Spondyloarthritis-related and degenerative MRI changes in the axial skeleton - an inter- and intra-observer agreement study

BMC Musculoskeletal Disorders

Anne Grethe Jurik¹  Niels Egund¹  Anna Zejden¹  Claus Manniche²  Tue Secher Jensen²  Bodil Arnbak² 

[1] Department of Radiology, Aarhus University Hospital, Aarhus Sygehus, Noerrebrogade 44, 8000, Aarhus C, Denmark;Institute of Regional Health Services Research, University of Southern Denmark, Winsloewparken 19, Odense C 5000, Denmark

关键词: Spondylarthritis;    Spondyloarthropathy;    Spine;    Sacroiliitis;    Sacroiliac joint;    Magnetic resonance imaging;    Low back pain;    Kappa;    Diagnosis;    Arthritis;    Ankylosing spondylitis;    Agreement;   

Others  :  1129660
DOI  :  10.1186/1471-2474-14-274

 received in 2013-04-16, accepted in 2013-09-18,  发布年份 2013

【 摘 要 】

Background

The Back Pain Cohort of Southern Denmark (BaPa Cohort) was initiated with the aim of evaluating the clinical relevance of magnetic resonance imaging (MRI) in the diagnosis of early spondyloarthritis (SpA). In order to facilitate the collection of MRI data for this study, an electronic evaluation form was developed including both SpA-related and degenerative axial changes. The objective of the current study was to assess the intra- and inter-observer agreement of the MRI changes assessed.

Methods

Three radiologists evaluated 48 MRI scans of the whole spine and the sacroiliac joints from a subsample of the BaPa Cohort, consisting of patients with non-specific low back pain and patients with different stages of SpA features. The spine was evaluated for SpA-related and degenerative MRI changes and the SIJ for SpA-related changes. Inter- and intra-observer agreements were calculated with kappa statistics. In the interpretation of the kappa coefficient, the standards for strength of agreement reported by Landis and Koch were followed.

Results

A total of 48 patients, 40% men and mean age of 31 years (range 18 – 40 years), were evaluated once by all three readers and re-evaluated by two of the readers after 4-12 weeks. For MRI changes in the spine, substantial to almost perfect observer agreement was found for the location and the size of vertebral signal changes and for disc degeneration and disc contour. For the sacroiliac joints, substantial or almost perfect observer agreement was found for the grading of bone marrow oedema and fatty marrow deposition, the depth of bone marrow oedema and for subchondral sclerosis. Global assessment of the SpA diagnosis had substantial to almost perfect observer agreements.

Conclusion

The acceptable agreement for key MRI changes in the spine and sacroiliac joints makes it possible to use these MRI changes in the BaPa Cohort study and other studies investigating MRI changes in patients with non-specific low back pain and suspected SpA.

【 授权许可】

   
2013 Arnbak et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Ahlstrom H, Feltelius N, Nyman R, Hallgren R: Magnetic resonance imaging of sacroiliac joint inflammation. Arthritis Rheum 1990, 33:1763-1769.
• [2]Bennett AN, McGonagle D, O’Connor P, Hensor EM, Sivera F, Coates LC, Emery P, Marzo-Ortega H: Severity of baseline magnetic resonance imaging-evident sacroiliitis and HLA-B27 status in early inflammatory back pain predict radiographically evident ankylosing spondylitis at eight years. Arthritis Rheum 2008, 58:3413-3418.
• [3]Arnbak B, Leboeuf-Yde C, Jensen TS: A systematic critical review on MRI in spondyloarthritis. Arthritis Res Ther 2012, 14:R55. BioMed Central Full Text
• [4]Sieper J, Rudwaleit M, Baraliakos X, Brandt J, Braun J, Burgos-Vargas R, Dougados M, Hermann KG, Landewe R, Maksymowych W, van der Heijde D: The Assessment of SpondyloArthritis international Society (ASAS) handbook: a guide to assess spondyloarthritis. Ann Rheum Dis 2009, 68(Suppl 2):ii1-ii44.
• [5]Weber U, Lambert RG, Ostergaard M, Hodler J, Pedersen SJ, Maksymowych WP: The diagnostic utility of magnetic resonance imaging in spondylarthritis: an international multicenter evaluation of one hundred eighty-seven subjects. Arth Rheum 2010, 62:3048-3058.
• [6]Madsen KB, Jurik AG: MRI grading method for active and chronic spinal changes in spondyloarthritis. ClinRadiol 2010, 65:6-14.
• [7]Madsen KB, Jurik AG: Magnetic resonance imaging grading system for active and chronic spondylarthritis changes in the sacroiliac joint. Arth Care Res(Hoboken) 2010, 62:11-18.
• [8]Cohen JA: A coefficient of agreement for nominal scales. Educ Psycholog Measure 1960, 20:37-46.
• [9]Kirkwood B, Sterne J: Mesurement error: assessment and implications. In Essential medical statistics. 2nd edition. Malden: Blackwell Science; 2003:429-466.
• [10]Fleis JL: Statistical methods for rates and proportions. New York: Wiley; 1981.
• [11]Efron B, Tibshirani R: An introduction to the bootstrap. London: Chapman & Hall; 1993.
• [12]Lee J, Fung KP: Confidence interval of the kappa coefficient by bootstrap resampling. Psychiatry Res 1993, 49:97-98.
• [13]Landis JR, Koch GG: The measurement of observer agreement for categorical data. Biometrics 1977, 33:159-174.
• [14]Chiowchanwisawakit P, Ostergaard M, Pedersen SJ, Lambert RG, Conner-Spady B, Maksymowych WP: Validation of definitions for structural lesions detected by magnetic resonance imaging in the spine of patients with spondyloarthritis. J Rheumatol Suppl 2009, 84:39-47.
• [15]Lukas C, Braun J, van der Heijde D, Hermann KG, Rudwaleit M, Ostergaard M, Oostveen A, O’Connor P, Maksymowych WP, Lambert RG, Jurik AG, Baraliakos X, Landewe R: Scoring inflammatory activity of the spine by magnetic resonance imaging in ankylosing spondylitis: a multireader experiment. JRheumatol 2007, 34:862-870.
• [16]Jensen TS, Sorensen JS, Kjaer P: Intra- and interobserver reproducibility of vertebral endplate signal (modic) changes in the lumbar spine: the Nordic Modic Consensus Group classification. Acta Radiol 2007, 48:748-754.
• [17]Peterson CK, Gatterman B, Carter JC, Humphreys BK, Weibel A: Inter- and intraexaminer reliability in identifying and classifying degenerative marrow (Modic) changes on lumbar spine magnetic resonance scans. J Manipulative Physiol Ther 2007, 30:85-90.
• [18]Fayad F, Lefevre-Colau MM, Drape JL, Feydy A, Chemla N, Quintero N, Rannou F, Poiraudeau S, Fermanian J, Revel M: Reliability of a modified Modic classification of bone marrow changes in lumbar spine MRI. Joint Bone Spine 2009, 76:286-289.
• [19]Wang Y, Videman T, Niemelainen R, Battie MC: Quantitative measures of modic changes in lumbar spine magnetic resonance imaging: intra- and inter-rater reliability. Spine (Phila Pa 1976) 2011, 36:1236-1243.
• [20]Jones A, Clarke A, Freeman BJ, Lam KS, Grevitt MP: The Modic classification: inter- and intraobserver error in clinical practice. Spine (Phila Pa 1976) 2005, 30:1867-1869.
• [21]Mulconrey DS, Knight RQ, Bramble JD, Paknikar S, Harty PA: Interobserver reliability in the interpretation of diagnostic lumbar MRI and nuclear imaging. Spine J 2006, 6:177-184.
• [22]Kuisma M, Karppinen J, Niinimaki J, Kurunlahti M, Haapea M, Vanharanta H, Tervonen O: A three-year follow-up of lumbar spine endplate (Modic) changes. Spine (Phila Pa 1976) 2006, 31:1714-1718.
• [23]Kokkonen SM, Kurunlahti M, Tervonen O, Ilkko E, Vanharanta H: Endplate degeneration observed on magnetic resonance imaging of the lumbar spine: correlation with pain provocation and disc changes observed on computed tomography diskography. Spine (Phila Pa 1976) 2002, 27:2274-2278.
• [24]Karchevsky M, Schweitzer ME, Carrino JA, Zoga A, Montgomery D, Parker L: Reactive endplate marrow changes: a systematic morphologic and epidemiologic evaluation. Skeletal Radiol 2005, 34:125-129.
• [25]Chung CB, Vande Berg BC, Tavernier T, Cotten A, Laredo JD, Vallee C, Malghem J: End plate marrow changes in the asymptomatic lumbosacral spine: frequency, distribution and correlation with age and degenerative changes. Skeletal Radiol 2004, 33:399-404.
• [26]Pedersen SJ, Ostergaard M, Chiowchanwisawakit P, Lambert RG, Maksymowych WP: Validation of definitions for active inflammatory lesions detected by magnetic resonance imaging in the spine of patients with spondyloarthritis. J Rheumatol Suppl 2009, 84:35-38.
• [27]Pfirrmann CW, Metzdorf A, Zanetti M, Hodler J, Boos N: Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine (Phila Pa 1976) 2001, 26:1873-1878.
• [28]Griffith JF, Wang YX, Antonio GE, Choi KC, Yu A, Ahuja AT, Leung PC: Modified Pfirrmann grading system for lumbar intervertebral disc degeneration. Spine (Phila Pa 1976) 2007, 32:E708-E712.
• [29]Solgaard SJ, Kjaer P, Jensen TS, Andersen P: Low-field magnetic resonance imaging of the lumbar spine: reliability of qualitative evaluation of disc and muscle parameters. Acta Radiol 2006, 47:947-953.
• [30]Lurie JD, Tosteson AN, Tosteson TD, Carragee E, Carrino JA, Kaiser J, Sequeiros RT, Lecomte AR, Grove MR, Blood EA, Pearson LH, Herzog R, Weinstein JN: Reliability of magnetic resonance imaging readings for lumbar disc herniation in the Spine Patient Outcomes Research Trial (SPORT). Spine (Phila Pa 1976) 2008, 33:991-998.
• [31]Arana E, Royuela A, Kovacs FM, Estremera A, Sarasibar H, Amengual G, Galarraga I, Martinez C, Muriel A, Abraira V, Gil Del Real MT, Zamora J, Campillo C: Lumbar spine: agreement in the interpretation of 1.5-T MR images by using the Nordic Modic Consensus Group classification form. Radiology 2010, 254:809-817.
• [32]Puhakka KB, Jurik AG, Egund N, Schiottz-Christensen B, Stengaard-Pedersen K, van Overeem HG, Christiansen JV: Imaging of sacroiliitis in early seronegative spondylarthropathy. Assessment of abnormalities by MR in comparison with radiography and CT. Acta Radiol 2003, 44:218-229.
• [33]Docherty P, Mitchell MJ, MacMillan L, Mosher D, Barnes DC, Hanly JG: Magnetic resonance imaging in the detection of sacroiliitis. JRheumatol 1992, 19:393-401.
• [34]Heuft-Dorenbosch L, Weijers R, Landewe R, van der Linden S, van der Heijde D: Magnetic resonance imaging changes of sacroiliac joints in patients with recent-onset inflammatory back pain: inter-reader reliability and prevalence of abnormalities. Arthritis Res Ther 2006, 8:R11. BioMed Central Full Text
• [35]Maksymowych WP, Inman RD, Salonen D, Dhillon SS, Williams M, Stone M, Conner-Spady B, Palsat J, Lambert RG: Spondyloarthritis research Consortium of Canada magnetic resonance imaging index for assessment of sacroiliac joint inflammation in ankylosing spondylitis. Arthritis Rheum 2005, 53:703-709.
• [36]Weber U, Pedersen SJ, Ostergaard M, Rufibach K, Lambert RG, Maksymowych WP: Can erosions on MRI of the sacroiliac joints be reliably detected in patients with ankylosing spondylitis? - A cross-sectional study. Arth Res Therapy 2012, 14:R124. BioMed Central Full Text
• [37]Weber U, Zubler V, Pedersen SJ, Rufibach K, Lambert RG, Chan SM, Ostergaard M, Maksymowych WP: Development and validation of a magnetic resonance imaging reference criterion for defining a positive sacroiliac joint magnetic resonance imaging finding in spondyloarthritis. Arth Care Res 2013, 65:977-985.