全身MRI与临床检查在检测早期中轴脊柱关节病患者附着点炎方面一致性差－来自ESTHER临床试验基线水平的

原文

译文

Poor Agreement Between Enthesitis on Whole-Body Magnetic Resonance Imaging and Enthesitis on Clinical Examination in Patients with Early Axial Spondyloarthritis – Results From the ESTHER Trial At Baseline

 

 

In-Ho Song ¹, Kay-Geert Hermann², Hildrun Haibel¹, Christian Althoff², Denis Poddubnyy¹, Joachim Listing³, Anja Weiß³, Bruce Freundlich⁴, Martin Rudwaleit⁵ and Joachim Sieper¹, ¹Charité Medical University, Campus Benjamin Franklin, Berlin, Germany, ²Charite Medical School, Berlin, Germany, ³German Rheumatism Research Centre, Berlin, Germany, ⁴University of Pennsylvania, Philadelphia, PA, ⁵Ev. Krankenhaus Hagen-Haspe, Hagen, Germany

 

Presentation Number: 515

 

Background/Purpose: In patients with early axial spondyloarthritis (SpA) with a disease duration of < 5 years to assess the agreement between enthesitis on whole-body magnetic resonance imaging (MRI) and enthesitis by clinical examination.

Method: At baseline 76 patients with early axial SpA were examined for enthesitis by clinical examination and by whole-body MRI. The following 7 enthesitis sites were assessed by MRI (M) and clinical examination (C): manubriosternal synchondrosis (M)/ first costosternal joint (C) (1 site), lower rip insertions at the sternum (M)/ 7^th costochondral joints (C) (2 sites, each left and right), pelvic rim (M)/ iliac crest (C) (2 sites, each left and right), proximal insertion of Achilles tendon/ plantar fascia (M/C) (2 sites, each left and right). Kappa values were calculated to assess agreement between MRI findings and clinical examination. MRI enthesitis assessment was performed by two radiologists in consensus approach.

Results:

By clinical enthesitis assessment in the above described locations 108 enthesitic sites were found in 40 out of 76 (60.5%) patients. The most frequently affected location was the iliac crest (45 sites in 30 patients) followed by the 7^th costosternal joint (26 sites in 16 patients), the insertion of the Achilles tendon/plantar fascia (22 sites in 14 patients) and the 1^st costosternal joint (15 sites in 15 patients) (table 1).

Of MRI examination in the above described locations 9 enthesitic sites were found in 6 out of the 76 patients. The most frequently affected sites were the manubriosternal synchondrosis (3 sites in 3 patients), followed by the Achilles tendon insertion (4 sites in 3 patients).

67 out of 76 patients scored the enthesitis question (BASDAI question 4) of the BASDAI ≥1.

The kappa values in terms of single enthesitic sites between MRI and clinical examination was only 0.038. The kappa value on a patient level was also only -0.011. Kappa between clinical examination and self-assessment by BASDAI question 4 was 0.1. In all patients enthesitic only 3 enthesitic sites were found to be positive in both by MRI and clinical examination at the same time.

Conclusion: Clinical and MRI enthesitis was found in 52.6% and 7.9% of patients in the above mentioned enthesitis sites with early axial SpA, respectively. The agreement between clinical and MRI enthesitis assessment was poor.

 

 

 

 

 

 

 

 

 

 

全身MRI与临床检查在检测早期中轴脊柱关节病患者附着点炎方面一致性差－来自ESTHER临床试验基线水平的数据

In-Ho Song , et al. Present No: 515

 

背景/目的:评价全身核磁共振(MRI)和临床体检在检测病程< 5年的早期中轴脊柱关节炎 (SpA)患者的附着点炎的一致性 。

方法:在基线水平，通过临床体检和全身MRI检测了76例早期SpA的附着点炎，MRI(M)和临床检查(C)下列7个部位: 胸柄结合(M)/第一肋胸关节 (C)(1个部位), 低位肋骨与胸骨连接部位 (M)/ 第7肋胸关节(C)(2个部位,每个部位左和右)、骨盆环(M)/髂嵴(C)(2个部位,每个左和右),近端跟腱附着处/跖筋膜(M / C)(2个部位,每个左和右)。计算MRI和临床检查结果一致性的Kappa值。由两个放射科医师采用相同方法评估MRI 附着点炎 。

结果:上述部位的检测中，临床检查发现76例患者中40例(60.5%)有附着点炎，共有108个部位。最常见的部位是髂嵴(30例患者45个部位),其次是第7肋胸关节 (16例患者26个部位),跟腱附着处/跖筋膜(14例患者22个部位)和第1肋胸关节 (15例患者15个部位)(表1)。

MRI检查发现76例患者中有6例患者存在附着点炎，共9个部位。最常见胸柄结合处(3名患者3个部位),其次是跟腱附着处(3例患者4个部位)。

76例患者中有67例在BASDAI积分时附着点问题积分 (BASDAI问题4) ≥1 。

MRI和临床检查在检测附着点炎方面的Kappa值仅0.038。单病人水平的Kappa也只有-0.011。临床检查和患者BASDAI问题4的自我评估之间Kappa值为0.1。所有病人中,仅有3个附着点炎的部位在同一时间的MRI和临床检查中有一致性的发现。

结论:在早期中轴SpA患者的上述附着点炎部位，临床及MRI 的检出率分别为 52.6%和7.9% 。两种方法的一致性较差。

Table 1.

MRI enthesitis location	Clinical examination enthesitis location	Number of positive enthesitic sites on MRI	Number of positive enthesitic sites on clinical examination	Agreement*
Synchondrosis manubriosternalis	First Costosternal joint	3 sites in 3 patients	15 sites in 15 patients	1
Lower rip insertions at the sternum (Rip)	Seventh Costosternal joint	Right: 0 sites in 0 patients	11 sites in 11 patients	0
		Left: 0 sites in 0 patients	15 sites in patients	0
		Both: 0 sites in 0 patients	26 sites in 16 patients	0
Pelvic rim  (Bec)	Crista iliaca/ Spina iliaca anterior superior/Spina iliaca posterior superior	Right: 1 site in 1 patient	23 sites in 23 patients	1
		Left: 1 site in 1 patient	22 sites in 22 pts	0
		Both: 2 sites in 1 patient	45 sites in 30 patients	1
Achilles tendon insertion (Ach)	Prox. Achilles tendon insertion	Right: 2 sites in 2 patients	9 sites in 9 pts	0
		Left: 2 sites in 2 patients	13 sites in 13 pts	1
		Both: 4 sites in 3 patient	22 sites in 14 patients	1

* 1= yes, 0= no.

[1] Song I.-H. et al.  2011. Ann Rheum Dis. 2011 Apr;70(4):590-6.