Background Magnetic resonance imaging (MRI) of the spine is increasingly employed to detect spinal inflammation in the patients with ankylosing spondylitis (AS). AS spinal MRI activity score (ASspiMRI-a) is a novel scoring system, which was described to be reliable for assessment and quantification of acute spinal lesions of AS patients. However, the relation between ASspiMRI-a and the disease activity of AS patients is still unclear.
Objectives The aim of this study was to determine whether ASspiMRI-a is correlate with the disease activity of AS patients through a systemic literature review with meta-analysis.
Methods A systematic literature review was conducted using electronic databases (Medline, EMBase, and the Cochrane Library). Studies were eligible if they reported the correlation coefficients between ASspiMRI-a and disease activity scores, including Bath AS disease activity score (BASDAI), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Two authors performed literature selection and data extraction independently, with disagreement resolved by consensus. In the meta-analysis of correlation coefficients, data were converted into Fisher's z values. The pooled Fisher's z values and their 95% confidence intervals (CIs) were then computed using Review Manager 5.0 software. After that, all these results were transformed back into correlation values (r). Heterogeneity was assessed using the I2 statistic.
Results Of 322 studies initially identified, 6 were appropriate for further meta-analysis, comprising 212 patients. Based on these studies, high heterogeneity was observed only in the meta-analysis of correlation coefficient between ASspiMRI-a on short tau inversion recovery image and BASDAI (I2 =78%, p<0.05), so it was performed using a random effects model (p<0.05, r=0.90, 95% CI: 0.79∼0.97). For the other analysis, the pooled Fisher's z values and their 95% CIs were computed using a fix effects model. Otherwise, ASspiMRI-a on contrast-enhanced T1-weighted images was significantly associated with BASDAI (p<0.05, r=0.95, 95% CI: 0.91∼0.98). In addition, ASspiMRI-a correlated well with ESR (p<0.05, r=0.87, 95% CI: 0.79∼0.93) and CRP (p<0.05, r=0.88, 95% CI: 0.80∼0.94).
Conclusions This systematic literature review and meta-analysis suggested ASspiMRI-a is associated with BASDAI, ESR and CRP of AS patients, so the spinal inflammation assessment by MRI might contribute to the determination of the disease activity of AS patients.
Goh L, Suresh P, Gafoor A, et al. Disease activity in longstanding ankylosing spondylitis: a correlation of clinical and magnetic resonance imaging findings. Clin Rheumatol. 2008, 27(4):449-55.
Konca S, Keskin D, Cılız D, et al. Spinal inflammation by magnetic resonance imaging in patients with ankylosing spondylitis: association with disease activity and outcome parameters. Rheumatol Int. 2012, 32(12):3765-70.
Disclosure of Interest None declared
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