Background
Methods
The study population
Magnetic resonance imaging technique and evaluation
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Sagittal short-tau inversion recovery (STIR): time to repeat (TR)/ time to echo (TE)/ time to inversion (TI) 2500/60/170 ms and 2 acquisitions; matrix 320 × 231, field of view (FOV) 300 × 300 mm, 16 slices with a thickness of 4 mm and interslice distance 1 mm; scan time 1 min 55 s.
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Sagittal T1-weighted turbo spin echo: TR/TE 475/12 ms and 2 acquisitions; matrix 336 × 252, FOV 336 × 252 mm, 16 slices with a thickness of 4 mm and interslice distance 1 mm; scan time 2 min 3 s.
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Additionally for the lumbar spine: Sagittal T2-weighted VISTA (3D – turbo spin echo-T2-weighted sequence): TR/TE 2000/120 ms and 2 acquisitions; matrix 324 × 148, FOV 182 × 325 mm, 73 slices with a thickness of 1 mm; scan time 6 min 22 s. 3D reconstruction was not used in the current study.
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Semicoronal T1-weighted turbo spin echo: TR/TE 535/14 ms and 4 acquisitions; matrix 512 × 255, FOV 300 × 300 mm, 18 slices with a thickness of 4 mm and interslice distance 0.4 mm; scan time 5 min 36 s.
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Semicoronal T1-weighted Spectral Pre-saturation with Inversion Recovery (SPIR): TR/TE 525/8 ms and 4 acquisitions; matrix 200 × 274, FOV 343 × 180 mm, 18 slices with a thickness of 4 mm and interslice distance 0.4 mm; scan time 4 min 53 s.
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Semiaxial STIR long TE: TR/TE/TI 3500/60/155 ms and 8 acquisitions; matrix 500 × 153, FOV 250 × 205 mm, 22 slices of 4 mm thickness and interslice distance 0.4 mm; scan time 8 min 24 s scan time.
Name of the MRI changes | Grading |
---|---|
Type of signal change | BMO |
FMD | |
Mixed | |
Signal change in the corner
1
| Yes/No |
Location of signal change
| Anterior |
Posterior | |
Equally widespread | |
Size of signal change
| Small |
Medium | |
Large | |
Total size of BMO in the DVU | Small |
Medium | |
Large | |
Total size of FMD in the DVU | Small |
Medium | |
Large | |
Total size of mixed lesions in the DVU | Small |
Medium | |
Large | |
Erosions | None |
Slight | |
Moderate | |
Severe | |
Erosion of the corner1
| Yes/No |
Syndesmophytes or vertebral fusion | None |
Syndesmophytes between corners | |
Partial osseous bridging | |
Total fusion | |
BMO at the apophyseal joints | Yes/No |
BMO at the costovertebral joints | Yes/No |
FMD at the apophyseal joints | Yes/No |
Soft tissue oedema | Yes/No |
Disc degeneration | Normal height and signal intensity |
Slightly decrease in height and signal intensity | |
Decreased height and fluid signal | |
Elimination of the disc height | |
Disc contour | Broad-based protrusion |
Focal protrusion | |
Extrusion | |
Sequestration (free fragment) | |
Disc herniation in the vertebral endplate | Yes/No |
Scheuermann’s changes | Yes/No |
Name of the MRI changes | Grading |
---|---|
BMO | Slight |
Moderate | |
Severe | |
Intensity of BMO
| Normal or slightly increased intensity |
Pronounced increased | |
Depth of BMO
| Normal to moderate depth |
Pronounced | |
FMD | Slight |
Moderate | |
Severe | |
Depth of FMD
| Normal to moderate |
Pronounced | |
Erosions | Slight |
Moderate | |
Severe | |
Subchondral sclerosis | Slight |
Moderate | |
Severe | |
Ankylosis | Partial |
Total | |
Global assessment: ‘This patient has SpA’1
| Strongly disagree |
Disagree | |
Neither agree or disagree | |
Agree | |
Strongly agree |
Data entry
Statistical analysis
Ethics
Results
Spinal MRI changes
Name of the MRI changes | Reader A, first reading | Reader B, first Reading | Reader C, first reading | Reader A2, second reading | Reader B2, second reading | |
---|---|---|---|---|---|---|
Spine
| Type of signal change | 114 | 147 | 88 | 118 | 154 |
Signal change in the corner1
| 38 | 57 | 13 | 39 | 47 | |
Location of signal change1
| 114 | 147 | 88 | 118 | 154 | |
Size of signal change1
| 114 | 147 | 88 | 118 | 154 | |
Total size of BMO lesions in DVU | 36 | 32 | 11 | 12 | 31 | |
Total size of FMD lesions in DVU | 38 | 39 | 32 | 14 | 41 | |
Total size of mixed lesions in DVU | 9 | 25 | 10 | 4 | 27 | |
Erosions | 3 | 16 | 11 | 3 | 17 | |
Erosion of the corner | 1 | 3 | 0 | 0 | 0 | |
Syndesmophytes or vertebral fusion | 5 | 8 | 3 | 7 | 6 | |
BMO at apophyseal joints | 8 | 4 | 5 | 10 | 5 | |
BMO at costovertebral joints | 1 | 4 | 1 | 1 | 4 | |
FMD at apophyseal joints | 4 | 0 | 1 | 1 | 3 | |
Soft tissue oedema | 1 | 0 | 0 | 0 | 0 | |
Disc degeneration | 160 | 149 | 109 | 150 | 153 | |
Disc contour | 122 | 101 | 99 | 111 | 105 | |
Herniation in the vertebral endplate | 23 | 19 | 6 | 21 | 27 | |
Scheuermann’s changes | 12 | 5 | 15 | 9 | 10 | |
SIJ
| BMO | 71 | 77 | 58 | 70 | 85 |
Intensity of BMO1
| 15 | 6 | 0 | 13 | 7 | |
Depth of BMO1
| 27 | 21 | 24 | 27 | 30 | |
FMD | 59 | 84 | 60 | 62 | 80 | |
Depth of FMD1
| 36 | 44 | 48 | 33 | 42 | |
Erosions | 32 | 39 | 9 | 35 | 43 | |
Subchondral sclerosis | 19 | 21 | 9 | 15 | 21 | |
Ankylosis | 4 | 11 | 8 | 4 | 8 |
Observers | Observed agreement (%) | Expected agreement (%) | Pairwise weighted Kappa (95% CI) | Number of levels1
| |
---|---|---|---|---|---|
Type of signal change | AB | 95.70 | 88.65 | .62 (.56–.68) | 2208 |
AC | 96.38 | 91.13 | .59 (.51–.66) | 2208 | |
BC | 95.70 | 89.73 | .58 (.51–.65) | 2208 | |
Combined | .60 (.55–.65) | 2208 | |||
Signal change in the corner
2
| AB | 83.51 | 56.32 | .62 (.46–.79) | 97 |
AC | 80.00 | 61.22 | .48 (.28–.69) | 70 | |
BC | 72.15 | 64.01 | .23 (.00–.46) | 79 | |
Combined3
| .53 (.42–.64) | 114 | |||
Location of signal change
2
| AB | 92.78 | 42.56 | .87 (.78–.95) | 97 |
AC | 97.14 | 45.31 | .95 (.86–1.00) | 70 | |
BC | 94.94 | 46.37 | .91 (.79–.98) | 79 | |
Combined | .90 (.83–.96) | 66 | |||
Size of signal change
2
| AB | 91.49 | 75.74 | .65 (.45–.80) | 97 |
AC | 93.57 | 74.92 | .74 (.54–.89) | 70 | |
BC | 97.61 | 90.05 | .76 (.64–.86) | 79 | |
Combined3
| .66 (.58–.75) | 114 | |||
Total size of BMO in the DVU | AB | 99.41 | 98.71 | .54 (.32–.74) | 1104 |
AC | 99.23 | 99.07 | .16 (.06–.33) | 1104 | |
BC | 99.62 | 99.40 | .43 (.24–.63) | 1104 | |
Combined3
| .38 (.34–.41) | 1104 | |||
Total size of FMD in the DVU | AB | 99.09 | 98.12 | .52 (.36–.66) | 1104 |
AC | 99.25 | 98.27 | .57 (.41–.72) | 1104 | |
BC | 99.12 | 98.31 | .47 (.32–.63) | 1104 | |
Combined3
| .52 (.49–.56) | 1104 | |||
Total size of mixed lesions in the DVU | AB | 99.39 | 98.99 | .39 (.12–.65) | 1104 |
AC | 99.50 | 99.42 | .13 (.00–.36) | 1104 | |
BC | 99.59 | 99.19 | .49 (.22–.74) | 1104 | |
Combined3
| .36 (.32–.40) | 1104 | |||
Erosions | AB | - | - | - | - |
AC | - | - | - | - | |
BC | 99.83 | 99.72 | .40 (.17–.56) | 2208 | |
Combined3
| - | ||||
Syndesmophytes or vertebral fusion | AB | 99.71 | 99.17 | .65 (0.00–.91) | 1104 |
AC | - | - | - | - | |
BC | - | - | - | - | |
Combined3
| - | - | |||
BMO at the apophyseal joint | AB | - | - | - | - |
AC | 99.55 | 98.83 | .61 (.30–.93) | 1104 | |
BC | - | - | - | - | |
Combined3
| - | - | |||
Disc degeneration | AB | 98.61 | 94.73 | .74 (.67–.79) | 1104 |
AC | 98.91 | 94.98 | .78 (.72– .84) | 1104 | |
BC | 98.97 | 95.61 | .77 (.70–.82) | 1104 | |
Combined3
| .76 (.74–.78) | 1104 | |||
Disc contour | AB | 98.55 | 95.17 | .70 (.63–.76) | 1104 |
AC | 98.44 | 94.29 | .73 (.65–.79) | 1104 | |
BC | 97.36 | 91.96 | .67 (.60–.74) | 1104 | |
Combined3
| .70 (.68–.73) | 1104 | |||
Herniation in the vertebral endplate | AB | 98.73 | 96.27 | .66 (.49–.83) | 1104 |
AC | 98.10 | 97.40 | .27 (.06–.48) | 1104 | |
BC | 98.28 | 97.75 | .23 (.01–.46) | 1104 | |
Combined3
| .43 (.40–.47) | 1104 | |||
Scheurmann’s changes | AB | 98.46 | 98.47 | -.01 (-.01–0.00) | 1104 |
AC | 98.92 | 97.58 | .14 (-.05–.32) | 1104 | |
BC | 98.55 | 98.20 | .20 (-.04–.43) | 1104 | |
Combined3
| .12 (.08–.15) | 1104 |
MRI changes | Observers | Observed agreement (%) | Expected agreement (%) | Pairwise weighted Kappa (95% CI) | Number of levels1
|
---|---|---|---|---|---|
Type of signal change | AA | 98.32 | 89.88 | .84 (.78–.88) | 2208 |
BB | 97.96 | 87.00 | .84 (.80–.88) | 2208 | |
Signal change in the corner
2
| AA | 89.22 | 54.61 | .76 (.63–.90) | 102 |
BB | 87.31 | 54.81 | .72 (.60–.84) | 134 | |
Location of signal change
2
| AA | 99.02 | 42.43 | .98 (.94–1.00) | 102 |
BB | 96.27 | 43.54 | .93 (.87–.99) | 134 | |
Size of signal change
2
| AA | 99.02 | 87.80 | .92 (.85–.97) | 102 |
BB | 98.18 | 91.18 | .79 (.64–.91) | 134 | |
Total size of BMO in the DVU | AA | 99.51 | 98.89 | .56 (.23–.78) | 1104 |
BB | 99.76 | 99.16 | .71(.48–.88) | 1104 | |
Total size of FMD in the DVU | AA | 99.43 | 98.64 | .58 (.39–.74) | 1104 |
BB | 99.81 | 99.12 | .78 (.67–.87) | 1104 | |
Total size of mixed lesions in the DVU | AA | 99.83 | 99.43 | .71 (0.00–.95) | 1104 |
BB | 99.61 | 98.52 | .73 (.50–.88) | 1104 | |
Erosions | AA | - | - | - | - |
BB | 99.91 | 99.61 | .77 (.47–.91) | 2208 | |
Syndesmophytes or vertebral fusion | AA | 99.95 | 99.19 | .94 (.67–1.00) | 1104 |
BB | 99.93 | 99.57 | .83 (.40–.98) | 1104 | |
BMO at the apophyseal joint | AA | 99.82 | 98.38 | .88 (.73–1.00) | 1104 |
BB | - | - | - | - | |
Disc degeneration | AA | 99.58 | 94.43 | .92 (.89–.95) | 1104 |
BB | 99.55 | 95.35 | .90 (.87–.93) | 1104 | |
Disc contour | AA | 99.26 | 94.28 | .87 (.82–.91) | 1104 |
BB | 99.25 | 93.36 | .89 (.84–.93) | 1104 | |
Herniation in the vertebral endplate | AA | 99.82 | 96.09 | .95 (.89–1.00) | 1104 |
BB | 98.91 | 95.92 | .73 (.59–.88) | 1104 | |
Scheurmann’s changes | AA | 99.55 | 98.12 | .76 (.56–.96) | 1104 |
BB | 99.55 | 98.65 | .67 (.39–.94) | 1104 |
Changes in the sacroiliac joints
MRI changes | Observers | Observed agreement (%) | Expected agreement (%) | Pairwise weighted Kappa (95% CI) | Number of SIJ regions |
---|---|---|---|---|---|
BMO | AB | 97.77 | 89.52 | .79 (.69–.86) | 384 |
AC | 98.09 | 91.08 | .79 (.68–.87) | 384 | |
BC | 98.70 | 91.38 | .85 (.79–.90) | 384 | |
Combined1
| .81 (.78–.84) | 384 | |||
Intensity BMO
2
| AB | 85.00 | 72.22 | .46 (.19–.73) | 60 |
AC | - | - | - | - | |
BC | - | - | - | - | |
Combined1
| - | - | |||
Depth BMO
2
| AB | 85.00 | 53.67 | .68 (.49–.87) | 60 |
AC | 82.35 | 50.52 | .64 (.43–.85) | 51 | |
BC | 92.86 | 53.06 | .85 (.71–.99) | 56 | |
Combined1
| .73 (.63–.82) | 65 | |||
FMD | AB | 97.25 | 83.26 | .84 (.77–.89) | 384 |
AC | 97.19 | 87.28 | .78 (.69–.85) | 384 | |
BC | 95.60 | 84.77 | .71 (.60–.80) | 384 | |
Combined1
| .78 (.74–.81) | 384 | |||
Depth FMD
2
| AB | 84.91 | 56.14 | .66 (.44–.87) | 53 |
AC | 78.05 | 63.65 | .40 (.08–.71) | 41 | |
BC | 72.55 | 58.94 | .33 (.07–.60) | 51 | |
Combined1
| .52 (.38–.67) | 67 | |||
Erosions | AB | 97.77 | 92.99 | .68 (.49–.81) | 384 |
AC | 98.32 | 96.12 | .57 (.30–.76) | 384 | |
BC | 96.90 | 94.69 | .42 (.20–.63) | 384 | |
Combined1
| .57 (.51–.62) | 384 | |||
Subchondral sclerosis | AB | 98.73 | 96.29 | .66 (.40–.81) | 384 |
AC | 99.16 | 97.21 | .70 (.37–.87) | 384 | |
BC | 98.87 | 97.15 | .60 (.28–.81) | 384 | |
Combined1
| .65 (.61–.70) | 384 | |||
Ankylosis | AB | - | - | - | - |
AC | - | - | - | - | |
BC | 99.28 | 97.26 | .74 (35–.90) | 384 | |
Combined1
| - | - | |||
Global assessment3
| AB | 94.2 | 81.31 | .69 (.44–.86) | 474
|
AC | 90.75 | 74.95 | .59 (.35–.75) | 444
| |
BC | 89.39 | 74.64 | .58 (.32–.78) | 434
| |
Combined1
| .61 (.46–.75) | 474
|
MRI changes | Observers | Observed agreement (%) | Expected agreement (%) | Weighted Kappa (95% CI) | Number of SIJ regions |
---|---|---|---|---|---|
BMO | AA | 99.57 | 89.42 | .96 (.92–.98) | 384 |
BB | 98.99 | 89.19 | .91 (.85–.95) | 384 | |
Intensity of BMO
1
| AA | 92.42 | 67.36 | .77 (.58–.96) | 66 |
BB | 95.95 | 83.97 | .75 (.47–1.00) | 74 | |
Depth of BMO
1
| AA | 95.45 | 51.93 | .91 (.80–1.00) | 66 |
BB | 91.89 | 55.84 | .82 (.68–.96) | 74 | |
FMD | AA | 99.33 | 85.49 | .95 (.92–.97) | 384 |
BB | 98.06 | 82.15 | .89 (.84–.93) | 384 | |
Depth of FMD
1
| AA | 95.57 | 52.40 | .80 (.64–.97) | 53 |
BB | 87.88 | 52.25 | .75 (.58–.91) | 66 | |
Erosions | AA | 98.61 | 93.52 | .79 (.60–.92) | 348 |
BB | 99.02 | 91.96 | .88 (.80–.93) | 384 | |
Subchondral sclerosis | AA | 99.62 | 96.84 | .88 (.71–.96) | 384 |
BB | 99.62 | 96.48 | .89 (.77–.95) | 384 | |
Ankylosis | AA | - | - | - | - |
BB | 99.54 | 97.26 | .83 (.52–.95) | 384 | |
Global assessment2
| AA | 98.37 | 84.61 | .89 (.82–.95) | 463
|
BB | 95.79 | 80.20 | .79 (.52–.93) | 463
|