ObjectiveBone marrow lesions (BML) are an MRI feature of osteoarthritis (OA) offering a potential target for therapy. We developed the Knee Inflammation MRI Scoring System (KIMRISS) to semiquantitatively score BML with high sensitivity to small changes, and compared feasibility, reliability and responsiveness versus the established MRI Osteoarthritis Knee Score (MOAKS).MethodsKIMRISS incorporates a web-based graphic overlay to facilitate detailed regional BML scoring. Observers scored BML by MOAKS and KIMRISS on sagittal fluid-sensitive sequences. Exercise 1 focused on interobserver reliability in Osteoarthritis Initiative observational data, with 4 readers (two experienced/two new to KIMRISS) scoring BML in 80 patients (baseline/1 year). Exercise 2 focused on responsiveness in an open-label trial of adalimumab, with 2 experienced readers scoring BML in 16 patients (baseline/12 weeks).ResultsScoring time was similar for KIMRISS and MOAKS. Interobserver reliability of KIMRISS was equivalent to MOAKS for BML status (ICC=0.84 vs 0.79), but consistently better than MOAKS for change in BML: Exercise 1 (ICC 0.82 vs 0.53), Exercise 2 (ICC 0.90 vs 0.32), and in new readers (0.87–0.92 vs 0.32–0.51). KIMRISS BML was more responsive than MOAKS BML: post-treatment BML improvement in Exercise 2 reached statistical significance for KIMRISS (SRM −0.69, p=0.015), but not MOAKS (SRM −0.12, p=0.625). KIMRISS BML also more strongly correlated to WOMAC scores than MOAKS BML (r=0.80 vs 0.58, p<0.05).ConclusionsKIMRISS BML scoring was highly feasible, and was more reliable for assessment of change and more responsive to change than MOAKS BML for expert and new readers.

SUMMARY:Use of advanced imaging in the emergency department has been increasing in the United States during the past 2 decades. This trend has been most notable in CT, which has increased concern over the effects of increasing levels of medical ionizing radiation. MR imaging offers a safe, nonionizing alternative to CT and is diagnostically superior in many neurologic conditions encountered in the emergency department. Herein, we describe the process of developing and installing a dedicated MR imaging scanner in the Neuroscience Emergency Department at the Barrow Neurological Institute and its effects on neuroradiology and the emergency department in general.

49,XXXXY is a rare aneuploidy with neuroanatomic findings scarcely reported in the literature. Given the fact that many of its phenotypic characteristics are similar to Klinefelter patients, 49,XXXXY has been treated as a variant of Klinefelter syndrome in the past. Newer studies have shown that intellectual disabilities and cardiac sequelae are more common in 49,XXXXY making the need for more precise characterization of the disorder essential. Prior case studies have demonstrated focal (and to a lesser extent confluent) white abnormalities as well as enlarged perivascular cysts (often in clustered arrangements) in the brains of these patients, but high resolution magnetic resonance images of severe myelinopathy are infrequently documented. Presented here is an exceptional manifestation of this rare disease with substantial findings in the brain exhibiting both confluent white matter changes and diffuse perivascular cysts. Cases such as this one serve to expand the differential considerations for confluent dysmyelinating disease and improve diagnostic efficacy.

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