Diffusion-weighted imaging versus short tau inversion recovery sequence: Usefulness in detection of active sacroiliitis and early diagnosis of axial spondyloarthritis

Chiu Wai Shirley Chan; Helen Hoi Lun Tsang; Philip Hei Li; Kam Ho Lee; Chak Sing Lau; Pui Yan Stella Wong; Ho Yin Chung

doi:10.1371/journal.pone.0201040

Diffusion-weighted imaging versus short tau inversion recovery sequence: Usefulness in detection of active sacroiliitis and early diagnosis of axial spondyloarthritis

PLoS One. 2018 Aug 7;13(8):e0201040. doi: 10.1371/journal.pone.0201040. eCollection 2018.

Authors

Chiu Wai Shirley Chan¹, Helen Hoi Lun Tsang¹, Philip Hei Li¹, Kam Ho Lee², Chak Sing Lau¹, Pui Yan Stella Wong³, Ho Yin Chung¹

Affiliations

¹ Division of Rheumatology and Clinical Immunology, The University of Hong Kong, Hong Kong, China.
² Department of Radiology, Queen Mary Hospital, Hong Kong, China.
³ Division of Rheumatology, Tseung Kwan O Hospital, Hong Kong, China.

Abstract

Objective: To compare the utility of Diffusion weighted imaging (DWI) with short tau inversion recovery (STIR) sequence in the diagnosis of early axial spondyloarthritis (SpA).

Methods: Three hundred and five patients with chronic back pain were recruited consecutively from 3 rheumatology centers. Clinical, radiological and blood parameters were recorded. Patients with back pain duration no more than 3 years were classified as having early disease. STIR sequence and DWI of the sacroiliac joints were obtained and assessed using the Spondyloarthritis Research Consortium of Canada (SPARCC) method. The Assessment in Spondyloarthritis international Society definition was used to define positive STIR and DWI. Results were compared to expert diagnosed axial SpA.

Results: When compared to STIR sequence, DWI had similar sensitivity (STIR 0.29, DWI 0.30) and specificity (STIR 0.97, DWI 0.92) in diagnosing sacroiliitis. However, STIR sequence had better reliability (STIR 0.78, DWI 0.61). In early disease group, DWI was not better than STIR sequence in detecting active sacroiliitis (sensitivity DWI vs STIR: 0.34 vs 0.36; specificity DWI vs STIR: 0.93 vs 0.93; positive predictive value DWI vs STIR: 0.92 vs 0.92; negative predictive value DWI vs STIR: 0.36 vs 0.37). Using the Assessment in SpondyloArthritis international Society (ASAS) classification criteria, 67/98 patients with early disease (sensitivity 0.91 specificity 0.90) and 221/305 overall (sensitivity 0.90; specificity 0.92) were classified as axial SpA. Among the expert diagnosed axial SpA patients who did not meet the ASAS criteria, only 2 had positive DWI.

Conclusion: DWI and STIR have similar sensitivity in diagnosing axSpA in early disease. However, the use of DWI is limited by poorer reliability when compared with STIR.

Publication types

Comparative Study
Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Cohort Studies
Cross-Sectional Studies
Diffusion Magnetic Resonance Imaging / methods*
Early Diagnosis
Humans
Lumbar Vertebrae / diagnostic imaging
Magnetic Resonance Imaging / methods*
Reproducibility of Results
Sacroiliac Joint / diagnostic imaging
Sacroiliitis / diagnostic imaging*
Sacrum / diagnostic imaging
Spondylarthritis / diagnostic imaging*

Grants and funding

This study is supported by the Hong Kong Society of Rheumatology and Min Yuen Tong Charity Foundation. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.