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Central reader evaluation of MRI scans of the sacroiliac joints from the ASAS classification cohort: discrepancies with local readers and impact on the performance of the ASAS criteria
  1. Walter P Maksymowych1,
  2. Susanne Juhl Pedersen2,
  3. Ulrich Weber3,4,
  4. Xenofon Baraliakos5,
  5. Pedro M Machado6,7,
  6. Iris Eshed8,
  7. Manouk de Hooge9,
  8. Joachim Sieper10,
  9. Stephanie Wichuk11,
  10. Martin Rudwaleit12,
  11. Désirée van der Heijde13,14,
  12. Robert B M Landewé15,16,
  13. Denis Poddubnyy17,
  14. Mikkel Ostergaard18,
  15. Robert G W Lambert19
  1. 1 Medicine, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
  2. 2 Department of Rheumatology, Copenhagen University Hospital Glostrup, Glostrup, Denmark
  3. 3 Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg, Denmark
  4. 4 Regional Health Research, University of Southern Denmark, Odense, Denmark
  5. 5 Rheumazentrum Ruhrgebiet, Herne, Germany
  6. 6 MRC Centre for Neuromuscular Diseases, University College London, London, UK
  7. 7 Rheumatology, University College London Centre for Rheumatology, London, UK
  8. 8 Radiology, Sheba Medical Center, Tel Hashomer, Israel
  9. 9 VIB Center of Inflammation Research, Ghent University, Gent, Belgium
  10. 10 Medical Department I, Rheumatology, University Clinic Benjamin Franklin, Berlin, Germany
  11. 11 Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
  12. 12 Internal Medicine and Rheumatology, Klinikum Bielefeld Rosenhöhe, Bielefeld, Germany
  13. 13 Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
  14. 14 Rheumatology, Diakonhjemmet Hospital, Norway
  15. 15 Amsterdam Rheumatology Center, AMC, Amsterdam, The Netherlands
  16. 16 Rheumatology, Zuyderland MC, Heerlen, The Netherlands
  17. 17 Department of Rheumatology, Infectious Diseases and Rheumatology, Charité Universitätsmedizin Berlin, Berlin, Germany
  18. 18 Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet Glostrup, Glostrup, Denmark
  19. 19 Radiology and Diagnostic Imaging and Medical Imaging Consultants, University of Alberta, Edmonton, Alberta, Canada
  1. Correspondence to Dr Walter P Maksymowych, Medicine, University of Alberta Faculty of Medicine and Dentistry, Edmonton, AB T6R 2G8, Canada; walter.maksymowych{at}


Objectives The Assessment of SpondyloArthritis international Society (ASAS) MRI working group conducted a multireader exercise on MRI scans from the ASAS classification cohort to assess the spectrum and evolution of lesions in the sacroiliac joint and impact of discrepancies with local readers on numbers of patients classified as axial spondyloarthritis (axSpA).

Methods Seven readers assessed baseline scans from 278 cases and 8 readers assessed baseline and follow-up scans from 107 cases. Agreement for detection of MRI lesions between central and local readers was assessed descriptively and by the kappa statistic. We calculated the number of patients classified as axSpA by the ASAS criteria after replacing local detection of active lesions by central readers and replacing local reader radiographic sacroiliitis by central reader structural lesions on MRI.

Results Structural lesions, especially erosions, were as frequent as active lesions (≈40%), the majority of patients having both types of lesions. The ASAS definitions for active MRI lesion typical of axSpA and erosion were comparatively discriminatory between axSpA and non-axSpA. Local reader overcall for active MRI lesions was about 30% but this had a minor impact on the number of patients (6.4%) classified as axSpA. Substitution of radiography with MRI structural lesions also had little impact on classification status (1.4%).

Conclusion Despite substantial discrepancy between central and local readers in interpretation of both types of MRI lesion, this had a minor impact on the numbers of patients classified as axSpA supporting the robustness of the ASAS criteria for differences in assessment of imaging.

  • magnetic resonance imaging
  • spondyloarthritis
  • outcomes research

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  • Handling editor Josef S Smolen

  • Twitter @pedrommcmachado

  • Contributors All authors contributed to the design of the study, review of study data, drafting of the final manuscript and agreed to the final version of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement This consensus-based initiative was done without patient involvement. Patients were not invited to comment on the study design of the MRI reading exercise and were not consulted to interpret the results. Patients were not invited to contribute to the writing or editing of this document for readability or accuracy.

  • Patient consent for publication Not required.

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

  • Data availability statement The MRI scans and data from the readings reported in this study can be made available after submission of a study proposal to the ASAS MRI-WG.