Assessing structural changes in axial spondyloarthritis using a low-dose biplanar imaging system

Anna Moltó; Véronique Freire; Antoine Feydy; Simon Paternotte; Walter P Maksymowych; Mathilde Benhamou; François Rannou; Maxime Dougados; Laure Gossec

doi:10.1093/rheumatology/keu143

Assessing structural changes in axial spondyloarthritis using a low-dose biplanar imaging system

Rheumatology (Oxford). 2014 Sep;53(9):1669-75. doi: 10.1093/rheumatology/keu143. Epub 2014 Apr 15.

Authors

Anna Moltó¹, Véronique Freire², Antoine Feydy³, Simon Paternotte³, Walter P Maksymowych³, Mathilde Benhamou³, François Rannou³, Maxime Dougados², Laure Gossec¹

Affiliations

¹ Rheumatology B Department, Cochin Hospital, Medicine Faculty, APHP, Paris Descartes University, Paris, France, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, France, Department of Radiology, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada, Radiology B Department, Cochin Hospital, Medicine Faculty, APHP, Paris Descartes University, Paris, France and Department of Medicine, University of Alberta, Edmonton, AB, Canada, Physical Medicine and Rehabilitation Department, Cochin Hospital, Paris Descartes University, APHP, Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique and AP-HP, Dept of Rheumatology, Pitie Salpetriere University Hospital, Paris, France.Rheumatology B Department, Cochin Hospital, Medicine Faculty, APHP, Paris Descartes University, Paris, France, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, France, Department of Radiology, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada, Radiology B Department, Cochin Hospital, Medicine Faculty, APHP, Paris Descartes University, Paris, France and Department of Medicine, University of Alberta, Edmonton, AB, Canada, Physical Medicine and Rehabilitation Department, Cochin Hospital, Paris Descartes University, APHP, Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique and AP-HP, Dept of Rheumatology, Pitie Salpetriere University Hospital, Paris, France.Rheumatology B Department, Cochin Hospital, Medicine Faculty, APHP, Paris Descartes University, Paris, France, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Franc
² Rheumatology B Department, Cochin Hospital, Medicine Faculty, APHP, Paris Descartes University, Paris, France, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, France, Department of Radiology, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada, Radiology B Department, Cochin Hospital, Medicine Faculty, APHP, Paris Descartes University, Paris, France and Department of Medicine, University of Alberta, Edmonton, AB, Canada, Physical Medicine and Rehabilitation Department, Cochin Hospital, Paris Descartes University, APHP, Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique and AP-HP, Dept of Rheumatology, Pitie Salpetriere University Hospital, Paris, France.Rheumatology B Department, Cochin Hospital, Medicine Faculty, APHP, Paris Descartes University, Paris, France, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, France, Department of Radiology, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada, Radiology B Department, Cochin Hospital, Medicine Faculty, APHP, Paris Descartes University, Paris, France and Department of Medicine, University of Alberta, Edmonton, AB, Canada, Physical Medicine and Rehabilitation Department, Cochin Hospital, Paris Descartes University, APHP, Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique and AP-HP, Dept of Rheumatology, Pitie Salpetriere University Hospital, Paris, France.
³ Rheumatology B Department, Cochin Hospital, Medicine Faculty, APHP, Paris Descartes University, Paris, France, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, France, Department of Radiology, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada, Radiology B Department, Cochin Hospital, Medicine Faculty, APHP, Paris Descartes University, Paris, France and Department of Medicine, University of Alberta, Edmonton, AB, Canada, Physical Medicine and Rehabilitation Department, Cochin Hospital, Paris Descartes University, APHP, Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique and AP-HP, Dept of Rheumatology, Pitie Salpetriere University Hospital, Paris, France.

PMID: 24736165
DOI: 10.1093/rheumatology/keu143

Abstract

Objectives: Patients with axial SpA experience repeated spine imaging. EOS is a new low-dose imaging system with significantly lower irradiation than conventional radiography (CR). The objective was to explore the EOS performances compared with CR for the classification and follow-up of SpA.

Methods: We performed an observational, cross-sectional, single-centre study including SpA patients (definite diagnosis by expert opinion) and control patients [definite chronic mechanical low back pain (cLBP)]. All patients underwent pelvic and frontal and lateral CR of the entire spine and two-dimensional (2D) EOS imaging on the same day. Images were blindly assessed for sacroiliitis [modified New York criteria (mNY)] and for ankylosis of the spine [modified Stoke AS Spine Score (mSASSS)]. Global ease of interpretation was rated on a scale of 0-10. The primary outcome was intermodality agreement, with an a priori defined non-inferiority limit of 0.7. Interobserver, intra-observer and intermodality agreement were measured by kappa, weighted kappa, intraclass correlation coefficient and Bland-Altman plots.

Results: Forty-eight SpA patients [mean age 47.6 years (s.d. 14.9), symptom duration 21.4 years (s.d. 13.3), 35 (70%) men] and 48 cLBP controls [mean age 49.1 years (s.d. 10.7), 9 (22.5%) men] were included. Intermodality agreement between EOS and CR was 0.50 (95% CI 0.26, 0.75) and 0.97 (95% CI 0.95, 0.98) for sacroiliitis and mSASSS, respectively. Ease of interpretation was greater for CR [8.2 (s.d. 0.9)] compared with EOS [7.2 (s.d. 0.8), P < 0.0001).

Conclusion: Our results suggest that EOS could replace CR for the follow-up of structural damage of the spine, but its place in the classification of sacroiliitis needs to be further explored.

Keywords: EOS; ankylosis; radiography; sacroiliitis; spondyloarthritis; syndesmophytes.

Publication types

Observational Study

MeSH terms

Adult
Cross-Sectional Studies
Female
Humans
Low Back Pain / diagnostic imaging
Male
Middle Aged
Observer Variation
Radiation Dosage
Radiographic Image Interpretation, Computer-Assisted / methods
Reproducibility of Results
Sacroiliac Joint / diagnostic imaging
Sacroiliitis / diagnostic imaging
Severity of Illness Index
Spondylarthritis / diagnostic imaging*