MRI lesions in the sacroiliac joints of patients with spondyloarthritis: an update of definitions and validation by the ASAS MRI working group

Walter P Maksymowych¹, Robert Gw Lambert², Mikkel Østergaard³, Susanne Juhl Pedersen³, Pedro M Machado^{4

5

6}, Ulrich Weber^{7

8

9}, Alexander N Bennett¹⁰, Juergen Braun¹¹, Ruben Burgos-Vargas¹², Manouk de Hooge^{13

14}, Atul A Deodhar¹⁵, Iris Eshed¹⁶, Anne Grethe Jurik^{17

18}, Kay-Geert Armin Hermann¹⁹, Robert Bm Landewé^{20

21}, Helena Marzo-Ortega²², Victoria Navarro-Compán²³, Denis Poddubnyy²⁴, Monique Reijnierse²⁵, Martin Rudwaleit²⁶, Joachim Sieper²⁴, Filip E Van den Bosch^{13

14}, Désirée van der Heijde²⁷, Irene E van der Horst-Bruinsma²⁸, Stephanie Wichuk²⁹, Xenofon Baraliakos¹¹

Affiliations

¹ Department of Medicine, University of Alberta, Edmonton, Alberta, Canada walter.maksymowych@ualberta.ca.
² Department of Radiology, University of Alberta, Edmonton, Alberta, Canada.
³ Center for Rheumatology and Spine Diseasesses, Rigshospitalet, Copenhagen, Denmark.
⁴ Department of Rheumatology, University College London Hospitals NHS Foundation Trust, London, UK.
⁵ Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK.
⁶ Centre for Rheumatology and MRC Centre for Neuromuscular Diseases, University College London, London, UK.
⁷ Danish Hospital for Rheumatic Diseases, University of Southern Denmark, Sønderborg, Denmark.
⁸ Hospital of Southern Jutland, University Hospital of the Region of Southern Denmark, Aabenraa, Denmark.
⁹ Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
¹⁰ Academic Department of Military Rehabilitation, DMRC, and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.
¹¹ Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Herne, Germany.
¹² Department of Rheumatology, Hospital General de Mexico Dr Eduardo Liceaga and School of Medicine, Universidad Nacional Autonoma de Mexico, Mexico City, Mexico.
¹³ VIB Inflammation Research Center, Ghent University, Gent, Belgium.
¹⁴ Rheumatology Department, Ghent University Hospital, Ghent, Belgium.
¹⁵ Oregon Health and Science University, Portland, Oregon, USA.
¹⁶ Department of Radiology, Radiology, Sheba Medical Center, affiliated to the Sackler School of Medicine, Tel Aviv, Israel.
¹⁷ Department of Radiology, Aarhus University, Aarhus, Denmark.
¹⁸ Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark.
¹⁹ Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
²⁰ Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
²¹ Atrium Medical Center, Heerlen, The Netherlands.
²² NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.
²³ Immuno-Rheumatology Research Group, IdiPaz, University Hospital La Paz, Madrid, Spain.
²⁴ Charité - Universitätsmedizin Berlin and German Rheumatism Research Centre, Berlin, Germany.
²⁵ Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
²⁶ Klinikum Bielefeld, Bielefeld, and Charité - Universitätsmedizin Berlin, Berlin, Bielefeld, Germany.
²⁷ Leiden University Medical Center, Leiden, The Netherlands.
²⁸ Department of Rheumatology, VU University Medical Centre, Amsterdam, The Netherlands.
²⁹ Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.

PMID: 31422357
DOI: 10.1136/annrheumdis-2019-215589

MRI lesions in the sacroiliac joints of patients with spondyloarthritis: an update of definitions and validation by the ASAS MRI working group

Walter P Maksymowych et al. Ann Rheum Dis. 2019 Nov.

. 2019 Nov;78(11):1550-1558.

doi: 10.1136/annrheumdis-2019-215589. Epub 2019 Aug 17.

Authors

Affiliations

¹ Department of Medicine, University of Alberta, Edmonton, Alberta, Canada walter.maksymowych@ualberta.ca.
² Department of Radiology, University of Alberta, Edmonton, Alberta, Canada.
³ Center for Rheumatology and Spine Diseasesses, Rigshospitalet, Copenhagen, Denmark.
⁴ Department of Rheumatology, University College London Hospitals NHS Foundation Trust, London, UK.
⁵ Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK.
⁶ Centre for Rheumatology and MRC Centre for Neuromuscular Diseases, University College London, London, UK.
⁷ Danish Hospital for Rheumatic Diseases, University of Southern Denmark, Sønderborg, Denmark.
⁸ Hospital of Southern Jutland, University Hospital of the Region of Southern Denmark, Aabenraa, Denmark.
⁹ Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
¹⁰ Academic Department of Military Rehabilitation, DMRC, and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.
¹¹ Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Herne, Germany.
¹² Department of Rheumatology, Hospital General de Mexico Dr Eduardo Liceaga and School of Medicine, Universidad Nacional Autonoma de Mexico, Mexico City, Mexico.
¹³ VIB Inflammation Research Center, Ghent University, Gent, Belgium.
¹⁴ Rheumatology Department, Ghent University Hospital, Ghent, Belgium.
¹⁵ Oregon Health and Science University, Portland, Oregon, USA.
¹⁶ Department of Radiology, Radiology, Sheba Medical Center, affiliated to the Sackler School of Medicine, Tel Aviv, Israel.
¹⁷ Department of Radiology, Aarhus University, Aarhus, Denmark.
¹⁸ Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark.
¹⁹ Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
²⁰ Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
²¹ Atrium Medical Center, Heerlen, The Netherlands.
²² NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.
²³ Immuno-Rheumatology Research Group, IdiPaz, University Hospital La Paz, Madrid, Spain.
²⁴ Charité - Universitätsmedizin Berlin and German Rheumatism Research Centre, Berlin, Germany.
²⁵ Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
²⁶ Klinikum Bielefeld, Bielefeld, and Charité - Universitätsmedizin Berlin, Berlin, Bielefeld, Germany.
²⁷ Leiden University Medical Center, Leiden, The Netherlands.
²⁸ Department of Rheumatology, VU University Medical Centre, Amsterdam, The Netherlands.
²⁹ Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.

PMID: 31422357
DOI: 10.1136/annrheumdis-2019-215589

Abstract

Objectives: The Assessment of SpondyloArthritis international Society (ASAS) MRI working group (WG) was convened to generate a consensus update on standardised definitions for MRI lesions in the sacroiliac joint (SIJ) of patients with spondyloarthritis (SpA), and to conduct preliminary validation.

Methods: The literature pertaining to these MRI lesion definitions was discussed at three meetings of the group. 25 investigators (20 rheumatologists, 5 radiologists) determined which definitions should be retained or required revision, and which required a new definition. Lesion definitions were assessed in a multi-reader validation exercise using 278 MRI scans from the ASAS classification cohort by global assessment (lesion present/absent) and detailed scoring (inflammation and structural). Reliability of detection of lesions was analysed using kappa statistics and the intraclass correlation coefficient (ICC).

Results: No revisions were made to the current ASAS definition of a positive SIJ MRI or definitions for subchondral inflammation and sclerosis. The following definitions were revised: capsulitis, enthesitis, fat lesion and erosion. New definitions were developed for joint space enhancement, joint space fluid, fat metaplasia in an erosion cavity, ankylosis and bone bud. The most frequently detected structural lesion, erosion, was detected almost as reliably as subchondral inflammation (κappa/ICC:0.61/0.54 and 0.60/0.83) . Fat metaplasia in an erosion cavity and ankylosis were also reliably detected despite their low frequency (κappa/ICC:0.50/0.37 and 0.58/0.97).

Conclusion: The ASAS-MRI WG concluded that several definitions required revision and some new definitions were necessary. Multi-reader validation demonstrated substantial reliability for the most frequently detected lesions and comparable reliability between active and structural lesions.

Keywords: definitions; lesions; magnetic resonance imaging; reliability; sacroiliac joint; spondyloarthritis.

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Conflict of interest statement

Competing interests: None declared.

Comment in

Correspondence on 'MRI lesions in the sacroiliac joints of patients with spondyloarthritis: an update of definitions and validation by the ASAS MRI working group'.
Jibri Z, Gazel U, Solmaz D, Ayan G, Karsh J, Aydin SZ, Sampaio M. Jibri Z, et al. Ann Rheum Dis. 2023 May;82(5):e121. doi: 10.1136/annrheumdis-2021-220008. Epub 2021 Mar 3. Ann Rheum Dis. 2023. PMID: 33658237 No abstract available.
Response to: 'Correspondence on 'MRI lesions in the sacroiliac joints of patients with spondyloarthritis: an update of definitions and validation by the ASAS MRI working group'' by Jibri et al.
Maksymowych WP, Lambert RG, Østergaard M, Baraliakos X. Maksymowych WP, et al. Ann Rheum Dis. 2023 May;82(5):e122. doi: 10.1136/annrheumdis-2021-220078. Epub 2021 Mar 3. Ann Rheum Dis. 2023. PMID: 33658238 No abstract available.

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MRI lesions in the sacroiliac joints of patients with spondyloarthritis: an update of definitions and validation by the ASAS MRI working group

Affiliations

MRI lesions in the sacroiliac joints of patients with spondyloarthritis: an update of definitions and validation by the ASAS MRI working group

Authors

Affiliations

Abstract

Conflict of interest statement

Comment in

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