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Can we use structural lesions seen on MRI of the sacroiliac joints reliably for the classification of patients according to the ASAS axial spondyloarthritis criteria? Data from the DESIR cohort
  1. Pauline A C Bakker1,
  2. Rosaline van den Berg1,
  3. Gregory Lenczner2,
  4. Fabrice Thévenin3,
  5. Monique Reijnierse4,
  6. Pascal Claudepierre5,
  7. Daniel Wendling6,
  8. Maxime Dougados7,
  9. Désirée van der Heijde1
  1. 1Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
  2. 2Department of Rheumatology, Clinique Hartmann, Neuilly sur Seine, France
  3. 3Department of Radiology B, Paris Descartes University, Cochin Hospital, Paris, France
  4. 4Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
  5. 5Department of Rheumatology, Hôpital Albert Chenevier, Henri Mondor, Créteil, France
  6. 6Department of Rheumatology, Université de Franche-Comté, Besancon, France
  7. 7Department of Rheumatology, Hôpital Cochin, Paris, France
  1. Correspondence to Pauline A C Bakker, Department of Rheumatology, Leiden University Medical Centre, P.O. Box 9600, Leiden 2300 RC, The Netherlands; p.a.c.bakker{at}


Objectives Investigating the utility of adding structural lesions seen on MRI of the sacroiliac joints to the imaging criterion of the Assessment of SpondyloArthritis (ASAS) axial SpondyloArthritis (axSpA) criteria and the utility of replacement of radiographic sacroiliitis by structural lesions on MRI.

Methods Two well-calibrated readers scored MRI STIR (inflammation, MRI-SI), MRI T1-w images (structural lesions, MRI-SI-s) and radiographs of the sacroiliac joints (X-SI) of patients in the DEvenir des Spondyloarthrites Indifférenciées Récentes cohort (inflammatory back pain: ≥3 months, <3 years, age <50). A third reader adjudicated MRI-SI and X-SI discrepancies. Previously proposed cut-offs for a positive MRI-SI-s were used (based on <5% prevalence among no-SpA patients): erosions (E) ≥3, fatty lesions (FL) ≥3, E/FL ≥5. Patients were classified according to the ASAS axSpA criteria using the various definitions of MRI-SI-s.

Results Of the 582 patients included in this analysis, 418 fulfilled the ASAS axSpA criteria, of which 127 patients were modified New York (mNY) positive and 134 and 75 were MRI-SI-s positive (E/FL≥5) for readers 1 and 2, respectively. Agreement between mNY and MRI-SI-s (E/FL≥5) was moderate (reader 1: κ: 0.39; reader 2: κ: 0.44). Using the E/FL≥5 cut-off instead of mNY classification did not change in 478 (82.1%) and 469 (80.6%) patients for readers 1 and 2, respectively. Twelve (reader 1) or ten (reader 2) patients would not be classified as axSpA if only MRI-SI-s was performed (in the scenario of replacement of mNY), while three (reader 1) or six (reader 2) patients would be additionally classified as axSpA in both scenarios (replacement of mNY and addition of MRI-SI-s). Similar results were seen for the other cut-offs (E≥3, FL≥3).

Conclusions Structural lesions on MRI can be used reliably either as an addition to or as a substitute for radiographs in the ASAS axSpA classification of patients in our cohort of patients with short symptom duration.

  • Spondyloarthritis
  • Magnetic Resonance Imaging
  • Ankylosing Spondylitis
  • Low Back Pain

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  • Handling editor Tore K Kvien

  • Contributors PB performed the statistical analyses and writing of the manuscript. DvdH gave methodological advice and supervised all procedures. All authors contributed to the acquisition and interpretation of data, read, revised and approved the final manuscript.

  • Funding The DESIR cohort is financially supported by unrestricted grants from both the French Society of Rheumatology and Pfizer France. Neither funding source had any role in designing the study; collecting, analysing or interpreting the data; writing the manuscript; or deciding to submit the manuscript for publication.

  • Competing interests None declared.

  • Ethics approval Local medical ethical committees (of all participating centres).

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