ASAS definition for sacroiliitis on MRI in SpA: applicable to children?
Abstract Background The Assessment of Spondyloarthritis International Society (ASAS) definition for a ‘positive’ Magnetic Resonance Imaging (MRI) for sacroiliitis is well studied and validated in adults, but studies about the value of this definition in children are lacking. The aim of this study is...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2017-04-01
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| Series: | Pediatric Rheumatology Online Journal |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12969-017-0159-z |
| _version_ | 1819011558976520192 |
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| author | Nele Herregods Joke Dehoorne Filip Van den Bosch Jacob Lester Jaremko Joke Van Vlaenderen Rik Joos Xenofon Baraliakos Gaëlle Varkas Koenraad Verstraete Dirk Elewaut Lennart Jans |
| author_facet | Nele Herregods Joke Dehoorne Filip Van den Bosch Jacob Lester Jaremko Joke Van Vlaenderen Rik Joos Xenofon Baraliakos Gaëlle Varkas Koenraad Verstraete Dirk Elewaut Lennart Jans |
| author_sort | Nele Herregods |
| collection | DOAJ |
| description | Abstract Background The Assessment of Spondyloarthritis International Society (ASAS) definition for a ‘positive’ Magnetic Resonance Imaging (MRI) for sacroiliitis is well studied and validated in adults, but studies about the value of this definition in children are lacking. The aim of this study is to evaluate whether the adult ASAS definition of a positive MRI of the sacroiliac joints can be applied to children with a clinical suspicion of Juvenile Spondyloarthritis (JSpA). Methods Two pediatric musculoskeletal radiologists blinded to clinical data independently retrospectively reviewed sacroiliac (SI) joint MRI in 109 children suspected of sacroiliitis. They recorded global impression (sacroiliitis yes/no) and whether the adult ASAS definition for sacroiliitis was met at each joint. This was compared to gold-standard clinical diagnosis of JSpA. Additionally, MRI were scored according to’adapted’ ASAS definitions including other features of sacroiliitis on MRI. Results JSpA was diagnosed clinically in 47/109 (43%) patients. On MRI, sacroiliitis was diagnosed by global assessment in 30/109 patients, of whom 14 also fulfilled ASAS criteria. No patients with negative global assessment for sacroiliitis fulfilled ASAS criteria. Sensitivity (SN) for JSpA was higher for global assessment (SN = 49%) than for ASAS definition (SN = 26%), but the ASAS definition was more specific (SP = 97% vs. 89%). Modifying adult ASAS criteria to allow bone marrow edema (BME) lesions seen on only one slice, synovitis or capsulitis, increased SN to 36%, 32% and 32% respectively, only slightly lowering SP. Including structural lesions increased SN to 28%, but lowered specificity to 95%. Conclusion The adult ASAS definition for sacroiliitis has low sensitivity in children. A pediatric-specific definition of MRI-positive sacroiliitis including BME lesions visible on one slice only, synovitis and/or capsulitis may improve diagnostic utility, and increase relevance of MRI in pediatric rheumatology practice. |
| first_indexed | 2024-12-21T01:30:05Z |
| format | Article |
| id | doaj.art-0d5597061a824ec19e0da1e51d9f29c5 |
| institution | Directory Open Access Journal |
| issn | 1546-0096 |
| language | English |
| last_indexed | 2024-12-21T01:30:05Z |
| publishDate | 2017-04-01 |
| publisher | BMC |
| record_format | Article |
| series | Pediatric Rheumatology Online Journal |
| spelling | doaj.art-0d5597061a824ec19e0da1e51d9f29c52022-12-21T19:20:23ZengBMCPediatric Rheumatology Online Journal1546-00962017-04-0115111010.1186/s12969-017-0159-zASAS definition for sacroiliitis on MRI in SpA: applicable to children?Nele Herregods0Joke Dehoorne1Filip Van den Bosch2Jacob Lester Jaremko3Joke Van Vlaenderen4Rik Joos5Xenofon Baraliakos6Gaëlle Varkas7Koenraad Verstraete8Dirk Elewaut9Lennart Jans10Department of Radiology and Medical Imaging, Ghent University HospitalDepartment of Pediatric Rheumatology, Ghent University HospitalDepartment of Rheumatology and VIB Inflammation Research Center, Unit for Molecular Immunology and Inflammation, Ghent University HospitalDepartment of Radiology & Diagnostic Imaging, University of Alberta HospitalDepartment of Pediatric Rheumatology, Ghent University HospitalDepartment of Pediatric Rheumatology, Ghent University HospitalRheumazentrum Ruhrgebiet, Ruhr-University BochumDepartment of Rheumatology and VIB Inflammation Research Center, Unit for Molecular Immunology and Inflammation, Ghent University HospitalDepartment of Radiology and Medical Imaging, Ghent University HospitalDepartment of Rheumatology and VIB Inflammation Research Center, Unit for Molecular Immunology and Inflammation, Ghent University HospitalDepartment of Radiology and Medical Imaging, Ghent University HospitalAbstract Background The Assessment of Spondyloarthritis International Society (ASAS) definition for a ‘positive’ Magnetic Resonance Imaging (MRI) for sacroiliitis is well studied and validated in adults, but studies about the value of this definition in children are lacking. The aim of this study is to evaluate whether the adult ASAS definition of a positive MRI of the sacroiliac joints can be applied to children with a clinical suspicion of Juvenile Spondyloarthritis (JSpA). Methods Two pediatric musculoskeletal radiologists blinded to clinical data independently retrospectively reviewed sacroiliac (SI) joint MRI in 109 children suspected of sacroiliitis. They recorded global impression (sacroiliitis yes/no) and whether the adult ASAS definition for sacroiliitis was met at each joint. This was compared to gold-standard clinical diagnosis of JSpA. Additionally, MRI were scored according to’adapted’ ASAS definitions including other features of sacroiliitis on MRI. Results JSpA was diagnosed clinically in 47/109 (43%) patients. On MRI, sacroiliitis was diagnosed by global assessment in 30/109 patients, of whom 14 also fulfilled ASAS criteria. No patients with negative global assessment for sacroiliitis fulfilled ASAS criteria. Sensitivity (SN) for JSpA was higher for global assessment (SN = 49%) than for ASAS definition (SN = 26%), but the ASAS definition was more specific (SP = 97% vs. 89%). Modifying adult ASAS criteria to allow bone marrow edema (BME) lesions seen on only one slice, synovitis or capsulitis, increased SN to 36%, 32% and 32% respectively, only slightly lowering SP. Including structural lesions increased SN to 28%, but lowered specificity to 95%. Conclusion The adult ASAS definition for sacroiliitis has low sensitivity in children. A pediatric-specific definition of MRI-positive sacroiliitis including BME lesions visible on one slice only, synovitis and/or capsulitis may improve diagnostic utility, and increase relevance of MRI in pediatric rheumatology practice.http://link.springer.com/article/10.1186/s12969-017-0159-zASAS definitionSacroiliitisMRIJuvenile spondyloarthritis |
| spellingShingle | Nele Herregods Joke Dehoorne Filip Van den Bosch Jacob Lester Jaremko Joke Van Vlaenderen Rik Joos Xenofon Baraliakos Gaëlle Varkas Koenraad Verstraete Dirk Elewaut Lennart Jans ASAS definition for sacroiliitis on MRI in SpA: applicable to children? Pediatric Rheumatology Online Journal ASAS definition Sacroiliitis MRI Juvenile spondyloarthritis |
| title | ASAS definition for sacroiliitis on MRI in SpA: applicable to children? |
| title_full | ASAS definition for sacroiliitis on MRI in SpA: applicable to children? |
| title_fullStr | ASAS definition for sacroiliitis on MRI in SpA: applicable to children? |
| title_full_unstemmed | ASAS definition for sacroiliitis on MRI in SpA: applicable to children? |
| title_short | ASAS definition for sacroiliitis on MRI in SpA: applicable to children? |
| title_sort | asas definition for sacroiliitis on mri in spa applicable to children |
| topic | ASAS definition Sacroiliitis MRI Juvenile spondyloarthritis |
| url | http://link.springer.com/article/10.1186/s12969-017-0159-z |
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