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Diagnostic utility of whole spine and thoracic spine MRI corner inflammatory lesions in axial spondyloarthritis.

ABSTRACT: Background: The presence of ?3 corner inflammatory lesions has been proposed as the definition of a positive spinal magnetic resonance imaging (MRI) for axial spondyloarthritis (axSpA), but subsequent studies showed inconclusive findings. Our objective was to evaluate whether locations of corner inflammatory lesions (CILs) would affect the diagnostic utility of MRI in axSpA.

Method: Two groups were consecutively recruited from eight rheumatology centers in Hong Kong. The 'axSpA' group included 369 participants with a known diagnosis of axSpA. The 'non-specific back pain' (NSBP) control group consisted of 117 participants. Clinical, biochemical, and radiological parameters were collected and all patients underwent MRI of the spine and sacroiliac joints. CILs were assessed based on their locations (cervical, thoracic or lumbar) to determine the optimal cutoff for diagnosis.

Results: The cutoff of ?5 whole spine CILs (W-CILs) and ?3 thoracic spine CILs (T-CILs) had comparable specificity to MRI sacroiliitis. Of 85/369 axSpA patients without sacroiliitis on conventional radiograph or MRI, 7 had ?5 W-CILs and 11 had ?3 T-CILs. Incorporating the proposed cutoffs into Assessment of SpondyloArthritis international Society axSpA criteria, ?5 W-CILs and ?3 T-CILs had similar performance when added to the imaging criteria for sacroiliitis (sensitivity 0.79 versus 0.80, specificity 0.92 versus 0.91).

Conclusion: Spinal MRI provided little incremental diagnostic value in unselected axSpA patients. However, in patients without sacroiliitis on MRI or radiographs, 8-13% might be diagnosed by spinal MRI. Thoracic and whole spine MRI had similar diagnostic performance using the proposed cutoff of ?5 W-CILs and ?3 T-CILs.

SUBMITTER: Chan SCW

PROVIDER: S-EPMC7691898 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Diagnostic utility of whole spine and thoracic spine MRI corner inflammatory lesions in axial spondyloarthritis.

Chan Shirley Chiu Wai SCW Li Philip Hei PH Lee Kam Ho KH Tsang Helen Hoi Lun HHL Lau Chak Sing CS Chung Ho Yin HY

Therapeutic advances in musculoskeletal disease 20201124

<h4>Background</h4>The presence of ⩾3 corner inflammatory lesions has been proposed as the definition of a positive spinal magnetic resonance imaging (MRI) for axial spondyloarthritis (axSpA), but subsequent studies showed inconclusive findings. Our objective was to evaluate whether locations of corner inflammatory lesions (CILs) would affect the diagnostic utility of MRI in axSpA.<h4>Method</h4>Two groups were consecutively recruited from eight rheumatology centers in Hong Kong. The 'axSpA' gro ...[more]

PMID: 33281954

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Project description:Identification of axial spondyloarthritis (axSpA) remains challenging, frequently resulting in a diagnostic delay for patients. Current benchmarks of delay are usually reported as mean data, which are typically skewed and therefore may be overestimating delay. Our aim was to determine the extent of median delay patients' experience in receiving a diagnosis of axSpA and examine whether specific factors are associated with the presence of such delay. We conducted a systematic review across five literature databases (from inception to November 2021), with studies reporting the average time period of diagnostic delay in patients with axSpA being included. Any additional information examining associations between specific factors and delay were also extracted. A narrative synthesis was used to report the median range of diagnostic delay experienced by patients with axSpA and summarise which factors have a role in the delay. From an initial 11,995 articles, 69 reported an average time period of diagnostic delay, with 25 of these providing a median delay from symptom onset to diagnosis. Across these studies, delay ranged from 0.67 to 8 years, with over three-quarters reporting a median of between 2 years and 6 years. A third of all studies reported median delay data ranging from just 2 to 2.3 years. Of seven variables reported with sufficient frequency to evaluate, only 'gender' and 'family history of axSpA' had sufficient concordant data to draw any conclusion on their role, neither influenced the extent of the delay. Despite improvements in recent decades, patients with axSpA frequently experience years of diagnostic delay and this remains an extensive worldwide problem. This is further compounded by a mixed picture of the disease, patient and healthcare-related factors influencing delay. Key points • Despite improvements in recent decades, patients with axSpA frequently experience years of diagnostic delay. • Median diagnostic delay typically ranges from 2 to 6 years globally. • Neither 'gender' nor 'family history of axSpA' influenced the extent of diagnostic delay experienced. • Diagnostic delay based on mean, rather than median, data influences the interpretation of the delay time period and consistently reports a longer delay period.

Dataset Information

Diagnostic utility of whole spine and thoracic spine MRI corner inflammatory lesions in axial spondyloarthritis.

Publications

Diagnostic utility of whole spine and thoracic spine MRI corner inflammatory lesions in axial spondyloarthritis.

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