SAT0417 Impact of an online training on MRI sacroiliac joints reading and active SPA sacroiliitis diagnosing
Authors: T. Pham, C. Hacquard-Bouder, F. Roux, A. Cotten, D. Loeuille, J. Malghem, L. Dunogeant, P. Claudepierre, P. Goupille, D. Wendling, F. Tubach
Journal: Annals of the Rheumatic Diseases (2013)

<h3>Background</h3> New axial SpA classification criteria have recently been established in which MRI of the sacroiliac joint (SIJ) is key in the imaging arm. The ASAS/OMERACT MRI group have described and defined MRI findings that are essential for the diagnosis of sacroiliitis in patients with axial SpA. <h3>Objectives</h3> We proposed to train rheumatologists online on SIJ MRI reading and to assess the impact of this training on their SpA sacroiliitis (SI) diagnosis accuracy. <h3>Methods</h3> 168 French rheumatologists, not members of ASAS or OMERACT, were invited to participate to this nationwide prospective randomized controlled trial. <i>Study design:</i> After a baseline reading test (test 1), rheumatologists were randomized in 2 groups: Group 1 had access to 3 e-learning sessions: on elementary MRI lesions, active SpA SI diagnosis (including images from the ASAS/OMERACT consensus), and differential diagnoses. Two weeks after the e-learning session, rheumatologists were asked to redo an online test (test 2). Group 2 was the control group, without e-learning before test 2. The reading test consisted on 15 MRI files including 7 SpA SI, 6 differential diagnosis and 2 normal SIJ. During test, rheumatologists were asked to click on areas they considered as being an MRI lesion according to the ASAS/OMERACT consensus: bone marrow edema/osteitis, synovitis, enthesitis, capsulitis, sclerosis, erosions, fat deposition and ankylosis. Then, they were asked to give their diagnosis (SpA active SI yes/no) and to grade their diagnosis confidence on a 0-10 scale. Test 1 and 2 file presentation orders were different. The main outcome criterion was the rate of adequate diagnosis for SI at test 2 compared to the diagnosis made by an experts panel. <i>Analysis:</i> The rate of adequate diagnoses at test 2 was compared between groups using a multiple linear regression adjusted on baseline value. Elementary lesions associated to SI diagnosis were evaluated using a multivariate logistic regression. <h3>Results</h3> Answers of 161 rheumatologists (male: 52%, mean age: 43±11 years) were analysable (Group 1: 80 and Group 2: 81). Characteristics of both groups were similar. At test 1, 69±12% diagnosed SpA active SI were adequate and mean rate of adequate identification of the elementary lesions was 32±23%. Elementary lesions that were significantly associated to SpA sacroiliitis diagnosis were bone marrow edema (OR=6.91), ankylosis (OR=6.13), enthesitis (OR=4.24) and synovitis (OR=3.45). Elementary lesions significantly associated to a reject of diagnosis of SpA active SI were fracture (OR=0.00), soft tissues inflammation (OR=0.06) and fat deposition (OR=0.50). At test 2, the proportion of adequate diagnoses was equal in both groups: 72±11%. Considering diagnosis with a level of confidence ≥9/10, the proportion of adequate diagnoses was statistically higher in the e-learning group (Group 1: 24±2% and Group 2: 19±2%; p=0.044). <h3>Conclusions</h3> French rheumatologists already correctly diagnosed SI on MRI. E-learning sessions reinforced the level of confidence in SI diagnosis in rheumatologists that adequately made that diagnosis. <h3>Disclosure of Interest</h3> T. Pham Consultant for: Abbott, C. Hacquard-Bouder Employee of: Abbott, F. Roux Consultant for: Abbott, A. Cotten Paid Instructor for: Abbott, D. Loeuille Paid Instructor for: Abbott, J. Malghem Paid Instructor for: Abbott, L. Dunogeant: None Declared, P. Claudepierre Consultant for: Abbott, P. Goupille Consultant for: Abbott, D. Wendling Consultant for: Abbott, F. Tubach Consultant for: Abbott