Diffusion-weighted Imaging Is a Sensitive and Specific Magnetic Resonance Sequence in the Diagnosis of Ankylosing Spondylitis

Linda A Bradbury; Kelly A Hollis; Benoît Gautier; Sateesh Shankaranarayana; Philip C Robinson; Nivene Saad; Kim-Anh Lê Cao; Matthew A Brown

doi:10.3899/jrheum.170312

Diffusion-weighted Imaging Is a Sensitive and Specific Magnetic Resonance Sequence in the Diagnosis of Ankylosing Spondylitis

J Rheumatol. 2018 Jun;45(6):771-778. doi: 10.3899/jrheum.170312. Epub 2018 Feb 15.

Authors

Linda A Bradbury^{1

2}, Kelly A Hollis^{1

2}, Benoît Gautier^{1

2}, Sateesh Shankaranarayana^{1

2}, Philip C Robinson^{1

2}, Nivene Saad^{1

2}, Kim-Anh Lê Cao^{1

2}, Matthew A Brown^{3

4}

Affiliations

¹ From the Institute of Health and Biomedical Innovation, Queensland University of Technology, Translational Research Institute, Princess Alexandra Hospital; University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital; Royal Brisbane and Women's Hospital; The University of Queensland, School of Medicine, Brisbane, Queensland, Australia.
² L.A. Bradbury, MSc, MNPSt, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology at Translational Research Institute; K.A. Hollis, BScN, RN, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology at Translational Research Institute; B. Gautier, PhD, University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital; S. Shankaranarayana, MBBS, PhD, Princess Alexandra Hospital; P.C. Robinson, PhD, FRACP, Royal Brisbane and Women's Hospital; N. Saad, MD, FRANZCR, Princess Alexandra Hospital; K.A. Lê Cao, PhD, University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital; M.A. Brown, MD, PhD, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology at Translational Research Institute.
³ From the Institute of Health and Biomedical Innovation, Queensland University of Technology, Translational Research Institute, Princess Alexandra Hospital; University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital; Royal Brisbane and Women's Hospital; The University of Queensland, School of Medicine, Brisbane, Queensland, Australia. Matt.brown@qut.edu.au.
⁴ L.A. Bradbury, MSc, MNPSt, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology at Translational Research Institute; K.A. Hollis, BScN, RN, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology at Translational Research Institute; B. Gautier, PhD, University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital; S. Shankaranarayana, MBBS, PhD, Princess Alexandra Hospital; P.C. Robinson, PhD, FRACP, Royal Brisbane and Women's Hospital; N. Saad, MD, FRANZCR, Princess Alexandra Hospital; K.A. Lê Cao, PhD, University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital; M.A. Brown, MD, PhD, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology at Translational Research Institute. Matt.brown@qut.edu.au.

PMID: 29449501
DOI: 10.3899/jrheum.170312

Abstract

Objective: We tested the discriminatory capacity of diffusion-weighted magnetic resonance imaging (DWI) and its potential as an objective measure of treatment response to tumor necrosis factor inhibition in ankylosing spondylitis (AS).

Methods: Three cohorts were studied prospectively: (1) 18 AS patients with Bath Ankylosing Spondylitis Disease Activity Index > 4, and erythrocyte sedimentation rate > 25 and/or C-reactive protein > 10 meeting the modified New York criteria for AS; (2) 20 cases of nonradiographic axial spondyloarthritis (nr-axSpA) as defined by the Assessment of Spondyloarthritis international Society (ASAS) criteria; and (3) 20 non-AS patients with chronic low back pain, aged between 18 and 45 years, who did not meet the imaging arm of the ASAS criteria for axSpA. Group 1 patients were studied prior to and following adalimumab treatment. Patients were assessed by DWI and conventional magnetic resonance imaging (MRI), and standard nonimaging measures.

Results: At baseline, in contrast to standard nonimaging measures, DWI apparent diffusion coefficient (ADC) values showed good discriminatory performance [area under the curve (AUC) > 80% for Group 1 or 2 compared with Group 3]. DWI ADC values were significantly lower posttreatment (0.45 ± 0.433 before, 0.154 ± 0.23 after, p = 0.0017), but had modest discriminating capacity comparing pre- and posttreatment measures (AUC = 68%). This performance was similar to the manual Spondyloarthritis Research Consortium of Canada (SPARCC) scoring system.

Conclusion: DWI is informative for diagnosis of AS and nr-axSpA, and has moderate utility in assessment of disease activity or treatment response, with performance similar to that of the SPARCC MRI score.

Keywords: ADALIMUMAB; ANKYLOSING SPONDYLITIS; DIFFUSION MAGNETIC RESONANCE IMAGING; SENSITIVITY; SPECIFICITY; SPONDYLOARTHRITIS.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Blood Sedimentation
Diffusion Magnetic Resonance Imaging / methods*
Female
Humans
Low Back Pain / blood
Low Back Pain / diagnostic imaging*
Male
Middle Aged
Prospective Studies
Sacroiliac Joint / diagnostic imaging*
Sensitivity and Specificity
Severity of Illness Index
Spondylarthritis / blood
Spondylarthritis / diagnostic imaging*
Spondylitis, Ankylosing / blood
Spondylitis, Ankylosing / diagnostic imaging*
Young Adult