Learning Imaging in Axial Spondyloarthritis: More Than Just a Matter of Experience

Overview

Journal RMD Open

Publisher BMJ Publishing Group

Specialty Rheumatology

Date 2024 Mar 5

PMID 38443089

Authors

Felix Radny

Katharina Ziegeler

Iris Eshed

Juliane Greese

Dominik Deppe

Carsten Stelbrink

Robert Biesen

Hildrun Haibel

Valeria Rios Rodriguez

Judith Rademacher

Mikhail Protopopov

Fabian Proft

Kay Geert A Hermann

Denis Poddubnyy

Torsten Diekhoff

Sevtap Tugce Ulas

Affiliations

Soon will be listed here.

Abstract

Objective: Reliable interpretation of imaging findings is essential for the diagnosis of axial spondyloarthritis (axSpA) and requires a high level of experience. We investigated experience-dependent differences in diagnostic accuracies using X-ray (XR), MRI and CT.

Methods: This post hoc analysis included 163 subjects with low back pain. Eighty-nine patients had axSpA, and 74 patients had other conditions (mechanical, degenerative or non-specific low back pain). Final diagnoses were established by an experienced rheumatologist before the reading sessions. Nine blinded readers (divided into three groups with different levels of experience) scored the XR, CT and MRI of the sacroiliac joints for the presence versus absence of axSpA. Parameters for diagnostic performance were calculated using contingency tables. Differences in diagnostic performance between the reader groups were assessed using the McNemar test. Inter-rater reliability was assessed using Fleiss kappa.

Results: Diagnostic performance was highest for the most experienced reader group, except for XR. In the inexperienced and semi-experienced group, diagnostic performance was highest for CT&MRI (78.5% and 85.3%, respectively). In the experienced group, MRI showed the highest performance (85.9%). The greatest difference in diagnostic performance was found for MRI between the inexperienced and experienced group (76.1% vs 85.9%, p=0.001). Inter-rater agreement was best for CT in the experienced group with κ=0.87.

Conclusion: Differences exist in the learnability of the imaging modalities for axSpA diagnosis. MRI requires more experience, while CT is more suitable for inexperienced radiologists. However, diagnosis relies on both clinical and imaging information.

Citing Articles

Axial Imaging in Spondyloarthritis.

Mohan V, Hwang M Rheum Dis Clin North Am. 2024; 50(4):581-602.

PMID: 39415369 PMC: 11493334. DOI: 10.1016/j.rdc.2024.07.002.

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