MRI grading method for active and chronic spinal changes in spondyloarthritis

Aim: To describe a magnetic resonance imaging (MRI) grading method for both active and chronic spondyloarthritis (SpA) changes in the spine, to test its validity, and compare chronic MRI scores with findings obtained by radiography.

Material and methods: A total of 91 patients (41 males; 50 females) with back pain fulfilling the European Spondylarthropathy Study Group (ESSG) criteria for SpA were examined using MRI and radiography of the spine. The mean age was 36.7 years (range 16-51 years) and symptom duration was between 3 and 27 years. The MRI images were assessed for signs of disease activity (bone marrow oedema at the vertebral plates and costo-vertebral joints) and chronic structural changes [syndesmophytes/vertebral fusion, erosion, and fatty marrow deposition (FMD)]. The interobserver agreement was analysed based on 37 examinations. Radiographs were assessed for the presence of shiny corners, vertebral squaring, syndesmophytes/fusion, and erosion.

Results: The interobserver agreement for the assessed MRI abnormalities was acceptable, with kappa values between 0.62 and 0.77. A total of 56 patients had SpA-related spinal abnormalities as depicted using MRI. The total chronic MRI score was not significantly related to the radiographic score, mainly because syndesmophytes were difficult to detect by MRI and FMD was only visualized by MRI. However, FMD was significantly related to the total radiographic score and vertebral squaring.

Conclusion: The described MRI grading method was reliable for assessing both disease activity and chronic changes. MRI is promising for estimating chronic changes, but cervical radiography may still be needed. FMD seems to be an important sign of chronicity.