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Navallas M, Tolend M, Otobo TM, Panwar J, Clemente EJI, Hemke R, van Rossum MA, Doria AS. Developing standards for MRI evaluation of joints in children with juvenile idiopathic arthritis utilizing the temporomandibular joint as a model. Jpn J Radiol 2024; 42:56-68. [PMID: 37626169 DOI: 10.1007/s11604-023-01479-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 07/25/2023] [Indexed: 08/27/2023]
Abstract
The treatment of a patient with juvenile idiopathic arthritis (JIA) is best monitored with standardized and validated tools to measure joint changes over time. Treatment approaches are best indicated if the clinicians are aware of the structural status of the joint at a given time, especially in anatomically deep joints for which clinical assessment is limited. Magnetic resonance imaging (MRI) is of utmost importance for assessment of deep joints and extra-articular soft tissue of the entire body for which ultrasound may be suboptimal. Because the distinction between pathologic and physiologic joint changes on MRI is key for proper diagnosis and treatment of patients with arthropathies, a comprehensive standardized approach is needed to effectively measure outcomes of growing joints of children with JIA. Such an approach is essential for both clinical assessment and to conduct clinical trials in patients with JIA treated in different centers around the world. To meet this need, several international imaging collaborative research groups have been developing MRI scales over the past years, including the MRI in JIA (JAMRI) special interest group within the Outcome Measures in Rheumatology (OMERACT) research network. This manuscript reviews the efforts of the OMERACT JAMRI working group to generate and validate pediatric MRI scoring systems for different joints in children with JIA that can have ubiquitous utilization anywhere in the world. In particular, it describes the different steps of development and validation of an MRI scale using the TMJ as a model.
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Affiliation(s)
- Maria Navallas
- Department of Diagnostic Imaging. Hospital 12 de Octubre, Madrid, Spain
| | - Mirkamal Tolend
- Department of Diagnostic Imaging, Research Institute, The Hospital for Sick Children, and Department of Medical Imaging, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Tarimobo M Otobo
- Department of Diagnostic Imaging, Research Institute, The Hospital for Sick Children, and Department of Medical Imaging, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Jyoti Panwar
- Department of Medical Imaging, The Tweed Hospital, Lumus Imaging, Tweed Heads, NSW, Australia
| | - Emilio J Inarejos Clemente
- Department of Diagnostic Imaging. Sant Joan de Deu Barcelona Children Hospital, University of Barcelona, Barcelona, Spain
| | - Robert Hemke
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Amsterdam Movement Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - Marion A van Rossum
- Department of Pediatrics, Emma Children's Hospital Amsterdam University Medical Centers and Amsterdam Rheumatology and Immunology Center | Reade, Amsterdam, The Netherlands
| | - Andrea S Doria
- Department of Diagnostic Imaging, Research Institute, The Hospital for Sick Children, and Department of Medical Imaging, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
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2
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Verkuil F, van den Berg JM, van Gulik EC, Barendregt AM, Rashid ANS, Schonenberg-Meinema D, Dolman KM, Kuijpers TW, Maas M, Hemke R. Synovial signal intensity on static contrast-enhanced MRI for evaluation of disease activity in juvenile idiopathic arthritis – A look at the bright side of the knee. Clin Imaging 2022; 86:53-60. [DOI: 10.1016/j.clinimag.2022.03.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 03/15/2022] [Accepted: 03/15/2022] [Indexed: 11/16/2022]
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3
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van der Krogt JMA, Verkuil F, van Gulik EC, Hemke R, van den Berg JM, Schonenberg-Meinema D, Kindermann A, Dolman KM, Benninga MA, Kuijpers TW, Maas M, Nusman CM. Comparison of contrast-enhanced MRI features of the (teno)synovium in the wrist of patients with juvenile idiopathic arthritis and pediatric controls. Rheumatol Int 2021; 42:1257-1264. [PMID: 34811568 PMCID: PMC9203396 DOI: 10.1007/s00296-021-05041-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 10/26/2021] [Indexed: 11/12/2022]
Abstract
To directly compare and describe the differences between juvenile idiopathic arthritis (JIA) patients and pediatric controls regarding features of the synovial and tenosynovial membrane on contrast-enhanced magnetic resonance imaging (MRI) of the wrist. T1-weighted contrast-enhanced MRI scans of 25 JIA patients with clinically active wrist arthritis and 25 children without a history of joint complaints nor any clinical signs of joint inflammation were evaluated by two readers blinded to clinical data. The synovium was scored at five anatomical sites based on thickening of the synovium (0–3 scale) and synovial enhancement (0–2 scale). Thickening and/or enhancement of the tenosynovium was scored at four anatomical sites using a 0–3 scale. Significantly higher scores for synovial thickening (median 4 vs. 1, p < 0.001) and synovial enhancement (median 4 vs. 1, p < 0.001) are found in the wrist of JIA patients as compared to controls. JIA patients experienced the highest synovial scores at the mid-/inter-carpal, 2nd –5th carpometacarpal, and radiocarpal joints. No significant difference in tenosynovial scores is found between both groups (median 0 vs. 0, p = 0.220). This study highlights the higher synovial thickening/enhancement scores on contrast-enhanced MRI of the wrist in JIA patients compared to pediatric controls. Tenosynovial thickening and/or enhancement was rarely present in both groups. In JIA patients, synovial thickening and enhancement were particularly present at three anatomical sites. These results substantially support rheumatologists and radiologists when navigating through MRI of the wrist in search for JIA disease activity.
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Affiliation(s)
- Jeffrey M A van der Krogt
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers (Amsterdam UMC), Location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - F Verkuil
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers (Amsterdam UMC), Location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.,Department of Pediatric Immunology, Rheumatology and Infectious Diseases, Emma Children's Hospital, Amsterdam University Medical Centers (Amsterdam UMC), University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - E Charlotte van Gulik
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers (Amsterdam UMC), Location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.,Department of Pediatric Immunology, Rheumatology and Infectious Diseases, Emma Children's Hospital, Amsterdam University Medical Centers (Amsterdam UMC), University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Robert Hemke
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers (Amsterdam UMC), Location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - J Merlijn van den Berg
- Department of Pediatric Immunology, Rheumatology and Infectious Diseases, Emma Children's Hospital, Amsterdam University Medical Centers (Amsterdam UMC), University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Dieneke Schonenberg-Meinema
- Department of Pediatric Immunology, Rheumatology and Infectious Diseases, Emma Children's Hospital, Amsterdam University Medical Centers (Amsterdam UMC), University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Angelika Kindermann
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam University Medical Centers (Amsterdam UMC), University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Koert M Dolman
- Department of Pediatrics, OLVG Hospital, Location West, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands
| | - Marc A Benninga
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam University Medical Centers (Amsterdam UMC), University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Taco W Kuijpers
- Department of Pediatric Immunology, Rheumatology and Infectious Diseases, Emma Children's Hospital, Amsterdam University Medical Centers (Amsterdam UMC), University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Mario Maas
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers (Amsterdam UMC), Location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Charlotte M Nusman
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers (Amsterdam UMC), Location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. .,Department of Pediatric Immunology, Rheumatology and Infectious Diseases, Emma Children's Hospital, Amsterdam University Medical Centers (Amsterdam UMC), University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
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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. Semin Arthritis Rheum 2021; 51:1350-1359. [PMID: 34465447 DOI: 10.1016/j.semarthrit.2021.07.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 07/20/2021] [Accepted: 07/21/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Whole body-MRI is helpful in directing diagnostic and treatment approaches, and as a research outcome measure. We describe our initial consensus-driven phase towards developing a whole body-MRI scoring system for juvenile idiopathic arthritis. METHODS An iterative approach using three rounds of anonymous Delphi surveys followed by a consensus meeting was used to draft the structure of the whole body-MRI scoring system, including the relevant anatomic joints and entheses for assessment, diagnostic item selection, definition and grading, and selection of appropriate MRI planes and sequences. The surveys were completed independently by an international expert group consisting of pediatric radiologists and rheumatologists. RESULTS Twenty-two experts participated in at least one of three rounds of Delphi surveys and a concluding consensus meeting. A first iteration scoring system was developed which ultimately included the assessment of 100 peripheral, 23 chest, and 76 axial joints, and 64 entheses, with 2-4 diagnostic items graded in each of the items, using binary (presence/absence) and 2-3-level ordinal scores. Recommendations on anatomic MRI planes and sequences were specified as the minimally necessary imaging protocol for the scoring system. CONCLUSION A novel whole body-MRI scoring system for juvenile idiopathic arthritis was developed by consensus among members of MRI in JIA OMERACT working group. Further iterative refinements, reliability testing, and responsiveness are warranted in upcoming studies.
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Panwar J, Patel H, Tolend M, Akikusa J, Herregods N, Highmore K, Inarejos Clemente EJ, Jans L, Jaremko JL, von Kalle T, Kirkhus E, Meyers AB, van Rossum MA, Rumsey DG, Stimec J, Tse SM, Twilt M, Tzaribachev N, Doria AS. Toward Developing a Semiquantitative Whole Body-MRI Scoring for Juvenile Idiopathic Arthritis: Critical Appraisal of the State of the Art, Challenges, and Opportunities. Acad Radiol 2021; 28:271-286. [PMID: 32139304 DOI: 10.1016/j.acra.2020.01.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 01/05/2020] [Accepted: 01/15/2020] [Indexed: 12/18/2022]
Abstract
With powerful new therapies available for management of juvenile idiopathic arthritis (JIA), early diagnosis leading to appropriate treatment may prevent long-term structural joint damage. Although magnetic resonance imaging (MRI) is typically used to assess individual body parts, indications for whole body (WB) MRI are increasing. Its utility as a diagnostic and monitoring tool has already been widely investigated in adult rheumatology patients, but less so in pediatric rheumatologic patients. This paper is a comprehensive review of scoring systems and a proposal for the conceptual development of a WB-MRI scoring system for the evaluation of JIA. In this review we identify, summarize, and critically appraise the available literature on the use of WB-MRI in inflammatory arthritis, addressing relevant considerations on components of a classification system that can lead to the development of a future pediatric WB-MRI scoring system for use in children with JIA. We also discuss advantages and challenges of developing such a WB-MRI scoring system for assessment of JIA and outline next steps toward the conceptual development of this scoring system.
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Affiliation(s)
- Jyoti Panwar
- Department of Radiology, Christian Medical College and Hospital, Vellore, India; Department of Diagnostic Imaging, The Hospital for Sick Children, Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Hiten Patel
- Department of Radiology, Birmingham Children's Hospital, Birmingham, United Kingdom
| | - Mirkamal Tolend
- Department of Diagnostic Imaging, The Hospital for Sick Children, Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Jonathan Akikusa
- Department of Radiology, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Nele Herregods
- Department of Radiology, Ghent University, Ghent, Belgium
| | - Kerri Highmore
- Department of Radiology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | | | - Lennart Jans
- Department of Radiology, Ghent University, Ghent, Belgium
| | | | - Thekla von Kalle
- RadiologischesInstitut, Olga hospital Klinikum, Stuttgart, Germany
| | - Eva Kirkhus
- Department of Radiology, Oslo University Hospital, Oslo, Norway
| | - Arthur B Meyers
- Department of Radiology, Nemours Children's Hospital, Orlando, Florida, United States
| | - Marion A van Rossum
- Amsterdam Rheumatology and immunology Center, Reade, and Emma Children's Hospital Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Dax G Rumsey
- Division of Rheumatology, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Jennifer Stimec
- Department of Diagnostic Imaging, The Hospital for Sick Children, Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Shirley M Tse
- Division of Rheumatology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Marinka Twilt
- Department of Pediatrics, Division of rheumatology, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Andrea S Doria
- Department of Diagnostic Imaging, The Hospital for Sick Children, Department of Medical Imaging, University of Toronto, Toronto, ON, Canada.
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Magnetic resonance imaging of the knee joint in juvenile idiopathic arthritis. Reumatologia 2021; 58:416-423. [PMID: 33456085 PMCID: PMC7792535 DOI: 10.5114/reum.2020.102007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 11/30/2020] [Indexed: 11/17/2022] Open
Abstract
Juvenile idiopathic arthritis (JIA) is an umbrella term for a group of diseases in children younger than 16 years old lasting six weeks or longer. Synovitis may lead to destructive and irreversible joint changes with subsequent functional impairment. Prompt diagnosis is essential to prevent permanent joint damage and preserve joint functionality. In the course of JIA both the axial and peripheral skeleton may be involved in the inflammatory process, but the knee joint is most frequently affected. New drugs and treatment protocols have forced the need for diagnosis at the earliest possible stage. Magnetic resonance imaging (MRI) allows early detection of lesions and constitutes a superior diagnostic imaging method. Synovitis, tenosynovitis, enthesitis, bursitis, osteitis, cartilage loss, bone cysts, and erosions are lesions diagnosed in JIA, and they can be precisely imaged in MRI. This article aims to present MRI inflammatory features of the knee in children with JIA based on the literature.
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7
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Malattia C, Tolend M, Mazzoni M, Panwar J, Zlotnik M, Otobo T, Vidarsson L, Doria AS. Current status of MR imaging of juvenile idiopathic arthritis. Best Pract Res Clin Rheumatol 2020; 34:101629. [PMID: 33281052 DOI: 10.1016/j.berh.2020.101629] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Juvenile idiopathic arthritis (JIA) is the most common chronic arthropathy in the pediatric population. Although the diagnosis is essentially clinical for many affected joints, MR imaging has become an important tool for the assessment of joints that are difficult to evaluate clinically, such as temporomandibular and sacroiliac joints, and for screening of inflammatory changes in the entire body by whole body MRI (WBMRI) assessment. The utilization of MR imaging is challenging in the pediatric population given the need for discrimination between pathological and physiological changes in the growing skeleton. Several multicentric multidisciplinary organizations have made major efforts over the past decades to standardize, quantify, and validate scoring systems to measure joint changes both cross-sectionally and longitudinally according to rigorous methodological standards. In this paper, we (1) discuss current trends for the diagnosis and management of JIA, (2) review challenges for detecting real pathological changes in growing joints, (3) summarize the current status of standardization of MRI protocols for data acquisition and the quantification of joint pathology in JIA by means of scoring systems, and (4) outline novel MR imaging techniques for the evaluation of anatomy and function of joints in JIA. Optimizing the role of MRI as a robust biomarker and outcome measure remains a priority of future research in this field.
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Affiliation(s)
- Clara Malattia
- Clinica Pediatrica e Reumatologia, Istituto Giannina Gaslini, Genoa, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal Infantile Sciences (DINOGMI), University of Genoa, Italy
| | - Mirkamal Tolend
- Department of Diagnostic Imaging, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | - Marta Mazzoni
- Clinica Pediatrica e Reumatologia, Istituto Giannina Gaslini, Genoa, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal Infantile Sciences (DINOGMI), University of Genoa, Italy
| | - Jyoti Panwar
- Department of Radiology, Christian Medical College, Vellore, India
| | - Margalit Zlotnik
- Department of Diagnostic Imaging, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | - Tarimobo Otobo
- Department of Diagnostic Imaging, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | - Logi Vidarsson
- Department of Diagnostic Imaging, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | - Andrea S Doria
- Department of Diagnostic Imaging, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada; Department of Medical Imaging, University of Toronto, Toronto, ON, Canada.
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Hemke R, Herregods N, Jaremko JL, Åström G, Avenarius D, Becce F, Bielecki DK, Boesen M, Dalili D, Giraudo C, Hermann KG, Humphries P, Isaac A, Jurik AG, Klauser AS, Kvist O, Laloo F, Maas M, Mester A, Oei E, Offiah AC, Omoumi P, Papakonstantinou O, Plagou A, Shelmerdine S, Simoni P, Sudoł-Szopińska I, Tanturri de Horatio L, Teh J, Jans L, Rosendahl K. Imaging assessment of children presenting with suspected or known juvenile idiopathic arthritis: ESSR-ESPR points to consider. Eur Radiol 2020; 30:5237-5249. [PMID: 32399709 PMCID: PMC7476913 DOI: 10.1007/s00330-020-06807-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 02/08/2020] [Accepted: 03/12/2020] [Indexed: 12/17/2022]
Abstract
Juvenile idiopathic arthritis (JIA) is the most common paediatric rheumatic disease. It represents a group of heterogenous inflammatory disorders with unknown origin and is a diagnosis of exclusion in which imaging plays an important role. JIA is defined as arthritis of one or more joints that begins before the age of 16 years, persists for more than 6 weeks and is of unknown aetiology and pathophysiology. The clinical goal is early suppression of inflammation to prevent irreversible joint damage which has shifted the emphasis from detecting established joint damage to proactively detecting inflammatory change. This drives the need for imaging techniques that are more sensitive than conventional radiography in the evaluation of inflammatory processes as well as early osteochondral change. Physical examination has limited reliability, even if performed by an experienced clinician, emphasising the importance of imaging to aid in clinical decision-making. On behalf of the European Society of Musculoskeletal Radiology (ESSR) arthritis subcommittee and the European Society of Paediatric Radiology (ESPR) musculoskeletal imaging taskforce, based on literature review and/or expert opinion, we discuss paediatric-specific imaging characteristics of the most commonly involved, in literature best documented and clinically important joints in JIA, namely the temporomandibular joints (TMJs), spine, sacroiliac (SI) joints, wrists, hips and knees, followed by a clinically applicable point to consider for each joint. We will also touch upon controversies in the current literature that remain to be resolved with ongoing research. KEY POINTS: • Juvenile idiopathic arthritis (JIA) is the most common chronic paediatric rheumatic disease and, in JIA imaging, is increasingly important to aid in clinical decision-making. • Conventional radiographs have a lower sensitivity and specificity for detection of disease activity and early destructive change, as compared to MRI or ultrasound. Nonetheless, radiography remains important, particularly in narrowing the differential diagnosis and evaluating growth disturbances. • Mainly in peripheral joints, ultrasound can be helpful for assessment of inflammation and guiding joint injections. In JIA, MRI is the most validated technique. MRI should be considered as the modality of choice to assess the axial skeleton or where the clinical presentation overlaps with JIA.
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Affiliation(s)
- Robert Hemke
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam Movement Sciences, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Nele Herregods
- Department of Radiology and Medical Imaging, Ghent University Hospital, Ghent, Belgium
| | - Jacob L Jaremko
- Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Gunnar Åström
- Department of Radiology, Uppsala University, Uppsala, Sweden
| | - Derk Avenarius
- Department of Radiology, University Hospital of North Norway, Tromsø, Norway
| | - Fabio Becce
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Dennis K Bielecki
- Department of Diagnostic Imaging, Kings College Hospital, London, UK
| | - Mikael Boesen
- Department of Radiology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Danoob Dalili
- Department of Radiology, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Chiara Giraudo
- Radiology Institute, Department of Medicine - DIMED, Padova University, Padua, Italy
| | - Kay-Geert Hermann
- Department of Radiology, University Hospital Charité, Berlin, Germany
| | - Paul Humphries
- Department of Radiology, Great Ormond Street Hospital, London, UK
| | - Amanda Isaac
- Department of Radiology, Guy's & St Thomas Hospitals, London, UK
| | - Anne Grethe Jurik
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - Andrea S Klauser
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Ola Kvist
- Department of Paediatric Radiology, Karolinska University Hospital, Stockholm, Sweden
| | - Frederiek Laloo
- Department of Radiology and Medical Imaging, Ghent University Hospital, Ghent, Belgium
| | - Mario Maas
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam Movement Sciences, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Adam Mester
- Department of Radiology, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
| | - Edwin Oei
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center (Erasmus MC), Rotterdam, The Netherlands
| | - Amaka C Offiah
- Academic Unit of Child Health, University of Sheffield, Western Bank, Sheffield, UK
| | - Patrick Omoumi
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland
| | | | | | | | - Paolo Simoni
- Department of Radiology, Reine Fabiola Children's University Hospital of Bruxelles, University of Bruxelles, Brussels, Belgium
| | - Iwona Sudoł-Szopińska
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation and Department of Medical Imaging, Medical University of Warsaw, Warsaw, Poland
| | | | - James Teh
- Department of Radiology, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Lennart Jans
- Department of Radiology and Medical Imaging, Ghent University Hospital, Ghent, Belgium
| | - Karen Rosendahl
- Department of Radiology, University Hospital of North Norway, Tromsø, Norway
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9
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Verkuil F, van Gulik EC, Nusman CM, Barendregt AM, Nassar-Sheikh Rashid A, Schonenberg-Meinema D, Dolman KM, Maas M, Kuijpers TW, van den Berg JM, Hemke R. Exploring contrast-enhanced MRI findings of the clinically non-inflamed symptomatic pediatric wrist. Pediatr Radiol 2020; 50:1387-1396. [PMID: 32661590 PMCID: PMC7445206 DOI: 10.1007/s00247-020-04739-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 04/15/2020] [Accepted: 05/22/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Knowledge of the synovial and tenosynovial appearance of the clinically non-arthritic symptomatic juvenile wrist using contrast-enhanced magnetic resonance imaging (MRI) is sparse. OBJECTIVES To analyze contrast-enhanced MRI findings of the clinically non-inflamed symptomatic pediatric wrist, focusing on the enhancing synovial and tenosynovial membrane. To evaluate the coexistent presence of (teno)synovial enhancement, joint fluid, bony depressions and medullary changes suggestive of bone marrow edema. MATERIALS AND METHODS We included 20 children (15 girls; age range: 7.5-17.6 years) who underwent contrast-enhanced MRI of the wrist, based on initial clinical indication, and eventually turned out to be unaffected by arthritic or orthopedic disorders. Various imaging characteristics of the synovium, tenosynovium, joint fluid, bone tissue and bone marrow were evaluated using existing MRI scoring systems. RESULTS In 3/20 (15%) children, mild or moderate-severe synovial enhancement was observed and 2/20 (10%) children showed mild tenosynovial enhancement/thickening. Joint fluid (11/20 children; 55%), bony depressions (20/20 children; 100%) and medullary changes suggestive of bone marrow edema (6/20; 30%) were found in a substantial percentage of children. The most frequently observed combination of coexisting imaging characteristics was bony depressions with ≥2 mm joint fluid, which was found in 7/20 (35%) children. Simultaneous presence of synovial and tenosynovial enhancement/thickening, bony depressions and medullary changes suggestive of bone marrow edema was observed in one child. CONCLUSION Several juvenile idiopathic arthritis-relevant MRI characteristics can be observed in the clinically non-inflamed symptomatic pediatric wrist.
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Affiliation(s)
- Floris Verkuil
- Pediatric Immunology, Rheumatology and Infectious Diseases, Emma Children's Hospital, Amsterdam University Medical Centers, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. .,Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Academic Medical Center Amsterdam Movement Sciences, University of Amsterdam, Amsterdam, The Netherlands.
| | - E. Charlotte van Gulik
- grid.7177.60000000084992262Pediatric Immunology, Rheumatology and Infectious Diseases, Emma Children’s Hospital, Amsterdam University Medical Centers, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands ,grid.7177.60000000084992262Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Academic Medical Center Amsterdam Movement Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - Charlotte M. Nusman
- grid.7177.60000000084992262Pediatric Immunology, Rheumatology and Infectious Diseases, Emma Children’s Hospital, Amsterdam University Medical Centers, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands ,grid.7177.60000000084992262Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Academic Medical Center Amsterdam Movement Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - Anouk M. Barendregt
- grid.7177.60000000084992262Pediatric Immunology, Rheumatology and Infectious Diseases, Emma Children’s Hospital, Amsterdam University Medical Centers, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands ,grid.7177.60000000084992262Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Academic Medical Center Amsterdam Movement Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - Amara Nassar-Sheikh Rashid
- grid.7177.60000000084992262Pediatric Immunology, Rheumatology and Infectious Diseases, Emma Children’s Hospital, Amsterdam University Medical Centers, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Dieneke Schonenberg-Meinema
- grid.7177.60000000084992262Pediatric Immunology, Rheumatology and Infectious Diseases, Emma Children’s Hospital, Amsterdam University Medical Centers, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Koert M. Dolman
- Department of Pediatrics, OLVG Oost, Amsterdam, The Netherlands ,grid.440209.bDepartment of Pediatrics, OLVG West, Amsterdam, The Netherlands ,grid.418029.60000 0004 0624 3484Pediatric Rheumatology, Reade, Amsterdam, The Netherlands
| | - Mario Maas
- grid.7177.60000000084992262Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Academic Medical Center Amsterdam Movement Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - Taco W. Kuijpers
- grid.7177.60000000084992262Pediatric Immunology, Rheumatology and Infectious Diseases, Emma Children’s Hospital, Amsterdam University Medical Centers, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - J. Merlijn van den Berg
- grid.7177.60000000084992262Pediatric Immunology, Rheumatology and Infectious Diseases, Emma Children’s Hospital, Amsterdam University Medical Centers, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Robert Hemke
- grid.7177.60000000084992262Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Academic Medical Center Amsterdam Movement Sciences, University of Amsterdam, Amsterdam, The Netherlands
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10
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Montefiori E, Modenese L, Di Marco R, Magni-Manzoni S, Malattia C, Petrarca M, Ronchetti A, de Horatio LT, van Dijkhuizen P, Wang A, Wesarg S, Viceconti M, Mazzà C. Linking Joint Impairment and Gait Biomechanics in Patients with Juvenile Idiopathic Arthritis. Ann Biomed Eng 2019; 47:2155-2167. [PMID: 31111329 PMCID: PMC6838035 DOI: 10.1007/s10439-019-02287-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 05/08/2019] [Indexed: 11/27/2022]
Abstract
Juvenile Idiopathic Arthritis (JIA) is a paediatric musculoskeletal disease of unknown aetiology, leading to walking alterations when the lower-limb joints are involved. Diagnosis of JIA is mostly clinical. Imaging can quantify impairments associated to inflammation and joint damage. However, treatment planning could be better supported using dynamic information, such as joint contact forces (JCFs). To this purpose, we used a musculoskeletal model to predict JCFs and investigate how JCFs varied as a result of joint impairment in eighteen children with JIA. Gait analysis data and magnetic resonance images (MRI) were used to develop patient-specific lower-limb musculoskeletal models, which were evaluated for operator-dependent variability (< 3.6°, 0.05 N kg-1 and 0.5 BW for joint angles, moments, and JCFs, respectively). Gait alterations and JCF patterns showed high between-subjects variability reflecting the pathology heterogeneity in the cohort. Higher joint impairment, assessed with MRI-based evaluation, was weakly associated to overall joint overloading. A stronger correlation was observed between impairment of one limb and overload of the contralateral limb, suggesting risky compensatory strategies being adopted, especially at the knee level. This suggests that knee overloading during gait might be a good predictor of disease progression and gait biomechanics should be used to inform treatment planning.
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Affiliation(s)
- Erica Montefiori
- Department of Mechanical Engineering, University of Sheffield, Sheffield, UK.
- INSIGNEO Institute for In Silico Medicine, University of Sheffield, Sheffield, UK.
| | - Luca Modenese
- INSIGNEO Institute for In Silico Medicine, University of Sheffield, Sheffield, UK
- Department of Civil and Environmental Engineering, Imperial College London, London, UK
| | - Roberto Di Marco
- INSIGNEO Institute for In Silico Medicine, University of Sheffield, Sheffield, UK
- Department of Mechanical and Aerospace Engineering, "Sapienza" University of Rome, Rome, Italy
| | - Silvia Magni-Manzoni
- Pediatric Rheumatology Unit, IRCCS "Bambino Gesù" Children's Hospital, Passoscuro, Rome, Italy
| | - Clara Malattia
- Pediatria II - Reumatologia, Istituto Giannina Gaslini, Genoa, Italy
| | - Maurizio Petrarca
- Movement Analysis and Robotics Laboratory (MARLab), Neurorehabilitation Units, IRCCS "Bambino Gesù" Children's Hospital, Passoscuro, Rome, Italy
| | - Anna Ronchetti
- UOC Medicina Fisica e Riabilitazione, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | | | - Pieter van Dijkhuizen
- Paediatric Immunology, University Medical Centre Utrecht Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Anqi Wang
- Visual Healthcare Technologies, Fraunhofer IGD, Darmstadt, Germany
| | - Stefan Wesarg
- Visual Healthcare Technologies, Fraunhofer IGD, Darmstadt, Germany
| | - Marco Viceconti
- Department of Industrial Engineering, Alma Mater Studiorum - University of Bologna, Bologna, Italy
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Claudia Mazzà
- Department of Mechanical Engineering, University of Sheffield, Sheffield, UK
- INSIGNEO Institute for In Silico Medicine, University of Sheffield, Sheffield, UK
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11
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Consider the wrist: a retrospective study on pediatric connective tissue disease with MRI. Rheumatol Int 2019; 39:2095-2101. [PMID: 31222439 DOI: 10.1007/s00296-019-04353-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 06/17/2019] [Indexed: 10/26/2022]
Abstract
The aim of this study is to describe the clinical characteristics and MRI findings of the wrist in a cohort of children suffering from connective tissue disease with musculoskeletal involvement. Ten patients with pediatric connective tissue disease [median age 14.7 years (IQR 12.7-16.6 years), 70% female] were identified from a large MRI database. Clinical findings during the disease course were retrospectively obtained from patient charts and findings at the time of MRI were prospectively registered in the MRI database. MRI wrist datasets were evaluated by three readers in consensus for synovitis, tenosynovitis, bone marrow changes, bone erosions and myositis. Patients suffered from connective tissue disease with clinical overlap of subtypes systemic lupus erythematosus, Sjögren syndrome and dermatomyositis. Median onset of disease was at 12.3 years (IQR 7.8-14.8 years). Clinical arthritis activity was scored low (median visual analogue scale physician 19, IQR 7-31). Notwithstanding, extensive inflammatory abnormalities such as synovitis and tenosynovitis were found in the wrist of 7/10 patients. Osteochondral involvement was detected in 3/10 patients. In a small cohort of children with connective tissue disease and musculoskeletal symptoms, severe inflammatory abnormalities of the involved wrist were present in the MRI, while clinical disease scores suggested mild disease activity. Therefore, clinicians should consider the wrist as vulnerable for joint damage and can add MRI as a helpful tool in the management of patients with pediatric connective tissue disease and musculoskeletal involvement.
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12
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van Dijkhuizen EP, Vanoni F, Magnano GM, Magnaguagno F, Rosendahl K, van Rossum MA, Martini A, Malattia C. Effect of the Inclusion of the Metacarpophalangeal Joints on the Wrist Magnetic Resonance Imaging Scoring System in Juvenile Idiopathic Arthritis. J Rheumatol 2018; 45:1581-1587. [DOI: 10.3899/jrheum.171246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2018] [Indexed: 12/27/2022]
Abstract
Objective.To extend the magnetic resonance imaging (MRI) score for assessment of wrist synovitis in juvenile idiopathic arthritis (JIA) by inclusion of the metacarpophalangeal (MCP) joints, and to compare the metric properties of the original and the extended score.Methods.Wrist MRI of 70 patients with JIA were scored by 3 independent readers according to (1) the wrist component of the rheumatoid arthritis MRI synovitis score (comprising distal radioulnar, radiocarpal, and combined midcarpal and carpometacarpal joints); and (2) an extended score including the MCP joints. Thirty-eight patients had a 1-year MRI followup. The concordance between the readers [intraclass correlation coefficient (ICC), 95% limits of agreement (LOA), and weighted Cohen’s κ], correlations with clinical variables (Spearman’s ϱ), and the sensitivity to change [standardized response mean (SRM)] were calculated for both scores.Results.The interreader agreement was moderate for the original score (ICC 0.77; 95% CI 0.68–0.84) and good for the extended score (ICC 0.86; 95% CI 0.80–0.91). Using 95% LOA, the aggregate score variability was less favorable with relatively wide LOA. Weighted Cohen’s κ of the individual joints indicated good agreement for the original score and good to excellent agreement for the extended score. Correlations with clinical variables reflecting disease activity improved for the extended score and its SRM was higher compared to that of the original score.Conclusion.The extended score showed better reliability, construct validity, and sensitivity to change than the original. Inclusion of the MCP joints should be considered for a more accurate assessment of disease activity and treatment efficacy in JIA.
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13
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Malattia C, Tzaribachev N, van den Berg JM, Magni-Manzoni S. Juvenile idiopathic arthritis - the role of imaging from a rheumatologist's perspective. Pediatr Radiol 2018; 48:785-791. [PMID: 29766250 DOI: 10.1007/s00247-017-4014-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 10/11/2017] [Indexed: 10/17/2022]
Abstract
Alongside recent advances in treatment strategies for juvenile idiopathic arthritis (JIA), paediatric rheumatologists have taken increasing interest in the use of imaging. Magnetic resonance imaging (MRI) and musculoskeletal ultrasound, by providing more detailed information on disease activity than clinical examination and conventional radiography (CR), have become helpful diagnostic and managerial tools. The growing skeleton, however, with changing appearances over time, is still challenging in the establishment of valid scoring systems for pathological changes. Defining child- and age-specific reference standards is therefore a highly prioritized issue. The aim of this article is to raise awareness among radiologists of the substantial role that imaging can play to optimize the management of JIA patients and to describe the state-of-the-art validation process of imaging as an outcome measure. A closer collaboration between radiologists and pediatric rheumatologists is crucial to define a scheduled workflow for imaging in JIA.
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Affiliation(s)
- Clara Malattia
- Istituto Giannina Gaslini, Pediatria II, Reumatologia, Largo Gaslini, 5, 16147, Genoa, Italy.
- Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DINOGMI), University of Genova, Genoa, Italy.
| | | | - J Merlijn van den Berg
- Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Diseases, Emma Children's Hospital AMC University of Amsterdam, Amsterdam, The Netherlands
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14
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Avenarius DFM, Nusman C, Malattia C, de Horatio LT, Rosendahl K, Maas M, Müller LSO. Current status of wrist imaging in juvenile idiopathic arthritis. Pediatr Radiol 2018; 48:801-810. [PMID: 29766247 DOI: 10.1007/s00247-017-4063-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 11/19/2017] [Accepted: 12/18/2017] [Indexed: 10/17/2022]
Abstract
Wrist involvement occurs in about one-quarter of patients diagnosed with juvenile idiopathic arthritis (JIA), increasing to 40% 5 years after diagnosis. The imaging appearances, both for active inflammation and permanent change, differ from those seen in adult rheumatoid arthritis; therefore, a child-specific approach is crucial for correct assessment. In this review article, we provide an update on the current status for imaging wrist JIA, with a focus on evidence-based practice.
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Affiliation(s)
| | - Charlotte Nusman
- Department of Paediatric Haematology, Rheumatology, Immunology, and Infectious Disease, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands.,Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Clara Malattia
- Department of Paediatrics, University of Genoa, Genova, Italy
| | | | - Karen Rosendahl
- Department of Radiology, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, K1, University of Bergen, Bergen, Norway
| | - Mario Maas
- Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Lil-Sofie Ording Müller
- Department of Radiology and Intervention Unit for Paediatric Radiology, Oslo University, Oslo, Norway
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15
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Nusman CM, de Horatio LT, Hemke R, van Gulik EC, Ording Müller LS, Malattia C, Avenarius D, Toma P, Roth J, Tzaribachev N, Magni-Manzoni S, Maas M, Doria AS, Rosendahl K. Imaging in juvenile idiopathic arthritis - international initiatives and ongoing work. Pediatr Radiol 2018; 48:828-834. [PMID: 29332166 PMCID: PMC5953998 DOI: 10.1007/s00247-017-4054-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 11/14/2017] [Accepted: 12/05/2017] [Indexed: 12/17/2022]
Abstract
Imaging is increasingly being integrated into clinical practice to improve diagnosis, disease control and outcome in children with juvenile idiopathic arthritis. Over the last decades several international groups have been launched to standardize and validate different imaging techniques. To enhance transparency and facilitate collaboration, we present an overview of ongoing initiatives.
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Affiliation(s)
- Charlotte M. Nusman
- Department of Pediatric Hematology, Rheumatology, Immunology and Infectious Disease, Emma Children’s Hospital, Academic Medical Center, 1100 Amsterdam, the Netherlands ,Department of Radiology, Academic Medical Center, 1100 Amsterdam, the Netherlands
| | | | - Robert Hemke
- Department of Pediatric Hematology, Rheumatology, Immunology and Infectious Disease, Emma Children’s Hospital, Academic Medical Center, 1100 Amsterdam, the Netherlands ,Department of Radiology, Academic Medical Center, 1100 Amsterdam, the Netherlands
| | - E. Charlotte van Gulik
- Department of Pediatric Hematology, Rheumatology, Immunology and Infectious Disease, Emma Children’s Hospital, Academic Medical Center, 1100 Amsterdam, the Netherlands ,Department of Radiology, Academic Medical Center, 1100 Amsterdam, the Netherlands
| | - Lil-Sofie Ording Müller
- Department of Radiology and Intervention Unit for Paediatric Radiology, Oslo University Hospital, Ullevål, Oslo, Norway
| | - Clara Malattia
- Pediatria 2- Reumatologia Istituto Giannina Gaslini, Genova and Department of Pediatrics, University of Genova, Genova, Italy
| | - Derk Avenarius
- Department of Radiology, University Hospital of North Norway, Tromsø, Norway
| | - Paolo Toma
- Department of Imaging, Bambino Gesù Children’s Hospital, Rome, Italy
| | - Johannes Roth
- Division of Pediatric Rheumatology, Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada
| | | | | | - Mario Maas
- Department of Radiology, Academic Medical Center, 1100 Amsterdam, the Netherlands
| | | | - Karen Rosendahl
- Department of Radiology, Haukeland University Hospital, Bergen, Norway ,Department of Clinical Medicine, K1, University of Bergen, Bergen, Norway
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16
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Hemke R, Tzaribachev N, Nusman CM, van Rossum MAJ, Maas M, Doria AS. Magnetic Resonance Imaging (MRI) of the Knee as an Outcome Measure in Juvenile Idiopathic Arthritis: An OMERACT Reliability Study on MRI Scales. J Rheumatol 2017; 44:1224-1230. [PMID: 28572469 DOI: 10.3899/jrheum.160821] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE There is increasing evidence that early therapeutic intervention improves longterm joint outcome in juvenile idiopathic arthritis (JIA). Given the existence of highly effective treatments, there is an urgent need for reliable and accurate measures of disease activity and joint damage in JIA. Our objective was to assess the reliability of 2 magnetic resonance imaging (MRI) scoring methods: the Juvenile Arthritis MRI Scoring (JAMRIS) system and the International Prophylaxis Study Group (IPSG) consensus score, for evaluating disease status of the knee in patients with JIA. METHODS Four international readers independently scored an MRI dataset of 25 JIA patients with clinical knee involvement. Synovial thickening, joint effusion, bone marrow changes, cartilage lesions, bone erosions, and subchondral cysts were scored using the JAMRIS and IPSG systems. Further, synovial enhancement, infrapatellar fat pad heterogeneity, tendinopathy, and enthesopathy were scored. Interreader reliability was analyzed by using the generalized κ, ICC, and the smallest detectable difference (SDD). RESULTS ICC regarding interreader reliability ranged from 0.33 (95% CI 0.12-0.52, SDD = 0.29) for enthesopathy up to 0.95 (95% CI 0.92-0.97, SDD = 3.19) for synovial thickening. Good interreader reliability was found concerning joint effusion (ICC 0.93, 95% CI 0.89-0.95, SDD = 0.51), synovial enhancement (ICC 0.90, 95% CI 0.85-0.94, SDD = 9.85), and bone marrow changes (ICC 0.87, 95% CI 0.80-0.92, SDD = 10.94). Moderate to substantial reliability was found concerning cartilage lesions and bone erosions (ICC 0.55-0.72, SDD 1.41-13.65). CONCLUSION The preliminary results are promising for most of the scored JAMRIS and IPSG items. However, further refinement of the scoring system is warranted for unsatisfactorily reliable items such as bone erosions, cartilage lesions, and enthesopathy.
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Affiliation(s)
- Robert Hemke
- From the Department of Radiology, Academic Medical Center, University of Amsterdam; Department of Pediatrics, Emma Children's Hospital, Academic Medical Center, University of Amsterdam; Amsterdam Rheumatology and Immunology Center Reade, Amsterdam, the Netherlands; Pediatric Rheumatology Research Institute, Bad Bramstedt, Germany; Department of Diagnostic Imaging, the Hospital for Sick Children, Toronto, Ontario, Canada. .,R. Hemke, MD, PhD, Department of Radiology, Academic Medical Center, University of Amsterdam; N. Tzaribachev, MD, PhD, Pediatric Rheumatology Research Institute; C.M. Nusman, PhD, Department of Radiology, Academic Medical Center, University of Amsterdam; M.A. van Rossum, MD, PhD, Department of Pediatrics, Emma Children's Hospital, Academic Medical Center, University of Amsterdam, and Amsterdam Rheumatology and Immunology Center Reade; M. Maas, MD, PhD, Department of Radiology, Academic Medical Center, University of Amsterdam; A.S. Doria, MD, PhD, MSc, Department of Diagnostic Imaging, the Hospital for Sick Children.
| | - Nikolay Tzaribachev
- From the Department of Radiology, Academic Medical Center, University of Amsterdam; Department of Pediatrics, Emma Children's Hospital, Academic Medical Center, University of Amsterdam; Amsterdam Rheumatology and Immunology Center Reade, Amsterdam, the Netherlands; Pediatric Rheumatology Research Institute, Bad Bramstedt, Germany; Department of Diagnostic Imaging, the Hospital for Sick Children, Toronto, Ontario, Canada.,R. Hemke, MD, PhD, Department of Radiology, Academic Medical Center, University of Amsterdam; N. Tzaribachev, MD, PhD, Pediatric Rheumatology Research Institute; C.M. Nusman, PhD, Department of Radiology, Academic Medical Center, University of Amsterdam; M.A. van Rossum, MD, PhD, Department of Pediatrics, Emma Children's Hospital, Academic Medical Center, University of Amsterdam, and Amsterdam Rheumatology and Immunology Center Reade; M. Maas, MD, PhD, Department of Radiology, Academic Medical Center, University of Amsterdam; A.S. Doria, MD, PhD, MSc, Department of Diagnostic Imaging, the Hospital for Sick Children
| | - Charlotte M Nusman
- From the Department of Radiology, Academic Medical Center, University of Amsterdam; Department of Pediatrics, Emma Children's Hospital, Academic Medical Center, University of Amsterdam; Amsterdam Rheumatology and Immunology Center Reade, Amsterdam, the Netherlands; Pediatric Rheumatology Research Institute, Bad Bramstedt, Germany; Department of Diagnostic Imaging, the Hospital for Sick Children, Toronto, Ontario, Canada.,R. Hemke, MD, PhD, Department of Radiology, Academic Medical Center, University of Amsterdam; N. Tzaribachev, MD, PhD, Pediatric Rheumatology Research Institute; C.M. Nusman, PhD, Department of Radiology, Academic Medical Center, University of Amsterdam; M.A. van Rossum, MD, PhD, Department of Pediatrics, Emma Children's Hospital, Academic Medical Center, University of Amsterdam, and Amsterdam Rheumatology and Immunology Center Reade; M. Maas, MD, PhD, Department of Radiology, Academic Medical Center, University of Amsterdam; A.S. Doria, MD, PhD, MSc, Department of Diagnostic Imaging, the Hospital for Sick Children
| | - Marion A J van Rossum
- From the Department of Radiology, Academic Medical Center, University of Amsterdam; Department of Pediatrics, Emma Children's Hospital, Academic Medical Center, University of Amsterdam; Amsterdam Rheumatology and Immunology Center Reade, Amsterdam, the Netherlands; Pediatric Rheumatology Research Institute, Bad Bramstedt, Germany; Department of Diagnostic Imaging, the Hospital for Sick Children, Toronto, Ontario, Canada.,R. Hemke, MD, PhD, Department of Radiology, Academic Medical Center, University of Amsterdam; N. Tzaribachev, MD, PhD, Pediatric Rheumatology Research Institute; C.M. Nusman, PhD, Department of Radiology, Academic Medical Center, University of Amsterdam; M.A. van Rossum, MD, PhD, Department of Pediatrics, Emma Children's Hospital, Academic Medical Center, University of Amsterdam, and Amsterdam Rheumatology and Immunology Center Reade; M. Maas, MD, PhD, Department of Radiology, Academic Medical Center, University of Amsterdam; A.S. Doria, MD, PhD, MSc, Department of Diagnostic Imaging, the Hospital for Sick Children
| | - Mario Maas
- From the Department of Radiology, Academic Medical Center, University of Amsterdam; Department of Pediatrics, Emma Children's Hospital, Academic Medical Center, University of Amsterdam; Amsterdam Rheumatology and Immunology Center Reade, Amsterdam, the Netherlands; Pediatric Rheumatology Research Institute, Bad Bramstedt, Germany; Department of Diagnostic Imaging, the Hospital for Sick Children, Toronto, Ontario, Canada.,R. Hemke, MD, PhD, Department of Radiology, Academic Medical Center, University of Amsterdam; N. Tzaribachev, MD, PhD, Pediatric Rheumatology Research Institute; C.M. Nusman, PhD, Department of Radiology, Academic Medical Center, University of Amsterdam; M.A. van Rossum, MD, PhD, Department of Pediatrics, Emma Children's Hospital, Academic Medical Center, University of Amsterdam, and Amsterdam Rheumatology and Immunology Center Reade; M. Maas, MD, PhD, Department of Radiology, Academic Medical Center, University of Amsterdam; A.S. Doria, MD, PhD, MSc, Department of Diagnostic Imaging, the Hospital for Sick Children
| | - Andrea S Doria
- From the Department of Radiology, Academic Medical Center, University of Amsterdam; Department of Pediatrics, Emma Children's Hospital, Academic Medical Center, University of Amsterdam; Amsterdam Rheumatology and Immunology Center Reade, Amsterdam, the Netherlands; Pediatric Rheumatology Research Institute, Bad Bramstedt, Germany; Department of Diagnostic Imaging, the Hospital for Sick Children, Toronto, Ontario, Canada.,R. Hemke, MD, PhD, Department of Radiology, Academic Medical Center, University of Amsterdam; N. Tzaribachev, MD, PhD, Pediatric Rheumatology Research Institute; C.M. Nusman, PhD, Department of Radiology, Academic Medical Center, University of Amsterdam; M.A. van Rossum, MD, PhD, Department of Pediatrics, Emma Children's Hospital, Academic Medical Center, University of Amsterdam, and Amsterdam Rheumatology and Immunology Center Reade; M. Maas, MD, PhD, Department of Radiology, Academic Medical Center, University of Amsterdam; A.S. Doria, MD, PhD, MSc, Department of Diagnostic Imaging, the Hospital for Sick Children
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17
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Rieter JFMM, de Horatio LT, Nusman CM, Müller LSO, Hemke R, Avenarius DFM, van Rossum MAJ, Malattia C, Maas M, Rosendahl K. The many shades of enhancement: timing of post-gadolinium images strongly influences the scoring of juvenile idiopathic arthritis wrist involvement on MRI. Pediatr Radiol 2016; 46:1562-7. [PMID: 27406611 DOI: 10.1007/s00247-016-3657-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Revised: 05/12/2016] [Accepted: 06/08/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Potential long-term side effects of treatment for juvenile idiopathic arthritis are concerning. This has necessitated accurate tools, such as MRI, to monitor treatment response and allow for personalized therapy. OBJECTIVE To examine the extent to which timing of post-contrast MR images influences the scoring of inflammatory change in the wrist in children with juvenile idiopathic arthritis. MATERIALS AND METHODS We studied two sets of post-contrast 3-D gradient echo MRI series of the wrist in 34 children with juvenile idiopathic arthritis. These images were obtained immediately after administration of intravenous contrast material and again after approximately 10 min. The dataset was drawn from a prospective multicenter project conducted 2006-2010. We assessed five wrist locations for synovial enhancement, effusion and overall inflammation. Examinations were scored by one radiologist in two sessions - the first was based on the early post-contrast images, and the later session, for which the previous findings were masked, was based on the later post-contrast images. RESULTS Fifty-two of the 170 locations (30.6%) received a higher synovial enhancement score based on the late post-contrast images as compared to the early images. Sixty of the 170 (35%) locations received a higher total inflammation score. The mean scores of synovial enhancement and total inflammation were significantly higher when based on the late post-contrast images as compared to the early post-contrast images. CONCLUSION An MRI-based scoring system for the presence and degree of synovitis should be based on a standardized MR-protocol with a fixed interval between intravenous contrast injection and post-contrast images.
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Affiliation(s)
- Jasper F M M Rieter
- Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Charlotte M Nusman
- Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Robert Hemke
- Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Marion A J van Rossum
- Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Emma Children's Hospital, Amsterdam, The Netherlands
| | - Clara Malattia
- Department of Paediatrics, Ospedale Pediatrico Gaslini, Genoa, Italy
| | - Mario Maas
- Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Karen Rosendahl
- Radiology Department, Section of Pediatric Radiology, Haukeland University Hospital, Pb 1400, 5021, Bergen, Norway. .,Department of Clinical Medicine, K1, University of Bergen, Bergen, Norway.
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18
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Boavida P, Lambot-Juhan K, Müller LSO, Damasio B, de Horatio LT, Malattia C, Owens CM, Rosendahl K. Carpal erosions in children with juvenile idiopathic arthritis: repeatability of a newly devised MR-scoring system. Pediatr Radiol 2015. [PMID: 26209959 DOI: 10.1007/s00247-015-3421-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Juvenile idiopathic arthritis (JIA) is characterized by synovial inflammation, with potential risk of developing progressive joint destruction. Personalized state-of-the-art treatment depends on valid markers for disease activity to monitor response; however, no such markers exist. OBJECTIVE To evaluate the reliability of scoring of carpal bone erosions on MR in children with JIA using two semi-quantitative scoring systems. MATERIALS AND METHODS A total of 1,236 carpal bones (91 MR wrist examinations) were scored twice by two independent pediatric musculoskeletal radiologists. Bony erosions were scored according to estimated bone volume loss using a 0-4 scale and a 0-10 scale. An aggregate erosion score comprising the sum total carpal bone volume loss was calculated for each examination. RESULTS The 0-4 scoring system resulted in good intra-reader agreement and moderate to good inter-observer agreement in the assessment of individual bones. Fair and moderate agreement were achieved for inter-reader and intra-reader agreement, respectively, using the 0-10 scale. Intra- and particularly inter-reader aggregate score variability were much less favorable, with wide limits of agreement. CONCLUSION Further analysis of erosive disease patterns compared with normal subjects is required, and to facilitate the development of an alternative means of quantifying disease.
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Affiliation(s)
- Peter Boavida
- Department of Radiology, Great Ormond Street Hospital for Children, London, UK
| | | | | | - Beatrice Damasio
- Department of Rheumatology, Ospedale Pediatrico Gaslini, Genoa, Italy
| | | | - Clara Malattia
- Department of Rheumatology, Ospedale Pediatrico Gaslini, Genoa, Italy
| | - Catherine M Owens
- Department of Radiology, Great Ormond Street Hospital for Children, London, UK.,Institute of Child Health, UCL, London, UK
| | - Karen Rosendahl
- Department of Radiology, Haukeland University Hospital, Jonas Lies vei 65, N-5021, Bergen, Norway. .,Department of Clinical Medicine, University of Bergen, Bergen, Norway.
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19
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Nusman CM, Hemke R, Benninga MA, Schonenberg-Meinema D, Kindermann A, van Rossum MAJ, van den Berg JM, Maas M, Kuijpers TW. Contrast-enhanced MRI of the knee in children unaffected by clinical arthritis compared to clinically active juvenile idiopathic arthritis patients. Eur Radiol 2015; 26:1141-8. [PMID: 26233246 PMCID: PMC4778146 DOI: 10.1007/s00330-015-3912-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 06/26/2015] [Accepted: 06/30/2015] [Indexed: 01/17/2023]
Abstract
OBJECTIVES To evaluate enhancing synovial thickness upon contrast-enhanced magnetic resonance imaging (MRI) of the knee in children unaffected by clinical arthritis compared with clinically active juvenile idiopathic arthritis (JIA) patients. A secondary objective was optimization of the scoring method based on maximizing differences on MRI between these groups. METHODS Twenty-five children without history of joint complaints nor any clinical signs of joint inflammation were age/sex-matched with 25 clinically active JIA patients with arthritis of at least one knee. Two trained radiologists, blinded for clinical status, independently evaluated location and extent of enhancing synovial thickness with the validated Juvenile Arthritis MRI Scoring system (JAMRIS) on contrast-enhanced axial fat-saturated T1-weighted MRI of the knee. RESULTS Enhancing synovium (≥2 mm) was present in 13 (52 %) unaffected children. Using the total JAMRIS score for synovial thickening, no significant difference was found between unaffected children and active JIA patients (p = 0.091). Additional weighting of synovial thickening at the JIA-specific locations enabled more sensitive discrimination (p = 0.011). CONCLUSIONS Mild synovial thickening is commonly present in the knee of children unaffected by clinical arthritis. The infrapatellar and cruciate ligament synovial involvement were specific for JIA, which-in a revised JAMRIS-increases the ability to discriminate between JIA and unaffected children. KEY POINTS • Synovial inflammation is the primary disease feature in juvenile idiopathic arthritis (JIA). • Appearance of the synovium on contrast-enhanced MRI in unaffected children is unknown. • Validation of existing scoring methods requires comparison between JIA and unaffected children. • Mild enhancing synovial thickening was detected in half of the unaffected children. • Location-weighting for JIA-specific locations increased discriminative value of the scoring methods (p = 0.011).
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Affiliation(s)
- Charlotte M Nusman
- Department of Radiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
- Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital AMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
| | - Robert Hemke
- Department of Radiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital AMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Marc A Benninga
- Department of Pediatric Gastroenterology, Emma Children's Hospital AMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Dieneke Schonenberg-Meinema
- Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital AMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Angelika Kindermann
- Department of Pediatric Gastroenterology, Emma Children's Hospital AMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Marion A J van Rossum
- Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital AMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Department of Pediatric Rheumatology, Reade, Dr. Jan van Breemenstraat 2, Amsterdam, The Netherlands
| | - J Merlijn van den Berg
- Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital AMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Mario Maas
- Department of Radiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Taco W Kuijpers
- Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital AMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
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Nusman CM, Ording Muller LS, Hemke R, Doria AS, Avenarius D, Tzaribachev N, Malattia C, van Rossum MAJ, Maas M, Rosendahl K. Current Status of Efforts on Standardizing Magnetic Resonance Imaging of Juvenile Idiopathic Arthritis: Report from the OMERACT MRI in JIA Working Group and Health-e-Child. J Rheumatol 2015; 43:239-44. [PMID: 25979714 DOI: 10.3899/jrheum.141276] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To report on the progress of an ongoing research collaboration on magnetic resonance imaging (MRI) in juvenile idiopathic arthritis (JIA) and describe the proceedings of a meeting, held prior to Outcome Measures in Rheumatology (OMERACT) 12, bringing together the OMERACT MRI in JIA working group and the Health-e-Child radiology group. The goal of the meeting was to establish agreement on scoring definitions, locations, and scales for the assessment of MRI of patients with JIA for both large and small joints. METHODS The collaborative work process included premeeting surveys, presentations, group discussions, consensus on scoring methods, pilot scoring, conjoint review, and discussion of a future research agenda. RESULTS The meeting resulted in preliminary statements on the MR imaging protocol of the JIA knee and wrist and determination of the starting point for development of MRI scoring systems based on previous studies. It was also considered important to be descriptive rather than explanatory in the assessment of MRI in JIA (e.g., "thickening" instead of "hypertrophy"). Further, the group agreed that well-designed calibration sessions were warranted before any future scoring exercises were conducted. CONCLUSION The combined efforts of the OMERACT MRI in JIA working group and Health-e-Child included the assessment of currently available material in the literature and determination of the basis from which to start the development of MRI scoring systems for both the knee and wrist. The future research agenda for the knee and wrist will include establishment of MRI scoring systems, an atlas of MR imaging in healthy children, and MRI protocol requisites.
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Affiliation(s)
- Charlotte M Nusman
- From the Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands; Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands; Department of Radiology, Oslo University Hospital, Oslo, Norway; Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Radiology, University Hospital North Norway, Tromsø, Norway; Pediatric Rheumatology Research Institute, Bad Bramstedt, Germany; Department of Pediatrics, University of Genoa, Genoa, Italy; Department of Pediatric Rheumatology, Reade Institute, location Jan van Breemen, Amsterdam, The Netherlands; Department of Clinical Medicine, K1, University of Bergen, and Department of Pediatric Radiology, Haukeland University Hospital, Bergen, Norway.C.M. Nusman, MSc, Department of Radiology, Academic Medical Center; Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Academic Medical Center; L.S. Ording Muller, MD, PhD, Department of Radiology, Oslo University Hospital; R. Hemke, MD, PhD, Department of Radiology, Academic Medical Center; Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Academic Medical Center; A.S. Doria, MD, PhD, Department of Diagnostic Imaging, The Hospital for Sick Children; D. Avenarius, MD, Department of Radiology, University Hospital North Norway; N. Tzaribachev, MD, Pediatric Rheumatology Research Institute; C. Malattia, MD, PhD, Department of Pediatrics, University of Genoa; M.A. van Rossum, MD, PhD, Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Academic Medical Center, and Department of Pediatric Rheumatology, Reade Institute, location Jan van Breemen; M. Maas, MD, PhD, Department of Radiology, Academic Medical Center; K. Rosendahl, MD, PhD, Department o
| | - Lil-Sofie Ording Muller
- From the Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands; Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands; Department of Radiology, Oslo University Hospital, Oslo, Norway; Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Radiology, University Hospital North Norway, Tromsø, Norway; Pediatric Rheumatology Research Institute, Bad Bramstedt, Germany; Department of Pediatrics, University of Genoa, Genoa, Italy; Department of Pediatric Rheumatology, Reade Institute, location Jan van Breemen, Amsterdam, The Netherlands; Department of Clinical Medicine, K1, University of Bergen, and Department of Pediatric Radiology, Haukeland University Hospital, Bergen, Norway.C.M. Nusman, MSc, Department of Radiology, Academic Medical Center; Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Academic Medical Center; L.S. Ording Muller, MD, PhD, Department of Radiology, Oslo University Hospital; R. Hemke, MD, PhD, Department of Radiology, Academic Medical Center; Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Academic Medical Center; A.S. Doria, MD, PhD, Department of Diagnostic Imaging, The Hospital for Sick Children; D. Avenarius, MD, Department of Radiology, University Hospital North Norway; N. Tzaribachev, MD, Pediatric Rheumatology Research Institute; C. Malattia, MD, PhD, Department of Pediatrics, University of Genoa; M.A. van Rossum, MD, PhD, Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Academic Medical Center, and Department of Pediatric Rheumatology, Reade Institute, location Jan van Breemen; M. Maas, MD, PhD, Department of Radiology, Academic Medical Center; K. Rosendahl, MD, PhD, Department o
| | - Robert Hemke
- From the Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands; Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands; Department of Radiology, Oslo University Hospital, Oslo, Norway; Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Radiology, University Hospital North Norway, Tromsø, Norway; Pediatric Rheumatology Research Institute, Bad Bramstedt, Germany; Department of Pediatrics, University of Genoa, Genoa, Italy; Department of Pediatric Rheumatology, Reade Institute, location Jan van Breemen, Amsterdam, The Netherlands; Department of Clinical Medicine, K1, University of Bergen, and Department of Pediatric Radiology, Haukeland University Hospital, Bergen, Norway.C.M. Nusman, MSc, Department of Radiology, Academic Medical Center; Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Academic Medical Center; L.S. Ording Muller, MD, PhD, Department of Radiology, Oslo University Hospital; R. Hemke, MD, PhD, Department of Radiology, Academic Medical Center; Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Academic Medical Center; A.S. Doria, MD, PhD, Department of Diagnostic Imaging, The Hospital for Sick Children; D. Avenarius, MD, Department of Radiology, University Hospital North Norway; N. Tzaribachev, MD, Pediatric Rheumatology Research Institute; C. Malattia, MD, PhD, Department of Pediatrics, University of Genoa; M.A. van Rossum, MD, PhD, Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Academic Medical Center, and Department of Pediatric Rheumatology, Reade Institute, location Jan van Breemen; M. Maas, MD, PhD, Department of Radiology, Academic Medical Center; K. Rosendahl, MD, PhD, Department o
| | - Andrea S Doria
- From the Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands; Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands; Department of Radiology, Oslo University Hospital, Oslo, Norway; Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Radiology, University Hospital North Norway, Tromsø, Norway; Pediatric Rheumatology Research Institute, Bad Bramstedt, Germany; Department of Pediatrics, University of Genoa, Genoa, Italy; Department of Pediatric Rheumatology, Reade Institute, location Jan van Breemen, Amsterdam, The Netherlands; Department of Clinical Medicine, K1, University of Bergen, and Department of Pediatric Radiology, Haukeland University Hospital, Bergen, Norway.C.M. Nusman, MSc, Department of Radiology, Academic Medical Center; Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Academic Medical Center; L.S. Ording Muller, MD, PhD, Department of Radiology, Oslo University Hospital; R. Hemke, MD, PhD, Department of Radiology, Academic Medical Center; Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Academic Medical Center; A.S. Doria, MD, PhD, Department of Diagnostic Imaging, The Hospital for Sick Children; D. Avenarius, MD, Department of Radiology, University Hospital North Norway; N. Tzaribachev, MD, Pediatric Rheumatology Research Institute; C. Malattia, MD, PhD, Department of Pediatrics, University of Genoa; M.A. van Rossum, MD, PhD, Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Academic Medical Center, and Department of Pediatric Rheumatology, Reade Institute, location Jan van Breemen; M. Maas, MD, PhD, Department of Radiology, Academic Medical Center; K. Rosendahl, MD, PhD, Department o
| | - Derk Avenarius
- From the Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands; Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands; Department of Radiology, Oslo University Hospital, Oslo, Norway; Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Radiology, University Hospital North Norway, Tromsø, Norway; Pediatric Rheumatology Research Institute, Bad Bramstedt, Germany; Department of Pediatrics, University of Genoa, Genoa, Italy; Department of Pediatric Rheumatology, Reade Institute, location Jan van Breemen, Amsterdam, The Netherlands; Department of Clinical Medicine, K1, University of Bergen, and Department of Pediatric Radiology, Haukeland University Hospital, Bergen, Norway.C.M. Nusman, MSc, Department of Radiology, Academic Medical Center; Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Academic Medical Center; L.S. Ording Muller, MD, PhD, Department of Radiology, Oslo University Hospital; R. Hemke, MD, PhD, Department of Radiology, Academic Medical Center; Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Academic Medical Center; A.S. Doria, MD, PhD, Department of Diagnostic Imaging, The Hospital for Sick Children; D. Avenarius, MD, Department of Radiology, University Hospital North Norway; N. Tzaribachev, MD, Pediatric Rheumatology Research Institute; C. Malattia, MD, PhD, Department of Pediatrics, University of Genoa; M.A. van Rossum, MD, PhD, Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Academic Medical Center, and Department of Pediatric Rheumatology, Reade Institute, location Jan van Breemen; M. Maas, MD, PhD, Department of Radiology, Academic Medical Center; K. Rosendahl, MD, PhD, Department o
| | - Nikolay Tzaribachev
- From the Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands; Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands; Department of Radiology, Oslo University Hospital, Oslo, Norway; Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Radiology, University Hospital North Norway, Tromsø, Norway; Pediatric Rheumatology Research Institute, Bad Bramstedt, Germany; Department of Pediatrics, University of Genoa, Genoa, Italy; Department of Pediatric Rheumatology, Reade Institute, location Jan van Breemen, Amsterdam, The Netherlands; Department of Clinical Medicine, K1, University of Bergen, and Department of Pediatric Radiology, Haukeland University Hospital, Bergen, Norway.C.M. Nusman, MSc, Department of Radiology, Academic Medical Center; Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Academic Medical Center; L.S. Ording Muller, MD, PhD, Department of Radiology, Oslo University Hospital; R. Hemke, MD, PhD, Department of Radiology, Academic Medical Center; Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Academic Medical Center; A.S. Doria, MD, PhD, Department of Diagnostic Imaging, The Hospital for Sick Children; D. Avenarius, MD, Department of Radiology, University Hospital North Norway; N. Tzaribachev, MD, Pediatric Rheumatology Research Institute; C. Malattia, MD, PhD, Department of Pediatrics, University of Genoa; M.A. van Rossum, MD, PhD, Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Academic Medical Center, and Department of Pediatric Rheumatology, Reade Institute, location Jan van Breemen; M. Maas, MD, PhD, Department of Radiology, Academic Medical Center; K. Rosendahl, MD, PhD, Department o
| | - Clara Malattia
- From the Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands; Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands; Department of Radiology, Oslo University Hospital, Oslo, Norway; Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Radiology, University Hospital North Norway, Tromsø, Norway; Pediatric Rheumatology Research Institute, Bad Bramstedt, Germany; Department of Pediatrics, University of Genoa, Genoa, Italy; Department of Pediatric Rheumatology, Reade Institute, location Jan van Breemen, Amsterdam, The Netherlands; Department of Clinical Medicine, K1, University of Bergen, and Department of Pediatric Radiology, Haukeland University Hospital, Bergen, Norway.C.M. Nusman, MSc, Department of Radiology, Academic Medical Center; Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Academic Medical Center; L.S. Ording Muller, MD, PhD, Department of Radiology, Oslo University Hospital; R. Hemke, MD, PhD, Department of Radiology, Academic Medical Center; Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Academic Medical Center; A.S. Doria, MD, PhD, Department of Diagnostic Imaging, The Hospital for Sick Children; D. Avenarius, MD, Department of Radiology, University Hospital North Norway; N. Tzaribachev, MD, Pediatric Rheumatology Research Institute; C. Malattia, MD, PhD, Department of Pediatrics, University of Genoa; M.A. van Rossum, MD, PhD, Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Academic Medical Center, and Department of Pediatric Rheumatology, Reade Institute, location Jan van Breemen; M. Maas, MD, PhD, Department of Radiology, Academic Medical Center; K. Rosendahl, MD, PhD, Department o
| | - Marion A J van Rossum
- From the Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands; Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands; Department of Radiology, Oslo University Hospital, Oslo, Norway; Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Radiology, University Hospital North Norway, Tromsø, Norway; Pediatric Rheumatology Research Institute, Bad Bramstedt, Germany; Department of Pediatrics, University of Genoa, Genoa, Italy; Department of Pediatric Rheumatology, Reade Institute, location Jan van Breemen, Amsterdam, The Netherlands; Department of Clinical Medicine, K1, University of Bergen, and Department of Pediatric Radiology, Haukeland University Hospital, Bergen, Norway.C.M. Nusman, MSc, Department of Radiology, Academic Medical Center; Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Academic Medical Center; L.S. Ording Muller, MD, PhD, Department of Radiology, Oslo University Hospital; R. Hemke, MD, PhD, Department of Radiology, Academic Medical Center; Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Academic Medical Center; A.S. Doria, MD, PhD, Department of Diagnostic Imaging, The Hospital for Sick Children; D. Avenarius, MD, Department of Radiology, University Hospital North Norway; N. Tzaribachev, MD, Pediatric Rheumatology Research Institute; C. Malattia, MD, PhD, Department of Pediatrics, University of Genoa; M.A. van Rossum, MD, PhD, Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Academic Medical Center, and Department of Pediatric Rheumatology, Reade Institute, location Jan van Breemen; M. Maas, MD, PhD, Department of Radiology, Academic Medical Center; K. Rosendahl, MD, PhD, Department o
| | - Mario Maas
- From the Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands; Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands; Department of Radiology, Oslo University Hospital, Oslo, Norway; Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Radiology, University Hospital North Norway, Tromsø, Norway; Pediatric Rheumatology Research Institute, Bad Bramstedt, Germany; Department of Pediatrics, University of Genoa, Genoa, Italy; Department of Pediatric Rheumatology, Reade Institute, location Jan van Breemen, Amsterdam, The Netherlands; Department of Clinical Medicine, K1, University of Bergen, and Department of Pediatric Radiology, Haukeland University Hospital, Bergen, Norway.C.M. Nusman, MSc, Department of Radiology, Academic Medical Center; Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Academic Medical Center; L.S. Ording Muller, MD, PhD, Department of Radiology, Oslo University Hospital; R. Hemke, MD, PhD, Department of Radiology, Academic Medical Center; Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Academic Medical Center; A.S. Doria, MD, PhD, Department of Diagnostic Imaging, The Hospital for Sick Children; D. Avenarius, MD, Department of Radiology, University Hospital North Norway; N. Tzaribachev, MD, Pediatric Rheumatology Research Institute; C. Malattia, MD, PhD, Department of Pediatrics, University of Genoa; M.A. van Rossum, MD, PhD, Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Academic Medical Center, and Department of Pediatric Rheumatology, Reade Institute, location Jan van Breemen; M. Maas, MD, PhD, Department of Radiology, Academic Medical Center; K. Rosendahl, MD, PhD, Department o
| | - Karen Rosendahl
- From the Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands; Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands; Department of Radiology, Oslo University Hospital, Oslo, Norway; Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Radiology, University Hospital North Norway, Tromsø, Norway; Pediatric Rheumatology Research Institute, Bad Bramstedt, Germany; Department of Pediatrics, University of Genoa, Genoa, Italy; Department of Pediatric Rheumatology, Reade Institute, location Jan van Breemen, Amsterdam, The Netherlands; Department of Clinical Medicine, K1, University of Bergen, and Department of Pediatric Radiology, Haukeland University Hospital, Bergen, Norway.C.M. Nusman, MSc, Department of Radiology, Academic Medical Center; Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Academic Medical Center; L.S. Ording Muller, MD, PhD, Department of Radiology, Oslo University Hospital; R. Hemke, MD, PhD, Department of Radiology, Academic Medical Center; Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Academic Medical Center; A.S. Doria, MD, PhD, Department of Diagnostic Imaging, The Hospital for Sick Children; D. Avenarius, MD, Department of Radiology, University Hospital North Norway; N. Tzaribachev, MD, Pediatric Rheumatology Research Institute; C. Malattia, MD, PhD, Department of Pediatrics, University of Genoa; M.A. van Rossum, MD, PhD, Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Academic Medical Center, and Department of Pediatric Rheumatology, Reade Institute, location Jan van Breemen; M. Maas, MD, PhD, Department of Radiology, Academic Medical Center; K. Rosendahl, MD, PhD, Department o
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Ording Muller LS, Humphries P, Rosendahl K. The joints in juvenile idiopathic arthritis. Insights Imaging 2015; 6:275-84. [PMID: 25903287 PMCID: PMC4444796 DOI: 10.1007/s13244-015-0406-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 03/19/2015] [Accepted: 03/25/2015] [Indexed: 11/25/2022] Open
Abstract
Abstract Juvenile idiopathic arthritis is the most common rheumatic entity in childhood. Imaging has become an important supplement to the clinical assessment of children with JIA. Radiographs still play an important role in the workup, and long-term follow-up in children with JIA, but are not sensitive to findings in the early disease stage. Both ultrasound and MRI are more sensitive to inflammatory changes than clinical assessment alone. However, the differentiation between normal findings and pathology can be challenging, particularly in early disease. The objective of this review is to discuss the role of imaging in JIA, describe the typical findings on different modalities and highlight the challenges we face regarding the reliability and accuracy of the different methods for imaging the joints in children with JIA. Key Points • Imaging is an important supplement to the clinical examination in JIA. • Ultrasound is more sensitive for detecting synovitis than clinical examination alone. • MRI can depict all relevant structures in joint inflammation. • The differentiation between normal variants and pathology is difficult in children.
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Affiliation(s)
| | - Paul Humphries
- />Institute of Child Health, UCL, University College London Hospital NHS Trust and Great Ormond Street Hospital for Children, London, UK
| | - Karen Rosendahl
- />Department of Radiology, Haukeland University Hospital, Bergen, Norway
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Clinical features of juvenile idiopathic arthritis. Rheumatology (Oxford) 2015. [DOI: 10.1016/b978-0-323-09138-1.00101-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Lanni S, Martini A, Malattia C. Heading Toward a Modern Imaging Approach in Juvenile Idiopathic Arthritis. Curr Rheumatol Rep 2014; 16:416. [DOI: 10.1007/s11926-014-0416-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Wrist and Ankle MRI of Patients With Juvenile Idiopathic Arthritis: Identification of Unsuspected Multicompartmental Tenosynovitis and Arthritis. AJR Am J Roentgenol 2014; 202:413-7. [DOI: 10.2214/ajr.13.10671] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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