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. 2025 Jul 30.
doi: 10.1007/s00330-025-11855-z. Online ahead of print.

Time-efficient MRI scoring system for axial spondyloarthritis: a feasibility study

Fatma I Abdelrahman  1 , Mohammad Abd Alkhalik Basha  2 , El-Sayed A H F El-Sayad  1 , Heba Abdelwahab Seliem  1 , Mohamed Hesham Saleh Saleh Radwan  3 , Rania Mostafa A Hassan  3 , Hamada M Khater  4 , Ahmed M Abdelkhalik Basha  5 , Mohamed Atia Mortada  1
Affiliations

Time-efficient MRI scoring system for axial spondyloarthritis: a feasibility study

Fatma I Abdelrahman et al. Eur Radiol. .

Abstract

Objective: To develop and assess the feasibility of a simplified Spondyloarthritis Research Consortium of Canada (SPARCC) MRI score for quantifying disease activity changes in patients with axial spondyloarthritis (axSpA) undergoing biological therapy, and compare its performance with the original SPARCC score.

Materials and methods: This prospective feasibility study included 60 axSpA patients receiving biological therapy. MRI examinations of the sacroiliac joints and spine were performed at baseline and six months after the initiation of biological therapy. The simplified SPARCC score, focusing on the three most affected slices/vertebrae instead of six, was developed and compared with the original SPARCC score. Both scores were correlated with clinical indices and inflammatory markers. Inter-reader agreement and sensitivity to inflammatory changes were evaluated to assess reliability and research utility.

Results: Both scores showed significant improvement after six months of initiating biological therapy (p < 0.001). The simplified SPARCC scores correlated strongly with disease activity markers, comparable to or stronger than the original scores, with median score reductions of 71.4-79.1%. Inter-reader agreement was substantial to almost perfect for all scores, with simplified SPARCC spine score exhibiting the highest agreement (κ = 0.817 at baseline and 0.784 at follow-up). The simplified score significantly reduced assessment time compared with the original score (11 vs 37 min, p < 0.001).

Conclusion: The simplified SPARCC MRI score is a promising research tool for assessing disease activity in axSpA patients, with the advantages of improved inter-reader reliability and significantly reduced assessment time. Further validation is required to confirm its broader clinical applicability.

Key points: Question Can a simplified SPARCC MRI score reduce assessment time while reliably tracking disease activity changes? Findings The simplified SPARCC MRI score showed comparable sensitivity to change and reliability vs the original score, reducing mean assessment time from 37 min to 11 min. Clinical relevance The simplified SPARCC MRI score provides a faster, reliable research method for tracking axSpA activity changes, potentially improving clinical trial efficiency. Further validation is needed to confirm routine clinical utility.

Keywords: Axial spondyloarthritis; Biological therapy; Magnetic resonance imaging; Sacroiliac joint; Spine.

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Conflict of interest statement

Compliance with ethical standards. Guarantor: The scientific guarantor of this publication is Mohammad Abd Alkhalik Basha. Conflict of interest: M.A.A.B. is a member of the Scientific Editorial Board of European Radiology (section: urogenital). As such, they have not participated in the selection or review processes for this article. The remaining authors of this manuscript declare no relevant conflicts of interest and no relationships with any companies whose products or services may be related to the subject matter of the article. Statistics and biometry: The corresponding author has great statistical expertise. Informed consent: Written informed consent was obtained from all patients. Ethical approval: Institutional review board approval was obtained (approval number: ZU-IRB#120). Study subjects or cohorts overlap: No study subjects have been previously reported. Methodology: Prospective Diagnostic or prognostic study Performed at a single center

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