title: Inflammatory and structural evaluation in spondyloarthritis: magnetic resonance imaging analysis of axial and peripheral involvement.
abstract: OBJECTIVE
  To determine the magnetic resonance imaging (MRI) criteria of most value in the assessment of patients with spondyloarthropathy (SpA) with axial or peripheral involvement.
  
  
  METHODS
  Fat suppressed (FS)-T2 and pre- and postinjection FS-T1 images were obtained in the most symptomatic region (axial or peripheral) of patients requiring tumor necrosis factor-a blockers. Thirty-eight MRI (21 axial and 17 peripheral) were blindly scored at synovial (S) and entheseal (E) sites by 2 experienced observers screening for 7 inflammatory and 7 structural predefined criteria, which were evaluated for frequency (N) and intra- and interobserver reproducibility.
  
  
  RESULTS
  In peripheral regions, synovitis (S; N = 69.4%), ligament inflammation (E; N = 39.7%), bone marrow edema (S; N = 22.1%; E; N = 15%), and tenosynovitis (S; N = 21%) were recorded with good to excellent intraobserver reproducibility [intraclass correlation coefficient (ICC) 0.49-0.93] and moderate to good interobserver reproducibility (ICC 0.49-0.66). With regard to structural criteria, erosions (S; N = 17.1%) and enthesophytes (E; N = 13.9%) exhibited good to excellent intraobserver (ICC 0.71-0.85) and moderate interobserver reproducibility (ICC 0.54-0.49); the reproducibility of fat inflation (N = 1.4%) was good (ICC 0.76-0.78). In axial regions, no inflammatory criteria achieved good interobserver reproducibility. However, fat inflation (S; N = 86%), chondral lesions (S; N = 85.8%), enthesophytes (E; N = 76.7%), fusion (S; N = 41.2%), and erosions (S; N = 25.1%) showed excellent intraobserver reproducibility (ICC 0.81-0.98), and moderate to excellent interobserver reproducibility (ICC 0.50-0.96).
  
  
  CONCLUSIONS
  In terms of intra- and interobserver reproducibility, MRI is a reliable tool with which to assess synovitis, bone edema, ligament inflammation, tenosynovitis, erosion, enthesophytes, and fat inflation in patients with peripheral involvement. In those with axial involvement, inflammatory criteria lack interobserver reproducibility, but chondral lesions, erosion, fat inflation, fusion, and enthesophytes are relevant.
authors.affiliation: Department of Rheumatology, Hôpitaux de Brabois, Vandoeuvre, France.
authors.forename: Virginie
authors.initials: V
authors.lastname: Hoenen-Clavert
authors.forename: Anne Christine
authors.initials: AC
authors.lastname: Rat
authors.forename: Damien
authors.initials: D
authors.lastname: Loeuille
authors.forename: Isabelle
authors.initials: I
authors.lastname: Bettembourg-Brault
authors.forename: Christine
authors.initials: C
authors.lastname: Michel-Batot
authors.forename: Alain
authors.initials: A
authors.lastname: Blum
authors.forename: Jacques
authors.initials: J
authors.lastname: Pourel
authors.forename: Isabelle
authors.initials: I
authors.lastname: Chary-Valckenaere
mesh_terms: D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D007596:Joints / Q000473:pathology*; D008022:Ligaments / Q000473:pathology; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D015588:Observer Variation; D010000:Osteitis / Q000175:diagnosis / Q000473:pathology*; D010147:Pain Measurement; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D016037:Single-Blind Method; D025242:Spondylarthropathies / Q000175:diagnosis / Q000473:pathology*; D013585:Synovitis / Q000473:pathology; D013717:Tenosynovitis / Q000473:pathology