Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.
CT Scan Facilitates the Diagnosis of Sacroiliitis in Patients with Suspected Spondyloarthritis, and without Proven Sacroiliitis on Pelvic X-RayResults of the ECHOSPA Cohort.
Devauchelle-Pensec1, Valérie, d'Agostino8, Maria-Antonietta, Marion1, Julien, Jousse-Joulin2, Sandrine, Lapierre1, Marie, Colin1, Daniele, Chary-Valkenaere6, Isabelle
To assess the performance of CT-scan for detecting sacroiliitis in patients with suspected spondylarthritis, and without obvious abnormalities of sacroiliac joints on X-ray.
489 outpatients with suspected spondyloarthritis were recruited in a multicenter cohort study. At entry, they were submitted to clinical examination, pelvic X-ray, and HLA-B typing. Pelvic CT-scan was performed when rheumatologist was uncertain about the presence of sacroiliitis on X-ray. A set of 100 paired radiograph/CT-scan was read blindly by two radiologists, and the kappa coefficient was used to assess their reliability. One of them read the 173 pairs of X-ray/CT-scan available.
After training, inter-reader reliability was moderate for sacroiliitis staging on X-ray (kappa = 0.52), excellent on CT-scan (kappa = 0.92), and perfect for diagnosing sacroiliitis on X-ray (New York criteria; kappa = 1). Quality was considered as good in 66, and 67 of 100 X-rays (kappa = 0.88), and in 93, and 92 of 100 CT-scans (kappa = 0.93), by readers one and two, respectively. Reliability between X-ray and CT-scan was low for sacroiliitis staging (kappa = 0.08), and diagnosing (kappa = 0.02). Sacroiliitis was retained in 6 (3.5%) patients on X-ray (4 confirmed by CT scan), and in 32 (18.5%) patients on CT-scan. Uveitis was associated with sacroiliitis on both X-rays (P :0.04) and CT-scan (P < 0.0001). Age, sex, HLA B27, arthralgia, enthesitis, rachialgia and buttock pain were not associated to sacroiliitis in our population.
Radiographic sacroiliitis was underestimated on X-ray, whereas CT-scan increased the detection of structural abnormalities leading to a proven diagnosis of sacroiliitis. CT-scan should facilitate the diagnosis of ankylosing spondylitis in patients with suspected spondyloarthritis.
To cite this abstract, please use the following information:
Devauchelle-Pensec, Valérie, d'Agostino, Maria-Antonietta, Marion, Julien, Jousse-Joulin, Sandrine, Lapierre, Marie, Colin, Daniele, et al; CT Scan Facilitates the Diagnosis of Sacroiliitis in Patients with Suspected Spondyloarthritis, and without Proven Sacroiliitis on Pelvic X-RayResults of the ECHOSPA Cohort. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1931