Agreement between clinical practice and trained central reading in reading of sacroiliac joints on plain pelvic radiographs. Results from the DESIR cohort

septembre 12, 2014 | Posted by admin

Un nouvel article scientifique intitulé « Agreement between clinical practice and trained central reading in reading of sacroiliac joints on plain pelvic radiographs. Results from the DESIR cohort » a été publié dans le journal Arthritis Rhheumatology

van den Berg R, Lenczner G, Feydy A, van der Heijde D, Reijnierse M, Saraux A, Rahmouni A, Dougados M, Claudepierre P

Arthritis Rheumatol. 2014 Sep;66(9):2403-11. doi: 10.1002/art.38738.

Abstract

OBJECTIVE:

To investigate the degree of agreement between local rheumatologists/radiologists and central trained readers (external standard) on the presence/absence of sacroiliitis on radiographs of the sacroiliac (SI) joints.

METHODS:

Patients with inflammatory back pain (duration ≥3 months but <3 years) suggestive of axial spondyloarthritis (SpA) were included in the Devenir des Spondylarthropathies Indifferérenciées Récentes (DESIR) cohort. Baseline radiographs of the SI joints were interpreted by 2 centralreaders (modified New York criteria); cases of disagreement were adjudicated by a third reader, yielding a positive or a negative result (centralreading). The same radiographs were also interpreted by local radiologists/rheumatologists and were rated as « normal, » « doubtful sacroiliitis, » « obvious sacroiliitis, » or « SI joint fusion » (local reading); positive findings were defined as « at least unilateral obvious sacroiliitis, » « bilateral obvious sacroiliitis, » or « at least unilateral fusion. » Agreement and misclassifications between central readers and between central reading versus localreading were calculated (kappa values).

RESULTS:

Interreader agreement between the central readers was moderate (κ = 0.54); 108 of 688 radiographs (15.7%) were adjudicated. According to local reading ( »at least unilateral obvious sacroiliitis »), 183 of the 688 patients (26.6%) had sacroiliitis, whereas according to central reading, 145 of 688 patients (21.1%) had sacroiliitis. Agreement between local reading and central reading was also moderate (κ = 0.55); 76 of 183 patients (41.5%) with « at least unilateral obvious sacroiliitis » (positive by local reading) and 32 of 109 patients (29.4%) with « bilateral obvious sacroiliitis » or « at least unilateral fusion » (positive by local reading) were rated as « negative » by central reading, and 38 of 505 patients (7.5%) and 68 of 579 patients (11.7%), respectively, without sacroiliitis (negative by local reading) were interpreted as « positive » by central reading.

CONCLUSION:

In patients with recent-onset inflammatory back pain, both trained readers and local rheumatologists/radiologists agreed only moderately on the recognition of radiographic sacroiliitis. A significant proportion of locally recognized ankylosing spondylitis (AS) patients were not confirmed as having AS by central reading (false positive), while a small minority of patients were false negative, indicating the necessity of reevaluating the role of radiographic sacroiliitis as diagnostic criterion for axial SpA.

Categories: Publication de travaux dans des journaux médicaux | Tags: cohorte DESIR, DESIR, spondyloarthritis | No Comments »