title: Spondyloarthritis research Consortium of Canada magnetic resonance imaging index for assessment of sacroiliac joint inflammation in ankylosing spondylitis.
abstract: OBJECTIVE
  To develop a feasible magnetic resonance imaging (MRI)-based scoring system for sacroiliac joint inflammation in patients with ankylosing spondylitis (AS) that requires minimal scan time, does not require contrast enhancement, evaluates lesions separately at each articular surface, and limits the number of sacroiliac images that are scored.
  
  
  METHODS
  A scoring method based on the assessment of increased signal denoting bone marrow edema on T2-weighted STIR sequences was used. MRI films were assessed blindly in random order at 2 sites by multiple readers. Intra- and interreader reliability was assessed by intraclass correlation coefficient (ICC); the 24-week response of patients with AS randomized to placebo:infliximab (3:8) was assessed by effect size and standardized response mean. The reliability and responsiveness of the scoring method were compared for STIR and gadolinium diethylenetriaminepentaacetic (Gd-DTPA)-enhanced MRI sequences.
  
  
  RESULTS
  We scanned 11 patients with AS with clinically active disease and 11 additional patients randomized to the trial of infliximab therapy. ICC for total sacroiliac joint STIR score ranged from 0.90 to 0.98 (P < 0.00001) and interobserver ICC for combined readers from the 2 sites was 0.84 (P < 0.0001). ICC for change scores was lower for STIR (ICC 0.53) than for Gd-DTPA-enhanced sequences (ICC 0.79). Responsiveness was poor, although fusion was evident in one-third of patients who received treatment (placebo:infliximab) and inflammation scores were low.
  
  
  CONCLUSIONS
  The Spondyloarthritis Research Consortium of Canada MRI index is a feasible and reproducible index for measuring sacroiliac joint inflammation in patients with AS.
authors.affiliation: University of Alberta, Edmonton, Canada. walter.maksymowych@ualberta.ca
authors.forename: Walter P
authors.initials: WP
authors.lastname: Maksymowych
authors.forename: Robert D
authors.initials: RD
authors.lastname: Inman
authors.forename: David
authors.initials: D
authors.lastname: Salonen
authors.forename: Suhkvinder S
authors.initials: SS
authors.lastname: Dhillon
authors.forename: Martin
authors.initials: M
authors.lastname: Williams
authors.forename: Millicent
authors.initials: M
authors.lastname: Stone
authors.forename: Barbara
authors.initials: B
authors.lastname: Conner-Spady
authors.forename: Janice
authors.initials: J
authors.lastname: Palsat
authors.forename: Robert G W
authors.initials: RG
authors.lastname: Lambert
mesh_terms: D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000627:therapeutic use; D002170:Canada; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007249:Inflammation / Q000145:classification / Q000175:diagnosis*; D000069285:Infliximab; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012446:Sacroiliac Joint / Q000473:pathology*; D012720:Severity of Illness Index; D013167:Spondylitis, Ankylosing / Q000145:classification / Q000175:diagnosis* / Q000188:drug therapy
chemical_list: D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D000069285:Infliximab