University Hospital of Hadassah

West Jerusalem, Israel

University Hospital of Hadassah

West Jerusalem, Israel
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Melchior J.,Nancy University Hospital Center | Azraq Y.,University Hospital of Hadassah | Chary-Valckenaere I.,Nancy University Hospital Center | Rat A.-C.,Nancy University Hospital Center | And 3 more authors.
Acta Radiologica | Year: 2017

Background The presence of structural sacroiliitis is strong evidence for the diagnosis of spondyloarthritis (SpA). Purpose To assess the performance of abdominal computed tomography (CT) and pelvic plain radiography for the diagnosis of structural sacroiliitis compared with sacroiliac CT (SI joint CT) considered the reference technique in patients with SpA. Material and Methods All SpA patients eligible for biologic treatment were selected from 2005 to 2012. An assessment of sacroiliitis was based on radiography according to the modified New York criteria and on abdominal CT and SI joint CT scans depending on the presence of erosion on at least two consecutive slices. A senior rheumatologist and radiologist independently scored the grade and diagnosis of structural sacroiliitis for the three imaging modalities. After a consensus reading of conflicting examinations (radiography and CT), a final diagnosis of structural sacroiliitis was attained. Results Of the 72 patients selected, sacroiliitis was diagnosed on radiography, abdominal CT, and SI joint CT in 40, 31, and 44 patients, respectively. Inter-reader agreements for the grade of sacroiliitis were substantial for the three imaging modalities, with a weighted kappa range of 0.63-0.75 (95% confidence interval [CI], 0.52-0.83), and they were moderate for the diagnosis of sacroiliitis, with a kappa range of 0.50-0.55 (95% CI, 0.32-0.74). The sensitivity and specificity were 79.1% and 70.5%, respectively, for radiography and 82.1% and 100%, respectively, for abdominal CT. Conclusion This study demonstrates the relevance of abdominal CT for the diagnosis of structural sacroiliitis, with good sensitivity and excellent specificity. These imaging techniques avoid unnecessary examinations. © 2016 The Foundation Acta Radiologica.


Melchior J.,Nancy University Hospital Center | Azraq Y.,University Hospital of Hadassah | Chary-Valckenaere I.,Nancy University Hospital Center | Rat A.-C.,Nancy University Hospital Center | And 4 more authors.
European Journal of Radiology | Year: 2017

Objective To assess the performance of pelvic plain radiograph (radiography), abdominal CT and sacroiliac joint MRI (MRI) compared with sacroiliac joints CT (SI joint CT) for the diagnosis of structural sacroiliitis in a population suffering from spondyloarthritis (SpA) meeting the New York or ASAS criteria. Methods All SpA patients eligible for biologic treatment who received a pre-therapeutic check-up including the four imaging techniques in the same year were selected from 2005 to 2012. An assessment of sacroiliitis was based independently by a rheumatologist and a radiologist on radiography according to the modified New York criteria and on abdominal CT, MRI and SI Joint CT depending on the presence of erosion on at least two consecutive slices. A final diagnosis was established for conflicting exams. Results Of the 58 selected patients, sacroiliitis was diagnosed on radiography, abdominal CT, MRI and SI Joint CT in 32, 26, 34 and 35 patients, respectively. Inter-reader agreements for the grade of sacroiliitis were substantial with a weighted Kappa that varied between 0.60 and 0.76 and they were moderate for the diagnosis of sacroiliitis with a Kappa that varied between 0.45 and 0.55 for the four imaging modalities. The sensitivities of radiography, abdominal CT and MRI were 82.8%, 71.4% and 85.7% respectively and the specificities were 86.9%, 100% and 82.6% respectively with excellent accuracy and positive predictive value and good negative predictive value. Conclusion This study demonstrates the relevance of MRI and abdominal CT for the diagnosis of structural sacroiliitis with good sensitivities and excellent specificities. These imaging modalities may also contribute for the diagnosis of structural sacroiliitis. © 2017 Elsevier B.V.

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