A systematic critical review on MRI in spondyloarthritis

Research Department, Spine Centre of Southern Denmark, Hospital Lillebaelt, Clinical Locomotion Network, Oestre Hougvej 55, Middelfart 5500, Denmark. .
Arthritis research & therapy (Impact Factor: 3.75). 03/2012; 14(2):R55. DOI: 10.1186/ar3768
Source: PubMed


Magnetic resonance imaging (MRI) has been proven capable of showing inflammatory and structural changes in patients with spondyloarthritis (SpA) and has become widely used in the diagnosis of SpA. Despite this, no systematic reviews evaluate the diagnostic utility of MRI for SpA. Therefore, the objective of this systematic review was to determine the evidence for the utility of MRI in the clinical diagnosis of SpA. The aims were to identify which MRI findings are associated with the diagnosis of SpA and to quantify this association.
MEDLINE and EMBASE were electronically searched. Inclusion criteria were cross-sectional or longitudinal case-control or cohort MRI studies. The studies required a group with either SpA or inflammatory back pain (IBP) and a non-case group without SpA or IBP. Each group required a minimum of 20 participants. The included articles had to report results containing raw numbers suitable for the construction of two-by-two tables or report results by sensitivity and specificity for cross-sectional studies or odds ratios, relative risk ratios, or likelihood ratios for longitudinal studies. Method quality was assessed by using criteria based on the QUADAS tool.
In total, 2,395 articles were identified in MEDLINE and EMBASE before November 2011. All articles were reviewed by title and abstract. Seventy-seven articles were reviewed by full text, and 10 met the inclusion criteria. Two were considered of high quality: one evaluated the sacroiliac joints, and the other, the spine. Because of the small number of high-quality studies, a meta-analysis was not performed. The two high-quality studies found a positive association between MRI findings (bone marrow edema, erosions, fat infiltrations, global assessment of sacroiliitis, and ankylosis) and the diagnosis of IBP and SpA.
In this review, several MRI findings were found to be associated with SpA. However, because of the small number of high-quality studies, the evidence for the utility of MRI in the diagnosis of SpA must be considered limited. Therefore, caution should be taken to ensure that inflammatory and structural MRI findings are not interpreted as being more specific for SpA than is supported by research.

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    • "Magnetic resonance imaging (MRI) has been reported to identify both structural and inflammatory changes [1,2] and is considered essential in the diagnoses of SpA. However, there are still several uncertainties regarding the utility of MRI in the diagnosis of SpA [3], especially in the early stages when the clinical signs of SpA can be difficult to distinguish from non-specific low back pain (LBP) and the MRI signs of SpA can be difficult to distinguish from the much more common findings of degeneration. Signal changes related to degeneration such as Modic changes are an important pitfall in the assessment of SpA [4] and some studies have shown substantial variation in the extent of MRI lesions in the SIJ previously considered to be specific for SpA [5]. "
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    ABSTRACT: The Back Pain Cohort of Southern Denmark (BaPa Cohort) was initiated with the aim of evaluating the clinical relevance of magnetic resonance imaging (MRI) in the diagnosis of early spondyloarthritis (SpA). In order to facilitate the collection of MRI data for this study, an electronic evaluation form was developed including both SpA-related and degenerative axial changes. The objective of the current study was to assess the intra- and inter-observer agreement of the MRI changes assessed. Three radiologists evaluated 48 MRI scans of the whole spine and the sacroiliac joints from a subsample of the BaPa Cohort, consisting of patients with non-specific low back pain and patients with different stages of SpA features. The spine was evaluated for SpA-related and degenerative MRI changes and the SIJ for SpA-related changes. Inter- and intra-observer agreements were calculated with kappa statistics. In the interpretation of the kappa coefficient, the standards for strength of agreement reported by Landis and Koch were followed. A total of 48 patients, 40% men and mean age of 31 years (range 19 -- 40 years), were evaluated once by all three readers and re-evaluated by two of the readers after 4-12 weeks. For MRI changes in the spine, substantial to almost perfect observer agreement was found for the location and the size of vertebral signal changes and for disc degeneration and disc contour. For the sacroiliac joints, substantial or almost perfect observer agreement was found for the grading of bone marrow oedema and fatty marrow deposition, the depth of bone marrow oedema and for subchondral sclerosis. Global assessment of the SpA diagnosis had substantial to almost perfect observer agreements. The acceptable agreement for key MRI changes in the spine and sacroiliac joints makes it possible to use these MRI changes in the BaPa Cohort study and other studies investigating MRI changes in patients with non-specific low back pain and suspected SpA.
    Full-text · Article · Sep 2013 · BMC Musculoskeletal Disorders
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    ABSTRACT: The development of available treatments for spondyloarthritis increases the need for accurate diagnosis and objective monitoring of response to therapy. Advances in MRI technology are improving the effectiveness of imaging of the sacroiliac joints and spine in spondyloarthritis. We discuss best practice techniques for MR image acquisition and interpretation with a view to optimizing the diagnostic utility of MRI in spondyloarthritis.
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    ABSTRACT: The aim of the present study was to describe the outcomes of Brazilian patients with undifferentiated spondyloarthritis during an eight-year follow-up period. Patients fulfilling the European Spondyloarthritis (SpA) Study Group Classification Criteria were enrolled. Forty patients were seen at baseline, and 36 participated in the follow-up study. Twenty-three (58 %) were female, and there were 24 (60 %) African Brazilians enrolled. HLA-B27 was positive in 18 (45 %) patients. At disease onset, the first presenting symptoms were pure peripheral manifestations in 26 (72.2 %) patients. After the study period, mixed disease (axial + peripheral) predominated occurring in 25 (69.4 %) patients. The Assessment of SpA International society (ASAS) classification criteria for axial SpA were fulfilled by 77 % of patients, and the ASAS criteria for peripheral SpA were fulfilled by 59 % of patients. After 2.5 years, 6 (16.7 %) of the 36 patients fulfilled the modified New York Criteria for ankylosing spondylitis and 1 (2.7 %) progressed to psoriatic arthritis. A total of 10 (27.8 %) patients progressed to definite SpA during the eight-year study period. Buttock pain (p = 0.006, OR 10.55; 95 % CI 2.00-65.90) and low-grade radiographic sacroiliitis (p = 0.025, OR = 11.50; 95 % CI 1.33-83.39) at baseline were associated with definite SpA. Thus, in this Brazilian cohort, which had a predominance of female African-Brazilian patients, prevalent peripheral onset symptoms were followed by a high frequency of axial manifestations during the follow-up period. Evidence of clinical or radiological sacroiliitis was associated with progression to definite SpA.
    No preview · Article · Jun 2013 · Rheumatology International
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