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Master Thesis

Place de l’IRM dans le diagnostic des spondyloarthrites et évaluation de l’intérêt de l’injection de gadolinium : étude prospective monocentrique sur une période de 5 ans

Abstract : Background: the performance of spinal MRI for the diagnosis of spondyloarthritis (SpA) is still contentious. However, MRI with injection of gadolinium could be more sensitive in demonstrating sites of enthesis improving diagnostic strategy. Purpose: to evaluate the performance of the MRI in 2013 with and without injection of contrast compared to the clinical evolution, 5 years after the initial diagnosis and to assess the benefit of the gadolinium injection in the SpA diagnosis strategy. Materials and Methods: In this single-center prospective study, 165 patients with chronic low back pain who underwent both spinal and sacroiliac (SI) joints MRI in a radiology department were recruited between May 2013 and January 2014. Clinical, biological and radiologic parameters were collected. Three independent readers identified the presence of specific radiological features of SpA by using a five-point Likert scale to record the estimation of confidence. The centralized MRI interpretation from 2013 was compared to the established diagnosis in 2013 and at 5-year follow-up. The nonparametric Mann-Whitney, Fisher and McNemar X2 tests were conducted to compare quantitative and qualitative variables and sensitivity and specificity respectively. Results: a total of 145 patients were included in the final analysis. During the 5 years of follow-up, between 2013 and 2018, the evaluation by the rheumatologist led to a decrease of patients with SpA diagnosis from 93 to 58. Sensitivity of MRI realized in 2013 was increased and specificity was decreased. Compared to MRI without contrast, injection of gadolinium improved sensitivity but not specificity. By revealing enthesitis, the use of contrast injection increased correct diagnosis of SpA by 20% after 5 years of follow-up. Conclusion: the injection of gadolinium improve the visualization of enthesitis, including spinal posterior elements and increase the sensitivity of the MRI in some doubtful cases of SpA.
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Submitted on : Tuesday, January 21, 2020 - 11:49:00 AM
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Raphaëlle Meunier. Place de l’IRM dans le diagnostic des spondyloarthrites et évaluation de l’intérêt de l’injection de gadolinium : étude prospective monocentrique sur une période de 5 ans. Sciences du Vivant [q-bio]. 2019. ⟨dumas-02446946⟩

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