria for a positive spinal MRI finding of axial SpA showed clinically relevant diagnostic utility in nonradiographic axial SpA. These results question the value of proposed definitions for a positive finding of SpA based on MRI of the spine alone.</jats:p></jats:sec> Diagnostic Utility of Candidate Definitions for Demonstrating Axial Spondyloarthritis on Magnetic Resonance Imaging of the Spine Arthritis & Rheumatology
doi_str_mv 10.1002/art.39001
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series Arthritis & Rheumatology
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title Diagnostic Utility of Candidate Definitions for Demonstrating Axial Spondyloarthritis on Magnetic Resonance Imaging of the Spine
title_unstemmed Diagnostic Utility of Candidate Definitions for Demonstrating Axial Spondyloarthritis on Magnetic Resonance Imaging of the Spine
title_full Diagnostic Utility of Candidate Definitions for Demonstrating Axial Spondyloarthritis on Magnetic Resonance Imaging of the Spine
title_fullStr Diagnostic Utility of Candidate Definitions for Demonstrating Axial Spondyloarthritis on Magnetic Resonance Imaging of the Spine
title_full_unstemmed Diagnostic Utility of Candidate Definitions for Demonstrating Axial Spondyloarthritis on Magnetic Resonance Imaging of the Spine
title_short Diagnostic Utility of Candidate Definitions for Demonstrating Axial Spondyloarthritis on Magnetic Resonance Imaging of the Spine
title_sort diagnostic utility of candidate definitions for demonstrating axial spondyloarthritis on magnetic resonance imaging of the spine
topic Immunology
Rheumatology
Immunology and Allergy
url http://dx.doi.org/10.1002/art.39001
publishDate 2015
physical 924-933
description <jats:sec><jats:title>Objective</jats:title><jats:p>A recent consensus statement has suggested ≥3 corner inflammatory lesions (CILs) or several corner fatty lesions (CFLs) as candidate criteria indicative of axial spondyloarthritis (SpA) on magnetic resonance imaging (MRI) of the spine. The aim of this study was to evaluate the diagnostic utility of these cutoffs in nonradiographic axial SpA and ankylosing spondylitis (AS).</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>One hundred thirty consecutive patients with back pain who were ≤50 years of age and newly referred to 2 university clinics (cohorts A and B) were classified according to rheumatologist expert opinion based on results of clinical examination and pelvic radiography as having nonradiographic axial SpA (n = 50), AS (n = 33), or nonspecific back pain (n = 47). Cohort A also included 20 age‐matched healthy controls. Four blinded readers assessed MRIs of the spine using the standardized Canada–Denmark module. Readers recorded CILs and CFLs in 23 discovertebral units. We tested the diagnostic utility (mean sensitivity and specificity over 4 readers) of the cutoff for the number of lesions on spinal MRI as proposed in the literature (≥2 or ≥3 CILs and ≥6 CFLs), and we tested for possible thresholds (from ≥1 CIL or CFL to ≥10 CILs or CFLs) for nonradiographic axial SpA and AS patients in both cohorts.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>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 &gt;0.90.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>None of the previously proposed candidate criteria for a positive spinal MRI finding of axial SpA showed clinically relevant diagnostic utility in nonradiographic axial SpA. These results question the value of proposed definitions for a positive finding of SpA based on MRI of the spine alone.</jats:p></jats:sec>
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author Weber, Ulrich, Zhao, Zheng, Rufibach, Kaspar, Zubler, Veronika, Lambert, Robert G. W., Chan, Stanley M., Østergaard, Mikkel, Pedersen, Susanne J., Maksymowych, Walter P.
author_facet Weber, Ulrich, Zhao, Zheng, Rufibach, Kaspar, Zubler, Veronika, Lambert, Robert G. W., Chan, Stanley M., Østergaard, Mikkel, Pedersen, Susanne J., Maksymowych, Walter P., Weber, Ulrich, Zhao, Zheng, Rufibach, Kaspar, Zubler, Veronika, Lambert, Robert G. W., Chan, Stanley M., Østergaard, Mikkel, Pedersen, Susanne J., Maksymowych, Walter P.
author_sort weber, ulrich
container_issue 4
container_start_page 924
container_title Arthritis & Rheumatology
container_volume 67
description <jats:sec><jats:title>Objective</jats:title><jats:p>A recent consensus statement has suggested ≥3 corner inflammatory lesions (CILs) or several corner fatty lesions (CFLs) as candidate criteria indicative of axial spondyloarthritis (SpA) on magnetic resonance imaging (MRI) of the spine. The aim of this study was to evaluate the diagnostic utility of these cutoffs in nonradiographic axial SpA and ankylosing spondylitis (AS).</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>One hundred thirty consecutive patients with back pain who were ≤50 years of age and newly referred to 2 university clinics (cohorts A and B) were classified according to rheumatologist expert opinion based on results of clinical examination and pelvic radiography as having nonradiographic axial SpA (n = 50), AS (n = 33), or nonspecific back pain (n = 47). Cohort A also included 20 age‐matched healthy controls. Four blinded readers assessed MRIs of the spine using the standardized Canada–Denmark module. Readers recorded CILs and CFLs in 23 discovertebral units. We tested the diagnostic utility (mean sensitivity and specificity over 4 readers) of the cutoff for the number of lesions on spinal MRI as proposed in the literature (≥2 or ≥3 CILs and ≥6 CFLs), and we tested for possible thresholds (from ≥1 CIL or CFL to ≥10 CILs or CFLs) for nonradiographic axial SpA and AS patients in both cohorts.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>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 &gt;0.90.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>None of the previously proposed candidate criteria for a positive spinal MRI finding of axial SpA showed clinically relevant diagnostic utility in nonradiographic axial SpA. These results question the value of proposed definitions for a positive finding of SpA based on MRI of the spine alone.</jats:p></jats:sec>
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spelling Weber, Ulrich Zhao, Zheng Rufibach, Kaspar Zubler, Veronika Lambert, Robert G. W. Chan, Stanley M. Østergaard, Mikkel Pedersen, Susanne J. Maksymowych, Walter P. 2326-5191 2326-5205 Wiley Immunology Rheumatology Immunology and Allergy http://dx.doi.org/10.1002/art.39001 <jats:sec><jats:title>Objective</jats:title><jats:p>A recent consensus statement has suggested ≥3 corner inflammatory lesions (CILs) or several corner fatty lesions (CFLs) as candidate criteria indicative of axial spondyloarthritis (SpA) on magnetic resonance imaging (MRI) of the spine. The aim of this study was to evaluate the diagnostic utility of these cutoffs in nonradiographic axial SpA and ankylosing spondylitis (AS).</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>One hundred thirty consecutive patients with back pain who were ≤50 years of age and newly referred to 2 university clinics (cohorts A and B) were classified according to rheumatologist expert opinion based on results of clinical examination and pelvic radiography as having nonradiographic axial SpA (n = 50), AS (n = 33), or nonspecific back pain (n = 47). Cohort A also included 20 age‐matched healthy controls. Four blinded readers assessed MRIs of the spine using the standardized Canada–Denmark module. Readers recorded CILs and CFLs in 23 discovertebral units. We tested the diagnostic utility (mean sensitivity and specificity over 4 readers) of the cutoff for the number of lesions on spinal MRI as proposed in the literature (≥2 or ≥3 CILs and ≥6 CFLs), and we tested for possible thresholds (from ≥1 CIL or CFL to ≥10 CILs or CFLs) for nonradiographic axial SpA and AS patients in both cohorts.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>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 &gt;0.90.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>None of the previously proposed candidate criteria for a positive spinal MRI finding of axial SpA showed clinically relevant diagnostic utility in nonradiographic axial SpA. These results question the value of proposed definitions for a positive finding of SpA based on MRI of the spine alone.</jats:p></jats:sec> Diagnostic Utility of Candidate Definitions for Demonstrating Axial Spondyloarthritis on Magnetic Resonance Imaging of the Spine Arthritis & Rheumatology
spellingShingle Weber, Ulrich, Zhao, Zheng, Rufibach, Kaspar, Zubler, Veronika, Lambert, Robert G. W., Chan, Stanley M., Østergaard, Mikkel, Pedersen, Susanne J., Maksymowych, Walter P., Arthritis & Rheumatology, Diagnostic Utility of Candidate Definitions for Demonstrating Axial Spondyloarthritis on Magnetic Resonance Imaging of the Spine, Immunology, Rheumatology, Immunology and Allergy
title Diagnostic Utility of Candidate Definitions for Demonstrating Axial Spondyloarthritis on Magnetic Resonance Imaging of the Spine
title_full Diagnostic Utility of Candidate Definitions for Demonstrating Axial Spondyloarthritis on Magnetic Resonance Imaging of the Spine
title_fullStr Diagnostic Utility of Candidate Definitions for Demonstrating Axial Spondyloarthritis on Magnetic Resonance Imaging of the Spine
title_full_unstemmed Diagnostic Utility of Candidate Definitions for Demonstrating Axial Spondyloarthritis on Magnetic Resonance Imaging of the Spine
title_short Diagnostic Utility of Candidate Definitions for Demonstrating Axial Spondyloarthritis on Magnetic Resonance Imaging of the Spine
title_sort diagnostic utility of candidate definitions for demonstrating axial spondyloarthritis on magnetic resonance imaging of the spine
title_unstemmed Diagnostic Utility of Candidate Definitions for Demonstrating Axial Spondyloarthritis on Magnetic Resonance Imaging of the Spine
topic Immunology, Rheumatology, Immunology and Allergy
url http://dx.doi.org/10.1002/art.39001