Interobserver Agreement in Magnetic Resonance Imaging of Active Sacroiliitis

Yıl 2023, , 472 - 477, 30.09.2023

Ahmed Cihad Genç , Ahmet Burak Kara , Fevziye Türkoğlu Genç , Zeynep Öztürk , Damla Karataş , Aysel Toçoğlu , Ünal Erkorkmaz , Yasemin Gündüz , Emel Gönüllü

https://doi.org/10.31832/smj.1344675

Cited By: 1

Öz

Introduction
Axial spondyloarthritis has characteristic clinical features such as enthesitis, sacroiliitis and spondylitis, and extra-articular manifestations. Sacroiliitis (SI) occurs as a result of inflammation of the sacroiliac joint. Magnetic resonance imaging (MRI) of sacroiliac (SI) joints is used to detect early sacroiliitis. Sometimes, there can be variations in the interpretation of MRI findings of the SI joint among observers. Our aim was to investigate the inter-observer agreement among the observers.
Materials and methods
The study included the MRI results of 1150 patients who were diagnosed with active or chronic sacroiliitis based on the findings from sacroiliac MRIs, or whose MRI was deemed indicative of sacroiliitis by the rheumatologist. 1150 MRIs were re-evaluated by a different and expert radiologist.
Results
Out of the total 1150 patients investigated within the scope of this study. A statistically significant disparity emerged between the assessments provided by the expert radiologists and those obtained from outsourced radiologist evaluations.
Conclusion
The diagnosis of spondyloarthropathy may be delayed for some reasons. If the patient's clinic and MRI report are not consistent, the patient should not be removed from follow-up.

Anahtar Kelimeler

Ankylosing spondylitis, magnetic resonance imaging, inter-observer agreement

Aktif Sakroiliitin Manyetik Rezonans Görüntülemesinde Gözlemciler Arasındaki Uyum

Öz

Amaç
Aksiyal spondiloartropatiler entezit, sakroileit ve spondilit gibi karakteristik klinik özelliklere sahiptir, ayrıca eklem dışı belirtiler de görülebilir. Sakroiliak (SI) eklem manyetik rezonans görüntülemesi (MRG), erken sakroileiti tespit etmek için kullanılır. Bazen SI eklem MRG bulgularının yorumlanmasında gözlemciler arasında farklılıklar olabilir. Amacımız, gözlemciler arasındaki uyumu araştırmaktır.
Yöntem ve Gereçler
Çalışma, sakroiliak MRG bulgularına dayanarak aktif veya kronik sakroileit teşhisi konulan ve/veya MRG sonuçları birincil hekim tarafından sakroileiti gösterir nitelikte bulunan 1150 hastanın MRG sonuçlarını içeriyordu. 1150 MRG uzman bir radyolog tarafından yeniden değerlendirildi.
Bulgular
Bu çalışma kapsamında incelenen toplam 1150 hastadan; uzman radyologun değerlendirmeleri ile dış kaynaklı radyolog değerlendirmeleri arasında istatistiksel olarak anlamlı bir farklılık ortaya çıktı.
Sonuç
Spondiloartropatilerin teşhisi bazı nedenlerle gecikebilir. Eğer hastanın klinik durumu ve MRG raporu tam uyum göstermiyorsa, hastanın takipten çıkarılmaması gerekmektedir.

Anahtar Kelimeler

Ankilozan spondilit, manyetik rezonans görüntüleme, gözlemciler arası uyum

Kaynakça

• Huang PJ, Chen YH, Huang WN, Chen YM, Lai KL, Hsieh TY, et al. The electronic medical record management systems may improve monitoring and control of disease activity in patients with ankylosing spondylitis. Sci Rep. 2023;13(1):3957.
• Sieper J, Poddubnyy D. Axial spondyloarthritis. Lancet. 2017;390(10089):73-84.
• Onen F, Akar S, Birlik M, Sari I, Khan MA, Gurler O, et al. Prevalence of ankylosing spondylitis and related spondyloarthritides in an urban area of Izmir, Turkey. J Rheumatol. 2008;35(2):305-309.
• Zink A, Braun J, Listing J, Wollenhaupt J. Disability and handicap in rheumatoid arthritis and ankylosing spondylitis--results from the German rheumatological database. German Collaborative Arthritis Centers. J Rheumatol. 2000;27(3):613-622.
• Poddubnyy D. Classification vs diagnostic criteria: the challenge of diagnosing axial spondyloarthritis. Rheumatology . 2020;59(Suppl4):iv6-iv17.
• Rich-Garg N, Danve A, Choi D, Vakil-Gilani K, Akkoc N, Azevedo V, et al. Assessing rheumatologists’ attitudes and utilization of classification criteria for ankylosing spondylitis and axial spondyloarthritis: a global effort. Clin Rheumatol. 2021;40(3):949-954.
• Colglazier CL, Sutej PG. Laboratory testing in the rheumatic diseases: a practical review. South Med J. 2005;98(2):185-191.
• Lapić I, Padoan A, Bozzato D, Plebani M. Erythrocyte Sedimentation Rate and C-Reactive Protein in Acute Inflammation. Am J Clin Pathol. 2020;153(1):14-29.
• Benhamou M, Gossec L, Dougados M. Clinical relevance of C-reactive protein in ankylosing spondylitis and evaluation of the NSAIDs/coxibs’ treatment effect on C-reactive protein. Rheumatology . 2010;49(3):536-541.
• Jans L, Egund N, Eshed I, Sudoł-Szopińska I, Jurik AG. Sacroiliitis in Axial Spondyloarthritis: Assessing Morphology and Activity. Semin Musculoskelet Radiol. 2018;22(2):180-188.
• Quélin B, Duhamel F. Bringing together strategic outsourcing and corporate strategy: Eur Manag J. 2003;21(5):647-661.
• Vanaki N, Golmohammadi T, Jamshidi A, Akhtari M, Vojdanian M, Mostafaei S, et al. Increased inflammatory responsiveness of peripheral blood mononuclear cells (PBMCs) to NOD2 ligand stimulation in patients with ankylosing spondylitis. Immunopharmacol Immunotoxicol. 2018;40(5):393-400.
• Akkoc Y, Karatepe AG, Akar S, Kirazli Y, Akkoc N. A Turkish version of the Bath Ankylosing Spondylitis Disease Activity Index: reliability and validity. Rheumatol Int. 2005;25(4):280-284.
• Bashshur RL, Krupinski EA, Thrall JH, Bashshur N. The Empirical Foundations of Teleradiology and Related Applications: A Review of the Evidence. Telemed J E Health. 2016;22(11):868-898.
• Thrall JH. Teleradiology. Part I. History and clinical applications. Radiology. 2007;243(3):613-617.
• Prabhakar AM, Gottumukkala RV, Hemingway J, Hughes DR, Patel SS, Duszak R Jr. Increasing utilization of emergency department neuroimaging in Medicare beneficiaries from 1994 to 2015. Am J Emerg Med. 2018;36(4):680-683.
• Bhargavan M, Sunshine JH. Utilization of radiology services in the United States: levels and trends in modalities, regions, and populations. Radiology. 2005;234(3):824-832.
• Silva E 3rd, Breslau J, Barr RM, Liebscher LA, Bohl M, Hoffman T, et al. ACR white paper on teleradiology practice: a report from the Task Force on Teleradiology Practice. J Am Coll Radiol. 2013;10(8):575-585.
• Bressem KK, Vahldiek JL, Adams L, Niehues SM, Haibel H, Rodriguez VR, et al. Deep learning for detection of radiographic sacroiliitis: achieving expert-level performance. Arthritis Res Ther. 2021;23(1):106.
• Akar S, Isik S, Birlik B, Solmaz D, Sari I, Onen F, et al. Baseline sacroiliac joint magnetic resonance imaging abnormalities and male sex predict the development of radiographic sacroiliitis. Clin Rheumatol. 2013;32(10):1511-1517.
• Orr KE, Andronikou S, Bramham MJ, Holjar-Erlic I, Menegotto F, Ramanan AV. Magnetic resonance imaging of sacroiliitis in children: frequency of findings and interobserver reliability. Pediatr Radiol. 2018;48(11):1621-1628.