Gender as an important criteria in axSpA MRI assessment

22 Jul 2022

In the European Congress of Rheumatology 2022 (EULAR 2022)on the rheumatologic disease management, Dr. Sevtap Tugce Ulasfrom the Charité Universitätsmedizin of Berlin, Germany, presentedher study on gender-specific differences in magnetic resonanceimaging (MRI) among patients with axial spondyloarthritis (axSpA).1

Evidence from scientific literature and clinical practice has shedlight on the existence of gender differences in axSpA, with menhaving a higher risk of damage and women having a higher riskof peripheral manifestations, such as pain, stiffness and fatigue.1Women have shown a higher disease activity and a lower responseto therapy than men.1 Low back pain was more associated withdegenerative or mechanical stress-induced diseases among women.1The differences in joint biomechanics among gender may be areason behind these disparities and can contribute to the delayeddisease diagnosis in females.1


As imaging is an important tool in the diagnostic work-up of axSpA, this study was conducted to compare the diagnostic performance of MRI findings between men and women.1


In this post-hoc analysis, MRI images of the standard T1-weighted scanand the short-TI inversion recovery (STIR) sequence were obtained,while erosion, sclerosis, bone marrow edema, fat metaplasia andankylosis were assessed at 3 joint levels, namely the ventral, middleand dorsal levels.1

In this study, patients from 6 different perspective of axSpA cohorts were included. Of the 684 patients identified with clinical diagnosis and complete imaging data, 379 were men and women with axSpA, and 305 were without axSpA.1

Baseline characteristics showed equal distribution of men and womenwith no major gender differences for erosions and bone marrowedema.1 However, there was a significantly higher prevalence of fatmetaplasia in men and sclerosis in women.1

The results demonstrated a significant difference between menand women in all parameters, with the most significant differenceobserved for ankylosis showing a 10x stronger performance in men.Dr. Ulas explained that this difference was not only due to the lowprevalence in females, but also the higher rates of false positives.1Furthermore, erosion and fat metaplasia were also slightly higher inmen, while sclerosis and bone marrow edema were higher in women.1

Moreover, Dr. Ulas acknowledged the limitations of the study, includingthe use of a conventional T1-weighted spin-echo sequence that mayoverestimate damage, the intensity of bone marrow edema wasnot a part of the semi-quantitative scoring system, and the MRIimages under investigation were used in the diagnostic process,which carried the risk of circular reasoning.1

In conclusion, differences in the imaging appearance between men andwomen exist, except for bone marrow edema, and that the diagnosticperformance on MRI is lower in women as ankylosis leads to falsepositives in females.1 These findings might spark future revision onthe appropriateness of incorporating sex-specific recommendationsin the imagining criteria.1

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