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Published on: August 8, 2019
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MRI lesions in SpA: a comparison with noninflammatory back pain using propensity score adjustment method
Ho Yin Chung1, Jin Xian Huang2, Kam Ho Lee3
1Division of Rheumatology and Clinical Immunology, The University of Hong Kong, Hong Kong.
Therapeutic Advances in Musculoskeletal Disease
|September 2, 2022
Summary
Certain MRI lesions, including discovertebral lesions without Modic type 1, costovertebral joint lesions, corner inflammatory lesions, and fatty corner lesions, are more specific to axial spondyloarthritis (SpA). This helps differentiate SpA from noninflammatory back pain.
Area of Science:
- Radiology
- Rheumatology
- Medical Imaging
Background:
- Magnetic resonance imaging (MRI) is crucial for managing axial spondyloarthritis (SpA).
- Many MRI-detected lesions are not unique to axial SpA, necessitating further characterization for improved clinical decision-making.
- Understanding lesion specificity aids in accurate diagnosis and treatment planning for SpA patients.
Purpose of the Study:
- To compare the frequency of specific spinal MRI lesions between patients with axial SpA and those with noninflammatory back pain.
- To identify factors associated with individual MRI lesions in patients diagnosed with axial SpA.
- To enhance diagnostic accuracy by determining lesion specificity in axial SpA.
Main Methods:
- A cross-sectional observational study involving 447 patients with axial SpA and 122 with noninflammatory back pain.
- Propensity score adjustment was used to compare MRI lesion frequencies, including discovertebral lesions (DVL), Modic type 1 lesions, DVL without Modic type 1, facet joint lesions, costovertebral joint lesions, corner inflammatory lesions (CIL), and fatty corner lesions (FCL).
- Regression analyses were employed to determine factors associated with these lesions in the axial SpA cohort.
Main Results:
- Inflammatory lesions were present on spinal MRI in nearly half of axial SpA patients (48.6%) compared to 31.1% in the noninflammatory back pain group.
- Axial SpA showed a significantly increased occurrence of DVL without Modic type 1 lesion (OR=3.43), costovertebral lesions (OR=11.89), and higher counts of CIL (B=1.19) and FCL (B=3.33) after propensity score matching.
- Similar associations were observed in the radiographic axial SpA subgroup, reinforcing the specificity of these lesions.
Conclusions:
- MRI findings such as DVL without Modic type 1, costovertebral joint lesions, CIL, and FCL demonstrate higher specificity for axial SpA.
- These specific lesions can aid in differentiating axial SpA from noninflammatory back pain on spinal MRI.
- Further characterization of MRI lesions improves diagnostic precision in axial spondyloarthritis.
