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*, Robert G.W. Lambert, Mikkel Østergaard, Susanne Juhl Pedersen, Pedro M. Machado, Ulrich Weber, Alexander N. Bennett, Juergen Braun, Ruben Burgos-Vargas, Manouk De Hooge, Atul A. Deodhar, Iris Eshed, Anne Grethe Jurik, Kay Geert Armin Hermann, Robert B.M. Landewé, Helena Marzo-Ortega, Victoria Navarro-Compán, Denis Poddubnyy, Monique Reijnierse, Martin RudwaleitJoachim Sieper, Filip E. Van Den Bosch, Désirée Van Der Heijde, Irene E. Van Der Horst-Bruinsma, Stephanie Wichuk, Xenofon Baraliakos

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

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.

Original languageEnglish
JournalAnnals of the Rheumatic Diseases
Volume78
Issue number11
Pages (from-to)1550-1558
ISSN0003-4967
DOIs
Publication statusPublished - Nov 2019

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Sacroiliac Joint
Magnetic resonance imaging
Fats
Erosion
Joints
Sclerosis
Consensus
Research Personnel
Exercise
Bone
Statistics
Fluids

Keywords

  • definitions
  • lesions
  • magnetic resonance imaging
  • reliability
  • sacroiliac joint
  • spondyloarthritis

Cite this

Maksymowych, Walter P. ; Lambert, Robert G.W. ; Østergaard, Mikkel ; Pedersen, Susanne Juhl ; Machado, Pedro M. ; Weber, Ulrich ; Bennett, Alexander N. ; Braun, Juergen ; Burgos-Vargas, Ruben ; De Hooge, Manouk ; Deodhar, Atul A. ; Eshed, Iris ; Jurik, Anne Grethe ; Hermann, Kay Geert Armin ; Landewé, Robert B.M. ; Marzo-Ortega, Helena ; Navarro-Compán, Victoria ; Poddubnyy, Denis ; Reijnierse, Monique ; Rudwaleit, Martin ; Sieper, Joachim ; Van Den Bosch, Filip E. ; Van Der Heijde, Désirée ; Van Der Horst-Bruinsma, Irene E. ; Wichuk, Stephanie ; Baraliakos, Xenofon. / MRI lesions in the sacroiliac joints of patients with spondyloarthritis : An update of definitions and validation by the ASAS MRI working group. In: Annals of the Rheumatic Diseases. 2019 ; Vol. 78, No. 11. pp. 1550-1558.
@article{16d16073bcc448b497090768e95df61c,
title = "MRI lesions in the sacroiliac joints of patients with spondyloarthritis: An update of definitions and validation by the ASAS MRI working group",
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",
author = "Maksymowych, {Walter P.} and Lambert, {Robert G.W.} and Mikkel {\O}stergaard and Pedersen, {Susanne Juhl} and Machado, {Pedro M.} and Ulrich Weber and Bennett, {Alexander N.} and Juergen Braun and Ruben Burgos-Vargas and {De Hooge}, Manouk and Deodhar, {Atul A.} and Iris Eshed and Jurik, {Anne Grethe} and Hermann, {Kay Geert Armin} and Landew{\'e}, {Robert B.M.} and Helena Marzo-Ortega and Victoria Navarro-Comp{\'a}n and Denis Poddubnyy and Monique Reijnierse and Martin Rudwaleit and Joachim Sieper and {Van Den Bosch}, {Filip E.} and {Van Der Heijde}, D{\'e}sir{\'e}e and {Van Der Horst-Bruinsma}, {Irene E.} and Stephanie Wichuk and Xenofon Baraliakos",
year = "2019",
month = "11",
doi = "10.1136/annrheumdis-2019-215589",
language = "English",
volume = "78",
pages = "1550--1558",
journal = "Annals of the Rheumatic Diseases",
issn = "0003-4967",
publisher = "B M J Group",
number = "11",

}

Maksymowych, WP, Lambert, RGW, Østergaard, M, Pedersen, SJ, Machado, PM, Weber, U, Bennett, AN, Braun, J, Burgos-Vargas, R, De Hooge, M, Deodhar, AA, Eshed, I, Jurik, AG, Hermann, KGA, Landewé, RBM, Marzo-Ortega, H, Navarro-Compán, V, Poddubnyy, D, Reijnierse, M, Rudwaleit, M, Sieper, J, Van Den Bosch, FE, Van Der Heijde, D, Van Der Horst-Bruinsma, IE, Wichuk, S & Baraliakos, X 2019, 'MRI lesions in the sacroiliac joints of patients with spondyloarthritis: An update of definitions and validation by the ASAS MRI working group', Annals of the Rheumatic Diseases, vol. 78, no. 11, pp. 1550-1558. https://doi.org/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. / Maksymowych, Walter P.; Lambert, Robert G.W.; Østergaard, Mikkel; Pedersen, Susanne Juhl; Machado, Pedro M.; Weber, Ulrich; Bennett, Alexander N.; Braun, Juergen; Burgos-Vargas, Ruben; De Hooge, Manouk; Deodhar, Atul A.; Eshed, Iris; Jurik, Anne Grethe; Hermann, Kay Geert Armin; Landewé, Robert B.M.; Marzo-Ortega, Helena; Navarro-Compán, Victoria; Poddubnyy, Denis; Reijnierse, Monique; Rudwaleit, Martin; Sieper, Joachim; Van Den Bosch, Filip E.; Van Der Heijde, Désirée; Van Der Horst-Bruinsma, Irene E.; Wichuk, Stephanie; Baraliakos, Xenofon.

In: Annals of the Rheumatic Diseases, Vol. 78, No. 11, 11.2019, p. 1550-1558.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - MRI lesions in the sacroiliac joints of patients with spondyloarthritis

T2 - An update of definitions and validation by the ASAS MRI working group

AU - Maksymowych, Walter P.

AU - Lambert, Robert G.W.

AU - Østergaard, Mikkel

AU - Pedersen, Susanne Juhl

AU - Machado, Pedro M.

AU - Weber, Ulrich

AU - Bennett, Alexander N.

AU - Braun, Juergen

AU - Burgos-Vargas, Ruben

AU - De Hooge, Manouk

AU - Deodhar, Atul A.

AU - Eshed, Iris

AU - Jurik, Anne Grethe

AU - Hermann, Kay Geert Armin

AU - Landewé, Robert B.M.

AU - Marzo-Ortega, Helena

AU - Navarro-Compán, Victoria

AU - Poddubnyy, Denis

AU - Reijnierse, Monique

AU - Rudwaleit, Martin

AU - Sieper, Joachim

AU - Van Den Bosch, Filip E.

AU - Van Der Heijde, Désirée

AU - Van Der Horst-Bruinsma, Irene E.

AU - Wichuk, Stephanie

AU - Baraliakos, Xenofon

PY - 2019/11

Y1 - 2019/11

N2 - 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.

AB - 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.

KW - definitions

KW - lesions

KW - magnetic resonance imaging

KW - reliability

KW - sacroiliac joint

KW - spondyloarthritis

U2 - 10.1136/annrheumdis-2019-215589

DO - 10.1136/annrheumdis-2019-215589

M3 - Journal article

C2 - 31422357

AN - SCOPUS:85070947874

VL - 78

SP - 1550

EP - 1558

JO - Annals of the Rheumatic Diseases

JF - Annals of the Rheumatic Diseases

SN - 0003-4967

IS - 11

ER -