EXTENDED REPORT

Radiographic assessment of sacroiliitis by radiologists and rheumatologists: does training improve quality?

A van Tubergen, L Heuft-Dorenbosch, G Schulpen, R Landewé, R Wijers, D van der Heijde, J van Engelshoven, Sj van der Linden

University Hospital Maastricht, The Netherlands

Correspondence to:
Correspondence to:
Professor Sj van der Linden, Department of Internal Medicine, Division of Rheumatology, University Hospital Maastricht, PO Box 5800, 6202 AZ Maastricht, The Netherlands;
sli{at}sint.azm.nl

Objective: To assess performance of radiologists and rheumatologists in detecting sacroiliitis

Methods: 100 rheumatologists and 23 radiologists participated. One set of films was used for each assessment, another for training, and the third for confidence judgment. Films of HLA-B27+ patients with AS were used to assess sensitivity. For specificity films of healthy HLA-B27- relatives were included. Plain sacroiliac (SI) films with simultaneously taken computed tomographic scans (CTs) were used for confidence judgment. Three months after reading the training set, sensitivity and specificity assessments were repeated. Next, participants attended a workshop. They also rated 26 SI radiographs and 26 CTs for their trust in each judgment. Three months later final assessments were done.

Results: Sensitivity (84.3%/79.8%) and specificity (70.6%/74.7%) for radiologists and rheumatologists were comparable. Rheumatologists showed 6.3% decrease in sensitivity after self education (p=0.001), but 3.0% better specificity (p=0.008). The decrease in sensitivity reversed after the workshop. Difference in sensitivity three months after the workshop and baseline was only 0.5%. Sensitivity <50% occurred in 13% of participants. Only a few participants showed changes of >5% in both sensitivity and specificity. Intraobserver agreement for sacroiliitis grade 1 or 2 ranged from 65% to 100%. Sensitivity for CT (86%) was higher than for plain films (72%) (p<0.001) with the same specificity (84%). Confidence ratings for correctly diagnosing presence (7.7) or absence (8.3) of sacroiliitis were somewhat higher than incorrectly diagnosing the presence (6.6) or absence (7.4) of sacroiliitis (p<0.001).

Conclusion: Radiologists and rheumatologists show modest sensitivity and specificity for sacroiliitis and sizeable intraobserver variation. Overall, neither individual training nor workshops improved performance.

Keywords: ankylosing spondylitis; radiography; sacroiliitis; training

Abbreviations: AS, ankylosing spondylitis; CT, computed tomography scans; MRI, magnetic resonance imaging; SI, sacroiliac

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• Heuft-Dorenbosch, L, Landewe, R, Weijers, R, Wanders, A, Houben, H, van der Linden, S, van der Heijde, D (2006). Combining information obtained from magnetic resonance imaging and conventional radiographs to detect sacroiliitis in patients with recent onset inflammatory back pain. Ann Rheum Dis 65: 804-808 [Abstract] [Full Text]  
• Huerta-Sil, G, Casasola-Vargas, J C, Londono, J D, Rivas-Ruiz, R, Chavez, J, Pacheco-Tena, C, Cardiel, M H, Vargas-Alarcon, G, Burgos-Vargas, R (2006). Low grade radiographic sacroiliitis as prognostic factor in patients with undifferentiated spondyloarthritis fulfilling diagnostic criteria for ankylosing spondylitis throughout follow up. Ann Rheum Dis 65: 642-646 [Abstract] [Full Text]  
• Mannoja, A, Pekkola, J, Hamalainen, M, Leirisalo-Repo, M, Laasonen, L, Kivisaari, L (2005). Lumbosacral radiographic signs in patients with previous enteroarthritis or uroarthritis. Ann Rheum Dis 64: 936-939 [Abstract] [Full Text]  
• Sieper, J, Rudwaleit, M (2005). Early referral recommendations for ankylosing spondylitis (including pre-radiographic and radiographic forms) in primary care. Ann Rheum Dis 64: 659-663 [Abstract] [Full Text]