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Scoring sacroiliac joints by magnetic resonance imaging. A multiple-reader reliability experiment
Robert B M Landewé1, Kay-Geert A Hermann, Désirée M F M van der Heijde
1Department of Internal Medicine, Division of Rheumatology, University Hospital Maastricht, University Maastricht, 6202 AZ Maastricht, The Netherlands. rlan@sint.azm.nl
The Journal of Rheumatology
|October 6, 2005
Summary
This study found that comprehensive scoring systems, like the SPARCC method, show better reliability and sensitivity for assessing ankylosing spondylitis (AS) disease activity in MRI scans. These findings support their use in clinical trials for evaluating SI joint inflammation.
Area of Science:
- Radiology
- Rheumatology
- Clinical Trials
Background:
- Magnetic resonance imaging (MRI) is crucial for evaluating inflammatory activity and structural damage in ankylosing spondylitis (AS).
- Standardized scoring systems are needed to reliably assess disease activity and changes over time in clinical trials.
Purpose of the Study:
- To investigate the inter-reader reliability and sensitivity to change of different scoring systems for assessing MRI-based disease activity in sacroiliac (SI) joints and spine in AS patients.
- To compare the performance of a global score, a comprehensive global score, and the Spondyloarthritis Research Consortium of Canada (SPARCC) scoring system.
Main Methods:
- Seven experienced readers scored 20 sets of AS patient MRIs using four different methods, including the SPARCC system.
- Inter-reader reliability was assessed using intraclass correlation coefficients (ICC).
- Sensitivity to change was evaluated using standardized response means (SRM).
Main Results:
- Overall inter-reader ICC for scoring status ranged from 0.47 to 0.58, and for scoring change from 0.40 to 0.53.
- Agreement varied significantly between reader pairs, with some showing excellent agreement (>0.80).
- The comprehensive SPARCC system demonstrated better agreement for status scores and slightly better sensitivity to change compared to more condensed systems.
Conclusions:
- The study demonstrates the feasibility of scoring exercises for comparing methods in real-world conditions.
- Evidence supports the reliability and sensitivity to change of scoring systems, particularly the comprehensive SPARCC system, for assessing SI joint activity in AS clinical trials.
- Further validation research is warranted for these scoring systems in the context of AS clinical trials.