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European Radiology

, Volume 28, Issue 10, pp 4163–4173 | Cite as

Whole body MRI in spondyloarthritis (SpA): Preliminary results suggest that DWI outperforms STIR for lesion detection

  • Frederic E. Lecouvet
  • Nicolas Vander Maren
  • Laurence Collette
  • Nicolas Michoux
  • Perrine Triqueneaux
  • Maria Stoenoiu
  • Frederic Houssiau
  • Jacques Malghem
  • Marie-Laurence Denis
  • Ahmed Larbi
  • Adrien Nzeusseu Toukap
Musculoskeletal

Abstract

Purpose

To compare the diagnostic accuracy of DWI and STIR sequences in Whole body (WB) MRI of SpA patients.

Materials and methods

Twenty consecutive patients with confirmed active SpA and 20 controls were investigated with identical WB MRI protocols, including DWI and STIR images. Two observers recorded ‘lesions’ (high signal intensity foci on STIR and high b-value DWI) in 17 anatomical areas, making a 17-point ‘area score’ and a 40-point ‘lesion score’. ROC performance, inter-observer agreement, correlation with clinical parameters and spine and sacro-iliac joints (SIJ) MRI scores were assessed.

Results

SpA patients had significantly higher lesion scores on DWI than on STIR (p<0.025). The lesion score area under the curve was significantly higher with DWI (99.9) than with STIR (95.8, p=0.02). DWI lesion score ≥5 had both sensitivity and specificity ≥85 %. With STIR the best threshold ≥3 yielded sensitivity ≥85 % and specificity ≥60 %. DWI area score ≥3 yielded sensitivity ≥85 % and specificity ≥80 %. With STIR the best threshold ≥4 yielded sensitivity ≥70 % and specificity ≥80 %. Inter-observer agreement was strong for both sequences. In patients, the lesion score was positively correlated with ASDAS-CRP, log(CRP), and local MRI scores.

Conclusions

DWI is a promising alternative to STIR in WB MRI to detect active SpA lesions.

Key Points

DWI is a robust alternative to STIR in WBMRI in SpA.

DWI might be superior in discriminating relevant inflammatory and degenerative changes.

Positive correlations exist between WB MRI, clinical, biological, local MRI data.

Distribution and frequency of abnormal MRI findings in SpA are highlighted.

Keywords

Spondylarthritis Spine Whole body imaging Diffusion, magnetic resonance imaging Magnetic resonance imaging 

Abbreviations

ADC

Average diffusion coefficient

ASAS

Assessment of SpondyloArthritis International Society

ASDAS

Ankylosing Spondylitis Disease Activity Score

BASDAI

Bath Ankylosing Spondylitis Disease Activity Index

BASFI

Bath Ankylosing Spondylitis Functional Index

CRP

C-reactive protein

DMARDs

Disease-modifying anti-rheumatic drugs

DWI

Diffusion-weighted imaging

GC

Glucocorticoids

HLA-B27

Human leucocyte antigen –B27

IBP

Inflammatory back pain

mNY

Modified New-York

NSAIDs

Non-steroidal anti-inflammatory drugs

SIJ

Sacro-iliac joints

SpA

Axial spondyloarthritis

STIR

Short tau (τ) inversion recovery

TNFa

Tumour necrosis factor alpha

T1-w

T1-weighted

VAS

Visual analogue scale

WB

Whole body

Notes

Funding

The authors state that this work has not received any funding.

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is F.E. Lecouvet.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

The institution’s ethics committee did not require informed consent for the retrospective review of prospectively acquired data.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• retrospective

• case-control study

• performed at one institution

Supplementary material

330_2018_5377_MOESM1_ESM.doc (580 kb)
ESM 1 (DOC 580 kb)

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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  • Frederic E. Lecouvet
    • 1
  • Nicolas Vander Maren
    • 1
  • Laurence Collette
    • 2
  • Nicolas Michoux
    • 1
  • Perrine Triqueneaux
    • 1
  • Maria Stoenoiu
    • 3
  • Frederic Houssiau
    • 3
  • Jacques Malghem
    • 1
  • Marie-Laurence Denis
    • 1
  • Ahmed Larbi
    • 1
  • Adrien Nzeusseu Toukap
    • 3
  1. 1.Department of Radiology and Medical ImagingInstitut de Recherche Expérimentale et Clinique (IREC),Université Catholique de Louvain (UCL), Cliniques Universitaires Saint LucBrusselsBelgium
  2. 2.EORTC, Head of the Statistics UnitEORTC HeadquartersBrusselsBelgium
  3. 3.Department of RheumatologyCliniques Universitaires Saint-LucBrusselsBelgium

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