Diagnostic performance of sacroiliac joint MRI and added value of spine MRI to detect active spondyloarthritis

M Plier; A Nzeusseu Toukap; N Michoux; M S Stoenoiu; T Kirchgesner; P Durez; B Lauwerys; F E Lecouvet

doi:10.1016/j.diii.2020.07.001

Diagnostic performance of sacroiliac joint MRI and added value of spine MRI to detect active spondyloarthritis

Diagn Interv Imaging. 2021 Mar;102(3):171-180. doi: 10.1016/j.diii.2020.07.001. Epub 2020 Aug 20.

Authors

M Plier¹, A Nzeusseu Toukap², N Michoux³, M S Stoenoiu², T Kirchgesner³, P Durez², B Lauwerys², F E Lecouvet⁴

Affiliations

¹ Department of Rheumatology, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain (UCLouvain), 1200 Brussels, Belgium; Department of Rheumatology, Centre Hospitalier de Luxembourg, 1210 Luxembourg, Luxembourg.
² Department of Rheumatology, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain (UCLouvain), 1200 Brussels, Belgium.
³ Department of Radiology, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain (UCLouvain), 1200 Brussels, Belgium.
⁴ Department of Radiology, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain (UCLouvain), 1200 Brussels, Belgium. Electronic address: frederic.lecouvet@uclouvain.be.

PMID: 32830083
DOI: 10.1016/j.diii.2020.07.001

Abstract

Purpose: To investigate the diagnostic performance of sacroiliac joint (SIJ) magnetic resonance imaging (MRI) and the incremental value of spine MRI to "predict" clinical disease activity in patients with axial spondyloarthritis (axSpA).

Materials and methods: This cross-sectional study included adult patients with known axSpA according to the SpondyloArthritis International Society (ASAS) classification criteria, radiological arm. MRI disease activity was scored semi-quantitatively for SIJ and total spine MRI in each patient. Two cut-off levels (≥ 1.3 and ≥ 2.1) for ankylosing spondylitis disease activity score with C-reactive protein (ASDAS-CRP) were considered for clinical disease activity categorization. MRI scores were first evaluated individually. Then, SIJ score was combined with the score from a spine segment (lumbar, cervical, thoracic or total spine) to build a bi-parametric model using a classification tree. Receiver operating characteristic (ROC) curves were constructed to evaluate the classification performance according to disease activity category of these models.

Results: Forty-four patients (30 men, 14 women; mean age, 37 years±10 [SD] [range: 17-64 years]) with a mean disease duration of 5 years±8 (SD) (range: 0-35 years) were included. Thirty-six patients (36/44; 82%) had ASDAS-CRP≥1.3 and 27 patients (27/44; 61%) had ASDAS-CRP≥2.1. The most frequently involved spinal segment was mid-thoracic (T7-T8). The SIJ MRI score was an informative model to identify active axSpA (AUC≥0.7, regardless of the cut-off level on ASDAS-CRP). Performance of bi-parametric models based on "SIJ+thoracic spine" (for detecting patients with ASDAS-CRP≥1.3) or "SIJ+total spine" (for detecting patients with ASDAS-CRP≥2.1) outperformed that of the individual SIJ score (P<0.05).

Conclusion: The combination of MRI of the SIJ and spine allows to accurately discriminate between active and inactive axSpA, outperforming SIJ MRI alone.

Keywords: Axial spondyloarthritis; Disease activity; Magnetic resonance imaging (MRI); Sacro-iliac joint; Spine.

MeSH terms

Adult
Cross-Sectional Studies
Female
Humans
Magnetic Resonance Imaging
Male
Sacroiliac Joint* / diagnostic imaging
Sacroiliac Joint* / pathology
Severity of Illness Index
Spine / diagnostic imaging
Spondylarthritis* / diagnostic imaging
Spondylitis, Ankylosing* / pathology