title: Scoring with the Berlin MRI method for assessment of spinal inflammatory activity in patients with ankylosing spondylitis: a calibration exercise among rheumatologists.
abstract: OBJECTIVE
  To test the reliability of the Berlin MRI scoring method and the effect of a calibration exercise on the score's reliability among untrained readers in MRI examinations of patients with established ankylosing spondylitis (AS).
  
  
  METHODS
  Eleven rheumatologists read blinded images of 20 AS patients before and after a two-day workshop on the Berlin MRI scoring method. Reliability (intra- and inter-reader) and concordance with the expert (all measured by intraclass correlation coefficient (ICC)) were compared before and after 2 weeks of the training. Feasibility in terms of time and difficulty was also measured.
  
  
  RESULTS
  The mean Berlin score increased from (mean ± standard deviation) 5.04 ± 6.41 before to 6.40±7.08 after the calibration exercise (p<0.01). Inter-reader ICC decreased from 0.83 (95% CI: 0.75-0.93) to 0.78 (95% CI: 0.66-0.90), and intra-reader ICC from 0.89 (95% CI: 0.84-0.94) to 0.87 (95% CI: 0.82-0.92). Agreement with an experienced reader improved after the calibration exercise, with ICC = 0.59 (95% CI 0.45-0.76) before vs. ICC = 0.65 (95% CI 0.50-0.80) after training.
  
  
  CONCLUSIONS
  The Berlin method is a reliable scoring method for assessment of spinal inflammatory activity by using MRI in patients with AS, even in the hands of inexperienced readers. A calibration exercise can improve feasibility and sensitivity of the scoring method.
authors.affiliation: Institute for Musculoskeletal Health, Madrid, Spain. loreto.carmona@inmusc.eu.
authors.forename: Loreto
authors.initials: L
authors.lastname: Carmona
authors.forename: Agusti
authors.initials: A
authors.lastname: Sellas
authors.forename: Carlos
authors.initials: C
authors.lastname: Rodríguez-Lozano
authors.forename: Xavier
authors.initials: X
authors.lastname: Juanola
authors.forename: José Francisco
authors.initials: JF
authors.lastname: García Llorente
authors.forename: José Luis
authors.initials: JL
authors.lastname: Fernández Sueiro
authors.forename: Luis Francisco
authors.initials: LF
authors.lastname: Linares
authors.forename: M Carmen
authors.initials: MC
authors.lastname: de Castro
authors.forename: Mireia
authors.initials: M
authors.lastname: Moreno
authors.forename: Pedro
authors.initials: P
authors.lastname: Zarco
authors.forename: Rafael
authors.initials: R
authors.lastname: Ariza
authors.forename: Xenofon
authors.initials: X
authors.lastname: Baraliakos
authors.forename: Eugenio
authors.initials: E
authors.lastname: de Miguel
mesh_terms: D002138:Calibration; D004502:Education, Medical, Continuing; D005240:Feasibility Studies; D006801:Humans; D059032:Learning Curve; D008279:Magnetic Resonance Imaging / Q000592:standards*; D015588:Observer Variation; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012219:Rheumatology / Q000193:education / Q000379:methods / Q000592:standards*; D012720:Severity of Illness Index; D013131:Spine / Q000473:pathology*; D013167:Spondylitis, Ankylosing / Q000175:diagnosis* / Q000473:pathology