Background In clinical practice radiologists and rheumatologists assess whether lesions compatible with axial SpondyloArthritis (axSpA) are present on spinal MRI
Objectives To compare the results of local readings (LocR) to centralized reading (CentR) as external standard of BME and structural lesions on MRI-spine, in patients (pts) with inflammatory back pain (IBP)
Methods Pts aged 18-50 with recent IBP (≥3 months, ≤3 years) from 25 participating centers in France were included in the DESIR-cohort (n=708). All available baseline MRIs-spine were scored on BME and structural lesions as present, absent or doubtful by the local radiologist/rheumatologist who might have access to clinical data. In addition, 2 well-calibrated centralized readers independently scored the same MRIs for BME lesions and structural lesions (fatty lesions, erosions and (bridging) syndesmophytes). In case the centralized readers disagreed, an experienced radiologist served as adjudicator. Agreement between CentR and LocR was calculated excluding the cases assessed as doubtful by LocR (kappa κ)
Results BME/structural lesions were in 492/492 pts scored by a radiologist, 206/205 by a rheumatologist and in 32/32 pts by both. The k agreement between LocR and CentR was 0.27 for BME lesions and 0.13 for structural lesions. For radiologists, κ=0.36 for BME, and κ=0.15 for structural lesions. For rheumatologists κ=0.006 for BME and κ=0.12 for structural lesions. Overall, local specialists are highly overrating positive findings: 42.3% and 85.7% of the positive MRIs for BME are scored negative by the central read (radiologists and rheumatologist respectively). Similarly findings for structural lesions: 48.4% and 70% of MRIs positive for structural lesions are scored normal by central reading
Conclusions Both local radiologists, but especially rheumatologists overrate the presence of BME lesions and structural lesions on MRI of the spine compared to trained central readers. These results do not even take doubtful cases into account
Disclosure of Interest None declared
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