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Underreporting of sacroiliac joint structural abnormalities on routine abdominal CT in axial spondyloarthritis: a
Basak Gulsah Kalaslioglu1, Hasan Yardimci2, Tuba Yuce Inel3
1Department of Internal Medicine, Dokuz Eylul University School of Medicine, Izmir, Türkiye.
Objective:
To quantify documentation of predefined, conspicuous sacroiliac joint (SIJ) structural abnormalities on routine abdominal CT in patients with established axial spondyloarthritis (axSpA) and identify associated factors.
Materials And Methods:
This retrospective longitudinal study evaluated 516 abdominal CT examinations from 188 patients with established SpA. Two readers applied a predefined hierarchical SIJ classification, with adjudication of disagreements. The primary analysis included 226 Moderate or Major examinations; all had fusion-based patterns. Patient-clustered logistic generalized estimating equations included workflow, request-level context, structural severity, prior recognition, and scan year.
Results:
SIJ findings were absent from 152 of 226 reports (67.3%). Total fusion was unreported in 90 of 136 examinations (66.2%), including 83 of 129 with bilateral total fusion (64.3%). Crude non-reporting was 89.2% in acute care and 50.0% in rheumatology. The four-examination MSK-oriented subgroup was combined with rheumatology for modeling. Adjusted non-reporting was 82.7% in acute care and 50.6% in the combined MSK-pathway, a 32.1-point difference (95% CI, 6.2-52.0); the corresponding OR was 0.20 (95% CI, 0.05-0.75). Structural severity and request-level context were not independently associated with non-reporting.
Conclusion:
Documentation of conspicuous SIJ structural abnormalities on routine abdominal CT was frequently absent and varied by workflow. Including a field for SIJ findings in structured abdominal CT reports may lead more radiologists to look for joint abnormalities. Automated detection requires external and prospective validation before clinical implementation.