Skeletal radiology · 2026
Underreporting of sacroiliac joint structural abnormalities on routine abdominal CT in axial spondyloarthritis: a longitudinal workflow analysis.
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Kalaslioglu Basak Gulsah, Yardimci Hasan, Yuce Inel Tuba, Balci Ali, Sari Ismail
Аннотация
OBJECTIVE: To quantify documentation of predefined, conspicuous sacroiliac joint (SIJ) structural abnormalities on routine abdominal CT in patients with established axial spondyloarthritis (axSpA) and identify associated factors.
MATERIALS AND METHODS: This retrospective longitudinal study evaluated 516 abdominal CT examinations from 188 patients with established SpA. Two readers applied a predefined hierarchical SIJ classification, with adjudication of disagreements. The primary analysis included 226 Moderate or Major examinations; all had fusion-based patterns. Patient-clustered logistic generalized estimating equations included workflow, request-level context, structural severity, prior recognition, and scan year.
RESULTS: SIJ findings were absent from 152 of 226 reports (67.3%). Total fusion was unreported in 90 of 136 examinations (66.2%), including 83 of 129 with bilateral total fusion (64.3%). Crude non-reporting was 89.2% in acute care and 50.0% in rheumatology. The four-examination MSK-oriented subgroup was combined with rheumatology for modeling. Adjusted non-reporting was 82.7% in acute care and 50.6% in the combined MSK-pathway, a 32.1-point difference (95% CI, 6.2-52.0); the corresponding OR was 0.20 (95% CI, 0.05-0.75). Structural severity and request-level context were not independently associated with non-reporting.
CONCLUSION: Documentation of conspicuous SIJ structural abnormalities on routine abdominal CT was frequently absent and varied by workflow. Including a field for SIJ findings in structured abdominal CT reports may lead more radiologists to look for joint abnormalities. Automated detection requires external and prospective validation before clinical implementation.
MATERIALS AND METHODS: This retrospective longitudinal study evaluated 516 abdominal CT examinations from 188 patients with established SpA. Two readers applied a predefined hierarchical SIJ classification, with adjudication of disagreements. The primary analysis included 226 Moderate or Major examinations; all had fusion-based patterns. Patient-clustered logistic generalized estimating equations included workflow, request-level context, structural severity, prior recognition, and scan year.
RESULTS: SIJ findings were absent from 152 of 226 reports (67.3%). Total fusion was unreported in 90 of 136 examinations (66.2%), including 83 of 129 with bilateral total fusion (64.3%). Crude non-reporting was 89.2% in acute care and 50.0% in rheumatology. The four-examination MSK-oriented subgroup was combined with rheumatology for modeling. Adjusted non-reporting was 82.7% in acute care and 50.6% in the combined MSK-pathway, a 32.1-point difference (95% CI, 6.2-52.0); the corresponding OR was 0.20 (95% CI, 0.05-0.75). Structural severity and request-level context were not independently associated with non-reporting.
CONCLUSION: Documentation of conspicuous SIJ structural abnormalities on routine abdominal CT was frequently absent and varied by workflow. Including a field for SIJ findings in structured abdominal CT reports may lead more radiologists to look for joint abnormalities. Automated detection requires external and prospective validation before clinical implementation.