MRI contributes to accurate and early diagnosis of non-radiographic HLA-B27 negative axial spondyloarthritis
Abstract Background Nonradiographic axial spondyloarthropathies (nr-axSpA) are diagnosed by the absence of radiographic sacroiliitis and the presence of bone marrow edema (BME) on magnetic resonance imaging (MRI). According to the classification criteria of the international Assessment of Spondyloar...
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2021-07-01
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Series: | Journal of Translational Medicine |
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Online Access: | https://doi.org/10.1186/s12967-021-02959-3 |
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Article |
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DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Chun-Chi Lu Guo-Shu Huang Tony Szu-Hsien Lee En Chao Hsiang-Cheng Chen Yong-Si Guo Shi-Jye Chu Feng-Cheng Liu San-Yuan Kao Tsung-Yun Hou Chen-Hung Chen Deh-Ming Chang Sin-Yi Lyu |
spellingShingle |
Chun-Chi Lu Guo-Shu Huang Tony Szu-Hsien Lee En Chao Hsiang-Cheng Chen Yong-Si Guo Shi-Jye Chu Feng-Cheng Liu San-Yuan Kao Tsung-Yun Hou Chen-Hung Chen Deh-Ming Chang Sin-Yi Lyu MRI contributes to accurate and early diagnosis of non-radiographic HLA-B27 negative axial spondyloarthritis Journal of Translational Medicine Magnetic resonance imaging Spondyloarthritis Joint space widening Bone marrow edema |
author_facet |
Chun-Chi Lu Guo-Shu Huang Tony Szu-Hsien Lee En Chao Hsiang-Cheng Chen Yong-Si Guo Shi-Jye Chu Feng-Cheng Liu San-Yuan Kao Tsung-Yun Hou Chen-Hung Chen Deh-Ming Chang Sin-Yi Lyu |
author_sort |
Chun-Chi Lu |
title |
MRI contributes to accurate and early diagnosis of non-radiographic HLA-B27 negative axial spondyloarthritis |
title_short |
MRI contributes to accurate and early diagnosis of non-radiographic HLA-B27 negative axial spondyloarthritis |
title_full |
MRI contributes to accurate and early diagnosis of non-radiographic HLA-B27 negative axial spondyloarthritis |
title_fullStr |
MRI contributes to accurate and early diagnosis of non-radiographic HLA-B27 negative axial spondyloarthritis |
title_full_unstemmed |
MRI contributes to accurate and early diagnosis of non-radiographic HLA-B27 negative axial spondyloarthritis |
title_sort |
mri contributes to accurate and early diagnosis of non-radiographic hla-b27 negative axial spondyloarthritis |
publisher |
BMC |
series |
Journal of Translational Medicine |
issn |
1479-5876 |
publishDate |
2021-07-01 |
description |
Abstract Background Nonradiographic axial spondyloarthropathies (nr-axSpA) are diagnosed by the absence of radiographic sacroiliitis and the presence of bone marrow edema (BME) on magnetic resonance imaging (MRI). According to the classification criteria of the international Assessment of Spondyloarthritis Society (ASAS), structural changes to sacroiliac joints (SIJs) on MRI cannot be used as criteria in the absence of BME. However, less than half the Asian patients with clinically active axSpA show BME. The incidence of human leukocyte antigen (HLA)-B27 is low in Asian populations, which makes it more difficult to identify nr-axSpA. We used MRI to evaluate the structural damage to SIJs in patients with nr-axSpA with and without BME with the aim of identifying the best methodology for accurate diagnosis, especially in populations with less common BME and HLA-B27. Methods One hundred three patients with inflammatory back pain were included in this prospective study. No patient’s radiograph met the definition of positive modified New York criteria. BME and structural damage to SIJ including sclerosis and erosion were assessed independently on coronal and axial short-tau inversion recovery and T1-weighted spin echo MRI scans by two well-trained musculoskeletal radiologists using the Spondyloarthritis Research Consortium of Canada (SPARCC) score. Demographics of patients were collected. Disease characteristics and structural damage were analyzed in patients with and without BME on SIJ MRI. Receiver operating characteristic (ROC) curve analysis was used to assess the diagnostic performance of structural damage. Results All individuals in the cohort had at least one abnormal finding on SIJ MRI, including BME or structural damage; 36 of 103 patients had BME. We identified a significant positive correlation between SPARCC scores and severe erosion assessed by focal joint space widening (fJSW) (p = 0.001) in these 36 patients. Fifty-eight of the 103 enrolled patients fulfilled the ASAS criteria for nr-axSpA in the either absence or presence of BME. Of these 58 patients, 57 and 19 had erosions or fJSW, respectively, and the presence of BME was significantly correlated with fJSW (phi score of 0.319 and p = 0.015). We demonstrated a significant positive correlation between fJSW and either the presence or the severity of BME in patients with nr-axSpA who met the ASAS definition. There was a positive correlation between BME and fJSW across the whole study cohort (phi score of 0.389; p < 0.001). The area under the ROC curve (AUC) for fJSW on SIJ MRI was 0.736, p < 0.001. In both HLA-B27-positive and -negative groups, BME was more common in the presence of fJSW (phi scores of 0.370 and 0.377, p = 0.018 and 0.003, respectively) and SPARCC scores were higher in patients with fJSW (p < 0.001 and p = 0.005). We also identified a positive correlation between fJSW and BME in patients with nr-axSpA and normal serum levels of C-reactive protein (phi score of 0.362 and p = 0.001). Conclusion Structural damage detected on SIJ MRI, sclerosis, erosions and fJSW may be present in patients without detectable inflammation on SIJ MRI. However, fJSW is significantly correlated with the severity of inflammation seen on SIJ MRI, which contributes to the accurate diagnosis of nr-axSpA, and it could be used as an alternative diagnostic test for nr-axSpA in the general population, especially for those who do not carry the HLA-B27 gene, Asian patients without BME, or patients with normal serum inflammatory biomarkers. |
topic |
Magnetic resonance imaging Spondyloarthritis Joint space widening Bone marrow edema |
url |
https://doi.org/10.1186/s12967-021-02959-3 |
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doaj-a150bbe83efa4a0287afc911fda2f7922021-07-11T11:07:40ZengBMCJournal of Translational Medicine1479-58762021-07-0119111110.1186/s12967-021-02959-3MRI contributes to accurate and early diagnosis of non-radiographic HLA-B27 negative axial spondyloarthritisChun-Chi Lu0Guo-Shu Huang1Tony Szu-Hsien Lee2En Chao3Hsiang-Cheng Chen4Yong-Si Guo5Shi-Jye Chu6Feng-Cheng Liu7San-Yuan Kao8Tsung-Yun Hou9Chen-Hung Chen10Deh-Ming Chang11Sin-Yi Lyu12Division of Rheumatology/Immunology/Allergy, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical CenterDepartment of Radiology, Tri-Service General Hospital, National Defense Medical Center, National Defense Medical Center, National Defense Medical CenterDepartment of Health Promotion and Health Education, National Taiwan Normal UniversityDepartment of Health Promotion and Health Education, National Taiwan Normal UniversityDivision of Rheumatology/Immunology/Allergy, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical CenterDivision of Rheumatology/Immunology/Allergy, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical CenterDivision of Rheumatology/Immunology/Allergy, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical CenterDivision of Rheumatology/Immunology/Allergy, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical CenterDivision of Rheumatology/Immunology/Allergy, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical CenterDivision of Rheumatology/Immunology/Allergy, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical CenterDivision of Rheumatology, Department of Internal Medicine, Taipei Tzu Chi HospitalDivision of Rheumatology/Immunology/Allergy, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical CenterDivision of Radiology, Tri-Service General Hospital, National Defense Medical CenterAbstract Background Nonradiographic axial spondyloarthropathies (nr-axSpA) are diagnosed by the absence of radiographic sacroiliitis and the presence of bone marrow edema (BME) on magnetic resonance imaging (MRI). According to the classification criteria of the international Assessment of Spondyloarthritis Society (ASAS), structural changes to sacroiliac joints (SIJs) on MRI cannot be used as criteria in the absence of BME. However, less than half the Asian patients with clinically active axSpA show BME. The incidence of human leukocyte antigen (HLA)-B27 is low in Asian populations, which makes it more difficult to identify nr-axSpA. We used MRI to evaluate the structural damage to SIJs in patients with nr-axSpA with and without BME with the aim of identifying the best methodology for accurate diagnosis, especially in populations with less common BME and HLA-B27. Methods One hundred three patients with inflammatory back pain were included in this prospective study. No patient’s radiograph met the definition of positive modified New York criteria. BME and structural damage to SIJ including sclerosis and erosion were assessed independently on coronal and axial short-tau inversion recovery and T1-weighted spin echo MRI scans by two well-trained musculoskeletal radiologists using the Spondyloarthritis Research Consortium of Canada (SPARCC) score. Demographics of patients were collected. Disease characteristics and structural damage were analyzed in patients with and without BME on SIJ MRI. Receiver operating characteristic (ROC) curve analysis was used to assess the diagnostic performance of structural damage. Results All individuals in the cohort had at least one abnormal finding on SIJ MRI, including BME or structural damage; 36 of 103 patients had BME. We identified a significant positive correlation between SPARCC scores and severe erosion assessed by focal joint space widening (fJSW) (p = 0.001) in these 36 patients. Fifty-eight of the 103 enrolled patients fulfilled the ASAS criteria for nr-axSpA in the either absence or presence of BME. Of these 58 patients, 57 and 19 had erosions or fJSW, respectively, and the presence of BME was significantly correlated with fJSW (phi score of 0.319 and p = 0.015). We demonstrated a significant positive correlation between fJSW and either the presence or the severity of BME in patients with nr-axSpA who met the ASAS definition. There was a positive correlation between BME and fJSW across the whole study cohort (phi score of 0.389; p < 0.001). The area under the ROC curve (AUC) for fJSW on SIJ MRI was 0.736, p < 0.001. In both HLA-B27-positive and -negative groups, BME was more common in the presence of fJSW (phi scores of 0.370 and 0.377, p = 0.018 and 0.003, respectively) and SPARCC scores were higher in patients with fJSW (p < 0.001 and p = 0.005). We also identified a positive correlation between fJSW and BME in patients with nr-axSpA and normal serum levels of C-reactive protein (phi score of 0.362 and p = 0.001). Conclusion Structural damage detected on SIJ MRI, sclerosis, erosions and fJSW may be present in patients without detectable inflammation on SIJ MRI. However, fJSW is significantly correlated with the severity of inflammation seen on SIJ MRI, which contributes to the accurate diagnosis of nr-axSpA, and it could be used as an alternative diagnostic test for nr-axSpA in the general population, especially for those who do not carry the HLA-B27 gene, Asian patients without BME, or patients with normal serum inflammatory biomarkers.https://doi.org/10.1186/s12967-021-02959-3Magnetic resonance imagingSpondyloarthritisJoint space wideningBone marrow edema |