Agreement Between Clinical Practice and Trained Central Reading in Reading of Sacroiliac Joints on Plain Pelvic Radiographs Results From the DESIR Cohort

作者：van den Berg Rosaline; Lenczner Gregory; Feydy Antoine; van der Heijde Desiree; Reijnierse Monique; Saraux Alain; Rahmouni Alain; Dougados Maxime; Claudepierre Pascal^*

来源：Arthritis & Rheumatology, 2014, 66(9): 2403-2411.

DOI：10.1002/art.38738

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 Indiffererenciees Recentes (DESIR) cohort. Baseline radiographs of the SI joints were interpreted by 2 central readers (modified New York criteria); cases of disagreement were adjudicated by a third reader, yielding a positive or a negative result (central reading). 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 local reading were calculated (kappa values).
Results. Interreader agreement between the central readers was moderate (kappa = 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 (kappa = 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.

• 出版日期2014-9