目的:在全球范围内,放射摄影术仍用于检测青少年脊柱关节炎(SpA)的骶髂关节炎,尽管灵敏度和可靠性低。我们旨在在无法使用MRI的情况下,在骨骼未成熟的年轻人的骨盆X线摄影中定义明确的骶髂关节炎证据,以用于分类标准。
方法:受试者是青少年脊柱关节炎(SpA)患者的回顾性队列,其X线片和MRI作为轴性疾病诊断评估的一部分。六名肌肉骨骼成像专家进行了迭代共识过程,以在骨骼未成熟的年轻人的X线摄影中定义“明确的骶髂关节炎”。使用改良的纽约(mNY)标准和明确的骶髂关节炎标准对射线照片进行分级。使用Fleiss\'kappa统计数据评估了评估者之间的协议。特异性,接收机操作特性下的区域(AUROC),使用2种MRI参考标准测试了两种测量的灵敏度。
结果:112名受试者,包括中位年龄14.9岁.Fleiss\'kappa对于mNY[0.51(95%CI:0.39-0.64)]和明确的骶髂关节炎标准[0.55(95%CI:0.43-0.66)]是公平的。使用两种MRI参考标准,明确的骶髂关节炎标准达到>90%的特异性。敏感性(59.26/57.14vs44.83/43.33)和AUROC(0.76/0.76vs0.71/0.71)较高,对于这两个参考标准,对于年轻人明确定义的骶髂关节炎,而不是MNY标准,分别。
结论:我们提出了在骨骼未成熟的青少年中通过X线摄影得出明确的骶髂关节炎定义的第一个共识。该定义实现了优异的特异性,并且具有比使用两种MRI参考标准的mNY标准更高的AUROC和灵敏度。当MRI不可用时,该定义适用于青少年SpA轴向疾病分类成像标准。
Radiography is still used worldwide for the detection of
sacroiliitis in juvenile spondyloarthritis (JSpA), despite its low sensitivity and reliability. We aimed to define unequivocal evidence of
sacroiliitis on pelvic radiography in skeletally immature youth for use in classification criteria when magnetic resonance imaging (MRI) is unavailable.
Subjects were a retrospective cohort of juvenile patients with spondyloarthritis with a radiograph and MRI as part of a diagnostic evaluation for axial disease. Six musculoskeletal imaging experts underwent an iterative
consensus process to define unequivocal
sacroiliitis on radiography in skeletally immature youth. Radiographs were graded using the modified New York (mNY) criteria and the unequivocal sacroiliitis criteria. Interrater agreement was assessed with the Fleiss [Formula: see text] statistic. Specificity, area under the receiver operator characteristic curve (AUROC), and sensitivity of the 2 measures were tested using 2 MRI reference standards.
A total of 112 subjects, with a median age of 14.9 (range 6.7-20.1) years, were included. The Fleiss [Formula: see text] was fair for the mNY criteria (0.54, 95% CI 0.42-0.67) and the unequivocal sacroiliitis criteria (0.58, 95% CI 0.46-0.69). The unequivocal sacroiliitis criteria achieved > 90% specificity using both MRI reference standards. Sensitivity (59.26 and 57.14 vs 44.83 and 43.33) and AUROC (0.76 and 0.76 vs 0.71 and 0.71) were higher, for both reference standards, for the unequivocal sacroiliitis in youth definition than for the mNY criteria, respectively.
In this study, we propose the first
consensus-derived definition to our knowledge of unequivocal
sacroiliitis by radiography in skeletally immature youth. This definition achieved excellent specificity and had higher AUROC and sensitivity values than the mNY criteria using both MRI reference standards. This definition has applicability to the JSpA axial disease classification imaging criterion when MRI is unavailable.