Consensus-driven conceptual development of a standardized whole body-MRI scoring system for assessment of disease activity in juvenile idiopathic arthritis: MRI in JIA OMERACT working group

Panwar, Jyoti; Tolend, Mirkamal; Redd, Bernadette; Srinivasalu, Hemalatha; Colbert, Robert A.; Akikusa, Jonathan; Appenzeller, Simone; Carrino, John A.; Herregods, Nele; Jans, Lennart; Highmore, Kerri; Kalle, Thekla von; Kirkhus, Eva; Rumsey, Dax G.; Jaremko, Jacob L.; Clemente, Inarejos Emilio J.; Rossum, Marion A. van; Stimec, Jennifer; Tse, Shirley M. L.; Twilt, Marinka; Tzaribachev, Nikolay; Sudoł‐Szopińska, Iwona; Meyers, Arthur B.; Doria, A.

doi:10.1016/j.semarthrit.2021.07.017

Cited by 19 publications

(21 citation statements)

References 14 publications

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“…Stage 1 effusion, which was a trace of fluid (thickness ≤ 2 mm) was also used in other researchers' staging systems for hip joint [4,27,37]. At the same time, such small amounts of fluid in the hip were detected in healthy joints and was regarded as physiologic [22,37]. In a study performed on adult patients with normal and ischemic hips [37], stage 1 fluid was seen in the majority of asymptomatic hips (95%), whereas stage 2 fluid (surrounding the femoral neck) was present in only four hips (5%) and none had stage 3 effusion.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, even though macrocyclic contrast agents have not been suspended, they should still be used with care and a strict indication [20]. The new term "effusion/synovial thickening" was used lately by Panwar et al [22] defined as "an increased amount (greater than physiologic) of high signal intensity within the joint space distending the joint capsule on T2-weighted fat-saturated or STIR or fluid sensitive sequences". "Effusion/synovial thickening" was considered altogether as a single item as it is often difficult to differentiate these two findings by MRI without intravenous administration of contrast [22].…”

Section: Introductionmentioning

confidence: 99%

“…The new term "effusion/synovial thickening" was used lately by Panwar et al [22] defined as "an increased amount (greater than physiologic) of high signal intensity within the joint space distending the joint capsule on T2-weighted fat-saturated or STIR or fluid sensitive sequences". "Effusion/synovial thickening" was considered altogether as a single item as it is often difficult to differentiate these two findings by MRI without intravenous administration of contrast [22]. In addition to synovitis and osteitis, other inflammatory lesions that may be seen in children with JIA include bursitis, enthesitis and myositis [23][24][25][26].…”

Section: Introductionmentioning

confidence: 99%

“…Several scoring systems for juvenile hip arthritis assessment on MRI have been proposed [4,5,11,27,28]; however, none of them includes all the above-mentioned items in JIA (i.e., active, destructive and developmental) and, to date, a validated MRI scoring system for assessing the hips in JIA has not been established [29]. An important methodological work on standardizing the whole-body-MRI scoring system, including the hip joint, for assessment of disease activity in JIA was published in 2021 by the MRI in JIA OMERACT working group [22].…”

Section: Introductionmentioning

confidence: 99%

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MRI Findings in Hip in Juvenile Idiopathic Arthritis

Ostrowska

Gietka

Mańczak

et al. 2021

JCM

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The aim of this study was to evaluate if magnetic resonance imaging allows hip arthritis in JIA to be differentiated from hip arthralgia of unknown etiology in juveniles clinically suspected for hip arthritis. This was a retrospective observational study which included 97 children with clinically suspected hip arthritis. Each hip was assessed and scored in MRI for signs of active and destructive inflammatory lesions and developmental lesions. MRI findings between JIA-confirmed patients and without final diagnosis of JIA were compared and the MRI summarized score was calculated, as the sum of scorings of all 24 hip lesions in an individual patient (i.a., effusion, synovitis, bone marrow edema, enthesitis). MRI showed at least one lesion in the majority of patients (95 patients; 98%). Effusion was the most common feature, followed by bone marrow oedema and synovitis. All lesions were more common in patients with a final diagnosis of JIA, especially synovitis and enthesitis (p = 0.037 and p = 0.047). The MRI summarized score was significantly higher in the JIA group than the non-JIA group: 3 (2–5) vs. 2 (2–2), respectively, p = 0.002. Using a cut-off score of 6, the MRI summarized score showed 25% sensitivity and 100% specificity indicating a good ability in discriminating hip arthritis during JIA from non-JIA patients. MRI allows hip arthritis in JIA to be differentiated from hip arthralgia of unknown etiology with good specificity, thus, may be helpful in confirming the diagnosis of JIA.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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MRI Findings in Hip in Juvenile Idiopathic Arthritis

Ostrowska

Gietka

Mańczak

et al. 2021

JCM

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“…Most accurately joint effusions and synovitis are distinguished on postcontrast MRI images using gadolinium injection [1,22]. Since there is no evidence to date that gadolinium accumulation in the brain and kidneys is harmful to the human body [23,24], with hypothetical cumulative and long term effects of retained gadolinium, it warrants special attention while making decisions when performing contrast examination in children and young adults [25], and indicates the need to investigate the non-contrast MRI to assess inflammation in the pediatric population [23,24].…”

Section: Introductionmentioning

confidence: 99%

Ankle Magnetic Resonance Imaging in Juvenile Idiopathic Arthritis Versus Non-Juvenile Idiopathic Arthritis Patients with Arthralgia

Ostrowska

Gietka

et al. 2022

JCM

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This retrospective case–control study aimed to evaluate whether Magnetic Resonance Imaging (MRI) enables differentiation of ankle arthritis in Juvenile Idiopathic Afrthritis JIA from ankle arthralgia of unknown aetiology in patients clinically suspected of JIA. Forty-four children, at ages 5–16, who underwent MRI of the ankle from January 2016 to March 2021 for clinically suspected active ankle arthritis in the course of JIA were included. MRI findings in both groups—patients with the final diagnosis of JIA and without final diagnosis of JIA—were compared and scored. The sum of the scores of 22 ankle lesions in an individual patient (active, destructive and developmental), so-called the MRI summarized score, was calculated and tested in terms of the most optimal diagnosis of JIA. Interobserver agreement was calculated. Inflammatory features were seen on MRI in 38 out of all the included patients (86%). The most common lesions in both groups were effusion in the tibio-talar joint (68% in JIA and 64% in the arthralgia group) and effusion in subtalar joint (64% in JIA vs. 59% in the arthralgia group). In general, more lesions were identified in the JIA group than in non-JIA. However, only tenosynovitis was significantly more common in the JIA vs. non-JIA group (p = 0.031). The MRI summarized score did not allow for discrimination between ankle arthritis in JIA from non-JIA patients; the best levels of sensitivity (32%), specificity (91%), positive predictive value PPV (78%) and negative predictive value NPV (57%) were achieved only at the cut-off point of 10.

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