ARTICLEOpen Access

Comparing the Accuracy and Reliability of Detecting the Intensity of Spinal Inflammation on STIR Sequence with Apparent Diffusion Coefficient Values in Axial Spondyloarthritis

Division of Rheumatology and Clinical Immunology, The University of Hong Kong, Hong Kong SAR, China

Rheumatology, Eclat Medical Center, Hong Kong SAR, China

E-mail Address: jameschunghoyin@gmail.com

Corresponding author: Ho Yin Chung, Eclat Medical Center, Room 1402, 14/F, Hing Wai Building, 36 Queen’s Road Central, Central, Hong Kong SAR, China.

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Tommy Tsang Cheung

https://orcid.org/0000-0001-6575-9497

Division of Rheumatology and Clinical Immunology, The University of Hong Kong, Hong Kong SAR, China

Department of Rheumatology, Hong Kong Sanatorium Hospital, Hong Kong SAR, China

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Vince Wing Hang Lau

https://orcid.org/0000-0001-5315-3017

Department of Radiology, Gleneagles Hospital, Hong Kong SAR, China

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Kam Ho Lee

https://orcid.org/0000-0002-1641-7180

Department of Radiology, Chinese University Medical Center, Hong Kong SAR, China

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, and

Florence King Pui Chan

https://orcid.org/0000-0003-2094-1206

Department of Medicine, Queen Mary Hospital, Hong Kong SAR, China

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https://doi.org/10.1142/S2661341724500044Cited by:0 (Source: Crossref)

Abstract

Objective: To compare the accuracy and reliability of detecting the intensity of spinal inflammation on short tau inversion recovery (STIR) with the apparent diffusion coefficient (ADC) values of the active magnetic resonance imaging (MRI) lesions in axial spondyloarthritis (axSpA).

Materials and methods: Fifty active lesions in the STIR sequence of spinal MRI were identified. With reference to sites of active lesions in STIR, the corresponding region of interest (ROI) on the ADC map was drawn to determine the maximum ADC (ADC $_{max}$ $_{max}$ ), mean ADC (ADC $_{mean}$ $_{mean}$ ), normalized maximum (nADC $_{max}$ $_{max}$ ), and mean (nADC $_{mean}$ $_{mean}$ ). Four independent readers scored the identified active lesions as “intense” or “non-intense” according to the Spondyloarthritis Research Consortium of Canada (SPARCC) MRI index. They were compared to various ADC parameters for assessment of accuracy and reliability. Regression analyses were used to adjust potential factors that could affect ADC.

Results: Significant differences were found in ADC $_{max}$ $_{max}$ between “intense” and “non-intense” lesions scored by three of the four readers (1,405.7 ± 271.4 vs. 1,165.8 ± 223.8, $p$ $p$ = 0.01; 1,420.7 ± 272.1 vs. 1,209.0 ± 248.5, $p$ $p$ = 0.01; 1,438.0 ± 307.2 vs. 1,213.6 ± 231.0, $p$ $p$ = 0.01). Only one reader could differentiate a difference in “intense” and “non-intense” lesions with respect to ADC $_{mean}$ $_{mean}$ (899.2 ± 248.3 vs. 711.0 ± 222.6, $p$ $p$ = 0.01) and nADC $_{mean}$ $_{mean}$ (4.4 ± 2.1 vs. 3.4 ± 1.4, $p$ $p$ = 0.05). Inter-reader agreements were slight to moderate (kappa = 0.07–0.45). Reliability substantially improved when only the lowest and highest 25th percentiles of ADC values were included (kappa = 0.17–0.75). Regression analyses showed that the “intense” lesions were associated with higher ADC values after adjustment for confounders.

Conclusion: Reading of STIR MRI is limited by the lack of ability in differentiating subtle differences of spinal inflammation. ADC could be an alternative method.

Keywords:

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Vol. 24, No. 02

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History

Received 23 June 2024

Accepted 19 November 2024

Published: 16 December 2024

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This is an Open Access article published by World Scientific Publishing Company. It is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 (CC BY-NC-ND) License which permits use, distribution and reproduction, provided that the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

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Comparing the Accuracy and Reliability of Detecting the Intensity of Spinal Inflammation on STIR Sequence with Apparent Diffusion Coefficient Values in Axial Spondyloarthritis

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