Defining and validating a high specificity MRI cut-off for the radiographic part of the modified New York criteria in patients with axial spondyloarthritis

BACKGROUND: According to the modified New York criteria (mNYc), moderate-severe sacroiliac joint (SIJ) structural damage on radiography is necessary for classifying radiographic axial spondyloarthritis (r-axSpA). In contrast to radiography, MRI provides no ionizing radiation, higher sensitivity for structural damage, better inter-reader reliability, and is gradually replacing radiography. Therefore, we aimed to develop and validate a high specificity MRI cut-off to the radiographic component of the mNYc (rad-mNYc), defined as MRI findings that correspond to an mNY-positive radiograph. METHODS: based on erosion, backfill and ankylosis in 5/all slices) and ROC curves were calculated. Internal validation by bootstrapping was performed. RESULTS: predicting rad-mNYc (specificity 0.95, sensitivity 0.39, area-under-curve 0.83, accuracy with mNYc 69.2%. Internal validation showed moderate accuracy and high positive predictive value. Cut-offs for sclerosis, erosion, backfill and ankylosis were ≥ 9, ≥12, ≥ 5, and ≥ 1, respectively, with sensitivities all ≤ 0.21 except ankylosis 0.34 and accuracy ~ 60%, except ankylosis 67%. Cut-offs using all MRI-slices performed slightly worse or similarly. CONCLUSIONS: ) was the optimal high specificity MRI cut-off to rad-mNYc positivity, being potentially usable in both research and clinical settings, with different thresholds depending on whether sensitivity or specificity is prioritized.

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Publication Details

Journal
Arthritis Research & Therapy
Published
2026-07-17
DOI
https://doi.org/10.1186/s13075-026-03865-z
Primary Topic
Spondyloarthritis Studies and Treatments
Type
article
Field-Weighted Citation Impact
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article

Defining and validating a high specificity MRI cut-off for the radiographic part of the modified New York criteria in patients with axial spondyloarthritis

Simon Krabbe, Stylianos Georgiadis, Torsten Diekhoff, Adrian Ciurea et al.
Arthritis Research & Therapy
Spondyloarthritis Studies and Treatments
article

Defining and validating a high specificity MRI cut-off for the radiographic part of the modified New York criteria in patients with axial spondyloarthritis

Simon Krabbe, Stylianos Georgiadis, Torsten Diekhoff, Adrian Ciurea, Jakub Závada, Manouk de Hooge, Susanne Juhl Pedersen, Raphael Micheroli, Iwona Sudoł‐Szopińska, Lykke Midtbøll Ørnbjerg, Nora Vladimirova, Karlo Pintarić, Monika Gregová, Björn Guðbjörnsson, Merete Lund Hetland, Kristýna Bubová, Žiga Snoj, Marie Wetterslev, A. E. F. Hadsbjerg, Žiga Rotar, Alexander Bernatschek, Maurice Donzallaz, Iris Eshed, Karel Gorican, Robert GW Lambert, Kasper Gosvig, Stephanie Wichuk, Jakob M Møller, Burkhard Möller, Michael J. Nissen, Mikkel Østergaard
article en

Abstract

BACKGROUND: According to the modified New York criteria (mNYc), moderate-severe sacroiliac joint (SIJ) structural damage on radiography is necessary for classifying radiographic axial spondyloarthritis (r-axSpA). In contrast to radiography, MRI provides no ionizing radiation, higher sensitivity for structural damage, better inter-reader reliability, and is gradually replacing radiography. Therefore, we aimed to develop and validate a high specificity MRI cut-off to the radiographic component of the mNYc (rad-mNYc), defined as MRI findings that correspond to an mNY-positive radiograph. METHODS: based on erosion, backfill and ankylosis in 5/all slices) and ROC curves were calculated. Internal validation by bootstrapping was performed. RESULTS: predicting rad-mNYc (specificity 0.95, sensitivity 0.39, area-under-curve 0.83, accuracy with mNYc 69.2%. Internal validation showed moderate accuracy and high positive predictive value. Cut-offs for sclerosis, erosion, backfill and ankylosis were ≥ 9, ≥12, ≥ 5, and ≥ 1, respectively, with sensitivities all ≤ 0.21 except ankylosis 0.34 and accuracy ~ 60%, except ankylosis 67%. Cut-offs using all MRI-slices performed slightly worse or similarly. CONCLUSIONS: ) was the optimal high specificity MRI cut-off to rad-mNYc positivity, being potentially usable in both research and clinical settings, with different thresholds depending on whether sensitivity or specificity is prioritized.

Arthritis Research & Therapy
Reykjavík University (IS), University of Copenhagen (DK), University of Ljubljana (SI), University of Alberta (CA), University of Iceland (IS), Charles University (CZ), Sheba Medical Center (IL), University Hospital of Bern (CH), Ghent University Hospital (BE), Ljubljana University Medical Centre (SI), Herlev Hospital (DK), Glostrup Hospital (DK), Gentofte Hospital (DK), Institute of Oncology Ljubljana (SI), Institute of Rheumatology (CZ), University Hospital of Zurich (CH), University Hospital of Geneva (CH), National University Hospital of Iceland (IS), National Institute of Geriatrics, Rheumatology and Rehabilitation (PL), LungenClinic Grosshansdorf (DE), Université de Montréal (CA)
Københavns Universitet
Zero hunger
Openalex Percentile: Top 8%
Spondyloarthritis Studies and Treatments
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