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ASAS definition for sacroiliitis on MRI in SpA : applicable to children?

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Abstract
Background: The Assessment of Spondyloarthritis International Society (ASAS) definition for a'positive' Magnetic Resonance Imaging (MRI) for sacroiliitis is well studied and validated in adults, but studies about the value of this definition in children are lacking. The aim of this study is to evaluate whether the adult ASAS definition of a positive MRI of the sacroiliac joints can be applied to children with a clinical suspicion of Juvenile Spondyloarthritis (JSpA). Methods: Two pediatric musculoskeletal radiologists blinded to clinical data independently retrospectively reviewed sacroiliac (SI) joint MRI in 109 children suspected of sacroiliitis. They recorded global impression (sacroiliitis yes/no) and whether the adult ASAS definition for sacroiliitis was met at each joint. This was compared to goldstandard clinical diagnosis of JSpA. Additionally, MRI were scored according to'adapted' ASAS definitions including other features of sacroiliitis on MRI. Results: JSpA was diagnosed clinically in 47/109 (43%) patients. On MRI, sacroiliitis was diagnosed by global assessment in 30/109 patients, of whom 14 also fulfilled ASAS criteria. No patients with negative global assessment for sacroiliitis fulfilled ASAS criteria. Sensitivity (SN) for JSpA was higher for global assessment (SN = 49%) than for ASAS definition (SN = 26%), but the ASAS definition was more specific (SP = 97% vs. 89%). Modifying adult ASAS criteria to allow bone marrow edema (BME) lesions seen on only one slice, synovitis or capsulitis, increased SN to 36%, 32% and 32% respectively, only slightly lowering SP. Including structural lesions increased SN to 28%, but lowered specificity to 95%. Conclusion: The adult ASAS definition for sacroiliitis has low sensitivity in children. A pediatric-specific definition of MRI-positive sacroiliitis including BME lesions visible on one slice only, synovitis and/or capsulitis may improve diagnostic utility, and increase relevance of MRI in pediatric rheumatology practice.
Keywords
ENTHESITIS-RELATED ARTHRITIS, SPONDYLOARTHRITIS RESEARCH CONSORTIUM, SOCIETY CLASSIFICATION CRITERIA, JUVENILE IDIOPATHIC ARTHRITIS, INFLAMMATORY BACK-PAIN, MAGNETIC-RESONANCE, ANKYLOSING-SPONDYLITIS, DIAGNOSTIC UTILITY, JOINT, VALIDATION, ASAS definition, Sacroiliitis, MRI, Juvenile spondyloarthritis

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MLA
Herregods, Nele, Jo Dehoorne, Filip Van den Bosch, et al. “ASAS Definition for Sacroiliitis on MRI in SpA : Applicable to Children?” PEDIATRIC RHEUMATOLOGY 15 (2017): n. pag. Print.
APA
Herregods, N., Dehoorne, J., Van den Bosch, F., Jaremko, J. L., Van Vlaenderen, J., Joos, R., Baraliakos, X., et al. (2017). ASAS definition for sacroiliitis on MRI in SpA : applicable to children? PEDIATRIC RHEUMATOLOGY, 15.
Chicago author-date
Herregods, Nele, Jo Dehoorne, Filip Van den Bosch, Jacob Lester Jaremko, Joke Van Vlaenderen, Rik Joos, Xenofon Baraliakos, et al. 2017. “ASAS Definition for Sacroiliitis on MRI in SpA : Applicable to Children?” Pediatric Rheumatology 15.
Chicago author-date (all authors)
Herregods, Nele, Jo Dehoorne, Filip Van den Bosch, Jacob Lester Jaremko, Joke Van Vlaenderen, Rik Joos, Xenofon Baraliakos, Gaëlle Varkas, Koenraad Verstraete, Dirk Elewaut, and Lennart Jans. 2017. “ASAS Definition for Sacroiliitis on MRI in SpA : Applicable to Children?” Pediatric Rheumatology 15.
Vancouver
1.
Herregods N, Dehoorne J, Van den Bosch F, Jaremko JL, Van Vlaenderen J, Joos R, et al. ASAS definition for sacroiliitis on MRI in SpA : applicable to children? PEDIATRIC RHEUMATOLOGY. 2017;15.
IEEE
[1]
N. Herregods et al., “ASAS definition for sacroiliitis on MRI in SpA : applicable to children?,” PEDIATRIC RHEUMATOLOGY, vol. 15, 2017.
@article{8522240,
  abstract     = {Background: The Assessment of Spondyloarthritis International Society (ASAS) definition for a'positive' Magnetic Resonance Imaging (MRI) for sacroiliitis is well studied and validated in adults, but studies about the value of this definition in children are lacking. The aim of this study is to evaluate whether the adult ASAS definition of a positive MRI of the sacroiliac joints can be applied to children with a clinical suspicion of Juvenile Spondyloarthritis (JSpA). 
Methods: Two pediatric musculoskeletal radiologists blinded to clinical data independently retrospectively reviewed sacroiliac (SI) joint MRI in 109 children suspected of sacroiliitis. They recorded global impression (sacroiliitis yes/no) and whether the adult ASAS definition for sacroiliitis was met at each joint. This was compared to goldstandard clinical diagnosis of JSpA. Additionally, MRI were scored according to'adapted' ASAS definitions including other features of sacroiliitis on MRI. 
Results: JSpA was diagnosed clinically in 47/109 (43%) patients. On MRI, sacroiliitis was diagnosed by global assessment in 30/109 patients, of whom 14 also fulfilled ASAS criteria. No patients with negative global assessment for sacroiliitis fulfilled ASAS criteria. Sensitivity (SN) for JSpA was higher for global assessment (SN = 49%) than for ASAS definition (SN = 26%), but the ASAS definition was more specific (SP = 97% vs. 89%). Modifying adult ASAS criteria to allow bone marrow edema (BME) lesions seen on only one slice, synovitis or capsulitis, increased SN to 36%, 32% and 32% respectively, only slightly lowering SP. Including structural lesions increased SN to 28%, but lowered specificity to 95%. 
Conclusion: The adult ASAS definition for sacroiliitis has low sensitivity in children. A pediatric-specific definition of MRI-positive sacroiliitis including BME lesions visible on one slice only, synovitis and/or capsulitis may improve diagnostic utility, and increase relevance of MRI in pediatric rheumatology practice.},
  articleno    = {24},
  author       = {Herregods, Nele and Dehoorne, Jo and Van den Bosch, Filip and Jaremko, Jacob Lester and Van Vlaenderen, Joke and Joos, Rik and Baraliakos, Xenofon and Varkas, Gaëlle and Verstraete, Koenraad and Elewaut, Dirk and Jans, Lennart},
  issn         = {1546-0096},
  journal      = {PEDIATRIC RHEUMATOLOGY},
  keywords     = {ENTHESITIS-RELATED ARTHRITIS,SPONDYLOARTHRITIS RESEARCH CONSORTIUM,SOCIETY CLASSIFICATION CRITERIA,JUVENILE IDIOPATHIC ARTHRITIS,INFLAMMATORY BACK-PAIN,MAGNETIC-RESONANCE,ANKYLOSING-SPONDYLITIS,DIAGNOSTIC UTILITY,JOINT,VALIDATION,ASAS definition,Sacroiliitis,MRI,Juvenile spondyloarthritis},
  language     = {eng},
  pages        = {10},
  title        = {ASAS definition for sacroiliitis on MRI in SpA : applicable to children?},
  url          = {http://dx.doi.org/10.1186/s12969-017-0159-z},
  volume       = {15},
  year         = {2017},
}

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