Diagnostic utility of magnetic resonance imaging and radiography in juvenile spondyloarthritis: evaluation of the sacroiliac joints in controls and affected subjects

• Published in: Journal of rheumatology Vol. 41; no. 5; p. 963
• Main Authors: Jaremko, Jacob L, Liu, Lei, Winn, Naomi J, Ellsworth, Janet E, Lambert, Robert G W
• Format: Journal Article
• Language: English
• Published: Canada 01.05.2014
• Subjects: Adolescent; Arthrography - methods; Arthrography - standards; Arthrography - statistics & numerical data; Bone Marrow - diagnostic imaging; Bone Marrow - pathology; Databases, Factual; Edema - diagnostic imaging; Edema - pathology; Female; Humans; Magnetic Resonance Imaging - methods; Magnetic Resonance Imaging - standards; Magnetic Resonance Imaging - statistics & numerical data; Male; Observer Variation; Reproducibility of Results; Retrospective Studies; Sacroiliitis - diagnostic imaging; Sacroiliitis - pathology; Sensitivity and Specificity; Spondylarthropathies - diagnostic imaging; Spondylarthropathies - pathology; Spondylitis, Ankylosing - diagnostic imaging; Spondylitis, Ankylosing - pathology; PEDIATRICS; MAGNETIC RESONANCE IMAGING; ANKYLOSING SPONDYLITIS; SPONDYLARTHROPATHIES; RADIOGRAPHY
• ISSN: 0315-162X
• DOI: 10.3899/jrheum.131064

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. 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. 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 (κ = 0.80) compared to radiography (κ = 0.30). 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.