Introduction of a novel magnetic resonance imaging tenosynovitis score for rheumatoid arthritis: reliability in a multireader longitudinal study

Abstract

Objectives: To describe a novel scoring system for the assessment of tenosynovitis by magnetic resonance imaging (MRI) in patients with rheumatoid arthritis, and assess its intra-and inter-reader reliability in a multireader, longitudinal setting. Methods: Flexor and extensor tenosynovitis were evaluated at the level of the wrist in 10 different anatomical areas, graded semi-quantitatively from grade 0 to 3 (total score 0-30), based on the maximum width of postcontrast enhancement within each anatomical area on axial T1-weighted MR images. Ten sets of baseline and 1-year follow-up MR images of the wrists of patients with rheumatoid arthritis with early and established disease were scored independently by four readers twice on 2 consecutive days. Intra-and inter-reader agreements were evaluated. Results: The intrareader intraclass correlation coefficients (ICCs) were high for status scores (median ICCs 0.84-0.88) and slightly lower for change score (0.74). The smallest detectable difference (SDD) in % of the maximum score was 11.2-11.5% for status scores and 13.3% for change scores. Inter-reader single-measure ICCs were acceptable for both status scores (median 0.73-0.74) and change scores (0.67), while averagemeasures ICCs were very high for both status and change score (all >0.94). The median scoring time per patient (baseline and follow-up images) was 7 min (range 3-10). Conclusions: The introduced tenosynovitis scoring system demonstrates a high degree of multireader reliability, is feasible, and may be used as an adjuvant to the existing OMERACT RAMRIS score, allowing improved quantification of inflammatory soft tissue changes in patients with rheumatoid arthritis.

The impact of MRI on the clinical management of inflammatory arthritides

“…A EULAR-OMERACT RA MRI reference image atlas has been developed, providing an easy-to-use tool for standardized RAMRIS scoring of MR images for RA activity and damage by comparison with reference images [91]. Scoring systems for tenosynovitis [92] and joint space narrowing [93] may be used in addition to the OMERACT scoring system.…”

Niederfeldmagnetresonanztomographie bei rheumatoider Arthritis

“…Eine semiquantitatives Scoring von entzündlichen Veränderungen der Sehnenscheiden, welche durchaus als Frühzeichen der RA zu werten sind [2], wird durch den RAMRIS-Score nicht abgedeckt. Für das Hochfeld-MRT wurden daher von verschiedenen Arbeitsgruppen bereits Vorschläge für semiquantitative Tenosynovitisscores entwickelt [10]. Enthesitis: Entzündliche Weichteilveränderungen (z.…”

Revmatoid artritt

“…Konvensjonelle røntgenbilder er fortsatt standardmetoden for å vurdere tilstedevaerelse og endring i skjelettskade, og van der Heijdes modifisering av Sharp 3 score synes i dag å vaere mer brukt enn skå-ringssystemet som ble utviklet av Arvi Larsen og Knut Dale 68 . Det forventes at både ultralyd og spesielt MRI vil får en økende anvendelse fordi man kan bedømme inflammasjon, og erosjoner påvises tidligere [69][70][71] . Ved ultralyd kan man også diagnostisere canalis carpi syndrom 72 .…”