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Assessment of active spinal inflammatory changes in patients with axial spondyloarthritis: validation of whole body MRI against conventional MRI
  1. Ulrich Weber1,
  2. Juerg Hodler2,
  3. Anne G Jurik3,
  4. Christian W A Pfirrmann2,
  5. Kaspar Rufibach4,
  6. Rudolf O Kissling1,
  7. Muhammad A Khan5,
  8. Robert G W Lambert6,
  9. Walter P Maksymowych7
  1. 1Department of Rheumatology, Balgrist University Hospital, Zurich, Switzerland
  2. 2Department of Radiology, Balgrist University Hospital, Zurich, Switzerland
  3. 3Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
  4. 4Biostatistics Unit, Institute for Social and Preventive Medicine, University of Zurich, Zurich, Switzerland
  5. 5Department of Medicine, Division of Rheumatology, Case Western Reserve University, MetroHealth Medical Center, Cleveland, Ohio, USA
  6. 6Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
  7. 7Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
  1. Correspondence to Dr Ulrich Weber, Department of Rheumatology, Balgrist University Hospital, Forchstrasse 340, 8008 Zurich, Switzerland;{at}


Objective To evaluate the performance of whole body (WB) MRI versus conventional (CON) MRI in assessing active inflammatory lesions of the entire spine in patients with established and clinically active axial spondyloarthritis (SpA) using the Spondyloarthritis Research Consortium of Canada (SPARCC) MRI index.

Methods 32 consecutive patients with SpA fulfilling the modified New York criteria and with clinically active disease (Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score ≥4) were scanned by sagittal WB and CON MRI of the spine. The MR images were scored independently in random order by three readers blinded to patient identifiers. Active inflammatory lesions of the spine were recorded on a web-based scoring form. Pearson correlation coefficients were used to compare scores for WB MRI and CON MRI for each rater and intraclass correlation coefficients (ICC) were used to assess interobserver reliability.

Results The median percentage of inflammatory lesions recorded concordantly for both WB MRI and CON MRI ranged from 83% to 91% for the three readers; 4–9% were only recorded by WB MRI and 4–9% were recorded by CON MRI only. The Pearson correlation coefficients between WB and CON MRI per rater were 0.79, 0.89 and 0.81, respectively. The ICC(2, 1) were 0.75, 0.80 and 0.68 for CON MRI and 0.82, 0.83 and 0.93 for WB MRI for the three possible reader pairs.

Conclusion WB MRI and CON MRI scores showed a high correlation and comparable high reliability for the detection of active inflammatory lesions in the spine of patients with clinically active SpA.

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  • Funding The project was funded by the Walter L and Johanna Wolf Foundation, Zurich, Switzerland and the Foundation for Scientific Research at the University of Zurich, Switzerland.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Spezialisierte Unterkommission Orthopaedie/Bewegungsapparat der Kantonalen Ethikkommission Zuerich (KEK), Gesundheitsdirektion Kanton Zuerich. The local ethics committee approved the protocol and all patients gave written informed consent.

    WPM is a Scientist of the Alberta Heritage Foundation for Medical Research.

  • Provenance and peer review Not commissioned; externally peer reviewed.