Limited Reliability of Radiographic Assessment of Sacroiliac Joints in Patients with Suspected Early Spondyloarthritis

Alice Ashouri Christiansen, Oliver Hendricks, Dorota Paulina Küttel, Kim Hørslev-Petersen, Anne Grethe Jurik, Steen Nielsen, Kaspar Rufibach, Anne Gitte Loft, Susanne Juhl Pedersen, Louise Thuesen Hermansen, Mikkel Østergaard, Bodil Arnbak, Claus Manniche, Ulrich Weber

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Resumé

Objective. To determine the reproducibility of evaluation of sacroiliac joint (SIJ) radiographs among readers with varying levels of experience, and to identify potential drivers of disagreement in classification among 5 predefined radiographic lesion types.

Methods. The study sample consisted of 104 consecutive patients aged 18–40 with low back pain ≥ 3 months of duration who met the Assessment of SpondyloArthritis international Society (ASAS) definition for a positive SIJ magnetic resonance image, or were HLA-B27–positive and had ≥ 1 spondyloarthritis (SpA)-related clinical/laboratory feature according to the ASAS classification criteria for axial SpA. Seven blinded readers (2 musculoskeletal radiologists, 5 rheumatologists) classified pelvic radiographs according to the modified New York criteria (mNY) and recorded presence/absence of 5 lesion types in both SIJ: erosion, sclerosis, ankylosis, joint space widening, and joint space narrowing. Reproducibility of mNY classification among 21 reader pairs was assessed and potential drivers of disagreement were identified among 5 lesion types. A generalized linear mixed logistic regression model served to analyze to what extent discordance in lesion type was associated with discrepant mNY classification.

Results. Mean κ values (percent concordance) were 0.39 (84.1%) for mNY classification over 21 reader pairs, 0.46 (79.8%) between 2 musculoskeletal radiologists, and 0.55 (86.5%) and 0.36 (77.9%) between the most experienced rheumatologist and the 2 radiologists. Erosion showed the lowest agreement (25%) among patients with discordant classification and gave the highest OR of 13.5 for disagreement.

Conclusion. Reproducibility of radiographic SIJ classification in an SpA inception cohort was only fair to at best moderate among 7 readers with varying levels of experience, questioning the applicability of mNY in early SpA and low back pain.
OriginalsprogEngelsk
TidsskriftJournal of Rheumatology
Vol/bind44
Udgave nummer1
Sider (fra-til)70-77
ISSN0315-162X
DOI
StatusUdgivet - 2017

Fingeraftryk

Sacroiliac Joint
Low Back Pain
Joints
Logistic Models
Sclerosis

Citer dette

@article{ab49c9f981de4b12a9af243b7ac77822,
title = "Limited Reliability of Radiographic Assessment of Sacroiliac Joints in Patients with Suspected Early Spondyloarthritis",
abstract = "Objective. To determine the reproducibility of evaluation of sacroiliac joint (SIJ) radiographs among readers with varying levels of experience, and to identify potential drivers of disagreement in classification among 5 predefined radiographic lesion types.Methods. The study sample consisted of 104 consecutive patients aged 18–40 with low back pain ≥ 3 months of duration who met the Assessment of SpondyloArthritis international Society (ASAS) definition for a positive SIJ magnetic resonance image, or were HLA-B27–positive and had ≥ 1 spondyloarthritis (SpA)-related clinical/laboratory feature according to the ASAS classification criteria for axial SpA. Seven blinded readers (2 musculoskeletal radiologists, 5 rheumatologists) classified pelvic radiographs according to the modified New York criteria (mNY) and recorded presence/absence of 5 lesion types in both SIJ: erosion, sclerosis, ankylosis, joint space widening, and joint space narrowing. Reproducibility of mNY classification among 21 reader pairs was assessed and potential drivers of disagreement were identified among 5 lesion types. A generalized linear mixed logistic regression model served to analyze to what extent discordance in lesion type was associated with discrepant mNY classification.Results. Mean κ values (percent concordance) were 0.39 (84.1{\%}) for mNY classification over 21 reader pairs, 0.46 (79.8{\%}) between 2 musculoskeletal radiologists, and 0.55 (86.5{\%}) and 0.36 (77.9{\%}) between the most experienced rheumatologist and the 2 radiologists. Erosion showed the lowest agreement (25{\%}) among patients with discordant classification and gave the highest OR of 13.5 for disagreement.Conclusion. Reproducibility of radiographic SIJ classification in an SpA inception cohort was only fair to at best moderate among 7 readers with varying levels of experience, questioning the applicability of mNY in early SpA and low back pain.",
keywords = "SPONDYLOARTHRITISRADIOGRAPHIC SACROILIITISINTERREADER AGREEMENTMODIFIED NEW YORK CRITERIA LOW BACK PAIN, Reproducibility of Results, Sacroiliac Joint/diagnostic imaging, Spondylarthritis/diagnostic imaging, Humans, Male, Back Pain/diagnostic imaging, Sacroiliitis/diagnostic imaging, Disease Progression, Young Adult, Magnetic Resonance Imaging, Adolescent, Adult, Female",
author = "Christiansen, {Alice Ashouri} and Oliver Hendricks and K{\"u}ttel, {Dorota Paulina} and Kim H{\o}rslev-Petersen and Jurik, {Anne Grethe} and Steen Nielsen and Kaspar Rufibach and Loft, {Anne Gitte} and Pedersen, {Susanne Juhl} and Hermansen, {Louise Thuesen} and Mikkel {\O}stergaard and Bodil Arnbak and Claus Manniche and Ulrich Weber",
year = "2017",
doi = "10.3899/jrheum.160079",
language = "English",
volume = "44",
pages = "70--77",
journal = "Journal of Rheumatology",
issn = "0315-162X",
publisher = "Journal of Rheumatology Publishing Co. Ltd.",
number = "1",

}

Limited Reliability of Radiographic Assessment of Sacroiliac Joints in Patients with Suspected Early Spondyloarthritis. / Christiansen, Alice Ashouri; Hendricks, Oliver; Küttel, Dorota Paulina; Hørslev-Petersen, Kim; Jurik, Anne Grethe ; Nielsen, Steen; Rufibach, Kaspar; Loft, Anne Gitte; Pedersen, Susanne Juhl; Hermansen, Louise Thuesen; Østergaard, Mikkel ; Arnbak, Bodil; Manniche, Claus; Weber, Ulrich.

I: Journal of Rheumatology, Bind 44, Nr. 1, 2017, s. 70-77.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Limited Reliability of Radiographic Assessment of Sacroiliac Joints in Patients with Suspected Early Spondyloarthritis

AU - Christiansen, Alice Ashouri

AU - Hendricks, Oliver

AU - Küttel, Dorota Paulina

AU - Hørslev-Petersen, Kim

AU - Jurik, Anne Grethe

AU - Nielsen, Steen

AU - Rufibach, Kaspar

AU - Loft, Anne Gitte

AU - Pedersen, Susanne Juhl

AU - Hermansen, Louise Thuesen

AU - Østergaard, Mikkel

AU - Arnbak, Bodil

AU - Manniche, Claus

AU - Weber, Ulrich

PY - 2017

Y1 - 2017

N2 - Objective. To determine the reproducibility of evaluation of sacroiliac joint (SIJ) radiographs among readers with varying levels of experience, and to identify potential drivers of disagreement in classification among 5 predefined radiographic lesion types.Methods. The study sample consisted of 104 consecutive patients aged 18–40 with low back pain ≥ 3 months of duration who met the Assessment of SpondyloArthritis international Society (ASAS) definition for a positive SIJ magnetic resonance image, or were HLA-B27–positive and had ≥ 1 spondyloarthritis (SpA)-related clinical/laboratory feature according to the ASAS classification criteria for axial SpA. Seven blinded readers (2 musculoskeletal radiologists, 5 rheumatologists) classified pelvic radiographs according to the modified New York criteria (mNY) and recorded presence/absence of 5 lesion types in both SIJ: erosion, sclerosis, ankylosis, joint space widening, and joint space narrowing. Reproducibility of mNY classification among 21 reader pairs was assessed and potential drivers of disagreement were identified among 5 lesion types. A generalized linear mixed logistic regression model served to analyze to what extent discordance in lesion type was associated with discrepant mNY classification.Results. Mean κ values (percent concordance) were 0.39 (84.1%) for mNY classification over 21 reader pairs, 0.46 (79.8%) between 2 musculoskeletal radiologists, and 0.55 (86.5%) and 0.36 (77.9%) between the most experienced rheumatologist and the 2 radiologists. Erosion showed the lowest agreement (25%) among patients with discordant classification and gave the highest OR of 13.5 for disagreement.Conclusion. Reproducibility of radiographic SIJ classification in an SpA inception cohort was only fair to at best moderate among 7 readers with varying levels of experience, questioning the applicability of mNY in early SpA and low back pain.

AB - Objective. To determine the reproducibility of evaluation of sacroiliac joint (SIJ) radiographs among readers with varying levels of experience, and to identify potential drivers of disagreement in classification among 5 predefined radiographic lesion types.Methods. The study sample consisted of 104 consecutive patients aged 18–40 with low back pain ≥ 3 months of duration who met the Assessment of SpondyloArthritis international Society (ASAS) definition for a positive SIJ magnetic resonance image, or were HLA-B27–positive and had ≥ 1 spondyloarthritis (SpA)-related clinical/laboratory feature according to the ASAS classification criteria for axial SpA. Seven blinded readers (2 musculoskeletal radiologists, 5 rheumatologists) classified pelvic radiographs according to the modified New York criteria (mNY) and recorded presence/absence of 5 lesion types in both SIJ: erosion, sclerosis, ankylosis, joint space widening, and joint space narrowing. Reproducibility of mNY classification among 21 reader pairs was assessed and potential drivers of disagreement were identified among 5 lesion types. A generalized linear mixed logistic regression model served to analyze to what extent discordance in lesion type was associated with discrepant mNY classification.Results. Mean κ values (percent concordance) were 0.39 (84.1%) for mNY classification over 21 reader pairs, 0.46 (79.8%) between 2 musculoskeletal radiologists, and 0.55 (86.5%) and 0.36 (77.9%) between the most experienced rheumatologist and the 2 radiologists. Erosion showed the lowest agreement (25%) among patients with discordant classification and gave the highest OR of 13.5 for disagreement.Conclusion. Reproducibility of radiographic SIJ classification in an SpA inception cohort was only fair to at best moderate among 7 readers with varying levels of experience, questioning the applicability of mNY in early SpA and low back pain.

KW - SPONDYLOARTHRITISRADIOGRAPHIC SACROILIITISINTERREADER AGREEMENTMODIFIED NEW YORK CRITERIA LOW BACK PAIN

KW - Reproducibility of Results

KW - Sacroiliac Joint/diagnostic imaging

KW - Spondylarthritis/diagnostic imaging

KW - Humans

KW - Male

KW - Back Pain/diagnostic imaging

KW - Sacroiliitis/diagnostic imaging

KW - Disease Progression

KW - Young Adult

KW - Magnetic Resonance Imaging

KW - Adolescent

KW - Adult

KW - Female

U2 - 10.3899/jrheum.160079

DO - 10.3899/jrheum.160079

M3 - Journal article

C2 - 27744397

VL - 44

SP - 70

EP - 77

JO - Journal of Rheumatology

JF - Journal of Rheumatology

SN - 0315-162X

IS - 1

ER -