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Sacroiliac joint MRI for diagnosis of ax-SpA: algorithm to improve the specificity of the current ASAS MRI criteria

  • Musculoskeletal
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objective

To compare sacroiliac joint (SIJ) lesions on MRI in women with versus without axial spondyloarthritis (ax-SpA) and establish an algorithm to determine whether such lesions are due to ax-SpA.

Methods

This retrospective comparative study assessed bone marrow edema (BME), sclerosis, erosions, osteophytes, and ankylosis at the SIJ in two groups of women, one with and another without ax-SpA. Sensitivity and specificity were calculated for combinations/characteristics of lesions, using rheumatologists’ assessment with assessment of spondyloarthritis international society (ASAS) criteria as the gold standard for diagnosis of ax-SpA.

Results

Compared to women without ax-SpA, women with ax-SpA had more BME (61% vs 17%, p < 0.001), sclerosis (40% vs 22%, p < 0.001), erosions (35% vs 5%, p < 0.001), and ankylosis (2% vs 0%, p = 0.007), but less osteophytes (5% vs 33%, p < 0.001). The ASAS MRI criteria yielded 59% sensitivity and 88% specificity, while a new algorithm achieved 56% sensitivity and 95% specificity using the following criteria: no osteophytes at the SIJ and either (i) BME at the SIJ with at least one dimension ≥ 8 mm or (ii) at least one erosion at the SIJ.

Conclusions

We recommend the following pragmatic algorithm for MRI diagnosis of ax-SpA in women: no osteophytes at the SIJ and either (i) BME at the SIJ with at least one dimension ≥ 8 mm or (ii) at least one erosion at the SIJ. The false positive rate when using the new algorithm (3.3%) is less than half than when using the ASAS MRI criteria (7.7%); thus, its application in clinical practice could reduce overdiagnosis and prevent overtreatment of ax-SpA.

Clinical relevance statement

The developed algorithm has a false-positive rate that is less than half than when using the ASAS MRI criteria (3.3% vs 7.7%), thus its application in clinical practice could reduce overdiagnosis and prevent overtreatment of axial spondyloarthritis.

Key Points

• Compared to women without axial spondyloarthritis (ax-SpA), women with ax-SpA had a significantly higher prevalence of bone marrow edema (BME), sclerosis, erosions, and ankylosis, but a significantly lower prevalence of osteophytes.

• A new algorithm for positive ax-SpA based on sacroiliac joint MRI was developed: no osteophytes at the sacroiliac joint (SIJ) and either (i) BME at the SIJ with at least one dimension ≥ 8 mm or (ii) at least one erosion at the SIJ.

• We recommend this new algorithm for diagnosis of ax-SpA in women, as it has a significantly better specificity than the assessment of spondyloarthritis international society (ASAS) MRI criteria and less than half the false positive rate; thus, its application in clinical practice could reduce overdiagnosis and prevent overtreatment of ax-SpA.

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Abbreviations

ASAS:

Assessment of spondyloarthritis international society

AUC:

Area under the curve

ax-SpA:

Axial spondyloarthritis

BME:

Bone marrow edema

ICC:

Intraclass correlation coefficient

MRI:

Magnetic resonance imaging

NPV:

Negative predictive value

PACS:

Picture archiving communication system

PPV:

Positive predictive value

SIJ:

Sacroiliac joint

STIR:

Short Tau Inversion Recovery

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Acknowledgements

The authors are grateful to Celine Engrand for her assistance with data collection.

Funding

This study has received funding by Montpellier University Hospital, for statistical analysis and manuscript writing.

Author information

Authors and Affiliations

  1. Osteoarticular Medical Imaging Section, Department of Medical Imaging, Montpellier University Hospital, 34295, Montpellier, France

    Maxime Pastor, William Wantz & Catherine Cyteval

  2. Department of Rheumatology, Montpellier University Hospital, 34295, Montpellier, France

    Cedric Lukas

  3. ReSurg SA, 22 Rue Saint-Jean, 1260, Nyon, Switzerland

    Sonia Ramos-Pascual & Mo Saffarini

Authors
  1. Maxime Pastor
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  2. Cedric Lukas
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  3. Sonia Ramos-Pascual
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  4. Mo Saffarini
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  5. William Wantz
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  6. Catherine Cyteval
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Corresponding author

Correspondence to Sonia Ramos-Pascual.

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Guarantor

The scientific guarantor of this publication is Catherine Cyteval.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

Some study subjects or cohorts have been previously reported in Hoballah et al, 2020 (http://dx.doi.org/10.1136/ annrheumdis-2020-217208).

Methodology

• Retrospective

• Case–control study

• Multicentre study

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Pastor, M., Lukas, C., Ramos-Pascual, S. et al. Sacroiliac joint MRI for diagnosis of ax-SpA: algorithm to improve the specificity of the current ASAS MRI criteria. Eur Radiol 33, 8645–8655 (2023). https://doi.org/10.1007/s00330-023-09969-3

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  • DOI: https://doi.org/10.1007/s00330-023-09969-3

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