Spondyloarthritis research consortium of Canada magnetic resonance imaging index for assessment of spinal inflammation in ankylosing spondylitis
Spondyloarthritis research consortium of Canada magnetic resonance imaging index for assessment of spinal inflammation in ankylosing spondylitis
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DOI：
10.1002/art.21337
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发表时间：
2005-08-15
期刊：
影响因子：
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通讯作者：
Lambert, RGW
中科院分区：
文献类型：
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作者：
Maksymowych, WP;Inman, RD;Lambert, RGW
Objective.为了开发一种可行的基于磁共振成像（MRI）的脊柱关节病患者脊柱炎症评分系统，该系统需要最少的扫描时间，不需要造影剂增强，在三维平面上评估病变的程度，并且限制了评分的椎体节段的数量，因为MRI显示强直性脊柱炎（AS）患者脊柱中的特征性炎性病变在普通X线片上典型特征的发展之前。我们的评分方法完全基于T2加权STIR序列上信号增加表示骨髓水肿的评估。由2个研究中心（阿尔伯塔大学和多伦多大学）的3名盲态阅片人在2个研究中心以随机顺序评估盲态MRI影像。通过组内相关系数评估阅片者内和阅片者间的信度。通过效应量和标准化反应均值评估随机分配至英夫利西单抗：安慰剂组（8：3）的AS患者24周的反应。对11例患者脊柱中所有椎间盘单位（DVU）的初步分析表明，平均3.2（95%置信区间3.2，5.2）个受影响单位，而将评分限制为最多6个单位，可捕获大多数受影响单位。我们扫描了11例临床活动性AS患者和另外20例随机分配至24周英夫利昔单抗或安慰剂试验的患者。6-DVU STIR评分的观察者内重现性范围为0.93 - 0.98（P < 0.0001）。两个研究中心的阅片者之间的评分再现性分别为状态评分0.79（P < 0.0001）和变化评分0.82（P < 0.0001）。对所有20例随机分配至英夫利西单抗/安慰剂组的患者的治疗前和治疗后评分进行分析，结果显示出较大程度的反应性（标准化反应均值= 0.87）。二乙烯三胺五乙酸钆对比剂增强后仅轻微改善了再现性和反应性。加拿大脊柱关节炎研究联盟MRI指数是一种可行的、可重复的、反应灵敏的测量AS脊柱炎症的指数。
Objective. To develop a feasible magnetic resonance imaging (MRI)-based scoring system for spinal inflammation in patients with spondylarthropathy that requires minimal scan time, does not require contrast enhancement, evaluates the extent of lesions in 3 dimensional planes, and limits the number of vertebral levels that are scored because MRI demonstrates characteristic inflammatory lesions in the spine of patients with ankylosing spondylitis (AS) prior to the development of typical features on plain radiographic.Methods. Our scoring method was based entirely on the assessment of increased signal denoting bone marrow edema on T2-weighted STIR sequences. Blinded MRI films were assessed in random order at 2 sites by 3 blinded readers at each of the 2 sites (the Universities of Alberta and Toronto). Intra- and interreader reliability was assessed by intraclass correlation coefficient. The 24-week response of patients with AS randomized to infliximab:placebo (8:3) was assessed by effect size and standardized response mean.Results. An initial analysis of all discovertebral units (DVUs) in the spine of 11 patients demonstrated a mean of 3.2 (95% confidence interval 3.2, 5.2) affected units, while limiting the scoring to a maximum of 6 units captured most of the affected units. We scanned 11 patients with AS with clinically active disease and 20 additional patients randomized to a 24-week trial of either infliximab or placebo. Intraobserver reproducibility for the 6-DVU STIR score ranged from 0.93 to 0.98 (P < 0.0001). Interobserver reproducibility of scores by readers from both sites was 0.79 (P < 0.0001) for status score and 0.82 (P < 0.0001) for change score. Analysis of pretreatment and posttreatment scores for all 20 patients randomized to infliximab/placebo showed a large degree of responsiveness (standardized response mean = 0.87). Reproducibility and responsiveness were only slightly improved by using contrast enhancement with gadolinium diethylenetriaminepentaacetic acid.Conclusion. The Spondyloarthritis Research Consortium of Canada MRI index is a feasible, reproducible, and responsive index for measuring spinal inflammation in AS.