Diagnostic Utility of Magnetic Resonance Imaging and Radiography in Juvenile Spondyloarthritis: Evaluation of the Sacroiliac Joints in Controls and Affected Subjects

被引:58
作者
Jaremko, Jacob L. [1 ]
Liu, Lei [1 ]
Winn, Naomi J. [1 ]
Ellsworth, Janet E.
Lambert, Robert G. W. [1 ]
机构
[1] Univ Alberta, Dept Radiol & Diagnost Imaging, WC Mackenzie Hlth Sci Ctr, Edmonton, AB T6G 2B7, Canada
关键词
SPONDYLARTHROPATHIES; MAGNETIC RESONANCE IMAGING; ANKYLOSING SPONDYLITIS; RADIOGRAPHY; PEDIATRICS; ONSET ANKYLOSING-SPONDYLITIS; DETECT SACROILIITIS; MRI; SPONDYLARTHROPATHY; CLASSIFICATION; RECOGNITION; ARTHRITIS; CHILDREN;
D O I
10.3899/jrheum.131064
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objective. To compare the utility of radiography and magnetic resonance imaging (MRI) for the diagnosis of juvenile-onset spondyloarthritis in pediatric patients presenting with low back and/or sacroiliac (SI) pain of potentially inflammatory etiology. Methods. Radiographs and MRI studies of the SI joints in 26 patients with juvenile spondyloarthritis (JSpA) and 35 controls were assessed independently by 2 radiologists, with discrepancies arbitrated by a third. Radiographs and MRI were blinded and read in separate batches in random order. Results. Erosion was common and was the most useful diagnostic feature on radiography [positive likelihood ratio (LR) = 3.5] and was especially diagnostic of SpA on MRI (LR = 6.7). Subchondral sclerosis was common but was the least specific feature for both modalities. Joint space narrowing had some utility on radiography (LR = 2.0) and MRI (LR = 2.7) but was uncommon and had poor reader reliability. Bone marrow edema (LR = 3.1) and subarticular fat infiltration (LR = 4.5), detectable only on MRI, were both useful features. Global diagnostic impression of MRI (LR = 9.4) had very high utility for the diagnosis of JSpA, exceeding radiography (LR = 4.4) because of superior specificity. In addition, global diagnosis of SpA is much more reliably made on MRI (kappa = 0.80) compared to radiography (kappa = 0.30). Conclusion. Specificity and reliability of MRI of the SI joints are superior to radiography for the diagnosis of juvenile-onset SpA and, where available, MRI should replace radiography as the first line of investigation.
引用
收藏
页码:963 / 970
页数:8
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