加拿大脊柱关节炎研究联盟磁共振成像骶髂关节结构评分的开发与初步验证

Development and preliminary validation of the spondyloarthritis research consortium of Canada magnetic resonance imaging sacroiliac joint structural score.

作者信息

Maksymowych Walter P, Wichuk Stephanie, Chiowchanwisawakit Praveena, Lambert Robert G, Pedersen Susanne J

机构信息

From the Department of Medicine; Department of Radiology and Diagnostic Imaging, Spondyloarthritis Research Consortium of Canada (SPARCC) Center, University of Alberta, Edmonton, Alberta, Canada; the Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand; the Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, University of Copenhagen, Denmark.W.P. Maksymowych, FRCP(C), Professor; S. Wichuk, BSc, Research Associate, Department of Medicine; R.G. Lambert, FRCP(C), Professor, Department of Radiology and Diagnostic Imaging, Spondyloarthritis Research Consortium of Canada Center, University of Alberta; P. Chiowchanwisawakit, MD, Department of Medicine, Siriraj Hospital, Mahidol University; S.J. Pedersen, MD, Rheumatologist, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, University of Copenhagen.

出版信息

J Rheumatol. 2015 Jan;42(1):79-86. doi: 10.3899/jrheum.140519. Epub 2014 Oct 15.

DOI:10.3899/jrheum.140519

PMID:25320219

Abstract

OBJECTIVE

There is an unmet need for reliable assessment of structural progression in the sacroiliac joints (SIJ) of patients with spondyloarthritis (SpA), but radiography is unreliable and lacks responsiveness. We aimed to develop and validate a new scoring method for structural lesions based on magnetic resonance imaging (MRI), the Spondyloarthritis Research Consortium of Canada (SPARCC) SIJ Structural Score (SSS).

METHODS

The SSS method for assessment of structural lesions is based on T1-weighted spin echo MRI, validated lesion definitions, slice selection according to well-defined anatomical principles, and dichotomous scoring (lesion present/absent) of 5 consecutive slices through the cartilaginous portion of the joint. Scoring ranges are fat metaplasia (0-40), erosion (0-40), backfill (0-20), and ankylosis (0-20). We progressively conducted 3 validation exercises with 2-4 readers on baseline, and either 2-year (exercises 1 and 2) or 1-year (exercise 3) scans from 147 patients with SpA assessed blinded to timepoint. Interobserver reliability was assessed by intraclass correlation coefficient (ICC) and smallest detectable change (SDC).

RESULTS

Interobserver reliability for status score was good to excellent for ankylosis (ICC 0.79-0.98), consistently good for fat metaplasia (ICC 0.71-0.78), moderate to good for erosion (ICC 0.58-0.62), and fair to good for backfill (ICC 0.35-0.66). Reliability for change scores was moderate to good for all structural lesions despite the relatively small changes in scores, and was highest for fat metaplasia when both ICC and SDC values were compared.

CONCLUSION

The new SPARCC MRI SSS method can detect structural changes in the SIJ with acceptable reliability over a 1-2-year timeframe, and should be further validated in patients with SpA.

摘要

目的

对于脊柱关节炎（SpA）患者骶髂关节（SIJ）结构进展的可靠评估存在未满足的需求，但放射照相术不可靠且缺乏反应性。我们旨在开发并验证一种基于磁共振成像（MRI）的结构损伤新评分方法，即加拿大脊柱关节炎研究联盟（SPARCC）骶髂关节结构评分（SSS）。

方法

用于评估结构损伤的SSS方法基于T1加权自旋回波MRI、经过验证的损伤定义、根据明确的解剖学原理进行切片选择，以及对通过关节软骨部分的连续5个切片进行二分法评分（损伤存在/不存在）。评分范围包括脂肪化生（0 - 40）、侵蚀（0 - 40）、填充（0 - 20）和强直（0 - 20）。我们对147例SpA患者的基线以及2年（练习1和2）或1年（练习3）扫描图像，由2 - 4名阅片者逐步进行了3次验证练习，阅片时对时间点进行盲法评估。通过组内相关系数（ICC）和最小可检测变化（SDC）评估观察者间的可靠性。

结果

观察者间对强直状态评分的可靠性良好至优秀（ICC 0.79 - 0.98），对脂肪化生始终良好（ICC 0.71 - 0.78），对侵蚀为中等至良好（ICC 0.58 - 0.62），对填充为一般至良好（ICC 0.35 - 0.66）。尽管评分变化相对较小，但所有结构损伤的变化评分可靠性为中等至良好，在比较ICC和SDC值时，脂肪化生的可靠性最高。