Toward Developing a Semiquantitative Whole Body-MRI Scoring for Juvenile Idiopathic Arthritis: Critical Appraisal of the State of the Art, Challenges, and Opportunities

Panwar, Jyoti; Patel, Hiten J; Tolend, Mirkamal; Akikusa, Jonathan; Herregods, Nele; Highmore, Kerri; Clemente, Emilio J. Inarejos; Jans, Lennart; Jaremko, Jacob L.; Kalle, Thekla von; Kirkhus, Eva; Meyers, Arthur B.; Rossum, Marion A. van; Rumsey, Dax G.; Stimec, Jennifer; Tse, Shirley M. L.; Twilt, Marinka; Tzaribachev, Nikolay; Doria, A.

doi:10.1016/j.acra.2020.01.022

Cited by 16 publications

(7 citation statements)

References 78 publications

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“…In our study, we addressed one basic step toward a scoring system for whole-body MRI, namely reliability of identifying and grading bone marrow findings. In a recent review, Panwar and colleagues [ 20 ] describe their initial consensus-driven phase toward developing a whole-body MRI scoring system for screening juvenile idiopathic arthritis patients. Through Delphi surveys, experts within the field suggested that a coronal fluid sensitive sequence, either a short tau inversion recovery (STIR) or a fat-suppressed T2-weighted sequence with additional images for specific parts of the body, would suffice.…”

Section: Discussionmentioning

confidence: 99%

Whole-body MRI in children aged 6–18 years. Reliability of identifying and grading high signal intensity changes within bone marrow

et al. 2022

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Background Whole-body magnetic resonance imaging (MRI) is increasingly being used in children, however, to date there are no studies addressing the reliability of the findings. Objective To examine intra- and interobserver reliability of a scoring system for assessment of high signal areas within the bone marrow, as visualized on T2-weighted, fat-saturated images. Materials and methods Ninety-six whole-body MRIs (1.5 T) in 78 healthy volunteers (mean age: 11.5 years) and 18 children with chronic nonbacterial osteomyelitis (mean age: 12.4 years) were included. Coronal water-only Dixon T2-weighted images were used to score the left lower extremity/pelvis for high signal intensity areas, intensity (0–2 scale), extension (0–4 scale) and shape and contour in a blinded fashion by two pairs of radiologists. Results For the pelvis, grading of bone marrow signal showed moderate to good intra- and interobserver agreement with kappa values of 0.51–0.94 and 0.41–0.87, respectively. Corresponding figures for the femur were 0.61–0.68 within and 0.32–0.61 between observers, and for the tibia 0.60–0.72 and 0.51–0.73. Agreement for assessing extension was moderate to good both within and between observers for the pelvis (k = 0.52–0.85 and 0.35–0.80), for the femur (0.52–0.67 and 0.51–0.60) and for the tibia (k = 0.59–0.69 and 0.47–0.63) except for the femur metaphysis/diaphysis, with interobserver kappa values of 0.29–0.30. Scoring of shape was moderate to good within observers, but in general poorer between observers, with kappa values of 0.40–0.73 and 0.18–0.69, respectively. For contour, the corresponding figures were 0.35–0.62 and 0.09–0.54, respectively. Conclusion MRI grading of intensity and extension of high signal intensity areas within the bone marrow of pelvis and lower limb performs well and thus can be used interchangeably by different observers, while assessment of shape and contour is reliable for the same observer but is less reliable between observers. This should be considered when performing clinical trials.

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Section: Discussionmentioning

confidence: 99%

Whole-body MRI in children aged 6–18 years. Reliability of identifying and grading high signal intensity changes within bone marrow

et al. 2022

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“…Short tau inversion recovery (STIR) and T1W are the basic sequences in the WB-MRI. STIR, also known as short TI inversion recovery, provides an overall view of the inflammation present in tendons, bones, joints, and enthesis [10]. The STIR is a fat suppression technique with an inversion time: TI = ln(2)•T1 fat .…”

Section: Wb-mri: Acquisition Techniquesmentioning

confidence: 99%

“…The application of another 90 • excitation pulse in this period provides an image in which the fat signal is suppressed, thus there would not be any representation of the fat tissue in the final image [11]; it is usually acquired in coronal planes (Figure 2). Conversely, the T1 sequence offers better anatomic detail and allows for the identification of both disease-related structural changes and bone edema [10].…”

Section: Wb-mri: Acquisition Techniquesmentioning

confidence: 99%

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Whole-Body MRI in Rheumatology: Major Advances and Future Perspectives

et al. 2021

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Whole-body magnetic resonance imaging is constantly gaining more importance in rheumatology, particularly for what concerns the diagnosis, follow-up, and treatment response evaluation. Initially applied principally for the study of ankylosing spondylitis, in the last years, its use has been extended to several other rheumatic diseases. Particularly in the pediatric population, WB-MRI is rapidly becoming the gold-standard technique for the diagnosis and follow-up of both chronic recurrent multifocal osteomyelitis and juvenile spondyloarthritis. In this review, we analyze the benefits and limits of this technique as well as possible future applications.

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“…Herregods et al determined the diagnostic value of enthesitis on pelvic MRIs in patients with ERA, and noted high correlation between pelvic enthesitis and sacroiliitis (69). WBMRI is increasingly being used in the pediatric population to determine the overall inflammatory and structural burden of synovitis and enthesitis (70). Enthesitis has been included in the inflammatory MRI components of the recently developed OMERACT juvenile idiopathic arthritis MRI score (71).…”

Section: Utility Of Mri In Enthesitis In Juvenile Arthritismentioning

confidence: 99%

Magnetic Resonance Imaging of Enthesitis in Spondyloarthritis, Including Psoriatic Arthritis—Status and Recent Advances

Mathew

Østergaard

2020

Front. Med.

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Enthesitis, inflammation at the attachment sites of tendons, ligaments, fascia, and joint capsules to bones plays a critical role in the pathogenesis of spondyloarthritis (SpA), including psoriatic arthritis (PsA). Magnetic resonance imaging (MRI) has aided in a better understanding of pathophysiology, early diagnosis, prognostication, therapeutic outcomes, and follow up of enthesitis. The concept of enthesitis as a focal insertional pathology has transformed over the past decade, with the help of MRI, to a more widespread entity involving both bone and surrounding soft tissues. The utility of MRI in the differential diagnosis of suspected enthesitis has recently been explored. With the emergence of the treat-to-target concept, and a domain-based approach in the management of SpA, objective and sensitive monitoring of response to targeted therapy becomes prudent. Properties like high sensitivity, ability to image intra-osseous pathology along with surrounding structures exemplify the utility of MRI technology. Considering the lack of a comprehensive, validated MRI score the Outcome Measures in Rheumatology (OMERACT) MRI in Arthritis Working Group, informed by a systematic literature review, developed the first international, consensus-based MRI-scoring system, combined with MRI definitions of pathologies for enthesitis in patients with spondyloarthritis (SpA) and PsA. An atlas with representative images of each grade of the scoring system was subsequently developed by the group to aid readers interested in using the heel enthesitis MRI scoring system (HEMRIS). The HEMRIS can find utility in clinical trials targeting enthesitis as the primary outcome. MRI also finds value for global assessment of the total burden of enthesitis. The concept of whole-body MRI (WBMRI), enabling visualization of entheses throughout the body using a single image is relatively new. The MRI whole-body score for inflammation in peripheral joints and entheses (MRI-WIPE) is a promising scoring system, which is undergoing further testing in clinical trials and longitudinal cohorts evaluating global measures of inflammation at entheses. This review discusses the role of MRI in diagnosis and monitoring of enthesitis in SpA and PsA, along with recent advances in the field, based on published literature.

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Toward Developing a Semiquantitative Whole Body-MRI Scoring for Juvenile Idiopathic Arthritis: Critical Appraisal of the State of the Art, Challenges, and Opportunities

Cited by 16 publications

References 78 publications

Whole-body MRI in children aged 6–18 years. Reliability of identifying and grading high signal intensity changes within bone marrow

Whole-body MRI in children aged 6–18 years. Reliability of identifying and grading high signal intensity changes within bone marrow

Whole-Body MRI in Rheumatology: Major Advances and Future Perspectives

Magnetic Resonance Imaging of Enthesitis in Spondyloarthritis, Including Psoriatic Arthritis—Status and Recent Advances

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