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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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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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