1
|
Vereecke E, Diekhoff T, Eshed I, Herregods N, Morbée L, Jaremko JL, Jans L. ESR Essentials: Imaging of sacroiliitis-practice recommendations by ESSR. Eur Radiol 2024:10.1007/s00330-024-10653-3. [PMID: 38459347 DOI: 10.1007/s00330-024-10653-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/23/2024] [Accepted: 01/25/2024] [Indexed: 03/10/2024]
Abstract
Sacroiliitis is commonly seen in patients with axial spondyloarthritis, in whom timely diagnosis and treatment are crucial to prevent irreversible structural damage. Imaging has a prominent place in the diagnostic process and several new imaging techniques have been examined for this purpose. We present a summary of updated evidence-based practice recommendations for imaging of sacroiliitis. MRI remains the imaging modality of choice for patients with suspected sacroiliitis, using at least four sequences: coronal oblique T1-weighted and fluid-sensitive sequences, a perpendicular axial oblique sequence, and a sequence for optimal evaluation of the bone-cartilage interface. Both active inflammatory and structural lesions should be described in the report, indicating location and extent. Radiography and CT, especially low-dose CT, are reasonable alternatives when MRI is unavailable, as patients are often young. This is particularly true to evaluate structural lesions, at which CT excels. Dual-energy CT with virtual non-calcium images can be used to depict bone marrow edema. Knowledge of normal imaging features in children (e.g., flaring, blurring, or irregular appearance of the articular surface) is essential for interpreting sacroiliac joint MRI in children because these normal processes can simulate disease. CLINICAL RELEVANCE STATEMENT: Sacroiliitis is a potentially debilitating disease if not diagnosed and treated promptly, before structural damage to the sacroiliac joints occurs. Imaging has a prominent place in the diagnostic process. We present a summary of practice recommendations for imaging of sacroiliitis, including several new imaging techniques. KEY POINTS: • MRI is the modality of choice for suspected inflammatory sacroiliitis, including a joint-line-specific sequence for optimal evaluation of the bone-cartilage interface to improve detection of erosions. • Radiography and CT (especially low-dose CT) are reasonable alternatives when MRI is unavailable. • Knowledge of normal imaging features in children is mandatory for interpretation of MRI of pediatric sacroiliac joints.
Collapse
Affiliation(s)
- Elke Vereecke
- Department of Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Torsten Diekhoff
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität Zu Berlin, Freie Universität Berlin, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Iris Eshed
- Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, 5262000, Ramat Gan, Israel
| | - Nele Herregods
- Department of Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Lieve Morbée
- Department of Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Jacob L Jaremko
- Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta Hospital, Edmonton, AB, T6G 2B7, Canada
| | - Lennart Jans
- Department of Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| |
Collapse
|
2
|
Vereecke E, Jans L, Herregods N, Chen M, Jaremko JL, Laloo F, Carron P, Varkas G, de Hooge M, Van den Bosch F, Elewaut D, Morbée L. Association of anatomical variants of the sacroiliac joint with bone marrow edema in patients with axial spondyloarthritis. Skeletal Radiol 2024; 53:507-514. [PMID: 37682337 DOI: 10.1007/s00256-023-04435-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/17/2023] [Accepted: 08/17/2023] [Indexed: 09/09/2023]
Abstract
OBJECTIVE To determine the prevalence of sacroiliac joint variants in patients with axial spondyloarthritis (axSpA) using MRI-based synthetic CT images and to evaluate their relationships with the presence of bone marrow edema, as this may potentially complicate diagnosing active sacroiliitis on MRI in patients with suspected axSpA. METHODS 172 patients were retrospectively included. All patients underwent MRI because of clinical suspicion of sacroiliitis. The diagnosis of axSpA was made by a tertiary hospital rheumatologist. Two readers independently determined the presence of bone marrow edema and the presence of one or more of the nine known sacroiliac joint (SIJ) variants. RESULTS SIJ variants were common in axSpA patients (82.9%) and the non-SpA group (85.4%); there were no significant differences in prevalence. Bone marrow edema was frequently found in axSpA (86.8%) and non-SpA patients (34%). AxSpA patients with SIJ variants (except for accessory joint) demonstrated 4 to 10 times higher odds for bone marrow edema, however not statistically significant. The more variants were present in this group, the higher the chance of bone marrow edema. However, some multicollinearity cannot be excluded, since bone marrow edema is very frequent in the axSpA group by definition. CONCLUSION SIJ variants are common in axSpA and non-SpA patients. SIJ variants were associated with higher prevalence of bone marrow edema in axSpA patients, potentially due to altered biomechanics, except for accessory joint which may act as a stabilizer.
Collapse
Affiliation(s)
- Elke Vereecke
- Department of Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | - Lennart Jans
- Department of Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Nele Herregods
- Department of Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Min Chen
- Department of Radiology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Jacob L Jaremko
- Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta Hospital, Edmonton, AB, Canada
| | - Frederiek Laloo
- Department of Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Philippe Carron
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium
- Molecular Immunology and Inflammation Unit, VIB-UGent Center for Inflammation Research, Zwijnaarde, Belgium
| | - Gaëlle Varkas
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium
- Molecular Immunology and Inflammation Unit, VIB-UGent Center for Inflammation Research, Zwijnaarde, Belgium
- Department of Rheumatology, Jan Palfijn Hospital, Ghent, Belgium
| | - Manouk de Hooge
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium
- Molecular Immunology and Inflammation Unit, VIB-UGent Center for Inflammation Research, Zwijnaarde, Belgium
| | - Filip Van den Bosch
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium
- Molecular Immunology and Inflammation Unit, VIB-UGent Center for Inflammation Research, Zwijnaarde, Belgium
| | - Dirk Elewaut
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium
- Molecular Immunology and Inflammation Unit, VIB-UGent Center for Inflammation Research, Zwijnaarde, Belgium
| | - Lieve Morbée
- Department of Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| |
Collapse
|
3
|
Schiettecatte E, Vereecke E, Jaremko JL, Morbée L, Vande Walle C, Jans L, Herregods N. MRI-based synthetic CT for assessment of the bony elements of the sacroiliac joints in children. Insights Imaging 2024; 15:53. [PMID: 38369564 PMCID: PMC10874918 DOI: 10.1186/s13244-023-01603-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 12/06/2023] [Indexed: 02/20/2024] Open
Abstract
OBJECTIVES The purpose of this study is to assess the equivalency of MRI-based synthetic CT (sCT) to conventional CT for sacroiliac joint bony morphology assessment in children. METHODS A prospective study was performed. Children who had (PET-)CT-scan underwent additional MRI. sCT-CT image quality was analyzed by two readers subjectively overall, semi-quantitatively in terms of cortical delineation, joint facet defects, growth plate fusion, ossified nuclei, lumbosacral transitional anomaly, and bony bridges, and quantitatively for disc space height, spinal canal width, and sacral vertebrae width and height. Cohen's kappa and equivalence analyses with Bland-Altman plots were calculated for categorical and continuous measures respectively. RESULTS Ten patients were included (6 boys; aged 9-16 years; mean age 14 years). Overall sCT image quality was rated good. Semi-quantitative assessment of cortical delineation of sacroiliac joints, bony bridges, and joint facet defects on the right iliac and sacral sides showed perfect agreement. Correlation was good to excellent (kappa 0.615-1) for the presence of lumbosacral transitional anomaly, fusion of sacral growth plates, joint facet defect, and presence of ossified nuclei. sCT-CT measurements were statistically equivalent and within the equivalence margins (-1-1 mm) for intervertebral disc space height and spinal canal width. Intra- and inter-reader reliability was excellent for quantitative assessment (0.806 < ICC < 0.998). For categorical scoring, kappa ranged from substantial to excellent (0.615-1). CONCLUSION sCT appears to be visually equivalent to CT for the assessment of pediatric sacroiliac joints. sCT may aid in visualizing sacroiliac joints compared to conventional MRI, with the benefit that no ionizing radiation is used, especially important in children. CRITICAL RELEVANCE STATEMENT MRI-based synthetic CT, a new technique that generates CT-like images without ionizing radiation, appears to be visually equivalent to CT for assessment of normal pediatric sacroiliac joints and can potentially assess structural damage as it clearly depicts bony cortex. KEY POINTS • MRI-based sCT is a new image technique that can generate CT-like images. • We found that sCT performs similarly to CT in displaying bony structures of pediatric sacroiliac joints. • sCT has already been clinically validated in the sacroiliac joints in adults. • sCT can potentially assess structural damage from erosions or ankylosis as it clearly depicts bony cortex.
Collapse
Affiliation(s)
- Eva Schiettecatte
- Department of Radiology and Nuclear Medicine, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | - Elke Vereecke
- Department of Radiology and Nuclear Medicine, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Jacob L Jaremko
- Department of Radiology, University of Alberta Hospital, 8440-112 Street, Edmonton, Alberta, T6G 2B7, Canada
| | - Lieve Morbée
- Department of Radiology and Nuclear Medicine, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Caroline Vande Walle
- Department of Radiology and Nuclear Medicine, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Lennart Jans
- Department of Radiology and Nuclear Medicine, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Nele Herregods
- Department of Radiology and Nuclear Medicine, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| |
Collapse
|
4
|
Maksymowych WP, Herregods N, Varma N, Meyers AB, Stimec J, Doria AS, Tzaribachev N, Otobo TM, van Rossum MA, Paschke J, Wichuk S, Lambert RG. Systematic calibration reduces sources of variability for the preliminary OMERACT juvenile idiopathic arthritis MRI- sacroiliac joint score (OMERACT JAMRIS-SIJ). Semin Arthritis Rheum 2024; 64:152299. [PMID: 38039747 DOI: 10.1016/j.semarthrit.2023.152299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 10/23/2023] [Accepted: 10/26/2023] [Indexed: 12/03/2023]
Abstract
OBJECTIVE To determine whether systematic calibration enhances scoring proficiency of the OMERACT juvenile idiopathic arthritis MRI-Sacroiliac Joint score (JAMRIS-SIJ) and whether contrast-enhancement enhances its performance. METHODS MRI SIJ scans of 50 cases with juvenile spondyloarthritis were scored by 7 raters after calibration with 3 different knowledge transfer tools. RESULTS Calibrated readers achieved greater reliability for scoring certain inflammatory and structural lesions. Sensitivity and reliability for scoring inflammatory lesions was greater on fluid-sensitive compared to contrast-enhanced sequences. CONCLUSION Systematic calibration should be implemented prior to the use of JAMRIS-SIJ for clinical trials. It is unlikely that contrast-enhanced MRI will improve the performance of this method.
Collapse
Affiliation(s)
- Walter P Maksymowych
- Department of Medicine, University of Alberta, Edmonton, Canada; CARE Arthritis, Edmonton, Alberta, Canada.
| | - Nele Herregods
- Division of Pediatric Radiology, Universitair Ziekenhuis Ghent, Ghent, Belgium
| | - Nisha Varma
- Department of Paediatric Radiology, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia; Murdoch Children's Research Institute, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia; Medical Imaging Department, Western Health, Melbourne, Victoria, Australia
| | - Arthur B Meyers
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, USA
| | - Jennifer Stimec
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Canada; Department of Medical Imaging, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Andrea S Doria
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Canada
| | - Nikolay Tzaribachev
- Department of Pediatric Rheumatology, Medical Center Bad Bramstedt, Bramstedt, Germany
| | - Tarimobo M Otobo
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Canada
| | - Marion A van Rossum
- Amsterdam Rheumatology and Immunology Center, Reade, and Emma Children's Hospital Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | | | | | - Robert G Lambert
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Canada
| |
Collapse
|
5
|
Vande Walle C, Keymeulen A, Oostra A, Schiettecatte E, Dhooge I, Smets K, Herregods N. Apparent diffusion coefficient values of the white matter in magnetic resonance imaging of the neonatal brain may help predict outcome in congenital cytomegalovirus infection. Pediatr Radiol 2024; 54:337-346. [PMID: 38182852 PMCID: PMC10830666 DOI: 10.1007/s00247-023-05838-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 12/14/2023] [Accepted: 12/15/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND White matter change is a well-known abnormality in congenital cytomegalovirus (cCMV) infection, but grading remains challenging and clinical relevance unclear. OBJECTIVE To investigate if quantitative measurement of white matter apparent diffusion coefficient (ADC) values in magnetic resonance imaging (MRI) of the neonatal brain can predict outcome in cCMV. MATERIALS AND METHODS A retrospective, single-center observational study, including patients with cCMV who had a neonatal brain MRI with diffusion-weighted imaging, was performed between 2007 and 2020. Regions of interest were systematically placed in the white matter on the ADC maps. Two pediatric radiologists independently scored additional brain abnormalities. Outcome measures were neonatal hearing and cognitive and motor development. Statistical analysis included simple and penalized elastic net regression. RESULTS Neonatal brain MRI was evaluated in 255 patients (median age 21 days, 25-75 percentiles: 14-28 days, 121 male). Gyral abnormalities were noted in nine patients (3.5%), ventriculomegaly in 24 (9.4%), and subependymal cysts in 58 (22.7%). General white matter ADC was significantly higher in patients with neonatal hearing loss and cognitive and motor impairment (P< 0.05). For neonatal hearing loss, simple logistic regression using only general white matter was the best prediction model, with a receiver operating characteristic area under the curve (AUC)=0.76. For cognitive impairment, interacting elastic net regression, including other brain abnormalities and frontoparietal white matter ADC, performed best, with AUC=0.89. For motor impairment, interacting elastic net regression, including other brain abnormalities and deep anterior frontal white matter performed best, with AUC=0.73. CONCLUSION Neonatal white matter ADC was significantly higher in patients with clinical impairments. Quantitative ADC measurement may be a useful tool for predicting clinical outcome in cCMV.
Collapse
Affiliation(s)
- Caroline Vande Walle
- Department of Radiology and Nuclear Medicine, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium.
| | | | - Anna Oostra
- Center for Developmental Disorders, Ghent, Belgium
| | - Eva Schiettecatte
- Department of Radiology and Nuclear Medicine, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium
| | - Ingeborg Dhooge
- Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
| | - Koenraad Smets
- Department of Neonatology, Ghent University Hospital, Ghent, Belgium
| | - Nele Herregods
- Department of Radiology and Nuclear Medicine, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium
| |
Collapse
|
6
|
Roels J, De Craemer AS, Renson T, de Hooge M, Gevaert A, Van Den Berghe T, Jans L, Herregods N, Carron P, Van den Bosch F, Saeys Y, Elewaut D. Machine Learning Pipeline for Predicting Bone Marrow Edema Along the Sacroiliac Joints on Magnetic Resonance Imaging. Arthritis Rheumatol 2023; 75:2169-2177. [PMID: 37410803 DOI: 10.1002/art.42650] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 06/22/2023] [Accepted: 06/26/2023] [Indexed: 07/08/2023]
Abstract
OBJECTIVE We aimed to develop and validate a fully automated machine learning (ML) algorithm that predicts bone marrow edema (BME) on a quadrant level in sacroiliac (SI) joint magnetic resonance imaging (MRI). METHODS A computer vision workflow automatically locates the SI joints, segments regions of interest (ilium and sacrum), performs objective quadrant extraction, and predicts presence of BME, suggestive of inflammatory lesions, on a quadrant level in semicoronal slices of T1/T2-weighted MRI scans. Ground truth was determined by consensus among human readers. The inflammation classifier was trained using a ResNet18 backbone and five-fold cross-validated on scans of patients with spondyloarthritis (SpA) (n = 279), postpartum individuals (n = 71), and healthy subjects (n = 114). Independent SpA patient MRI scans (n = 243) served as test data set. Patient-level predictions were derived from aggregating quadrant-level predictions, ie, at least one positive quadrant. RESULTS The algorithm automatically detects the SI joints with a precision of 98.4% and segments ilium/sacrum with an intersection over union of 85.6% and 67.9%, respectively. The inflammation classifier performed well in cross-validation: area under the curve (AUC) 94.5%, balanced accuracy (B-ACC) 80.5%, and F1 score 64.1%. In the test data set, AUC was 88.2%, B-ACC 72.1%, and F1 score 50.8%. On a patient level, the model achieved a B-ACC of 81.6% and 81.4% in the cross-validation and test data set, respectively. CONCLUSION We propose a fully automated ML pipeline that enables objective and standardized evaluation of BME along the SI joints on MRI. This method has the potential to screen large numbers of patients with (suspected) SpA and is a step closer towards artificial intelligence-assisted diagnosis and follow-up.
Collapse
Affiliation(s)
- Joris Roels
- Vlaams Instituut voor Biotechnologie - Universiteit Gent (VIB-UGent), Ghent-Zwijnaarde, and Ghent University, Ghent, Belgium
| | - Ann-Sophie De Craemer
- Vlaams Instituut voor Biotechnologie - Universiteit Gent (VIB-UGent), Ghent-Zwijnaarde, and Ghent University Hospital, Ghent, Belgium
| | - Thomas Renson
- Vlaams Instituut voor Biotechnologie - Universiteit Gent (VIB-UGent), Ghent-Zwijnaarde, and Ghent University Hospital, Ghent, Belgium
| | - Manouk de Hooge
- Vlaams Instituut voor Biotechnologie - Universiteit Gent (VIB-UGent), Ghent-Zwijnaarde, and Ghent University Hospital, Ghent, Belgium
| | - Arne Gevaert
- Vlaams Instituut voor Biotechnologie - Universiteit Gent (VIB-UGent), Ghent-Zwijnaarde, and Ghent University, Ghent, Belgium
| | | | | | | | - Philippe Carron
- Vlaams Instituut voor Biotechnologie - Universiteit Gent (VIB-UGent), Ghent-Zwijnaarde, and Ghent University Hospital, Ghent, Belgium
| | - Filip Van den Bosch
- Vlaams Instituut voor Biotechnologie - Universiteit Gent (VIB-UGent), Ghent-Zwijnaarde, and Ghent University Hospital, Ghent, Belgium
| | - Yvan Saeys
- Vlaams Instituut voor Biotechnologie - Universiteit Gent (VIB-UGent), Ghent-Zwijnaarde, and Ghent University, Ghent, Belgium
| | - Dirk Elewaut
- Vlaams Instituut voor Biotechnologie - Universiteit Gent (VIB-UGent), Ghent-Zwijnaarde, and Ghent University Hospital, Ghent, Belgium
| |
Collapse
|
7
|
Van Den Berghe T, Babin D, Chen M, Callens M, Brack D, Maes H, Lievens J, Lammens M, Van Sumere M, Morbée L, Hautekeete S, Schatteman S, Jacobs T, Thooft WJ, Herregods N, Huysse W, Jaremko JL, Lambert R, Maksymowych W, Laloo F, Baraliakos X, De Craemer AS, Carron P, Van den Bosch F, Elewaut D, Jans L. Neural network algorithm for detection of erosions and ankylosis on CT of the sacroiliac joints: multicentre development and validation of diagnostic accuracy. Eur Radiol 2023; 33:8310-8323. [PMID: 37219619 DOI: 10.1007/s00330-023-09704-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 03/03/2023] [Accepted: 03/25/2023] [Indexed: 05/24/2023]
Abstract
OBJECTIVES To evaluate the feasibility and diagnostic accuracy of a deep learning network for detection of structural lesions of sacroiliitis on multicentre pelvic CT scans. METHODS Pelvic CT scans of 145 patients (81 female, 121 Ghent University/24 Alberta University, 18-87 years old, mean 40 ± 13 years, 2005-2021) with a clinical suspicion of sacroiliitis were retrospectively included. After manual sacroiliac joint (SIJ) segmentation and structural lesion annotation, a U-Net for SIJ segmentation and two separate convolutional neural networks (CNN) for erosion and ankylosis detection were trained. In-training validation and tenfold validation testing (U-Net-n = 10 × 58; CNN-n = 10 × 29) on a test dataset were performed to assess performance on a slice-by-slice and patient level (dice coefficient/accuracy/sensitivity/specificity/positive and negative predictive value/ROC AUC). Patient-level optimisation was applied to increase the performance regarding predefined statistical metrics. Gradient-weighted class activation mapping (Grad-CAM++) heatmap explainability analysis highlighted image parts with statistically important regions for algorithmic decisions. RESULTS Regarding SIJ segmentation, a dice coefficient of 0.75 was obtained in the test dataset. For slice-by-slice structural lesion detection, a sensitivity/specificity/ROC AUC of 95%/89%/0.92 and 93%/91%/0.91 were obtained in the test dataset for erosion and ankylosis detection, respectively. For patient-level lesion detection after pipeline optimisation for predefined statistical metrics, a sensitivity/specificity of 95%/85% and 82%/97% were obtained for erosion and ankylosis detection, respectively. Grad-CAM++ explainability analysis highlighted cortical edges as focus for pipeline decisions. CONCLUSIONS An optimised deep learning pipeline, including an explainability analysis, detects structural lesions of sacroiliitis on pelvic CT scans with excellent statistical performance on a slice-by-slice and patient level. CLINICAL RELEVANCE STATEMENT An optimised deep learning pipeline, including a robust explainability analysis, detects structural lesions of sacroiliitis on pelvic CT scans with excellent statistical metrics on a slice-by-slice and patient level. KEY POINTS • Structural lesions of sacroiliitis can be detected automatically in pelvic CT scans. • Both automatic segmentation and disease detection yield excellent statistical outcome metrics. • The algorithm takes decisions based on cortical edges, rendering an explainable solution.
Collapse
Affiliation(s)
- Thomas Van Den Berghe
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | - Danilo Babin
- Department of Telecommunication and Information Processing - Image Processing and Interpretation (TELIN-IPI), Faculty of Engineering and Architecture, Ghent University - IMEC, Sint-Pietersnieuwstraat 41, 9000, Ghent, Belgium
| | - Min Chen
- Department of Radiology, Peking University Shenzhen Hospital, Shenzhen, 518036, China
| | - Martijn Callens
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Denim Brack
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Helena Maes
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Jan Lievens
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Marie Lammens
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Maxime Van Sumere
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Lieve Morbée
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Simon Hautekeete
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Stijn Schatteman
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Tom Jacobs
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Willem-Jan Thooft
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Nele Herregods
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Wouter Huysse
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Jacob L Jaremko
- Department of Radiology and Diagnostic Imaging and Rheumatology, University of Alberta, 8440 122 Street NW, Edmonton, Alberta, T6G 2B7, Canada
| | - Robert Lambert
- Department of Radiology and Diagnostic Imaging and Rheumatology, University of Alberta, 8440 122 Street NW, Edmonton, Alberta, T6G 2B7, Canada
| | - Walter Maksymowych
- Department of Radiology and Diagnostic Imaging and Rheumatology, University of Alberta, 8440 122 Street NW, Edmonton, Alberta, T6G 2B7, Canada
| | - Frederiek Laloo
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Xenofon Baraliakos
- Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Claudiusstraße 45, 44649, Herne, Germany
| | - Ann-Sophie De Craemer
- Department of Rheumatology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
- Vlaams Instituut voor Biotechnologie (VIB) Centre for Inflammation Research (IRC), Ghent University, Technologiepark 927, 9052, Ghent, Belgium
| | - Philippe Carron
- Department of Rheumatology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
- Vlaams Instituut voor Biotechnologie (VIB) Centre for Inflammation Research (IRC), Ghent University, Technologiepark 927, 9052, Ghent, Belgium
| | - Filip Van den Bosch
- Department of Rheumatology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
- Vlaams Instituut voor Biotechnologie (VIB) Centre for Inflammation Research (IRC), Ghent University, Technologiepark 927, 9052, Ghent, Belgium
| | - Dirk Elewaut
- Department of Rheumatology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
- Vlaams Instituut voor Biotechnologie (VIB) Centre for Inflammation Research (IRC), Ghent University, Technologiepark 927, 9052, Ghent, Belgium
| | - Lennart Jans
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| |
Collapse
|
8
|
Sudoł-Szopińska I, Herregods N, Zejden A, Jans L, Giraudo C, Boesen M, Becce F, Bazzocchi A, Simoni P, Aparisi Gómez MP, Jaremko J, Maas M, Teh J, Hermann KG, Menegotto F, Isaac A, Reijnierse M, Shah A, Rennie W, Jurik AG. Erratum: Current Role of Conventional Radiography of Sacroiliac Joints in Adults and Juveniles with Suspected Axial Spondyloarthritis: Opinion from the ESSR Arthritis and Pediatric Subcommittees. Semin Musculoskelet Radiol 2023; 27:e1. [PMID: 37890519 DOI: 10.1055/s-0043-1776395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2023]
Affiliation(s)
- Iwona Sudoł-Szopińska
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Nele Herregods
- Department of Radiology and Nuclear Medicine - Division of Pediatric Radiology, Princess Elisabeth Children's Hospital/Ghent University Hospital, Ghent, Belgium
| | - Anna Zejden
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - Lennart Jans
- Department of Radiology, Ghent University Hospital, Ghent, Belgium
| | - Chiara Giraudo
- Department of Medicine - DIMED, University of Padova, Padova, Italy
| | - Mikael Boesen
- Department of Radiology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Fabio Becce
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Alberto Bazzocchi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Paolo Simoni
- Pediatric Imaging Department, Reine Fabiola Children's University Hospital, ULB, Brussels, Belgium
| | - Maria Pilar Aparisi Gómez
- Department of Radiology, Auckland City Hospital, Auckland District Health Board, Grafton, Auckland, New Zealand
- Department of Radiology, IMSKE, Valencia, Spain
| | - Jacob Jaremko
- Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta Hospital, Edmonton, AB, Canada
| | - Mario Maas
- Department of Radiology & Nuclear Medicine, Amsterdam UMC, location AMC - University of Amsterdam, Amsterdam, Netherlands
| | - James Teh
- Radiology Department, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - Kay-Geert Hermann
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Flavia Menegotto
- Bristol Royal Hospital for Children Paediatric Radiology Department, University Hospitals Bristol and Weston NHS Foundation Trust (UHBW), Bristol, United Kingdom
| | - Amanda Isaac
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Monique Reijnierse
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | - Amit Shah
- Department of Radiology, University Hospitals of Leicester NHS Trust, Infirmary Square, Leicester, United Kingdom
| | - Winston Rennie
- Department of Radiology, University Hospitals of Leicester NHS Trust, Loughborough University, Loughborough, United Kingdom
| | - Anne Grethe Jurik
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
9
|
Sudoł-Szopińska I, Herregods N, Zejden A, Jans L, Giraudo C, Boesen M, Becce F, Bazzocchi A, Simoni P, Aparisi Gómez MP, Jaremko J, Maas M, Teh J, Hermann KG, Menegotto F, Isaac A, Reijnierse M, Shah A, Rennie W, Jurik AG. Current Role of Conventional Radiography of Sacroiliac Joints in Adults and Juveniles with Suspected Axial Spondyloarthritis: Opinion from the ESSR Arthritis and Pediatric Subcommittees. Semin Musculoskelet Radiol 2023; 27:588-595. [PMID: 37816367 DOI: 10.1055/s-0043-1772169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/12/2023]
Abstract
This opinion article by the European Society of Musculoskeletal Radiology Arthritis and Pediatric Subcommittees discusses the current use of conventional radiography (CR) of the sacroiliac joints in adults and juveniles with suspected axial spondyloarthritis (axSpA). The strengths and limitations of CR compared with magnetic resonance imaging (MRI) and computed tomography (CT) are presented.Based on the current literature and expert opinions, the subcommittees recognize the superior sensitivity of MRI to detect early sacroiliitis. In adults, supplementary pelvic radiography, low-dose CT, or synthetic CT may be needed to evaluate differential diagnoses. CR remains the method of choice to detect structural changes in patients with suspected late-stage axSpA or established disease and in patients with suspected concomitant hip or pubic symphysis involvement. In children, MRI is the imaging modality of choice because it can detect active as well as structural changes and is radiation free.
Collapse
Affiliation(s)
- Iwona Sudoł-Szopińska
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Nele Herregods
- Department of Radiology and Nuclear Medicine - Division of Pediatric Radiology, Princess Elisabeth Children's Hospital/Ghent University Hospital, Ghent, Belgium
| | - Anna Zejden
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - Lennart Jans
- Department of Radiology, Ghent University Hospital, Ghent, Belgium
| | - Chiara Giraudo
- Department of Medicine - DIMED, University of Padova, Padova, Italy
| | - Mikael Boesen
- Department of Radiology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Fabio Becce
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Alberto Bazzocchi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Paolo Simoni
- Pediatric Imaging Department, Reine Fabiola Children's University Hospital, ULB, Brussels, Belgium
| | - Maria Pilar Aparisi Gómez
- Department of Radiology, Auckland City Hospital, Auckland District Health Board, Grafton, Auckland, New Zealand
- Department of Radiology, IMSKE, Valencia, Spain
| | - Jacob Jaremko
- Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta Hospital, Edmonton, AB, Canada
| | - Mario Maas
- Department of Radiology & Nuclear Medicine, Amsterdam UMC, location AMC - University of Amsterdam, Amsterdam, Netherlands
| | - James Teh
- Radiology Department, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - Kay-Geert Hermann
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Flavia Menegotto
- Bristol Royal Hospital for Children Paediatric Radiology Department, University Hospitals Bristol and Weston NHS Foundation Trust (UHBW), Bristol, United Kingdom
| | - Amanda Isaac
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Monique Reijnierse
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | - Amit Shah
- Department of Radiology, University Hospitals of Leicester NHS Trust, Infirmary Square, Leicester, United Kingdom
| | - Winston Rennie
- Department of Radiology, University Hospitals of Leicester NHS Trust, Loughborough University, Loughborough, United Kingdom
| | - Anne Grethe Jurik
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
10
|
Vande Walle C, Keymeulen A, Oostra A, Schiettecatte E, Dhooge IJ, Smets K, Herregods N. Implications of isolated white matter abnormalities on neonatal MRI in congenital CMV infection: a prospective single-centre study. BMJ Paediatr Open 2023; 7:e002097. [PMID: 37844971 PMCID: PMC10582994 DOI: 10.1136/bmjpo-2023-002097] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/19/2023] [Indexed: 10/18/2023] Open
Abstract
OBJECTIVE Investigating the clinical implications of isolated white matter abnormalities on neonatal brain MRI in congenital cytomegalovirus (CMV). DESIGN Prospective, observational. PATIENTS/INTERVENTIONS Two paediatric radiologists, blinded to clinical data, independently scored the white matter in 286 newborns with congenital CMV. After assessing interobserver variability, mean score was used to categorise white matter (normal, doubtful or abnormal). Patients with other brain abnormalities were excluded. MAIN OUTCOME MEASURES Hearing and neuromotor evaluation. RESULTS Cohen's weighted kappa was 0.79 (95% CI 0.73 to 0.84). White matter was normal in 121 patients, doubtful in 62, abnormal in 28. Median clinical follow-up was 12.0 months (IQR 12.0-27.7 months). Neonatal hearing loss occurred in 4/27 patients (14.8%) with abnormal, 1/118 patients (0.8%) with normal and 1/62 patients (1.6%) with doubtful white matter (p<0.01). Impaired cognitive development was seen in 3/27 patients (11.1%) with abnormal, 3/114 patients (2.6%) with normal and 1/59 patients (1.7%) with doubtful white matter (p=0.104). Alberta Infant Motor Scale (AIMS) was below P75 in 21/26 patients (80.8%) with abnormal, 73/114 patients (64.0%) with normal and 36/57 patients (63.2%) with doubtful white matter (p=0.231). In a subgroup of patients with minimal clinical follow-up of 18 months, AIMS score was below P75 in 10/13 patients (76.9%) with abnormal, 13/34 patients (38.2%) with normal and 7/20 patients (35.0%) with doubtful white matter (p<0.05). CONCLUSIONS Abnormal white matter was associated with neonatal hearing loss and mild, lower motor scores. A tendency towards impaired cognitive development was seen. Patients with doubtful white matter did not show worse clinical outcome.
Collapse
Affiliation(s)
- Caroline Vande Walle
- Department of Radiology and Nuclear Medicine, Universitair Ziekenhuis Gent, Gent, Belgium
| | | | - Ann Oostra
- Centre for Developmental Disorders, Universitair Ziekenhuis Gent, Gent, Belgium
| | - Eva Schiettecatte
- Department of Radiology and Nuclear Medicine, Universitair Ziekenhuis Gent, Gent, Belgium
| | | | - Koenraad Smets
- Department of Neonatology, Universitair Ziekenhuis Gent, Gent, Belgium
| | - Nele Herregods
- Department of Radiology and Nuclear Medicine, Universitair Ziekenhuis Gent, Gent, Belgium
| |
Collapse
|
11
|
Schatteman S, Jaremko J, Jans L, Herregods N. Update on Pediatric Spine Imaging. Semin Musculoskelet Radiol 2023; 27:566-579. [PMID: 37816365 DOI: 10.1055/s-0043-1771333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/12/2023]
Abstract
The spine is often difficult to evaluate clinically in children, increasing the importance of diagnostic imaging to detect a wide variety of spinal disorders ranging from congenital abnormalities to severe infections. Clinical history and physical examination can help determine whether imaging is needed and which imaging technique would be best. The most common cause for back pain, even in children, is muscular strain/spasm that does not require any imaging. However, red flags such as pain at age < 5 years, constant pain, night pain, radicular pain, pain lasting > 4 weeks, or an abnormal neurologic examination may require further investigation. Imaging can be of great value for diagnosis but must be interpreted along with the clinical history, physical examination, and laboratory findings to achieve an accurate diagnosis. We discuss imaging for the most common and/or important spine pathologies in children: congenital and developmental pathologies, trauma, infectious processes, inflammatory causes, and tumors.
Collapse
Affiliation(s)
- Stijn Schatteman
- Department of Radiology and Nuclear Medicine, Ghent University Hospital, Ghent, Belgium
| | - Jacob Jaremko
- Department of Radiology and Diagnostic Imaging, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - Lennart Jans
- Department of Radiology and Nuclear Medicine, Ghent University Hospital, Ghent, Belgium
| | - Nele Herregods
- Department of Radiology and Nuclear Medicine, Ghent University Hospital, Ghent, Belgium
| |
Collapse
|
12
|
Weiss PF, Brandon TG, Lambert RG, Biko DM, Chauvin NA, Francavilla ML, Herregods N, Hendry AM, Maksymowych WP. Consensus-Driven Definition for Unequivocal Sacroiliitis on Radiographs in Juvenile Spondyloarthritis. J Rheumatol 2023; 50:1173-1177. [PMID: 37061228 PMCID: PMC10524560 DOI: 10.3899/jrheum.2022-0890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2023] [Indexed: 04/17/2023]
Abstract
OBJECTIVE Radiography is still used worldwide for the detection of sacroiliitis in juvenile spondyloarthritis (JSpA), despite its low sensitivity and reliability. We aimed to define unequivocal evidence of sacroiliitis on pelvic radiography in skeletally immature youth for use in classification criteria when magnetic resonance imaging (MRI) is unavailable. METHODS Subjects were a retrospective cohort of juvenile patients with spondyloarthritis with a radiograph and MRI as part of a diagnostic evaluation for axial disease. Six musculoskeletal imaging experts underwent an iterative consensus process to define unequivocal sacroiliitis on radiography in skeletally immature youth. Radiographs were graded using the modified New York (mNY) criteria and the unequivocal sacroiliitis criteria. Interrater agreement was assessed with the Fleiss [Formula: see text] statistic. Specificity, area under the receiver operator characteristic curve (AUROC), and sensitivity of the 2 measures were tested using 2 MRI reference standards. RESULTS A total of 112 subjects, with a median age of 14.9 (range 6.7-20.1) years, were included. The Fleiss [Formula: see text] was fair for the mNY criteria (0.54, 95% CI 0.42-0.67) and the unequivocal sacroiliitis criteria (0.58, 95% CI 0.46-0.69). The unequivocal sacroiliitis criteria achieved > 90% specificity using both MRI reference standards. Sensitivity (59.26 and 57.14 vs 44.83 and 43.33) and AUROC (0.76 and 0.76 vs 0.71 and 0.71) were higher, for both reference standards, for the unequivocal sacroiliitis in youth definition than for the mNY criteria, respectively. CONCLUSION In this study, we propose the first consensus-derived definition to our knowledge of unequivocal sacroiliitis by radiography in skeletally immature youth. This definition achieved excellent specificity and had higher AUROC and sensitivity values than the mNY criteria using both MRI reference standards. This definition has applicability to the JSpA axial disease classification imaging criterion when MRI is unavailable.
Collapse
Affiliation(s)
- Pamela F Weiss
- P.F. Weiss, MD, MSCE, Department of Pediatrics, Division of Rheumatology and Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, and Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA;
| | - Timothy G Brandon
- T.G. Brandon, MPH, Department of Pediatrics, Division of Rheumatology and Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Robert G Lambert
- R.G. Lambert, MB BCh, Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
| | - David M Biko
- D.M. Biko, MD, Department of Radiology, Children's Hospital of Philadelphia, and Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nancy A Chauvin
- N.A. Chauvin, MD, Department of Radiology, Penn State Health Milton S. Hershey Children's Hospital, Hershey, Pennsylvania, USA
| | - Michael L Francavilla
- M.L. Francavilla, MD, Department of Radiology, Whiddon College of Medicine, University of South Alabama, Mobile, Alabama USA
| | - Nele Herregods
- N. Herregods, MD, Department of Radiology and Nuclear Medicine, Ghent University Hospital, Ghent, Belgium
| | - Alison M Hendry
- A.M. Hendry, PGDipHealMgt, PGDipHSc, General Medicine and Rheumatology, Division of Medicine, Emergency and Integrated Care, Counties Manukau District Health Board, Auckland, New Zealand
| | - Walter P Maksymowych
- W.P. Maksymowych, MD, Department of Medicine, University of Alberta and CARE Arthritis, Edmonton, Alberta, Canada
| |
Collapse
|
13
|
Di Dier K, Deppe D, Diekhoff T, Herregods N, Jans L. Clash of the titans: Current CT and CT-like imaging modalities in sacroiliitis in spondyloarthritis. Best Pract Res Clin Rheumatol 2023; 37:101876. [PMID: 37953120 DOI: 10.1016/j.berh.2023.101876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 07/07/2023] [Accepted: 10/16/2023] [Indexed: 11/14/2023]
Abstract
Sacroiliitis is characterised by active and structural changes of the joint. While the Assessment of Spondyloarthritis international Society (ASAS) classification criteria stress the importance of bone marrow inflammation, recent reports suggest that osteitis can occur in various diseases, mechanical conditions and healthy individuals. Thus, structural lesions such as joint surface erosion and ankylosis are important factors for differential diagnosis. Various imaging modalities are available to examine these changes. However, computed tomography (CT) is generally considered the reference standard. Nonetheless, recent advances in magnetic resonance imaging (MRI) allow for direct bone imaging and the reconstruction of CT-like images that can provide similar information. This way, the ability of MRI to detect and measure structural lesions is strengthened. The aim of this review is to provide an overview of the pros and cons of CT and CT-like imaging modalities in sacroiliitis.
Collapse
Affiliation(s)
- Kelly Di Dier
- Department of Radiology, Faculty of Medicine, Ghent University Hospital, De Pintelaan 185, 9000, Gent, Belgium.
| | - Dominik Deppe
- Department of Radiology (CCM), Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt - Universität Zu Berlin, Freie Unversität Berlin, Charitéplaz 1, 10117, Berlin, Germany.
| | - Torsten Diekhoff
- Department of Radiology (CCM), Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt - Universität Zu Berlin, Freie Unversität Berlin, Charitéplaz 1, 10117, Berlin, Germany.
| | - Nele Herregods
- Department of Radiology, Faculty of Medicine, Ghent University Hospital, De Pintelaan 185, 9000, Gent, Belgium.
| | - Lennart Jans
- Department of Radiology, Faculty of Medicine, Ghent University Hospital, De Pintelaan 185, 9000, Gent, Belgium.
| |
Collapse
|
14
|
Herregods N, Anisau A, Schiettecatte E, Vereecke E, Morbée L, Laloo F, Jaremko JL, Jans L. MRI in pediatric sacroiliitis, what radiologists should know. Pediatr Radiol 2023; 53:1576-1586. [PMID: 36856758 DOI: 10.1007/s00247-023-05602-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 12/21/2022] [Accepted: 01/11/2023] [Indexed: 03/02/2023]
Abstract
MRI is used for early detection of inflammation of sacroiliac joints as it shows active lesions of sacroiliitis long before radiographs show damage to the sacroiliac joints. Early diagnosis of arthritis allows early treatment of inflammation and can help delay disease progression and prevent irreversible damage. Also, early identification of axial involvement in juvenile spondyloarthropathy is crucial, as treatment options are different than for peripheral juvenile spondyloarthropathy. In general, standard sequences used in adults are also applied to children. However, interpreting MR images of pediatric sacroiliac joints is more challenging than in adults, because of normal physiological changes during skeletal maturation, which can simulate disease on MR images. Furthermore, classical definitions of sacroiliitis used in adults, for both active inflammatory and structural lesions, can be difficult to extrapolate to children. The development of reliable pediatric-specific definitions for sacroiliitis is still in active study. Understanding both normal and pathological signal changes in children is important to distinguish physiologic findings from disease and to make a correct diagnosis. In this review, the main imaging characteristics of sacroiliitis on MRI in children and its frequent pitfalls will be illustrated, while also citing some discussion points regarding the scan protocol.
Collapse
Affiliation(s)
- Nele Herregods
- Department of Radiology and Nuclear Medicine, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium.
| | - Aliaksandr Anisau
- Department of Radiology and Nuclear Medicine, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium
| | - Eva Schiettecatte
- Department of Radiology and Nuclear Medicine, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium
| | - Elke Vereecke
- Department of Radiology and Nuclear Medicine, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium
| | - Lieve Morbée
- Department of Radiology and Nuclear Medicine, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium
| | - Frederiek Laloo
- Department of Radiology and Nuclear Medicine, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium
| | - Jacob L Jaremko
- Department of Radiology & Diagnostic Imaging, University of Alberta, 8440-112 Street, EdmontonAlberta, T6G 2B7, Canada
- Medical Imaging Consultants, Edmonton, AB, Canada
| | - Lennart Jans
- Department of Radiology and Nuclear Medicine, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium
| |
Collapse
|
15
|
Otobo TM, Tolend M, Meyers AB, Sudol-Szopinska I, Joshi S, Stimec J, Herregods N, Jaremko JL, Tse SML, Haroon N, Moineddin R, Tzaribachev N, Appenzeller S, Znajdek M, Perez M, Ligha AE, Jans L, Inarejos Clemente EJ, Weiss P, Papakonstantinou O, Kirkhus E, van Rossum MAJ, Rumsey DG, Carrino J, Akikusa JD, Conaghan PG, Doria AS. Determination of Relative Weightings for Sacroiliac Joint Pathologies in the OMERACT Juvenile Arthritis Magnetic Resonance Imaging Sacroiliac Joint Score. J Clin Med 2023; 12:jcm12072729. [PMID: 37048812 PMCID: PMC10095587 DOI: 10.3390/jcm12072729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/22/2023] [Accepted: 03/20/2023] [Indexed: 04/14/2023] Open
Abstract
This study aims to determine the relative weights (point value) of items of the juvenile idiopathic arthritis magnetic resonance imaging-sacroiliac joint scoring system (JAMRIS-SIJ). An adaptive multicriteria decision analysis was performed using the 1000Minds web application to determine the relative weights of the items in the JAMRIS-SIJ inflammation and damage domains. Experts in imaging and rheumatology independently completed a conjoint analysis survey (CAS) to determine the point value of the measurement items of the JAMRIS-SIJ. Each CAS survey question asked the expert to compare two hypothetical patient profiles, which were otherwise similar but different at two items at a time, and to select which item showed a more severe stage of inflammation or osteochondral damage. In addition, experts ranked 14 JAMRIS-SIJ grade only or image + grade patient vignettes while blinded to the CAS-derived weights. The validity of the weighted JAMRIS-SIJ was tested by comparing the expert CAS-weighted score and the image + grade ranking method. Seventeen experts completed the CAS (11 radiologists and 6 rheumatologists). Considering the point value for inflammation domain items, osteitis (24.7%) and bone marrow edema (24.3%) had higher group-averaged percentage weights compared to inflammation in erosion cavity (16.9%), joint space enhancement (13.1%), joint space fluid (9.1%), capsulitis (7.3%), and enthesitis (4.6%). Similarly, concerning the damage domain, ankylosis (41.3%) and erosion (25.1%) showed higher group-averaged weights compared to backfill (13.9%), sclerosis (10.7%), and fat metaplasia lesion (9.1%). The Spearman correlation coefficients of the CAS-weighted vignette order and unweighted JAMRIS-SIJ grade only order vignettes for all experts were 0.79 for inflammation and 0.80 for damage. The correlations of image vignettes among imaging experts to CAS were 0.75 for inflammation and 0.90 for damage. The multicriteria decision analysis identified differences in relative weights among the JAMRIS-SIJ measurement items. The determination of the relative weights provided expert-driven score scaling and face validity for the JAMRIS-SIJ, enabling the future evaluation of its longitudinal construct validity.
Collapse
Affiliation(s)
- Tarimobo M Otobo
- Department of Diagnostic Radiology, Hospital for SickKids, Toronto, ON M5G 0A4, Canada
| | - Mirkamal Tolend
- Department of Diagnostic Radiology, Hospital for SickKids, Toronto, ON M5G 0A4, Canada
| | - Arthur B Meyers
- Department of Radiology and Medical Imaging, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Iwona Sudol-Szopinska
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637 Warsaw, Poland
| | - Sayali Joshi
- Department of Diagnostic Radiology, Hospital for SickKids, Toronto, ON M5G 0A4, Canada
| | - Jennifer Stimec
- Department of Diagnostic Radiology, Hospital for SickKids, Toronto, ON M5G 0A4, Canada
| | - Nele Herregods
- Division of Pediatric of Radiology, Universitair Ziekenhuis Ghent, 9000 Ghent, Belgium
| | - Jacob L Jaremko
- Department of Radiology, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Shirley M L Tse
- Division of Rheumatology, SickKids, Toronto, ON M5G 1X8, Canada
| | - Nigil Haroon
- Department of Rheumatology, Toronto Western Hospital, Toronto, ON M5T 2S8, Canada
| | - Rahim Moineddin
- Department of Family Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada
| | - Nikolay Tzaribachev
- Department of Pediatric Rheumatology, Medical Center Bad Bramstedt, 24576 Bramstedt, Germany
| | - Simone Appenzeller
- Department of Rheumatology, Universidade Estadual de Campinas, São Paulo 13083-970, Brazil
| | - Michal Znajdek
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637 Warsaw, Poland
| | - Manuela Perez
- Department of Diagnostic Radiology, University of Toronto, Toronto, ON M5G 1V7, Canada
| | - Aloysius E Ligha
- Department of Anatomy, Niger Delta University, Amassoma 560103, Nigeria
| | - Lennart Jans
- Department of Radiology, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | | | - Pamela Weiss
- Department of Rheumatology, Children Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | | | - Eva Kirkhus
- Department of Radiology, Oslo University Hospital, 0372 Oslo, Norway
| | - Marion A J van Rossum
- Amsterdam Rheumatology and Immunology Center, Read and Emma Children's Hospital, Amsterdam University Medical Center, 1105 Amsterdam, The Netherlands
| | - Dax G Rumsey
- Division of Rheumatology, Department of Pediatrics, University of Alberta, Edmonton, AB T6G 1C9, Canada
| | - John Carrino
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY 10021, USA
| | - Jonathan D Akikusa
- Department of General Medicine, Rheumatology Service, Royal Children's Hospital Melbourne, Melbourne, VIC 3052, Australia
| | | | - Andrea S Doria
- Department of Diagnostic Radiology, Hospital for SickKids, Toronto, ON M5G 0A4, Canada
| |
Collapse
|
16
|
Vereecke E, Morbée L, Laloo F, Chen M, Jaremko JL, Herregods N, Jans L. Anatomical variation of the sacroiliac joints: an MRI study with synthetic CT images. Insights Imaging 2023; 14:30. [PMID: 36750489 PMCID: PMC9905396 DOI: 10.1186/s13244-023-01373-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 01/09/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Synthetic computed tomography (sCT) images are magnetic resonance imaging (MRI)-based images, generated using artificial intelligence. This study aimed to determine the prevalence of anatomical variants of sacroiliac joints (SIJ) on sCT images and the correlation with age, sex and body weight. METHODS MRI of the SIJ including sCT images of 215 patients clinically suspected for sacroiliitis were retrospectively analyzed. The presence of anatomical variants of the SIJ was assessed. Age, sex and body mass index at the time of the MRI were recorded. RESULTS SIJ variants were found in 82.8% (356/430) of the evaluated joints. The most frequent variants were iliosacral complex (27.7%), bipartite iliac bony plate (27.2%) and crescent iliac bony plate (27%). One new variant was identified, consisting of an accessory facet of the SIJ on the superior side. Overall, SIJ variants were slightly more frequent in women (85.8% vs. 77.8%), but iliosacral complex was significantly more frequent in men. Isolated synostosis was more prevalent with advancing age, in contrast to semicircular defect and unfused ossification center. The occurrence of iliosacral complex was associated with higher BMI, while crescent iliac bony plate occurred more in patients with lower BMI. CONCLUSION Over 80% of patients in this study, who were all suspected of sacroiliitis, had at least one SIJ variant. These variants may actually represent subtypes of the normal SIJ. sCT enables detection of very small or subtle findings including SIJ variants.
Collapse
Affiliation(s)
- Elke Vereecke
- Department of Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | - Lieve Morbée
- grid.410566.00000 0004 0626 3303Department of Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Frederiek Laloo
- grid.410566.00000 0004 0626 3303Department of Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Min Chen
- grid.440601.70000 0004 1798 0578Department of Radiology, Peking University Shenzhen Hospital, Shenzhen, 518036 China
| | - Jacob L. Jaremko
- grid.241114.30000 0004 0459 7625Department of Radiology and Diagnostic Imaging, University of Alberta Hospital, Edmonton, AB T6G 2B7 Canada
| | - Nele Herregods
- grid.410566.00000 0004 0626 3303Department of Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Lennart Jans
- grid.410566.00000 0004 0626 3303Department of Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| |
Collapse
|
17
|
Herregods N, Lambert RGW, Schiettecatte E, Dehoorne J, Renson T, Laloo F, Van Den Berghe T, Jans LBO, Jaremko JL. Blurring and Irregularity of the Subchondral Cortex in Pediatric Sacroiliac Joints on T1 Images: Incidence of Normal Findings That Can Mimic Erosions. Arthritis Care Res (Hoboken) 2023; 75:190-197. [PMID: 34235890 DOI: 10.1002/acr.24746] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/15/2021] [Accepted: 07/06/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To determine prevalence of variations of subchondral bone appearance that may mimic erosions on T1-weighted magnetic resonance imaging (MRI) of pediatric sacroiliac (SI) joints according to age and sex. METHODS With ethics committee approval and informed consent, SI joint MRIs of 251 children (132 girls), mean age 12.4 years (range 6.1-18.0 years), were obtained in 2 cohorts: 127 children imaged for nonrheumatic reasons, and 124 children with low back pain but no features of sacroiliitis at initial clinical MRI review. MRIs were reviewed by 3 experienced radiologists, blinded from each other, for 3 features of the cortical black line representing the subchondral bone plate on T1-weighted MRI: visibility, blurring, and irregularity. RESULTS Based on agreement from 2 or more readers, the cortical black line was partially absent in 88.4% of the children, blurred in 34.7%, and irregular in 41.4%. All these features were most common on the iliac side of SI joints and at the first sacral vertebra level. Clearly visualized, sharply delineated SI joints with none of these features were seen in only 8.0% of children, or in 35.1% if we conservatively required agreement of all 3 readers to consider a feature present. There was no significant difference between sexes or cohorts; findings were similar across pediatric age groups. CONCLUSION Understanding the normal MRI appearance of the developing SI joint is necessary to distinguish physiologic findings from disease. At least two-thirds (65%) of normal pediatric SI joints showed at least 1 feature that is a component of the adult definition of SI joint erosions, risking overdiagnosis of sacroiliitis.
Collapse
Affiliation(s)
| | - Robert G W Lambert
- University of Alberta and Medical Imaging Consultants, Edmonton, Alberta, Canada
| | | | | | | | | | | | | | - Jacob L Jaremko
- University of Alberta and Medical Imaging Consultants, Edmonton, Alberta, Canada
| |
Collapse
|
18
|
Morbée L, Vereecke E, Laloo F, Chen M, Herregods N, Jans LBO. Common incidental findings on sacroiliac joint MRI: Added value of MRI-based synthetic CT. Eur J Radiol 2023; 158:110651. [PMID: 36535080 DOI: 10.1016/j.ejrad.2022.110651] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 12/01/2022] [Accepted: 12/11/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE To determine the prevalence of incidental findings on sacroiliac joint MRI and to determine the added value of MRI-based synthetic CT in the detection and evaluation of these incidental findings. METHOD In this retrospective study 210 patients clinically suspected of spondyloarthritis who underwent MRI of the sacroiliac joint with synthetic CT sequence were included. The images were reviewed by two radiologists in consensus for the prevalence of sacroiliitis, incidental findings, and the ability of synthetic CT and the conventional MRI to detect and diagnose these findings. RESULTS In 44.7% of patients sacroiliitis was present. In 89.0% of patients MRI showed at least one incidental finding other than sacroiliitis. Degeneration of the sacroiliac joint was the most prevalent finding (140 patients, 66.6%). The most frequent incidental findings outside the sacroiliac joint were facet joint degeneration (29.0%), disc degeneration (25.2%), enostosis (19.5%) and lumbosacral transitional vertebrae (14.3%). A total of 788 lesions was recorded and synthetic CT was found to be problem solving or necessary for diagnosis in 543 (68.9%) of these lesions. 42.1% of lesions were not visible on conventional MRI (T1 TSE and STIR), most often degenerative osteophytes in the sacroiliac joint or lower lumbar spine. CONCLUSION Incidental findings are seen more frequently on sacroiliac joint MRI than sacroiliitis, which is relevant as some will have clinical significance or require treatment. Nearly half of these incidental lesions were only visible on synthetic CT, which additionally has been shown to be problem solving for diagnosis in many other cases.
Collapse
Affiliation(s)
- Lieve Morbée
- Department of Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium.
| | - Elke Vereecke
- Department of Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Frederiek Laloo
- Department of Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Min Chen
- Department of Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Nele Herregods
- Department of Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Lennart B O Jans
- Department of Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| |
Collapse
|
19
|
Ha MK, Bartholomeus E, Van Os L, Dandelooy J, Leysen J, Aerts O, Siozopoulou V, De Smet E, Gielen J, Guerti K, De Maeseneer M, Herregods N, Lechkar B, Wittoek R, Geens E, Claes L, Zaqout M, Dewals W, Lemay A, Tuerlinckx D, Weynants D, Vanlede K, van Berlaer G, Raes M, Verhelst H, Boiy T, Van Damme P, Jansen AC, Meuwissen M, Sabato V, Van Camp G, Suls A, Werff ten Bosch JVD, Dehoorne J, Joos R, Laukens K, Meysman P, Ogunjimi B. Blood transcriptomics to facilitate diagnosis and stratification in pediatric rheumatic diseases - a proof of concept study. Pediatr Rheumatol Online J 2022; 20:91. [PMID: 36253751 PMCID: PMC9575227 DOI: 10.1186/s12969-022-00747-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 09/24/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Transcriptome profiling of blood cells is an efficient tool to study the gene expression signatures of rheumatic diseases. This study aims to improve the early diagnosis of pediatric rheumatic diseases by investigating patients' blood gene expression and applying machine learning on the transcriptome data to develop predictive models. METHODS RNA sequencing was performed on whole blood collected from children with rheumatic diseases. Random Forest classification models were developed based on the transcriptome data of 48 rheumatic patients, 46 children with viral infection, and 35 controls to classify different disease groups. The performance of these classifiers was evaluated by leave-one-out cross-validation. Analyses of differentially expressed genes (DEG), gene ontology (GO), and interferon-stimulated gene (ISG) score were also conducted. RESULTS Our first classifier could differentiate pediatric rheumatic patients from controls and infection cases with high area-under-the-curve (AUC) values (AUC = 0.8 ± 0.1 and 0.7 ± 0.1, respectively). Three other classifiers could distinguish chronic recurrent multifocal osteomyelitis (CRMO), juvenile idiopathic arthritis (JIA), and interferonopathies (IFN) from control and infection cases with AUC ≥ 0.8. DEG and GO analyses reveal that the pathophysiology of CRMO, IFN, and JIA involves innate immune responses including myeloid leukocyte and granulocyte activation, neutrophil activation and degranulation. IFN is specifically mediated by antibacterial and antifungal defense responses, CRMO by cellular response to cytokine, and JIA by cellular response to chemical stimulus. IFN patients particularly had the highest mean ISG score among all disease groups. CONCLUSION Our data show that blood transcriptomics combined with machine learning is a promising diagnostic tool for pediatric rheumatic diseases and may assist physicians in making data-driven and patient-specific decisions in clinical practice.
Collapse
Affiliation(s)
- My Kieu Ha
- Center for Health Economics Research and Modelling Infectious Diseases (CHERMID), Vaccine and Infectious Disease Institute, University of Antwerp, Wilrijk, Belgium. .,Antwerp Unit for Data Analysis and Computation in Immunology and Sequencing (AUDACIS), University of Antwerp, Antwerp, Belgium. .,Antwerp Center for Translational Immunology and Virology (ACTIV), Vaccine and Infectious Disease Institute, University of Antwerp, Wilrijk, Belgium.
| | - Esther Bartholomeus
- grid.5284.b0000 0001 0790 3681Antwerp Unit for Data Analysis and Computation in Immunology and Sequencing (AUDACIS), University of Antwerp, Antwerp, Belgium ,grid.5284.b0000 0001 0790 3681Antwerp Center for Translational Immunology and Virology (ACTIV), Vaccine and Infectious Disease Institute, University of Antwerp, Wilrijk, Belgium ,grid.411414.50000 0004 0626 3418Center of Medical Genetics, University of Antwerp, Antwerp University Hospital, Edegem, Belgium
| | - Luc Van Os
- grid.411414.50000 0004 0626 3418Ophthalmology Department, Antwerp University Hospital, Edegem, Belgium
| | - Julie Dandelooy
- grid.411414.50000 0004 0626 3418Dermatology Department, Antwerp University Hospital, Edegem, Belgium
| | - Julie Leysen
- grid.411414.50000 0004 0626 3418Dermatology Department, Antwerp University Hospital, Edegem, Belgium ,grid.5284.b0000 0001 0790 3681Department of Translational Research in Immunology and Inflammation, University of Antwerp, Wilrijk, Belgium
| | - Olivier Aerts
- grid.411414.50000 0004 0626 3418Dermatology Department, Antwerp University Hospital, Edegem, Belgium ,grid.5284.b0000 0001 0790 3681Department of Translational Research in Immunology and Inflammation, University of Antwerp, Wilrijk, Belgium
| | - Vasiliki Siozopoulou
- grid.411414.50000 0004 0626 3418Pathology Department, Antwerp University Hospital, Edegem, Belgium
| | - Eline De Smet
- grid.411414.50000 0004 0626 3418Radiology Department, Antwerp University Hospital, Edegem, Belgium
| | - Jan Gielen
- grid.411414.50000 0004 0626 3418Radiology Department, Antwerp University Hospital, Edegem, Belgium ,grid.5284.b0000 0001 0790 3681Department of Molecular – Morphology – Microscopy, University of Antwerp, Wilrijk, Belgium
| | - Khadija Guerti
- grid.411414.50000 0004 0626 3418Clinical Biology Department, Antwerp University Hospital, Edegem, Belgium
| | | | - Nele Herregods
- grid.410566.00000 0004 0626 3303Radiology Department, Ghent University Hospital, Ghent, Belgium
| | - Bouchra Lechkar
- grid.411414.50000 0004 0626 3418Department of Immunology, Allergology, and Rheumatology, Antwerp University Hospital, Edegem, Belgium
| | - Ruth Wittoek
- grid.410566.00000 0004 0626 3303Rheumatology Department, Ghent University Hospital, Ghent, Belgium ,grid.411414.50000 0004 0626 3418Rheumatology Department, Antwerp Hospital Network, Antwerp, Belgium
| | - Elke Geens
- grid.411414.50000 0004 0626 3418Rheumatology Department, Antwerp Hospital Network, Antwerp, Belgium
| | - Laura Claes
- grid.411414.50000 0004 0626 3418Pediatric Neurology Unit, Antwerp University Hospital, Edegem, Belgium
| | - Mahmoud Zaqout
- grid.411414.50000 0004 0626 3418Pediatric Cardiology Department, Antwerp University Hospital, Edegem, Belgium ,grid.411414.50000 0004 0626 3418Pediatric Cardiology Department, Antwerp Hospital Network, Antwerp, Belgium
| | - Wendy Dewals
- grid.411414.50000 0004 0626 3418Pediatric Cardiology Department, Antwerp University Hospital, Edegem, Belgium
| | - Annelies Lemay
- Department of Pediatrics, Turnhout General Hospital, Turnhout, Belgium
| | - David Tuerlinckx
- grid.7942.80000 0001 2294 713XDepartment of Pediatrics, Catholic University of Louvain, Louvain-la-Neuve, Belgium ,grid.6520.10000 0001 2242 8479Department of Pediatrics, Namur University Hospital Center, Site Dinant, Dinant, Belgium
| | - David Weynants
- grid.6520.10000 0001 2242 8479Department of Pediatrics, Namur University Hospital Center, Site Sainte-Elisabeth, Namur, Belgium
| | - Koen Vanlede
- Department of Pediatrics, Nikolaas General Hospital, Sint-Niklaas, Belgium
| | - Gerlant van Berlaer
- Department of Emergency Medicine/Pediatric Care, Brussels University Hospital, Jette, Belgium
| | - Marc Raes
- grid.414977.80000 0004 0578 1096Department of Pediatrics, Jessa Hospital, Hasselt, Belgium
| | - Helene Verhelst
- grid.410566.00000 0004 0626 3303Department of Pediatric Neurology, Ghent University Hospital, Ghent, Belgium
| | - Tine Boiy
- grid.411414.50000 0004 0626 3418Department of Pediatric Rheumatology, Antwerp University Hospital, Edegem, Belgium
| | - Pierre Van Damme
- grid.5284.b0000 0001 0790 3681Antwerp Unit for Data Analysis and Computation in Immunology and Sequencing (AUDACIS), University of Antwerp, Antwerp, Belgium ,grid.5284.b0000 0001 0790 3681Center for the Evaluation of Vaccine, Vaccine and Infectious Disease Institute, University of Antwerp, Wilrijk, Belgium
| | - Anna C. Jansen
- grid.411414.50000 0004 0626 3418Pediatric Neurology Unit, Antwerp University Hospital, Edegem, Belgium
| | - Marije Meuwissen
- grid.5284.b0000 0001 0790 3681Antwerp Center for Translational Immunology and Virology (ACTIV), Vaccine and Infectious Disease Institute, University of Antwerp, Wilrijk, Belgium
| | - Vito Sabato
- grid.411414.50000 0004 0626 3418Department of Immunology, Allergology, and Rheumatology, Antwerp University Hospital, Edegem, Belgium ,Antwerp Center for Pediatric Rheumatology and Autoinflammatory Diseases, Antwerp, Belgium
| | - Guy Van Camp
- grid.411414.50000 0004 0626 3418Center of Medical Genetics, University of Antwerp, Antwerp University Hospital, Edegem, Belgium
| | - Arvid Suls
- grid.5284.b0000 0001 0790 3681Antwerp Unit for Data Analysis and Computation in Immunology and Sequencing (AUDACIS), University of Antwerp, Antwerp, Belgium
| | | | - Joke Dehoorne
- grid.410566.00000 0004 0626 3303Department of Pediatric Rheumatology, Ghent University Hospital, Ghent, Belgium
| | - Rik Joos
- grid.411414.50000 0004 0626 3418Rheumatology Department, Antwerp Hospital Network, Antwerp, Belgium ,grid.411414.50000 0004 0626 3418Department of Pediatric Rheumatology, Antwerp University Hospital, Edegem, Belgium ,Antwerp Center for Pediatric Rheumatology and Autoinflammatory Diseases, Antwerp, Belgium ,grid.410566.00000 0004 0626 3303Department of Pediatric Rheumatology, Ghent University Hospital, Ghent, Belgium
| | - Kris Laukens
- grid.5284.b0000 0001 0790 3681Antwerp Unit for Data Analysis and Computation in Immunology and Sequencing (AUDACIS), University of Antwerp, Antwerp, Belgium ,grid.5284.b0000 0001 0790 3681ADREM Data Lab, Department of Mathematics and Computer Science, University of Antwerp, Antwerp, Belgium ,grid.5284.b0000 0001 0790 3681Biomedical Informatics Research Network Antwerp, University of Antwerp, Antwerp, Belgium
| | - Pieter Meysman
- grid.5284.b0000 0001 0790 3681Antwerp Unit for Data Analysis and Computation in Immunology and Sequencing (AUDACIS), University of Antwerp, Antwerp, Belgium ,grid.5284.b0000 0001 0790 3681ADREM Data Lab, Department of Mathematics and Computer Science, University of Antwerp, Antwerp, Belgium ,grid.5284.b0000 0001 0790 3681Biomedical Informatics Research Network Antwerp, University of Antwerp, Antwerp, Belgium
| | - Benson Ogunjimi
- Center for Health Economics Research and Modelling Infectious Diseases (CHERMID), Vaccine and Infectious Disease Institute, University of Antwerp, Wilrijk, Belgium. .,Antwerp Unit for Data Analysis and Computation in Immunology and Sequencing (AUDACIS), University of Antwerp, Antwerp, Belgium. .,Rheumatology Department, Antwerp Hospital Network, Antwerp, Belgium. .,Department of Pediatric Rheumatology, Antwerp University Hospital, Edegem, Belgium. .,Antwerp Center for Pediatric Rheumatology and Autoinflammatory Diseases, Antwerp, Belgium. .,Department of Pediatric Rheumatology, Brussels University Hospital, Jette, Belgium.
| |
Collapse
|
20
|
Sudoł-Szopińska I, Herregods N, Doria AS, Taljanovic MS, Gietka P, Tzaribachev N, Klauser AS. Advances in Musculoskeletal Imaging in Juvenile Idiopathic Arthritis. Biomedicines 2022; 10:biomedicines10102417. [PMID: 36289680 PMCID: PMC9598961 DOI: 10.3390/biomedicines10102417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/11/2022] [Accepted: 09/20/2022] [Indexed: 12/03/2022] Open
Abstract
Over the past decade, imaging of inflammatory arthritis in juvenile arthropathies has significantly advanced due to technological improvements in the imaging modalities and elaboration of imaging recommendations and protocols through systematic international collaboration. This review presents the latest developments in ultrasound (US) and magnetic resonance imaging (MRI) of the peripheral and axial joints in juvenile idiopathic arthritis. In the field of US, the ultra-wideband and ultra-high-frequency transducers provide outstanding spatial resolution. The more sensitive Doppler options further improve the assessment and quantification of the vascularization of inflamed tissues, and shear wave elastography enables the diagnosis of tissue stiffness. Concerning MRI, substantial progress has been achieved due to technological improvements in combination with the development of semiquantitative scoring systems for the assessment of inflammation and the introduction of new definitions addressing the pediatric population. New solutions, such as superb microflow imaging, shear wave elastography, volume-interpolated breath-hold examination, and MRI-based synthetic computed tomography open new diagnostic possibilities and, at the same time, pose new challenges in terms of clinical applications and the interpretation of findings.
Collapse
Affiliation(s)
- Iwona Sudoł-Szopińska
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637 Warsaw, Poland
- Correspondence:
| | - Nele Herregods
- Department of Radiology and Nuclear Medicine, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium
| | - Andrea S. Doria
- Department of Diagnostic Imaging, The Hospital for Sick Children, University Avenue, Toronto, ON M5G 1X8, Canada
| | - Mihra S. Taljanovic
- Department of Medical Imaging and Orthopaedic Surgery, University of Arizona, Tucson, AZ 85719, USA
- Department of Radiology, University of New Mexico, Albuquerque, NM 87131, USA
| | - Piotr Gietka
- Clinic of Paediatric Rheumatology, National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637 Warsaw, Poland
| | - Nikolay Tzaribachev
- Pediatric Rheumatology Research Institute, Achtern Dieck 7, 24576 Bad Bramstedt, Germany
| | - Andrea Sabine Klauser
- Rheumatology and Sports Imaging, Department of Radiology, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| |
Collapse
|
21
|
Weiss PF, Brandon TG, Lambert RG, Biko DM, Chauvin NA, Francavilla ML, Jaremko JL, Herregods N, Kasapcopur O, Yildiz M, Hendry AM, Maksymowych WP. Data-Driven Magnetic Resonance Imaging Definitions for Active and Structural Sacroiliac Joint Lesions in Juvenile Spondyloarthritis Typical of Axial Disease: A Cross-Sectional International Study. Arthritis Care Res (Hoboken) 2022; 75:1220-1227. [PMID: 36063392 PMCID: PMC9985663 DOI: 10.1002/acr.25014] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 08/11/2022] [Accepted: 09/01/2022] [Indexed: 01/20/2023]
Abstract
OBJECTIVE We aimed to determine quantitative sacroiliac (SI) joint magnetic resonance imaging (MRI) cutoffs for active and structural lesions that will be incorporated as imaging domains in classification criteria of axial disease in juvenile spondyloarthritis (SpA). METHODS MRI scans from an international cross-section of juvenile SpA patients were reviewed by 6 musculoskeletal imaging experts blinded to clinical details. Raters globally assessed the presence/absence of lesions typical of axial SpA and performed SI joint quadrant- or joint-based scoring. Sensitivity and specificity of lesion cutoffs were calculated using a rater majority (≥4 of 6 raters) on a global assessment of the presence/absence of active or structural lesions typical of axial SpA with high confidence as the reference standard. Cutoffs were validated in an independent cohort. RESULTS Imaging from 243 subjects, 61% male, median age 14.9 years, had sequences available for detailed MRI scoring. Optimal cutoffs for defining lesions typical of axial disease in juvenile SpA were: 1) inflammatory lesion: bone marrow edema in ≥3 SI joint quadrants across all SI joint MRI slices (sensitivity 98.6%, specificity 96.5%); 2) structural lesions: erosion in ≥3 quadrants or sclerosis or fat lesion in ≥2 SI joint quadrants or backfill or ankylosis in ≥2 joint halves across all SI joint MRI slices (sensitivity 98.6%, specificity 95.5%). Sensitivity and specificity of the optimal cutoffs in the validation cohort were excellent. CONCLUSION We propose data-driven cutoffs for active inflammatory and structural lesions on MRI typical of axial disease in juvenile SpA that have high specificity and sensitivity using central imaging global assessment as the reference standard and excellent reliability.
Collapse
Affiliation(s)
- Pamela F. Weiss
- Department of Pediatrics, Division of Rheumatology and Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia and Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia PA, USA
| | - Timothy G. Brandon
- Department of Pediatrics, Division of Rheumatology and Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Robert G. Lambert
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, AB, Canada
| | - David M. Biko
- Department of Radiology, Children’s Hospital of Philadelphia and Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Nancy A. Chauvin
- Department of Radiology, Penn State Health Milton S. Hershey Children’s Hospital, Hershey, PA, USA
| | - Michael L. Francavilla
- Department of Radiology, Whiddon College of Medicine, University of South Alabama, Mobile, AL, USA
| | - Jacob L. Jaremko
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, AB, Canada
| | - Nele Herregods
- Department of Radiology and Nuclear Medicine, Ghent University Hospital, Ghent, Belgium
| | - Ozgur Kasapcopur
- Department of Pediatric Rheumatology, Istanbul University-Cerrahpasa Cerrahpasa Medical School, Istanbul, Turkey
| | - Mehmet Yildiz
- Department of Pediatric Rheumatology, Istanbul University-Cerrahpasa Cerrahpasa Medical School, Istanbul, Turkey
| | - Alison M. Hendry
- General Medicine and Rheumatology, Division of Medicine, Emergency and Integrated Care, Counties Manukau District Health Board, Auckland, New Zealand
| | - Walter P. Maksymowych
- Department of Medicine, University of Alberta and CARE Arthritis, Edmonton, AB, Canada
| |
Collapse
|
22
|
Vereecke E, Herregods N, Morbée L, Laloo F, Chen M, Jans L. Imaging of Structural Abnormalities of the Sacrum: The Old Faithful and Newly Emerging Techniques. Semin Musculoskelet Radiol 2022; 26:469-477. [PMID: 36103888 DOI: 10.1055/s-0042-1754342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
The sacrum and sacroiliac joints pose a long-standing challenge for adequate imaging because of their complex anatomical form, oblique orientation, and posterior location in the pelvis, making them subject to superimposition. The sacrum and sacroiliac joints are composed of multiple diverse tissues, further complicating their imaging. Varying imaging techniques are suited to evaluate the sacrum, each with its specific clinical indications, benefits, and drawbacks. New techniques continue to be developed and validated, such as dual-energy computed tomography (CT) and new magnetic resonance imaging (MRI) sequences, for example susceptibility-weighted imaging. Ongoing development of artificial intelligence, such as algorithms allowing reconstruction of MRI-based synthetic CT images, promises even more clinical imaging options.
Collapse
Affiliation(s)
- Elke Vereecke
- Department of Radiology, Ghent University Hospital, Gent, Belgium
| | - Nele Herregods
- Department of Radiology, Ghent University Hospital, Gent, Belgium
| | - Lieve Morbée
- Department of Radiology, Ghent University Hospital, Gent, Belgium
| | - Frederiek Laloo
- Department of Radiology, Ghent University Hospital, Gent, Belgium
| | - Min Chen
- Department of Radiology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Lennart Jans
- Department of Radiology, Ghent University Hospital, Gent, Belgium
| |
Collapse
|
23
|
Morbée L, Jans LBO, Herregods N. Novel imaging techniques for sacroiliac joint assessment. Curr Opin Rheumatol 2022; 34:187-194. [PMID: 35699310 DOI: 10.1097/bor.0000000000000871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW Imaging of the sacroiliac joints is one of the cornerstones in the diagnosis and monitoring of axial spondyloarthritis. We aim to present an overview of the emerging imaging techniques for sacroiliac joint assessment and provide an insight into their relevant benefits and pitfalls. RECENT FINDINGS Evaluation of structural and active inflammatory lesions in sacroiliitis are both important for understanding the disease process. Dual-energy computed tomography (CT) can detect inflammatory bone marrow edema in the sacroiliac joints and provides an alternative for magnetic resonance imaging (MRI). Three-dimensional gradient echo sequences improve the visualization of erosions on MRI. Susceptibility weighted MRI and deep learning-based synthetic CT are innovative MRI techniques that allow for generating 'CT-like' images and better depict osseous structural lesions than routine MRI sequences. SUMMARY New imaging innovations and developments result in significant improvements in the imaging of spondyloarthritis. Advanced MRI techniques enhance its potential for the accurate detection of structural and active inflammatory lesions of sacroiliitis in one single imaging session.
Collapse
Affiliation(s)
- Lieve Morbée
- Department of Radiology, Ghent University Hospital, Ghent, Belgium
| | | | | |
Collapse
|
24
|
Kaut S, Van den Wyngaert I, Christiaens D, Wouters C, Noppe N, Herregods N, Dehoorne J, De Somer L. Chronic nonbacterial osteomyelitis in children: a multicentre Belgian cohort of 30 children. Pediatr Rheumatol Online J 2022; 20:41. [PMID: 35698069 PMCID: PMC9195463 DOI: 10.1186/s12969-022-00698-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 05/27/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND To evaluate clinical characteristics, imaging findings, therapeutic approach and outcome of paediatric patients with Chronic Non-Bacterial Osteomyelitis (CNO). METHODS Retrospective review of 30 children diagnosed with CNO at two tertiary care centres in Belgium. Imaging data were evaluated by blinded paediatric radiologists. RESULTS Mean age at onset was 10.3 years and mean age at diagnosis was 11.7 years. Bone pain was the leading symptom (29/30 patients). Out of 180 symptomatic lesions, 131 were confirmed on MRI as hyperintense geographic lesions on STIR images at the metaphysis and epiphysis adjacent to growth plates of tubular bones. The most common sites of involvement were the lower limbs, spine, sternoclavicular joint and humerus. For nearly half of the patients (14/30) monotherapy with NSAIDs was sufficient to obtain remission. The remaining 16 patients received second-line therapy: bisphosphonates (n = 15/30), disease-modifying antirheumatic drugs (n = 7/30), etanercept (n = 4/30) and tocilizumab (n = 1/30). Remission was reached after a mean time of 37.6 months in 26/30 patients. The prognosis was worse for patients with spinal involvement, resulting in more long-term sequelae. CONCLUSIONS We present a multicentre paediatric cohort of 30 CNO patients. A typical pattern of bone involvement could be found on MRI. NSAIDs were administered as first-line treatment. Second-line strategies included bisphosphonates, corticosteroids, methotrexate, etanercept and tocilizumab. TRIAL REGISTRATION Retrospectively registered. Registratienummer EC KUL: MP018023.
Collapse
Affiliation(s)
- Sara Kaut
- grid.410569.f0000 0004 0626 3338Department of Paediatrics, Leuven University Hospitals, Leuven, Belgium
| | - Ine Van den Wyngaert
- grid.410569.f0000 0004 0626 3338Department of Paediatrics, Leuven University Hospitals, Leuven, Belgium
| | - Davy Christiaens
- grid.410569.f0000 0004 0626 3338Department of Radiology, Leuven University Hospitals, Leuven, Belgium
| | - Carine Wouters
- grid.410569.f0000 0004 0626 3338Department of Paediatrics, Paediatric Rheumatology and Immune-Inflammatory Diseases, Leuven University Hospitals, Herestraat 49, 3000 Leuven, Belgium
| | - Nathalie Noppe
- grid.410569.f0000 0004 0626 3338Department of Radiology, Leuven University Hospitals, Leuven, Belgium
| | - Nele Herregods
- grid.410566.00000 0004 0626 3303Department of Paediatric Radiology, Ghent University Hospital, Ghent, Belgium
| | - Joke Dehoorne
- grid.410566.00000 0004 0626 3303Paediatric Rheumatology, Ghent University Hospital, Ghent, Belgium
| | - Lien De Somer
- Department of Paediatrics, Paediatric Rheumatology and Immune-Inflammatory Diseases, Leuven University Hospitals, Herestraat 49, 3000, Leuven, Belgium.
| |
Collapse
|
25
|
Weiss PF, Brandon TG, Lambert RG, Biko DM, Chauvin NA, Francavilla ML, Herregods N, Hendry AM, Maksymowych WP. POS0341 CONSENSUS-DRIVEN DEFINITION FOR UNEQUIVOCAL SACROILIITIS ON RADIOGRAPHS IN JUVENILE SPONDYLOARTHRITIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundRadiographs are not a sensitive or reliable imaging tool for detection of early sacroiliitis in juvenile spondyloarthritis (JSpA). However, radiographs are still commonly performed in some areas due to difficulty in accessing MRI. As such, radiographs were included in the imaging data considered for an axial disease classification criteria development study, but only when there was no suitable MRI available.ObjectivesWe aimed to define criteria for unequivocal evidence of sacroiliitis on pelvic radiography in skeletally immature children and adolescents for use in classification criteria.MethodsSubjects were a cohort of JSpA patients with suspected axial disease. All subjects had symptom onset prior to age 18 years and underwent MRI as part of a diagnostic evaluation for axial disease; a subset of subjects also had a dedicated pelvic radiograph. Using a web-based interface, 6 musculoskeletal imaging experts, blinded to clinical details, reviewed the radiographs and graded them according to the modified New York (mNY) criteria. A two-way random effects intraclass correlation coefficient (ICC) was used to assess agreement. Next, the central imaging team underwent an iterative consensus process to define unequivocal evidence of sacroiliitis on pelvic radiography in skeletally immature children. Radiographs with at least two raters assigning a non-zero mNY grade were re-reviewed for the presence/absence of “unequivocal evidence of sacroiliitis” according to the consensus definition. Agreement was assessed with Fleiss’s kappa statistic with agreement interpreted as poor ≤0.40, fair 0.41-0.59, good 0.60-0.74, and ≥0.75 excellent. Sensitivity, specificity, and positive and negative predictive values (PPV, NPV) were calculated to assess performance of the novel definition using structural lesion typical of juvenile axial disease on MRI as the reference standard (erosion in ≥3 sacroiliac joint (SIJ) quadrants or at least one of the following lesions in ≥2 SIJ quadrants: sclerosis, fat lesion, backfill, ankylosis).ResultsRadiographs from 120 subjects, 61% male, median age 14.7 years (range 6.7-20.1 years), had an AP dedicated pelvic radiograph available for scoring. The ICC for mNY grade amongst 6 central raters was fair for joints with at least one rater reporting a non-zero grade (0.45, 95% CI: 0.34-0.57). After multiple iterations and discussion, the consensus definition of unequivocal sacroiliitis by radiograph in skeletally immature children and adolescents was deemed “Unequivocal lesion (erosion, sclerosis, or ankylosis [partial or complete]) that must include at least one iliac bone. When sclerosis is present in isolation, if measurable, should extend ≥5mm from the joint surface. The decision may be influenced by the presence of other lesions, which in themselves do not suffice to meet the criterion.” Sixteen radiographs were assessed using the consensus definition. 8 (50%) were rated as unequivocal sacroiliitis and Fleiss’ kappa statistic was good at 0.61 (95% CI: 0.41-0.80). Across raters, the sensitivity, specificity, PPV and NPV of the consensus definition on radiograph using structural lesions typical of sacroiliitis on MRI as the reference standard were 80% (95%CI: 44.4-97.5), 100% (95% CI: 54.1-100), 100% (63.1-100) and 75% (95% CI:34.9-96.8), respectively.ConclusionWe propose a consensus-derived definition of unequivocal sacroiliitis by radiography in skeletally immature children and adolescents with good expert rater agreement. Additionally, the consensus-definition had moderate to high sensitivity and PPV and high specificity and NPV with typical structural lesions on MRI as the reference standard. This definition has applicability to JSpA axial disease classification criteria when MRI is unavailable.Figure 1.Examples of radiographs with unequivocal evidence of sacroiliitis in skeletally immature children as indicated by definite erosions of both iliac bones (A and B) and definite iliac sclerosis (A).Disclosure of InterestsPamela F. Weiss Consultant of: PfizerNovartisBiogenLilly(All < $5K in the past fiscal year), Timothy G. Brandon: None declared, Robert G Lambert Paid instructor for: Novartis, Consultant of: CARE Arthritis, Calyx, Image Analysis Group, Novartis, David M. Biko Employee of: Merck (1998 to 2000), Nancy A. Chauvin Employee of: Forest Pharmaceuticals - Research scientist (1996) and Novartis - Pharmaceutical sales representative (1997), Michael L. Francavilla: None declared, Nele Herregods: None declared, Alison M. Hendry: None declared, Walter P Maksymowych Speakers bureau: Abbvie, Eli-Lilly, Janssen, Novartis, Pfizer, UCB Pharma, Consultant of: AbbVie, Boehringer Ingelheim, Celgene, Eli Lilly, Galapagos, Janssen, Novartis, Pfizer, UCB Pharma, Grant/research support from: Abbvie, Novartis, Pfizer
Collapse
|
26
|
Lambert R, Baraliakos X, Bernard S, Carrino J, Diekhoff T, Eshed I, Hermann KG, Herregods N, Jaremko JL, Jans L, Jurik AG, O’neill J, Reijnierse M, Tuite M, Maksymowych WP. POS0989 DEVELOPMENT OF INTERNATIONAL CONSENSUS ON A STANDARDIZED IMAGE ACQUISITION PROTOCOL FOR DIAGNOSTIC EVALUATION OF THE SACROILIAC JOINTS BY MRI – AN ASAS-SPARTAN COLLABORATION. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundIn 2009, ASAS published a ‘Definition of active sacroiliitis on MRI for classification of axial spondyloarthritis (axSpA)’. This definition relied on two MRI sequences to make this determination – semicoronal T1 and STIR. Since then, this approach has frequently been used for diagnosis, even though that was never the intent of the definition. In 2015, the European Society of Skeletal Radiology (ESSR) published its recommendations for an SIJ MRI image acquisition protocol (IAP) for diagnostic purposes that required 4 MRI sequences but there is still no IAP that has been widely accepted as a minimum standard worldwide. In 2020, an informal survey of 24 academic sites (12 Europe, 12 North America) confirmed that 24/24 sites performed a minimum of 3 MRI sequences for diagnosis (19 performed 4-8 sequences) because the 2-sequence protocol was considered inadequate.ObjectivesTo develop the minimum requirements for a standardized IAP for MRI of the sacroiliac joints for diagnostic ascertainment of sacroiliitis.MethodsAll radiologist members of the ASAS and SPARTAN Classification in axSpA (CLASSIC) project, along with one European and one North American rheumatologist with extensive MRI experience in SpA clinical practice and research, were invited to participate in a consensus exercise. A draft IAP was circulated to all participants along with background information and justification for the draft proposal. Feedback on all issues was received by email, tabulated and recirculated. Participants were broadly in favour of the proposal and two months later a teleconference meeting took place and remaining points of contention were resolved. Examples of the proposed IAP performed on new, 10 and 22 years’ old MRI scanners were made available for review in DICOM format. Next the revised draft of the IAP was presented at the ASAS annual meeting to the entire membership on 14 January 2022, and voted on.ResultsA 4-sequence IAP, 3-semicoronal and 1-semiaxial, is recommended for diagnostic ascertainment of sacroiliitis and its differential diagnoses (Table 1). It must meet the following requirements: Semicoronal sequences should be parallel to the dorsal cortex of the S2 vertebral body, and include: 1) a sequence sensitive for the detection of active inflammation being T2-weighted with suppression of fat signal; 2) a sequence sensitive for the detection of structural damage in bone and bone marrow with T1-weighting; 3) a sequence that is designed to optimally depict the bone-cartilage interface of the articular surface and be sensitive for detection of bone erosion; plus 4) a semiaxial sequence sensitive for inflammation detection. The IAP was approved at the ASAS annual meeting by a vote of the entire membership with 91% in favour.Table 1.A standardized SIJ MRI Acquisition Protocol for diagnostic ascertainment of sacroiliitisOrientationSequenceTarget Lesion(s)Semicoronal Parallel to the dorsal cortex of the S2 vertebral bodyT1-weighted Spin EchoStructural: Fat lesions, erosion, sclerosis, backfill, ankylosis.T2-weighted with suppressed fat signal (STIR, T2FS or equivalent)Inflammatory: Bone marrow edema (BME)T1-weighted with suppressed fat signal (2D or 3D T1FS)Structural: Erosion of the articular surfaceSemiaxial Perpendicular to semicoronalT2-weighted with suppressed fat signal (STIR, T2FS or equivalent)Inflammatory: Bone marrow edema (BME)ConclusionA standardized IAP for MRI of the sacroiliac joints for diagnostic ascertainment of sacroiliitis is recommended and should be comprised of a minimum of 4 sequences, in 2-planes, that will optimally visualize inflammation, structural damage, and the bone-cartilage interface.Disclosure of InterestsRobert Lambert Paid instructor for: Novartis, Consultant of: Calyx, CARE Arthritis, Image Analysis Group, Xenofon Baraliakos Speakers bureau: Abbvie, Pfizer, MSD, UCB, Novartis, Lilly, Galapagos, Hexal, Paid instructor for: Abbvie, Pfizer, MSD, UCB, Novartis, Lilly, Galapagos, Hexal, Consultant of: Abbvie, Pfizer, MSD, UCB, Novartis, Lilly, Galapagos, Hexal, Grant/research support from: Abbvie, MSD, Novartis, Lilly, Stephanie Bernard Consultant of: Elsevier Amirsys, John Carrino Consultant of: Pfizer, Regeneron, Globus, Carestream, Image Analysis Group, Image Biopsy Lab, Torsten Diekhoff Speakers bureau: Novartis, MSD, Canon MS, Consultant of: Eli Lilly, Iris Eshed: None declared, Kay-Geert Hermann Speakers bureau: AbbVie, Pfizer, MSD, Novartis. Co-founder: BerlinFlame GmbH, Nele Herregods: None declared, Jacob L Jaremko: None declared, Lennart Jans: None declared, Anne Grethe Jurik: None declared, John O’Neill: None declared, Monique Reijnierse: None declared, Michael Tuite Consultant of: GE HealthCare, Walter P Maksymowych Speakers bureau: Abbvie, Janssen, Novartis, Pfizer, UCB, Consultant of: Abbvie, Boehringer Ingelheim, Celgene, Eli-Lilly, Galapagos, Novartis, Pfizer, UCB, Grant/research support from: Abbvie, Novartis, Pfizer, UCB
Collapse
|
27
|
Weiss PF, Brandon TG, Aggarwal A, Burgos-Vargas R, Colbert RA, Horneff G, Joos R, Laxer R, Minden K, Ravelli A, Ruperto N, Smith J, Stoll ML, Tse SM, Van den Bosch F, Lambert RG, Biko DM, Chauvin NA, Francavilla ML, Jaremko JL, Herregods N, Kasapcopur O, Yildiz M, Hendry AM, Maksymowych WP. POS0173 DATA-DRIVEN MRI DEFINITIONS FOR ACTIVE AND STRUCTURAL SACROILIAC JOINT LESIONS IN JUVENILE SPONDYLOARTHRITIS TYPICAL OF AXIAL DISEASE. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundFor classification in juvenile spondyloarthritis (JSpA), it is important to develop cut-offs for active and structural lesions typical of axial disease on MRI that are readily and consistently interpreted. Since the maturing sacroiliac joint (SIJ) looks different from the adult SIJ, the criteria developed for positive MRI in adults may not be applicable in JSpA.ObjectivesAs part of a study developing classification criteria for axial disease in JSpA, we aimed to determine quantitative SIJ imaging lesion cut-offs for inflammatory and structural lesions typical of axial JSpA using majority imaging expert decision as the reference criterion.MethodsSubjects were a retrospective cohort of children with SpA who met the provisional Pediatric Rheumatology International Trials Organization criteria for enthesitis/spondylitis-related juvenile idiopathic arthritis or had a rheumatologist JSpA diagnosis. All subjects had symptom onset prior to age 18 years and underwent MRI as part of a diagnostic evaluation for axial disease. To enable SIJ quadrant-based scoring, all MRIs included semi-coronal slices through the cartilaginous part of the joint on fluid sensitive sequences and on T1-weighted sequences for the assessment of inflammation and structural lesions, respectively. MRIs were reviewed by 6 musculoskeletal imaging experts who were blinded to clinical details. MRI evaluation of the SIJ was based on standardized lesion definitions that were decided by consensus of the central imaging team and represented a mix of definitions from ASAS and the Juvenile Arthritis MRI Score Outcome Measures in Rheumatology working group. Using a web-based interface, raters globally assessed the presence or absence of lesions typical of axial SpA and performed SIJ quadrant or joint based scoring. Lesion scores were generated by averaging the scores of all raters. Sensitivity and specificity of lesion cut-offs were calculated using rater majority (≥4/6 raters) on a global assessment of the presence/absence of active or structural lesions typical of axial SpA with high confidence (confidence of ±3 or stronger on confidence scale from -5, “Definitely No”, to +5, “Definitely Yes”) as the reference standard.ResultsImaging from 243 subjects, 61% male, median age 14.9 years, had sequences available for detailed MRI scoring. Active inflammatory lesion typical of axial disease in JSpA was defined as bone marrow edema (BME) in at least 3 SIJ quadrants (sensitivity 98.6%, specificity 96.5%). For structural lesion typical of axial JSpA, the optimal cut-off was erosion in at least 3 quadrants or at least one of the following lesions in at least 2 SIJ quadrants: sclerosis, fat lesion, backfill, ankylosis (sensitivity 98.6%, specificity 95.5%).ConclusionWe propose data-driven cut-offs for active inflammatory and structural lesions on MRI typical of axial disease in JSpA that have high specificity and sensitivity using central imaging global assessment as the reference standard.Table 1.Performance of cut-offs for inflammatory and structural lesions of axial diseaseCut-offs for number of SIJ quadrants (any location)Sensitivity (95% CI)Specificity (95% CI)Definite active lesionBME score ≥2100 (95.0-100)93.5 (88.7-96.7)BME score ≥398.6 (92.5-100)96.5 (92.5-98.7)BME, same location on ≥3 consecutive slices88.6 (78.7-94.9)98.8 (95.8-99.9)Definite structural lesionErosion ≥295.7 (88-99.1)96.8 (92.7-99)Erosion, same location on ≥2 consecutive slices94.3 (86-98.4)98.1 (94.5-99.6)Erosion ≥391.4 (82.3-96.8)98.7 (95.4-99.8)Sclerosis ≥262.9 (50.5-74.1)98.1 (94.5-99.6)Fat lesion ≥222.9 (13.7-34.4%)98.7 (95.4-99.8%)Backfill ≥220 (11.4-31.3)100 (97.7-100)Ankylosis ≥21.3 (0.2-4.7)100 (94.9-100)ANY of the following in ≥2 SIJ quadrants: erosion, sclerosis, fat lesion, backfill, ankylosis98.6 (92.3-100)93.6 (88.5-96.9)Erosion ≥3 quadrants OR ≥2 quadrants of at least one of the following lesions: sclerosis, fat, backfill, ankylosis98.6 (92.3-100.0)95.5 (91.0-98.2)Disclosure of InterestsPamela F. Weiss Consultant of: PfizerNovartisBiogenLilly(All <$5K in the past fiscal year), Timothy G. Brandon: None declared, Amita Aggarwal: None declared, Ruben Burgos-Vargas Speakers bureau: Not in the last three years.Novartis, Consultant of: Not in the last four years.BMS, Lilly, Novartis, Robert A. Colbert: None declared, Gerd Horneff Speakers bureau: Pfizer, Novartis, Janssen, Chugai, Abbvie, Grant/research support from: Pfizer, Novartis, MSD, Chugai, Roche, Abbvie, Rik Joos Speakers bureau: Galapagos, Pfizer, AbbVie, Novartis, Amgen, BMS, Lilly, Grant/research support from: Pfizer, AbbVie, Roche, Ronald Laxer Consultant of: Abbvie, Novartis, Sobi, Sanofi, Eli Lilly Canada, Eli Lilly, Kirsten Minden Speakers bureau: Pfizer, Novartis, Consultant of: Pfizer, Novartis, Angelo Ravelli Speakers bureau: Abbvie, Novartis, SOBI, Angelini, Reckitt-Benkiser, Roche, Pfizer, Alexion, Grant/research support from: Novartis, Pfizer, Nicolino Ruperto Speakers bureau: NR has received honoraria for consultancies or speaker bureaus from the following pharmaceutical companies in the past 3 years: 2 Bridge, Amgen, AstraZeneca, Aurinia, Bayer, Brystol Myers and Squibb, Celgene, inMed, Cambridge Healthcare Research, Domain Therapeutic, EMD Serono, Glaxo Smith Kline, Idorsia, Janssen, Eli Lilly, Novartis, Pfizer, Sobi, UCB., Consultant of: NR has received honoraria for consultancies or speaker bureaus from the following pharmaceutical companies in the past 3 years: 2 Bridge, Amgen, AstraZeneca, Aurinia, Bayer, Brystol Myers and Squibb, Celgene, inMed, Cambridge Healthcare Research, Domain Therapeutic, EMD Serono, Glaxo Smith Kline, Idorsia, Janssen, Eli Lilly, Novartis, Pfizer, Sobi, UCB., Grant/research support from: The IRCCS Istituto Giannina Gaslini (IGG), where NR works as full-time public employee has received contributions from the following industries in the last 3 years: Bristol Myers and Squibb, Eli-Lilly, F Hoffmann-La Roche, Novartis, Pfizer, Sobi. This funding has been reinvested for the research activities of the hospital in a fully independent manner, without any commitment with third parties., Judith Smith Consultant of: Consulting panel of pediatric rheumatologists identifying issues in juvenile spondyloarthritis for Novartis. Paid < $5000, Matthew L. Stoll Consultant of: Currently consulting for Novartis, Shirley ML Tse: None declared, Filip van den Bosch Speakers bureau: Abbvie, Eli Lilly, Galapagos, Janssen, Novartis, Pfizer, UCB, Paid instructor for: Amgen, Eli Lilly, Consultant of: Abbvie, Eli Lilly, Galapagos, Janssen, Novartis, Pfizer, UCB, Robert G Lambert Paid instructor for: Novartis, Consultant of: CARE Arthritis, Calyx, Image Analysis Group, Novartis, David M. Biko Employee of: Merck (1998-2000), Nancy A. Chauvin Employee of: Forest Pharmaceuticals - Research scientist (1996) and Novartis - Pharmaceutical sales representative (1997), Michael L. Francavilla: None declared, Jacob L Jaremko: None declared, Nele Herregods: None declared, Ozgur Kasapcopur Speakers bureau: Pfizer, Abbvie, Novartis and Roche, Mehmet YILDIZ: None declared, Alison M. Hendry: None declared, Walter P Maksymowych Speakers bureau: Abbvie, Eli-Lilly, Janssen, Novartis, Pfizer, UCB Pharma, Consultant of: AbbVie, Boehringer Ingelheim, Celgene, Eli Lilly, Galapagos, Janssen, Novartis, Pfizer, UCB Pharma, Grant/research support from: Abbvie, Novartis, Pfizer
Collapse
|
28
|
Renson T, de Hooge M, De Craemer AS, Deroo L, Lukasik Z, Carron P, Herregods N, Jans L, Colman R, Van den Bosch F, Elewaut D. Progressive increase in sacroiliac joint and spinal mri lesions in healthy individuals in relation to age. Arthritis Rheumatol 2022; 74:1506-1514. [PMID: 35436391 DOI: 10.1002/art.42145] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 01/27/2022] [Accepted: 04/12/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVES MRI plays a pivotal role in spondyloarthritis (SpA) diagnosis. However, detailed description of MRI findings of the sacroiliac joints (SIJ) and spine in healthy individuals is currently lacking. We therefore sought to evaluate the occurrence of MRI-SIJ/spine lesions in healthy individuals in relation to age. METHODS Ninety-five healthy subjects (20-49 years) underwent MRI-SIJ and -spine. BME and structural lesions of the SIJ were scored using the SPARCC method. Spinal inflammatory and structural lesions were evaluated using the SPARCC MRI spine inflammation index and the CANDEN MRI scoring system, respectively. Fulfillment of the ASAS definition of a positive MRI for sacroiliitis/spondylitis was reviewed. Findings were compared with MRI of axial SpA patients from the Be-GIANT cohort. RESULTS 17.2% of subjects aged ≥30 fulfilled the definition of a positive MRI for sacroiliitis, but this occurred rarely in younger subjects. SIJ erosions (20.0%) and fat metaplasia (13.7%) were detected across all age groups. Erosions were more frequently visualized in subjects aged ≥40 (39.3%). Spinal BME (35.7%) and fat metaplasia (28.6%) were common in subjects older than 40 years. Nonetheless, only one subject had ≥3 corner inflammatory lesions. SIJ and spinal SPARCC scores and total structural lesions scores increased progressively with age. CONCLUSION Contrary to what is commonly believed, structural MRI-SIJ lesions are frequently seen in healthy individuals. Especially in older subjects, the high occurrence of inflammatory and structural MRI lesions impacts their specificity for SpA, which has important implications for the interpretation of MRI in patients with clinical suspicion of SpA.
Collapse
Affiliation(s)
- Thomas Renson
- Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent, Belgium.,VIB-UGent Center for Inflammation Research, Ghent University, Ghent, Belgium
| | - Manouk de Hooge
- Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent, Belgium.,VIB-UGent Center for Inflammation Research, Ghent University, Ghent, Belgium
| | - Ann-Sophie De Craemer
- Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent, Belgium.,VIB-UGent Center for Inflammation Research, Ghent University, Ghent, Belgium
| | - Liselotte Deroo
- Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent, Belgium.,VIB-UGent Center for Inflammation Research, Ghent University, Ghent, Belgium
| | - Zuzanna Lukasik
- Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent, Belgium.,VIB-UGent Center for Inflammation Research, Ghent University, Ghent, Belgium
| | - Philippe Carron
- Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent, Belgium.,VIB-UGent Center for Inflammation Research, Ghent University, Ghent, Belgium
| | - Nele Herregods
- Department of Radiology, Ghent University Hospital, Ghent, Belgium
| | - Lennart Jans
- Department of Radiology, Ghent University Hospital, Ghent, Belgium
| | - Roos Colman
- Department of Biostatistics, Ghent University, Ghent, Belgium
| | - Filip Van den Bosch
- Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent, Belgium.,VIB-UGent Center for Inflammation Research, Ghent University, Ghent, Belgium
| | - Dirk Elewaut
- Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent, Belgium.,VIB-UGent Center for Inflammation Research, Ghent University, Ghent, Belgium
| |
Collapse
|
29
|
Keymeulen A, De Leenheer E, Casaer A, Cossey V, Herregods N, Laroche S, Mahieu L, Van Mol C, Vanhaesebrouck S, Walle CV, Smets K. Cranial ultrasound and MRI: complementary or not in the diagnostic assessment of children with congenital CMV infection? Eur J Pediatr 2022; 181:911-920. [PMID: 34636957 DOI: 10.1007/s00431-021-04273-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 08/27/2021] [Accepted: 09/22/2021] [Indexed: 11/29/2022]
Abstract
Whether or not cranial ultrasound (crUS) and cerebral magnetic resonance imaging (MRI) have both a place in the assessment of children with congenital cytomegalovirus infection (cCMV) remains a topic of discussion between research groups. Literature suggests that MRI is indicated only in children with abnormal crUS.In Flanders, Belgium, combined crUS and MRI was performed on 639 children with cCMV, referred for diagnostic assessment. Cranial US was classified as abnormal in the presence of striatal vasculopathy, calcifications, cysts, cystic germinolysis, and/or ventriculomegaly. MRI findings were classified as abnormal in the presence of gyration disorders, cerebellar abnormalities, ventriculomegaly, cysts, or pathologic white matter lesions.One in five children (93/480) with normal crUS showed abnormal findings on MRI. Of them, 85 (91.4%) were classified as symptomatic. In 37 of those 93 children (39.8%), classification as severely symptomatic was made based on MRI lesions alone. MRI and crUS proved to be complementary in the assessment of CNS involvement in children with cCMV. Long-term studies are needed to evaluate the importance of this finding with respect to outcome and benefit of therapy in this particular subgroup of patients with cCMV infection.Conclusion: Our findings support an enhanced role of MRI in the diagnosis of CNS involvement in children with cCMV infection. The ideal assessment should include both imaging techniques, as the strengths of each test compensate for the other's weaknesses. What is Known: • Congenital CMV infection involves the central nervous system with direct injury to and possible disruption of brain development. • Experts suggest that MRI is indicated only in children with abnormal crUS. What is New: • In almost 20% of our children with a normal cranial ultrasound, abnormalities were detected on MRI. • Our results suggest that performing both MRI and cranial US is important to obtain a complete assessment of central nervous system involvement in children with cCMV.
Collapse
Affiliation(s)
- Annelies Keymeulen
- Neonatology Department, Ghent University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | - Els De Leenheer
- Ear-Nose-Throat Department, Ghent University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Alexandra Casaer
- Neonatology Department, AZ Sint Jan Bruges, Rudderhove 10, 8000, Bruges, Belgium
| | - Veerle Cossey
- Neonatology Department, University Hospital Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Nele Herregods
- Radiology Department, Neonatology Department, Ghent University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Sabine Laroche
- Neonatology Department, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Belgium
| | - Ludo Mahieu
- Neonatology Department, Antwerp University, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Belgium
| | - Christine Van Mol
- Neonatology Department, GZA Antwerp, Oosterveldlaan 24, 2610, Wilrijk, Belgium
| | - Sophie Vanhaesebrouck
- Neonatology Department, Ghent University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Caroline Vande Walle
- Radiology Department, Ghent University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Koenraad Smets
- Neonatology Department, Ghent University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| |
Collapse
|
30
|
Morbée L, Chen M, Van Den Berghe T, Schiettecatte E, Gosselin R, Herregods N, Jans LBO. MRI-based synthetic CT of the hip: can it be an alternative to conventional CT in the evaluation of osseous morphology? Eur Radiol 2022; 32:3112-3120. [DOI: 10.1007/s00330-021-08442-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 10/12/2021] [Accepted: 10/25/2021] [Indexed: 12/13/2022]
|
31
|
Herregods N, Jans LBO, Paschke J, De Buyser SL, Renson T, Dehoorne J, Joos R, Lambert RGW, Jaremko JL. Magnetic resonance imaging findings in the normal pediatric sacroiliac joint space that can simulate disease. Pediatr Radiol 2021; 51:2530-2538. [PMID: 34549314 DOI: 10.1007/s00247-021-05168-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 05/24/2021] [Accepted: 07/31/2021] [Indexed: 01/16/2023]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) features of active sacroiliac joint inflammation include joint space fluid and enhancement, but it is unclear to what extent these are present in normal children. OBJECTIVE To describe normal MRI appearances of pediatric sacroiliac joint spaces in boys and girls of varying ages. MATERIALS AND METHODS In this ethics-approved prospective study, 251 children (119 boys, 132 girls; mean age: 12.4 years, range: 6.1-18.0 years), had both oblique-coronal T1-weighted and short tau inversion recovery (STIR) sacroiliac joint MRI. Of these, 127 were imaged for other reasons and had asymptomatic sacroiliac joints ("normal cohort") while 124 had low back pain with no features of sacroiliitis on initial clinical MRI review ("low-back-pain cohort"). Post-gadolinium T1-weighted sequences were available in 16/127 normal and 124/124 low-back-pain subjects. Three experienced radiologists scored high signal in the sacroiliac joint space on STIR (score 0=absent; 1=high signal compared to normal bone marrow present anywhere in the joint but not as bright as fluid [compared to vessels, cerebrospinal fluid]; 2=definite fluid signal in part of the joint; 3=definite fluid signal, entire vertical height, majority of slices) and, when available, joint space post-contrast enhancement (0=no high signal/enhancement; 1=thin, symmetrical, mildly increased linear high signal present in the joint space; 2=focal, thick or intense enhancement). Associations between joint signal scores, age, gender and sacral apophyseal closure were analysed. RESULTS Increased signal on STIR (score 1-3) was present in 74.7% of pediatric sacroiliac joint spaces, as intense as fluid in 18.4%. There was no significant difference in proportion by gender, side or cohort, but girls showed peak signal earlier than boys (10 years old vs. 12 years old, respectively). On post-gadolinium T1-weighted sequences, a thin rim of increased signal was nearly universally seen in sacroiliac joint spaces without focal, intense or thick post-contrast enhancement. CONCLUSION Sacroiliac joint spaces of most children demonstrate mildly increased signal on STIR, compared to normal bone marrow, and thin rim-like enhancement on post-contrast T1 images, likely related to cartilage. These findings should not be confused with sacroiliitis.
Collapse
Affiliation(s)
- Nele Herregods
- Department of Radiology and Nuclear Medicine, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium.
| | - Lennart B O Jans
- Department of Radiology and Nuclear Medicine, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium
| | | | - Stefanie L De Buyser
- Biostatistics Unit, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Thomas Renson
- Department of Pediatric Rheumatology, Ghent University Hospital, Ghent, Belgium
| | - Joke Dehoorne
- Department of Pediatric Rheumatology, Ghent University Hospital, Ghent, Belgium
| | - Rik Joos
- Department of Pediatric Rheumatology, Ghent University Hospital, Ghent, Belgium
| | - Robert G W Lambert
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada.,Medical Imaging Consultants, Edmonton, Alberta, Canada
| | - Jacob L Jaremko
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada.,Medical Imaging Consultants, Edmonton, Alberta, Canada
| |
Collapse
|
32
|
Vanmarsnille T, Laloo F, Herregods N, Jaremko JL, Verstraete KL, Jans L. Pediatric Imaging of the Elbow: A Pictorial Review. Semin Musculoskelet Radiol 2021; 25:558-565. [PMID: 34706385 DOI: 10.1055/s-0041-1735468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The elbow is a complex joint, subject to a wide range of traumatic, inflammatory, metabolic and neoplastic insults. The pediatric elbow has several diagnostic pitfalls due to the normal developmental changes in children. Knowledge of these normal variants is essential for both diagnosis and management of their elbow injuries. Radiography remains the first imaging modality of choice. Magnetic resonance imaging is excellent in evaluating lesions within the bone and soft tissues. In this pictorial essay, we provide insights into pediatric elbow imaging, show a range of entities specific to the pediatric elbow, and discuss diagnostic pitfalls that result from normal elbow growth in children.
Collapse
Affiliation(s)
- Tim Vanmarsnille
- Department of Radiology and Medical Imaging, Ghent University Hospital, Ghent, Belgium.,Department of Diagnostic Sciences, Ghent University, Ghent, Belgium
| | - Frederiek Laloo
- Department of Radiology and Medical Imaging, Ghent University Hospital, Ghent, Belgium.,Department of Diagnostic Sciences, Ghent University, Ghent, Belgium
| | - Nele Herregods
- Department of Radiology and Medical Imaging, Ghent University Hospital, Ghent, Belgium.,Department of Diagnostic Sciences, Ghent University, Ghent, Belgium
| | - Jacob L Jaremko
- Department of Radiology & Diagnostic Imaging, Faculty of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Koenraad L Verstraete
- Department of Radiology and Medical Imaging, Ghent University Hospital, Ghent, Belgium.,Department of Diagnostic Sciences, Ghent University, Ghent, Belgium
| | - Lennart Jans
- Department of Radiology and Medical Imaging, Ghent University Hospital, Ghent, Belgium.,Department of Diagnostic Sciences, Ghent University, Ghent, Belgium
| |
Collapse
|
33
|
Morbée L, Chen M, Herregods N, Pullens P, Jans LBO. MRI-based synthetic CT of the lumbar spine: Geometric measurements for surgery planning in comparison with CT. Eur J Radiol 2021; 144:109999. [PMID: 34700094 DOI: 10.1016/j.ejrad.2021.109999] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 10/06/2021] [Accepted: 10/08/2021] [Indexed: 11/20/2022]
Abstract
PURPOSE MRI is the imaging modality of choice for soft tissue-related spine disease. However, CT is superior to MRI in providing clear visualization of bony morphology. The purpose of this study is to test equivalency of MRI-based synthetic CT to conventional CT in quantitatively assessing bony morphology of the lumbar spine. METHOD A prospective study with an equivalency design was performed. Adult patients who had undergone MRI and CT of the lumbar spine were included. Synthetic CT images were generated from MRI using a deep learning-based image synthesis method. Two readers independently measured pedicle width, spinal canal width, neuroforamen length, anterior and posterior vertebral body height, superior and inferior vertebral body length, superior and inferior vertebral body width, maximal disc height, lumbar curvature and spinous process length on synthetic CT and CT. The agreement among CT and synthetic CT was evaluated using equivalency statistical testing. RESULTS Thirty participants were included (14 men and 16 women, range 20-60 years). The measurements performed on synthetic CT of pedicle width, spinal canal width, vertebral body height, vertebral body width, vertebral body length and spinous process length were statistically equivalent to CT measurements at the considered margins. Excellent inter- and intra-reader reliability was found for both synthetic CT and CT. CONCLUSIONS Equivalency of MRI-based synthetic CT to CT was demonstrated on geometrical measurements in the lumbar spine. In combination with the soft tissue information of the conventional MRI, this provides new possibilities in diagnosis and surgical planning without ionizing radiation.
Collapse
Affiliation(s)
- Lieve Morbée
- Department of Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium.
| | - Min Chen
- Department of Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Nele Herregods
- Department of Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Pim Pullens
- Department of Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium; Ghent Institute for Functional and Metabolic Imaging, Ghent University, Ghent, Belgium
| | - Lennart B O Jans
- Department of Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| |
Collapse
|
34
|
Herregods N, Maksymowych WP, Jans L, Otobo TM, Sudoł-Szopińska I, Meyers AB, Van Rossum M, Kirkhus E, Panwar J, Appenzeller S, Weiss P, Tse S, Doria AS, Lambert R, Jaremko JL. Atlas of MRI findings of sacroiliitis in pediatric sacroiliac joints to accompany the updated preliminary OMERACT pediatric JAMRIS (Juvenile Idiopathic Arthritis MRI Score) scoring system: Part I: Active lesions. Semin Arthritis Rheum 2021; 51:1089-1098. [PMID: 34311986 DOI: 10.1016/j.semarthrit.2021.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 06/15/2021] [Accepted: 07/05/2021] [Indexed: 01/19/2023]
Abstract
Magnetic resonance imaging (MRI) is an increasingly important tool for identifying involvement of the sacroiliac joints (SIJ) in juvenile idiopathic arthritis (JIA). The key feature for diagnosing active sacroiliitis is bone marrow edema (BME), but other features of active arthritis such as joint space inflammation, inflammation in an erosion cavity, capsulitis and enthesitis can be seen as well. Structural changes may also be seen. Systematic MRI assessment of inflammation and structural damage may aid in monitoring the disease course, choice of therapeutics and evaluating treatment response. In this pictorial essay, we illustrate normal MRI findings and growth-related changes of the SIJ in the pediatric population, as well as the different MRI features of SIJ inflammation. This atlas demonstrates fundamental MRI disease features of active inflammation in a format that can serve as a reference for assessing SIJ arthritis according to the updated preliminary JAMRIS (Juvenile Idiopathic Arthritis MRI Score) scoring system proposed by the MRI in JIA working group of Outcome Measures in Rheumatology and Clinical Trials (OMERACT). The atlas is intended to be read in conjunction with its companion Part 2, Structural Lesions.
Collapse
Affiliation(s)
- N Herregods
- Department of Radiology and Nuclear Medicine, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium.
| | | | - Lbo Jans
- Department of Radiology and Nuclear Medicine, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium
| | - T M Otobo
- Institute of Medical Sciences, Faculty of Medicine, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children and Department of Translational Medicine, SickKids Research Institute, Peter Gilgan Center for Research and Learning, University of Toronto, Toronto, Canada
| | - I Sudoł-Szopińska
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - A B Meyers
- Department of Radiology, Cincinnati Children's Hospital, Cincinnati, OH, United States
| | - Maj Van Rossum
- Amsterdam Rheumatology and Immunology Center, Reade, and Emma Children's Hospital Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - E Kirkhus
- Department of Radiology, Oslo University Hospital, Oslo, Norway
| | - J Panwar
- Department of Radiology, Christian Medical College, Vellore, India
| | - S Appenzeller
- Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
| | - P Weiss
- University of Pennsylvania Perelman School of Medicine, Division of Rheumatology, Children's Hospital of Philadelphia and Department of Pediatrics, University of Pennsylvania, Philadelphia, USA
| | - Sml Tse
- Division of Rheumatology, The Hospital for Sick Children, Toronto, Canada
| | - A S Doria
- Department of Medical Imaging, University of Toronto, Toronto and Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Rgw Lambert
- Canada Department of Radiology and Diagnostic Imaging, University of Alberta and WC Mackenzie Health Sciences Center, Edmonton, Alberta, Canada
| | - J L Jaremko
- Canada Department of Radiology and Diagnostic Imaging, University of Alberta and WC Mackenzie Health Sciences Center, Edmonton, Alberta, Canada
| |
Collapse
|
35
|
Otobo TM, Herregods N, Jaremko JL, Lambert RG, Sudoł-Szopińska I, Meyers AB, Kirkhus E, Weiss P, Tse SM, Appenzeller S, Conaghan PG, Rumsey DG, Stimec J, Jans L, Van Rossum M, Tzaribachev N, Carrino J, Papakonstantinou O, Tolend M, Moineddin R, Haroon N, Maksymowych WP, Doria AS. POS1323 SACROILIAC JOINT MRI ABNORMALITIES IN JUVENILE SPONDYLOARTHRITIS: AN UPDATE OF DEFINITIONS AND SCORING OF THE OMERACT JUVENILE IDIOPATHIC ARTHRITIS MRI SCORE. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.3321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Preliminary definitions for SIJ lesions in the OMERACT Juvenile Idiopathic Arthritis Magnetic Resonance Imaging score has been reported1. Investigators identified the need to revise the JAMRIS-SIJ item definitions.Objectives:To update the JAMRIS-SIJ definitions and scoring method.Methods:The OMERACT JAMRI working group was convened to discuss the performance of the score in a reliability exercise using 30 patients. Twenty investigators (12 radiologists, 8 rheumatologists) decided which definitions and scoring methods to be revised, retained or added.Results:The revised JAMRI-SIJ is in the Table 1.Table 1.Revised OMERACT JAMRIS-SIJ.ComponentDefinitionSegmentation/sliceScore range/sliceBone Marrow Edema (BME)An ill-defined area of high bone marrow signal intensity within the subchondral bone in the ilium or sacrum on fluid sensitive images4 quadrants/SIJ0-8BME IntensityPresence of hyperintensity of the marrow on fluid sensitive images using the signal of the presacral veins or cerebrospinal fluid as reference1 score/SIJ0-2BME DepthContinuing increased signal on fluid sensitive images of depth ≥ 5mm/ ≥ 1cm from the articular surface using the signal of the presacral veins or cerebrospinal fluid as reference1 score/SIJ0-2OsteitisAn ill-defined area of high bone marrow signal intensity within the subchondral bone in the ilium or sacrum on contrast enhanced T1 weighted sequences4 quadrants/SIJ0-8CapsulitisIncreased signal on fluid sensitive or contrast enhanced T1 weighted sequences involving the superior portion of the SIJ capsulesuperior halves/SIJ0-2Joint space fluidHigh signal intensity equivalent to the CSF on fluid sensitive sequences within the joint space of the cartilaginous portion of the SIJhalves/SIJ0-4Joint space enhancementIncreased signal intensity on contrast enhanced T1 weighted sequences within the joint space of the cartilaginous portion of the SIJhalves/SIJ0-4Inflammation in erosion cavityIncreased signal intensity on fluid sensitive or contrast enhanced T1 weighted sequences in an erosion cavity of the cartilaginous portion of the SIJhalves/SIJ0-4EnthesitisIncreased signal intensity in bone marrow and/or adjacent soft tissue on fluid sensitive or contrast enhanced T1 weighted sequences at sites where ligaments and tendons attach to a bone excluding retroarticular enthesitisScore per case0-1Damage DomainSclerosisA substantially wider than normal area of very low bone marrow signal intensity within the subchondral bone in the ilium or sacrum on a non-fat suppressed sequence, preferably a non-fat suppressed T1 weighted sequence. This feature must also be present on all other sequences, as available4 quadrants/SIJ0-8ErosionA focal loss of the low signal of cortical bone at the osteochondral interface and adjacent marrow matrix on T1 weighted images4 quadrants/SIJ0-8Fat metaplasia lesionHomogeneous increased signal intensity within the subchondral bone marrow on T1weighted images4 quadrants/SIJ0-8BackfillA high signal on non-contrast enhanced T1 weighted sequences in a typical location for an erosion, with signal intensity greater than normal bone marrow, clearly demarcated from adjacent bone marrow by an irregular band of low signal reflecting sclerosis at the border of the original erosionhalves/SIJ0-4AnkylosisPresence of signal equivalent to regional bone marrow continuously bridging a portion of the joint space between the iliac and sacral boneshalves/SIJ0-4Statement of overarching consideration for all definitions: “[…] in comparison to physiological changes normally seen on MRI examinations of age- and sex-matched children, and visible in 2 planes wherever available.”Conclusion:Revised JAMRIS-SIJ has been developed. Validation steps are underway.References:[1]Otobo TM, et al. Preliminary Definitions for Sacroiliac Joint Pathologies in the OMERACT Juvenile Idiopathic Arthritis Magnetic Resonance Imaging Score (OMERACT JAMRIS-SIJ). The Journal of rheumatology. 2019;46(9):1192-7.Acknowledgements:The authors acknowledge The Hospital for SickKids Research Trainee Competition (RESTRACOMP) and Queen Elizabeth II/Edward Dunlop Foundation Scholarship In Science and Technology (QEII-GSST) at the University of Toronto for funding provided to Dr. Tarimobo M. Otobo. The authors also acknowledge Prof. Dr. Desiree van der Heijde for providing expert commentary.Disclosure of Interests:None declared
Collapse
|
36
|
Schiettecatte E, Jans L, Jaremko JL, Chen M, Vande Walle C, Herregods N. MR Imaging of Rheumatic Diseases Affecting the Pediatric Population. Semin Musculoskelet Radiol 2021; 25:82-93. [PMID: 34020470 DOI: 10.1055/s-0041-1726435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This article reviews the application of magnetic resonance imaging (MRI) to pediatric rheumatic diseases. MRI can detect early manifestations of arthritis, evaluate the extent of disease, and monitor disease activity and response to treatment.Juvenile idiopathic arthritis (JIA) is the most common pediatric rheumatic disorder, representing a diverse group of related diseases that share a definition of joint inflammation of unknown origin with onset before 16 years of age and lasting > 6 weeks. JIA may lead to significant functional impairment and is increasingly imaged with MRI to assess for active inflammation as a target for therapy. This is particularly true for juvenile spondyloarthritis that includes multiple subgroups of JIA and primarily involves the spine and sacroiliac joints.Other less common pediatric rheumatic diseases considered here are chronic recurrent multifocal osteomyelitis and collagen vascular diseases including polymyositis, dermatomyositis, scleroderma, and juvenile systemic lupus erythematosus.
Collapse
Affiliation(s)
- Eva Schiettecatte
- Department of Radiology and Medical Imaging, Ghent University Hospital, Ghent, Belgium
| | - Lennart Jans
- Department of Radiology and Medical Imaging, Ghent University Hospital, Ghent, Belgium
| | - Jacob Lester Jaremko
- Department of Radiology, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - Min Chen
- Department of Radiology and Medical Imaging, Ghent University Hospital, Ghent, Belgium
| | - Caroline Vande Walle
- Department of Radiology and Medical Imaging, Ghent University Hospital, Ghent, Belgium
| | - Nele Herregods
- Department of Radiology and Medical Imaging, Ghent University Hospital, Ghent, Belgium
| |
Collapse
|
37
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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.
| |
Collapse
|
38
|
Jans LBO, Chen M, Elewaut D, Van den Bosch F, Carron P, Jacques P, Wittoek R, Jaremko JL, Herregods N. MRI-based Synthetic CT in the Detection of Structural Lesions in Patients with Suspected Sacroiliitis: Comparison with MRI. Radiology 2020; 298:343-349. [PMID: 33350891 DOI: 10.1148/radiol.2020201537] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Background Evaluation of structural lesions in the sacroiliac (SI) joints can improve the accuracy for diagnosis of spondyloarthritis. However, structural lesions, such as erosions, are difficult to assess on routine T1-weighted MRI scans. Purpose To determine the diagnostic performance of MRI-based synthetic CT (sCT) in the depiction of erosions, sclerosis, and ankylosis of the SI joints compared with T1-weighted MRI, with CT as the reference standard. Materials and Methods A prospective study (clinical trial registration no. B670201837885) was performed from February 2019 to November 2019. Adults were referred from a tertiary hospital rheumatology outpatient clinic with clinical suspicion of inflammatory sacroiliitis. MRI and CT of the SI joints were performed on the same day. SCT images were generated from MRI scans using a commercially available deep learning-based image synthesis method. Two readers independently recorded if structural lesions (erosions, sclerosis, and ankylosis) were present on T1-weighted MRI, sCT, and CT scans in different reading sessions, with readers blinded to clinical information and other images. Diagnostic performance of sCT and T1-weighted MRI scans were analyzed using generalized estimating equation models, with consensus results of CT as the reference standard. Results Thirty participants were included (16 men, 14 women; mean age, 40 years ± 10 [standard deviation]). Diagnostic accuracy of sCT was higher than that of T1-weighted MRI for erosion (94% vs 86%, P = .003), sclerosis (97% vs 81%, P < .001), and ankylosis (92% vs 84%, P = .04). With sCT, specificity for erosion detection (96% [95% CI: 90, 98] vs 89% [95% CI: 81, 94], P = .01] and sensitivity for detection of sclerosis [94% [95% CI: 87, 97] vs 20% [95% CI: 10, 35], P < .001] and ankylosis (93% [95% CI: 78, 98] vs 70% [95% CI: 47, 87], P = .001) were improved. Conclusion With CT as the reference standard, synthetic CT of the sacroiliac joints has better diagnostic performance in the detection of structural lesions in individuals suspected of having sacroiliitis compared with routine T1-weighted MRI. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Fritz in this issue.
Collapse
Affiliation(s)
- Lennart B O Jans
- From the Departments of Radiology (L.B.O.J., M.C., N.H.) and Rheumatology (D.E., F.V.d.B., P.C., P.J., R.W.), Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium; VIB Center for Inflammation Research, Unit for Molecular Immunology and Inflammation, Ghent University, Ghent, Belgium (D.E., F.v.d.B., P.C., P.J., R.W.); and Department of Radiology & Diagnostic Imaging, University of Alberta Hospital, Edmonton, Canada (J.L.J.)
| | - Min Chen
- From the Departments of Radiology (L.B.O.J., M.C., N.H.) and Rheumatology (D.E., F.V.d.B., P.C., P.J., R.W.), Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium; VIB Center for Inflammation Research, Unit for Molecular Immunology and Inflammation, Ghent University, Ghent, Belgium (D.E., F.v.d.B., P.C., P.J., R.W.); and Department of Radiology & Diagnostic Imaging, University of Alberta Hospital, Edmonton, Canada (J.L.J.)
| | - Dirk Elewaut
- From the Departments of Radiology (L.B.O.J., M.C., N.H.) and Rheumatology (D.E., F.V.d.B., P.C., P.J., R.W.), Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium; VIB Center for Inflammation Research, Unit for Molecular Immunology and Inflammation, Ghent University, Ghent, Belgium (D.E., F.v.d.B., P.C., P.J., R.W.); and Department of Radiology & Diagnostic Imaging, University of Alberta Hospital, Edmonton, Canada (J.L.J.)
| | - Filip Van den Bosch
- From the Departments of Radiology (L.B.O.J., M.C., N.H.) and Rheumatology (D.E., F.V.d.B., P.C., P.J., R.W.), Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium; VIB Center for Inflammation Research, Unit for Molecular Immunology and Inflammation, Ghent University, Ghent, Belgium (D.E., F.v.d.B., P.C., P.J., R.W.); and Department of Radiology & Diagnostic Imaging, University of Alberta Hospital, Edmonton, Canada (J.L.J.)
| | - Philippe Carron
- From the Departments of Radiology (L.B.O.J., M.C., N.H.) and Rheumatology (D.E., F.V.d.B., P.C., P.J., R.W.), Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium; VIB Center for Inflammation Research, Unit for Molecular Immunology and Inflammation, Ghent University, Ghent, Belgium (D.E., F.v.d.B., P.C., P.J., R.W.); and Department of Radiology & Diagnostic Imaging, University of Alberta Hospital, Edmonton, Canada (J.L.J.)
| | - Peggy Jacques
- From the Departments of Radiology (L.B.O.J., M.C., N.H.) and Rheumatology (D.E., F.V.d.B., P.C., P.J., R.W.), Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium; VIB Center for Inflammation Research, Unit for Molecular Immunology and Inflammation, Ghent University, Ghent, Belgium (D.E., F.v.d.B., P.C., P.J., R.W.); and Department of Radiology & Diagnostic Imaging, University of Alberta Hospital, Edmonton, Canada (J.L.J.)
| | - Ruth Wittoek
- From the Departments of Radiology (L.B.O.J., M.C., N.H.) and Rheumatology (D.E., F.V.d.B., P.C., P.J., R.W.), Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium; VIB Center for Inflammation Research, Unit for Molecular Immunology and Inflammation, Ghent University, Ghent, Belgium (D.E., F.v.d.B., P.C., P.J., R.W.); and Department of Radiology & Diagnostic Imaging, University of Alberta Hospital, Edmonton, Canada (J.L.J.)
| | - Jacob L Jaremko
- From the Departments of Radiology (L.B.O.J., M.C., N.H.) and Rheumatology (D.E., F.V.d.B., P.C., P.J., R.W.), Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium; VIB Center for Inflammation Research, Unit for Molecular Immunology and Inflammation, Ghent University, Ghent, Belgium (D.E., F.v.d.B., P.C., P.J., R.W.); and Department of Radiology & Diagnostic Imaging, University of Alberta Hospital, Edmonton, Canada (J.L.J.)
| | - Nele Herregods
- From the Departments of Radiology (L.B.O.J., M.C., N.H.) and Rheumatology (D.E., F.V.d.B., P.C., P.J., R.W.), Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium; VIB Center for Inflammation Research, Unit for Molecular Immunology and Inflammation, Ghent University, Ghent, Belgium (D.E., F.v.d.B., P.C., P.J., R.W.); and Department of Radiology & Diagnostic Imaging, University of Alberta Hospital, Edmonton, Canada (J.L.J.)
| |
Collapse
|
39
|
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: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [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
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. Electronic supplementary material The online version of this article (10.1007/s00330-020-06807-8) contains supplementary material, which is available to authorized users.
Collapse
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
| |
Collapse
|
40
|
Renson T, Depicker A, De Craemer AS, Deroo L, Varkas G, de Hooge M, Carron P, Jans L, Herregods N, Dehaene I, Vandenberghe G, Roelens K, Van den Bosch FE, Elewaut D. High prevalence of spondyloarthritis-like MRI lesions in postpartum women: a prospective analysis in relation to maternal, child and birth characteristics. Ann Rheum Dis 2020; 79:929-934. [PMID: 32299794 DOI: 10.1136/annrheumdis-2020-217095] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 03/25/2020] [Accepted: 04/03/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Bone marrow oedema (BMO) on MRI of sacroiliac joints (SIJs) represents a hallmark of axial spondyloarthritis (SpA), yet such lesions may also occur under augmented mechanical stress in healthy subjects. We therefore sought to delineate the relationship between pregnancy/delivery and pelvic stress through a prospective study with repeated MRI. Results were matched with maternal, child and birth characteristics. METHODS Thirty-five women underwent a baseline MRI-SIJ within the first 10 days after giving birth. MRI was repeated after 6 months and, if positive for sacroiliitis according to the Assessment of SpondyloArthritis International Society (ASAS) definition, after 12 months. BMO and structural lesions were scored by three trained readers using the Spondyloarthritis Research Consortium of Canada (SPARCC) method. RESULTS Seventy-seven per cent of the subjects (27/35) displayed sacroiliac BMO immediately postpartum, 60% fulfilled the ASAS definition of a positive MRI. After 6 months, 46% of the subjects (15/33) still showed BMO, representing 15% (5/33) with a positive MRI. After 12 months, MRI was still positive in 12% of the subjects (4/33). Few structural lesions were detected. Intriguingly, in this study, the presence of BMO was related to a shorter duration of labour and lack of epidural anaesthesia. CONCLUSION A surprisingly high prevalence of sacroiliac BMO occurs in women immediately postpartum. Our data reveal a need for a waiting period of at least 6 months to perform an MRI-SIJ in postpartum women with back pain. This study also underscores the importance of interpreting MRI-SIJ findings in the appropriate clinical context.
Collapse
Affiliation(s)
- Thomas Renson
- Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent, Belgium .,VIB-UGent Center for Inflammation Research, Ghent University, Ghent, Belgium
| | - Anaïs Depicker
- Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent, Belgium
| | - Ann-Sophie De Craemer
- Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent, Belgium.,VIB-UGent Center for Inflammation Research, Ghent University, Ghent, Belgium
| | - Liselotte Deroo
- Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent, Belgium.,VIB-UGent Center for Inflammation Research, Ghent University, Ghent, Belgium
| | - Gaëlle Varkas
- Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent, Belgium.,VIB-UGent Center for Inflammation Research, Ghent University, Ghent, Belgium
| | - Manouk de Hooge
- Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent, Belgium.,VIB-UGent Center for Inflammation Research, Ghent University, Ghent, Belgium
| | - Philippe Carron
- Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent, Belgium.,VIB-UGent Center for Inflammation Research, Ghent University, Ghent, Belgium
| | - Lennart Jans
- Department of Radiology, Ghent University Hospital, Ghent, Belgium
| | - Nele Herregods
- Department of Radiology, Ghent University Hospital, Ghent, Belgium
| | - Isabelle Dehaene
- Department of Obstetrics, Ghent University Hospital, Ghent, Belgium
| | | | - Kristien Roelens
- Department of Obstetrics, Ghent University Hospital, Ghent, Belgium
| | - Filip E Van den Bosch
- Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent, Belgium.,VIB-UGent Center for Inflammation Research, Ghent University, Ghent, Belgium
| | - Dirk Elewaut
- Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent, Belgium.,VIB-UGent Center for Inflammation Research, Ghent University, Ghent, Belgium
| |
Collapse
|
41
|
Schiettecatte E, Jaremko J, Sudoł-Szopińska I, Znajdek M, Mandegaran R, Swami V, Jans L, Herregods N. Common incidental findings on sacroiliac joint MRI in children clinically suspected of juvenile spondyloarthritis. Eur J Radiol Open 2020; 7:100225. [PMID: 32154331 PMCID: PMC7058907 DOI: 10.1016/j.ejro.2020.100225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 02/18/2020] [Accepted: 02/22/2020] [Indexed: 02/07/2023] Open
Abstract
What to look for on MRI of the sacroiliac (SI) joint. Incidental findings are common on MRI of the sacroiliac (SI) joint in children. There is more to see than sacroiliitis on MRI of the sacroiliac (SI) joint. Degeneration, inflammation, tumor and normal variants can be seen on MRI of SI joint.
Purpose To determine the prevalence of incidental findings on sacroiliac (SI) joint MRI in children clinically suspected of Juvenile Spondyloarthritis (JSpA). Methods In this retrospective multi-center study of 540 children clinically suspected of JSpA who underwent MRI of SI joints from February 2012 to May 2018, the prevalence of sacroiliitis and other incidental findings was recorded. Results In 106/540 (20 %) children MRI features of sacroiliitis were present. In 228 (42 %) patients MRI showed at least one incidental finding other than sacroiliitis. A total of 271 abnormal findings were reported. The most frequent incidental findings were at lumbosacral spine (158 patients, 29 %) and hip (43 patients, 8 %). The most common incidental finding was axial degenerative changes, seen in 94 patients (17 %). Other less frequent pathologies were: simple (bone) cyst in 15 (2,8 %) patients; enthesitis/tendinitis in 16 (3 %) patients; non-specific focal bone marrow edema (BME) away from SI joints in 10 (1,9 %) patients; ovarian cysts in 7 (1,3 %) patients; BME in the course of chronic recurrent multifocal osteomyelitis (CRMO) in 4 (0,7 %) patients; muscle pathology in 4 (0,7%) patients; benign tumors in 3 (0,6 %) patients; (old) fractures in 3 (0,6 %) patients; bony apophyseal avulsion in 2 (0,4 %) patients and malignant tumors in 2 (0,4 %) patients. Conclusion Incidental findings are common on MRI of the SI joints in children clinically suspected of JSpA, particularly at the lumbar spine and hips. They are seen even more frequently than sacroiliitis and can be relevant, as some will have clinical significance or require treatment.
Collapse
Key Words
- AVN, avascular necrosis
- BME, bone marrow edema
- CRMO, chronic recurrent multifocal osteomyelitis
- FOV, field of view
- Gd, gadolinium DTPA
- HLA-B27, human leukocyte antigen B27
- IV, intravenous
- Inflammation
- JSpA, juvenile spondyloarthritis
- Juvenile spondyloarthritis
- MRI, magnetic resonance imaging
- Magnetic resonance imaging (MRI)
- SI, sacroiliac
- ST, slice thickness
- STIR, short tau inversion recovery
- Sacroiliac joint
- Sacroiliitis
- TE, echo time
- TR, repetition time
- TSE, turbo spin echo
Collapse
Affiliation(s)
- E. Schiettecatte
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Gent, Belgium
- Corresponding author.
| | - J.L. Jaremko
- Department of Radiology, University of Alberta Hospital, 8440-112 Street, Edmonton, T6G 2B7, Alberta, Canada
| | - I. Sudoł-Szopińska
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - M. Znajdek
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - R. Mandegaran
- Department of Radiology, University of Alberta Hospital, 8440-112 Street, Edmonton, T6G 2B7, Alberta, Canada
| | - V. Swami
- Department of Radiology, University of Alberta Hospital, 8440-112 Street, Edmonton, T6G 2B7, Alberta, Canada
| | - L. Jans
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Gent, Belgium
| | - N. Herregods
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Gent, Belgium
| |
Collapse
|
42
|
Chen M, Herregods N, Jaremko JL, Carron P, Elewaut D, Van den Bosch F, Jans L. Bone marrow edema in sacroiliitis: detection with dual-energy CT. Eur Radiol 2020; 30:3393-3400. [PMID: 32055947 DOI: 10.1007/s00330-020-06670-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 12/30/2019] [Accepted: 01/23/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To evaluate the feasibility and diagnostic accuracy of dual-energy computed tomography (DECT) for the detection of bone marrow edema (BME) in patients suspected for sacroiliitis. METHODS Patients aged 18-55 years with clinical suspicion for sacroiliitis were enrolled. All patients underwent DECT and 3.0 T MRI of the sacroiliac joints on the same day. Virtual non-calcium (VNCa) images were calculated from DECT images for demonstration of BME. VNCa images were scored by two readers independently using a binary system (0 = normal bone marrow, 1 = BME). Diagnostic performance was assessed with fluid-sensitive MRI as the reference standard. ROIs were placed on VNCa images, and CT numbers were displayed. Cutoff values for BME detection were determined based on ROC curves. RESULTS Forty patients (16 men, 24 women, mean age 37.1 years ± 9.6 years) were included. Overall inter-reader agreement for visual image reading of BME on VNCa images was good (κ = 0.70). The sensitivity and specificity of BME detection by DECT were 65.4% and 94.2% on the quadrant level and 81.3% and 91.7% on the patient level. ROC analyses revealed AUCs of 0.90 and 0.87 for CT numbers in the ilium and sacrum, respectively. Cutoff values of - 44.4 HU (for iliac quadrants) and - 40.8 HU (for sacral quadrants) yielded sensitivities of 76.9% and 76.7% and specificities of 91.5% and 87.5%, respectively. CONCLUSIONS Inflammatory sacroiliac BME can be detected by VNCa images calculated from DECT, with a good interobserver agreement, moderate sensitivity, and high specificity. KEY POINTS • Virtual non-calcium images calculated from dual-energy CT can detect sacroiliac bone marrow edema in patients suspected for sacroiliitis. • Dual-energy CT has a high specificity in bone marrow edema detection. • Virtual non-calcium images for bone marrow edema in patients with a large amount of red bone marrow or obvious sclerosis near the articular surface should be interpreted with caution.
Collapse
Affiliation(s)
- Min Chen
- Department of Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | - Nele Herregods
- Department of Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Jacob L Jaremko
- Department of Radiology & Diagnostic Imaging, University of Alberta Hospital, 8440-112 Street, Edmonton, Alberta, T6G 2B7, Canada
| | - Philippe Carron
- Department of Rheumatology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.,VIB Inflammation Research Center, Unit for Molecular Immunology and Inflammation, Ghent University, Technologiepark 927, 9052, Ghent, Belgium
| | - Dirk Elewaut
- Department of Rheumatology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.,VIB Inflammation Research Center, Unit for Molecular Immunology and Inflammation, Ghent University, Technologiepark 927, 9052, Ghent, Belgium
| | - Filip Van den Bosch
- Department of Rheumatology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.,VIB Inflammation Research Center, Unit for Molecular Immunology and Inflammation, Ghent University, Technologiepark 927, 9052, Ghent, Belgium
| | - Lennart Jans
- Department of Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| |
Collapse
|
43
|
Laloo F, Herregods N, Jaremko JL, Carron P, Elewaut D, Van den Bosch F, Verstraete K, Jans L. MRI of the axial skeleton in spondyloarthritis: the many faces of new bone formation. Insights Imaging 2019; 10:67. [PMID: 31338670 PMCID: PMC6650523 DOI: 10.1186/s13244-019-0752-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 05/14/2019] [Indexed: 12/17/2022] Open
Abstract
Spondyloarthritis has two hallmark features: active inflammation and structural lesions with new bone formation. MRI is well suited to assess active inflammation, but there is increasing interest in the role of structural lesions at MRI. Recent MRI studies have examined the established features of new bone formation and demonstrated some novel features which show diagnostic value and might even have potential as possible markers of disease progression. Although MRI is not the first imaging modality that comes into mind for assessment of bony changes, these features of new bone formation can be detected on MRI—if one knows how to recognize them. This review illustrates the MRI features of new bone formation and addresses possible pitfalls.
Collapse
Affiliation(s)
- Frederiek Laloo
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | - Nele Herregods
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Jacob L Jaremko
- Department of Radiology & Diagnostic Imaging, University of Alberta Hospital, 8440-112 Street, Edmonton, Alberta, T6G 2B7, Canada
| | - Philippe Carron
- Department of Rheumatology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.,VIB Inflammation Research Center, Unit for Molecular Immunology and Inflammation, Ghent University, Technologiepark 927, 9052, Ghent, Belgium
| | - Dirk Elewaut
- Department of Rheumatology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.,VIB Inflammation Research Center, Unit for Molecular Immunology and Inflammation, Ghent University, Technologiepark 927, 9052, Ghent, Belgium
| | - Filip Van den Bosch
- Department of Rheumatology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.,VIB Inflammation Research Center, Unit for Molecular Immunology and Inflammation, Ghent University, Technologiepark 927, 9052, Ghent, Belgium
| | - Koenraad Verstraete
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Lennart Jans
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| |
Collapse
|
44
|
De Coninck L, Goderis J, Herregods N, Vanspeybroeck S, Vermassen F, Dhont E. Massive pneumomediastinum with subcutaneous emphysema after elective adenotonsillectomy in children: Involvement of the Boyle-Davis mouth gag. Int J Pediatr Otorhinolaryngol 2019; 122:152-154. [PMID: 31029949 DOI: 10.1016/j.ijporl.2019.04.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 04/16/2019] [Accepted: 04/16/2019] [Indexed: 11/26/2022]
Abstract
Adenotonsillectomy, a very common surgical procedure in otorhinolaryngology, is considered easy and safe surgery. However, clinicians should be aware of some less common but potentially life-threatening complications. This report discusses subcutaneous emphysema with pneumomediastinum following elective adenotonsillar surgery in children. The Boyle-Davis mouth gag seemed to play a part in the pathogenic mechanism of this rare complication in this case. Better insights in the mechanism of this severe complication of adenotonsillectomy may contribute to the prevention of this complication.
Collapse
Affiliation(s)
- L De Coninck
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
| | - J Goderis
- Faculty of Medicine and Health Sciences, Department of Otorhinolaryngology, Ghent University, Ghent, Belgium
| | - N Herregods
- Department of Radiology, Ghent University Hospital, Ghent, Belgium
| | | | - F Vermassen
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - E Dhont
- Department of Pediatric Intensive Care, Ghent University Hospital, Ghent, Belgium
| |
Collapse
|
45
|
Jaremko JL, Teh J, Weidekamm C, Jans L, Herregods N. Hip Inflammatory Conditions: A Practical Differential Diagnosis Algorithmic Approach in Adults and Children. Semin Musculoskelet Radiol 2019; 23:e1-e16. [PMID: 31163507 DOI: 10.1055/s-0039-1683966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The child or adult patient presenting with acute hip pain in the absence of major trauma often presents a difficult diagnostic dilemma, due to the complex anatomy and diversity of pathology at the hip. A correct diagnosis is important because untreated hip inflammatory disease can lead to lifelong morbidity from structural damage at this weightbearing joint. An effective and efficient process of reaching an appropriate diagnosis often requires multiple imaging modalities overseen by careful clinical judgment. This article reviews an algorithmic approach to imaging the acutely painful hip, with attention to uses and limitations of each imaging modality, and it offers details on the key differential diagnoses in adults and children.
Collapse
Affiliation(s)
- Jacob L Jaremko
- Department of Radiology and Diagnostic Imaging, Faculty of Medicine, University of Alberta, Edmonton, Canada
| | - James Teh
- Department of Radiology, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - Claudia Weidekamm
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna/Vienna General Hospital, Vienna, Austria
| | - Lennart Jans
- Department of Radiology and Medical Imaging, Ghent University Hospital, Gent, Belgium
| | - Nele Herregods
- Department of Radiology and Medical Imaging, Ghent University Hospital, Gent, Belgium
| |
Collapse
|
46
|
Otobo TM, Tolend M, Maksymowych WP, Conaghan PG, Heijd D, Weiss P, Sudol‐Szopinska I, Herregods N, Jaremko JL, Jans L, Meyer AB, Rumsey DR, Inarejos EC, Kirkhus E, Thorpe K, Rossum MAJ, Perez M, Tzaribachev N, Sandhya P, Tse S, Simone A, Swami VG, Touma Z, Lambert RG, Doria AS. Preliminary Definitions for Sacroiliac Joint Pathologies in the OMERACT Juvenile Idiopathic Arthritis MRI Score (OMERACT JAMRIS‐SIJ). FASEB J 2019. [DOI: 10.1096/fasebj.2019.33.1_supplement.453.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Tarimobo Michael Otobo
- Institute of Medical SciencesUniversity of TorontoTorontoONCanada
- Diagnostic ImagingHospital for SickKidsTorontoONCanada
| | - Mirkamal Tolend
- Institute of Medical SciencesUniversity of TorontoTorontoONCanada
| | | | - Philip G Conaghan
- University of Leeds & NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds Teaching HospitalLeedsUnited Kingdom
| | - Desiree Heijd
- RheumatologyLeiden University Medical Center, LeidenLeidenNetherlands
| | | | - Iwona Sudol‐Szopinska
- RadiologyNational Institute of Geriatrics, Rheumatology and RehabilitationWarsawPoland
| | | | | | | | - Arthur B Meyer
- RadiologyNemours Children's Hospital and Health SystemOrlandoFL
| | | | | | - Eva Kirkhus
- RadiologyRikshospitalet, Oslo University HospitalOsloNorway
| | - Kevin Thorpe
- Public HealthUniversity of TorontoTorontoONCanada
| | | | - Manuela Perez
- Diagnostic ImagingHospital for SickKidsTorontoONCanada
| | | | | | - Shirley Tse
- RheumatologyHospital for SickKidsTorontoONCanada
| | | | - Vimarsha G Swami
- Institute of Medical SciencesUniversity of TorontoTorontoONCanada
| | - Zahi Touma
- RheumatologyUniversity of TorontoTorontoONCanada
| | | | | |
Collapse
|
47
|
Krabbe S, Eshed I, Gandjbakhch F, Pedersen SJ, Bird P, Mathew AJ, Lambert RG, Maksymowych WP, Glinatsi D, Stoenoiu MS, Poggenborg R, Jans L, Jaremko JL, Herregods N, Foltz V, Conaghan PG, Althoff CE, Paschke J, Peterfy C, Hermann KGA, Østergaard M. Development and Validation of an OMERACT MRI Whole-Body Score for Inflammation in Peripheral Joints and Entheses in Inflammatory Arthritis (MRI-WIPE). J Rheumatol 2019; 46:1215-1221. [PMID: 30770508 DOI: 10.3899/jrheum.181084] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2019] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To develop a whole-body magnetic resonance imaging (MRI) scoring system for peripheral arthritis and enthesitis. METHODS After consensus on definitions/locations of MRI pathologies, 4 multireader exercises were performed. Eighty-three joints were scored 0-3 separately for synovitis and osteitis, and 33 entheses 0-3 separately for soft tissue inflammation and osteitis. RESULTS In the last exercise, reliability was moderate-good for musculoskeletal radiologists and rheumatologists with previously demonstrated good scoring proficiency. Median pairwise single-measure/average-measure ICC were 0.67/0.80 for status scores and 0.69/0.82 for change scores; κ ranged 0.35-0.77. CONCLUSION Whole-body MRI scoring of peripheral arthritis and enthesitis is reliable, which encourages further testing and refinement in clinical trials.
Collapse
Affiliation(s)
- Simon Krabbe
- From the Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Diagnostic Imaging, Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; University Pierre et Marie Curie - Paris 6, Sorbonne Universités, GRC-08 (EEMOIS); AP-HP, Rheumatology Department, Pitié Salpêtrière University Hospital, Paris, France; Division of Medicine, University of New South Wales, Sydney, Australia; Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India; Department of Radiology and Diagnostic Imaging, and Department of Medicine, University of Alberta; CaRE Arthritis, Edmonton, Canada; Department of Rheumatology, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain, Brussels; Department of Radiology, Ghent University Hospital, Ghent, Belgium; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds Teaching Hospital National Health Service (NHS) Trust, UK; Department of Radiology, Arthritis Imaging Research Group, University Hospital Charité, Berlin, Germany; Spire Sciences Inc., Boca Raton, Florida, USA. .,S. Krabbe, MD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen; I. Eshed, MD, Department of Diagnostic Imaging, Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University; F. Gandjbakhch, MD, University Pierre et Marie Curie - Paris 6, Sorbonne Universités, GRC-08 (EEMOIS), and AP-HP, Rheumatology Department, Pitié Salpêtrière University Hospital; S.J. Pedersen, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; P. Bird, MD, PhD, Division of Medicine, University of New South Wales; A.J. Mathew, MD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, and Department of Clinical Immunology and Rheumatology, Christian Medical College; R.G. Lambert, MD, Department of Radiology and Diagnostic Imaging, University of Alberta; W.P. Maksymowych, MD, CaRE Arthritis, and Department of Medicine, University of Alberta; D. Glinatsi, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.S. Stoenoiu, MD, PhD, Department of Rheumatology, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain; R. Poggenborg, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; L. Jans, MD, PhD, Department of Radiology, Ghent University Hospital; J.L. Jaremko, MD, PhD, Department of Radiology and Diagnostic Imaging, University of Alberta; N. Herregods, MD, PhD, Department of Radiology, Ghent University Hospital; V. Foltz, MD, University Pierre et Marie Curie - Paris 6, Sorbonne Universités, GRC-08 (EEMOIS), and AP-HP, Rheumatology Department, Pitié Salpêtrière University Hospital; P.G. Conaghan, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospital NHS Trust; C.E. Althoff, MD, Department of Radiology, Arthritis Imaging Research Group, University Hospital Charité; J. Paschke, BSc, CaRE Arthritis; C. Peterfy, MD, PhD, Spire Sciences Inc.; K.A. Hermann, MD, PhD, Department of Radiology, Arthritis Imaging Research Group, University Hospital Charité; M. Østergaard, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen.
| | - Iris Eshed
- From the Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Diagnostic Imaging, Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; University Pierre et Marie Curie - Paris 6, Sorbonne Universités, GRC-08 (EEMOIS); AP-HP, Rheumatology Department, Pitié Salpêtrière University Hospital, Paris, France; Division of Medicine, University of New South Wales, Sydney, Australia; Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India; Department of Radiology and Diagnostic Imaging, and Department of Medicine, University of Alberta; CaRE Arthritis, Edmonton, Canada; Department of Rheumatology, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain, Brussels; Department of Radiology, Ghent University Hospital, Ghent, Belgium; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds Teaching Hospital National Health Service (NHS) Trust, UK; Department of Radiology, Arthritis Imaging Research Group, University Hospital Charité, Berlin, Germany; Spire Sciences Inc., Boca Raton, Florida, USA.,S. Krabbe, MD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen; I. Eshed, MD, Department of Diagnostic Imaging, Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University; F. Gandjbakhch, MD, University Pierre et Marie Curie - Paris 6, Sorbonne Universités, GRC-08 (EEMOIS), and AP-HP, Rheumatology Department, Pitié Salpêtrière University Hospital; S.J. Pedersen, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; P. Bird, MD, PhD, Division of Medicine, University of New South Wales; A.J. Mathew, MD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, and Department of Clinical Immunology and Rheumatology, Christian Medical College; R.G. Lambert, MD, Department of Radiology and Diagnostic Imaging, University of Alberta; W.P. Maksymowych, MD, CaRE Arthritis, and Department of Medicine, University of Alberta; D. Glinatsi, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.S. Stoenoiu, MD, PhD, Department of Rheumatology, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain; R. Poggenborg, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; L. Jans, MD, PhD, Department of Radiology, Ghent University Hospital; J.L. Jaremko, MD, PhD, Department of Radiology and Diagnostic Imaging, University of Alberta; N. Herregods, MD, PhD, Department of Radiology, Ghent University Hospital; V. Foltz, MD, University Pierre et Marie Curie - Paris 6, Sorbonne Universités, GRC-08 (EEMOIS), and AP-HP, Rheumatology Department, Pitié Salpêtrière University Hospital; P.G. Conaghan, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospital NHS Trust; C.E. Althoff, MD, Department of Radiology, Arthritis Imaging Research Group, University Hospital Charité; J. Paschke, BSc, CaRE Arthritis; C. Peterfy, MD, PhD, Spire Sciences Inc.; K.A. Hermann, MD, PhD, Department of Radiology, Arthritis Imaging Research Group, University Hospital Charité; M. Østergaard, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen
| | - Frédérique Gandjbakhch
- From the Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Diagnostic Imaging, Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; University Pierre et Marie Curie - Paris 6, Sorbonne Universités, GRC-08 (EEMOIS); AP-HP, Rheumatology Department, Pitié Salpêtrière University Hospital, Paris, France; Division of Medicine, University of New South Wales, Sydney, Australia; Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India; Department of Radiology and Diagnostic Imaging, and Department of Medicine, University of Alberta; CaRE Arthritis, Edmonton, Canada; Department of Rheumatology, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain, Brussels; Department of Radiology, Ghent University Hospital, Ghent, Belgium; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds Teaching Hospital National Health Service (NHS) Trust, UK; Department of Radiology, Arthritis Imaging Research Group, University Hospital Charité, Berlin, Germany; Spire Sciences Inc., Boca Raton, Florida, USA.,S. Krabbe, MD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen; I. Eshed, MD, Department of Diagnostic Imaging, Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University; F. Gandjbakhch, MD, University Pierre et Marie Curie - Paris 6, Sorbonne Universités, GRC-08 (EEMOIS), and AP-HP, Rheumatology Department, Pitié Salpêtrière University Hospital; S.J. Pedersen, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; P. Bird, MD, PhD, Division of Medicine, University of New South Wales; A.J. Mathew, MD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, and Department of Clinical Immunology and Rheumatology, Christian Medical College; R.G. Lambert, MD, Department of Radiology and Diagnostic Imaging, University of Alberta; W.P. Maksymowych, MD, CaRE Arthritis, and Department of Medicine, University of Alberta; D. Glinatsi, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.S. Stoenoiu, MD, PhD, Department of Rheumatology, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain; R. Poggenborg, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; L. Jans, MD, PhD, Department of Radiology, Ghent University Hospital; J.L. Jaremko, MD, PhD, Department of Radiology and Diagnostic Imaging, University of Alberta; N. Herregods, MD, PhD, Department of Radiology, Ghent University Hospital; V. Foltz, MD, University Pierre et Marie Curie - Paris 6, Sorbonne Universités, GRC-08 (EEMOIS), and AP-HP, Rheumatology Department, Pitié Salpêtrière University Hospital; P.G. Conaghan, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospital NHS Trust; C.E. Althoff, MD, Department of Radiology, Arthritis Imaging Research Group, University Hospital Charité; J. Paschke, BSc, CaRE Arthritis; C. Peterfy, MD, PhD, Spire Sciences Inc.; K.A. Hermann, MD, PhD, Department of Radiology, Arthritis Imaging Research Group, University Hospital Charité; M. Østergaard, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen
| | - Susanne J Pedersen
- From the Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Diagnostic Imaging, Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; University Pierre et Marie Curie - Paris 6, Sorbonne Universités, GRC-08 (EEMOIS); AP-HP, Rheumatology Department, Pitié Salpêtrière University Hospital, Paris, France; Division of Medicine, University of New South Wales, Sydney, Australia; Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India; Department of Radiology and Diagnostic Imaging, and Department of Medicine, University of Alberta; CaRE Arthritis, Edmonton, Canada; Department of Rheumatology, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain, Brussels; Department of Radiology, Ghent University Hospital, Ghent, Belgium; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds Teaching Hospital National Health Service (NHS) Trust, UK; Department of Radiology, Arthritis Imaging Research Group, University Hospital Charité, Berlin, Germany; Spire Sciences Inc., Boca Raton, Florida, USA.,S. Krabbe, MD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen; I. Eshed, MD, Department of Diagnostic Imaging, Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University; F. Gandjbakhch, MD, University Pierre et Marie Curie - Paris 6, Sorbonne Universités, GRC-08 (EEMOIS), and AP-HP, Rheumatology Department, Pitié Salpêtrière University Hospital; S.J. Pedersen, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; P. Bird, MD, PhD, Division of Medicine, University of New South Wales; A.J. Mathew, MD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, and Department of Clinical Immunology and Rheumatology, Christian Medical College; R.G. Lambert, MD, Department of Radiology and Diagnostic Imaging, University of Alberta; W.P. Maksymowych, MD, CaRE Arthritis, and Department of Medicine, University of Alberta; D. Glinatsi, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.S. Stoenoiu, MD, PhD, Department of Rheumatology, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain; R. Poggenborg, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; L. Jans, MD, PhD, Department of Radiology, Ghent University Hospital; J.L. Jaremko, MD, PhD, Department of Radiology and Diagnostic Imaging, University of Alberta; N. Herregods, MD, PhD, Department of Radiology, Ghent University Hospital; V. Foltz, MD, University Pierre et Marie Curie - Paris 6, Sorbonne Universités, GRC-08 (EEMOIS), and AP-HP, Rheumatology Department, Pitié Salpêtrière University Hospital; P.G. Conaghan, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospital NHS Trust; C.E. Althoff, MD, Department of Radiology, Arthritis Imaging Research Group, University Hospital Charité; J. Paschke, BSc, CaRE Arthritis; C. Peterfy, MD, PhD, Spire Sciences Inc.; K.A. Hermann, MD, PhD, Department of Radiology, Arthritis Imaging Research Group, University Hospital Charité; M. Østergaard, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen
| | - Paul Bird
- From the Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Diagnostic Imaging, Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; University Pierre et Marie Curie - Paris 6, Sorbonne Universités, GRC-08 (EEMOIS); AP-HP, Rheumatology Department, Pitié Salpêtrière University Hospital, Paris, France; Division of Medicine, University of New South Wales, Sydney, Australia; Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India; Department of Radiology and Diagnostic Imaging, and Department of Medicine, University of Alberta; CaRE Arthritis, Edmonton, Canada; Department of Rheumatology, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain, Brussels; Department of Radiology, Ghent University Hospital, Ghent, Belgium; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds Teaching Hospital National Health Service (NHS) Trust, UK; Department of Radiology, Arthritis Imaging Research Group, University Hospital Charité, Berlin, Germany; Spire Sciences Inc., Boca Raton, Florida, USA.,S. Krabbe, MD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen; I. Eshed, MD, Department of Diagnostic Imaging, Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University; F. Gandjbakhch, MD, University Pierre et Marie Curie - Paris 6, Sorbonne Universités, GRC-08 (EEMOIS), and AP-HP, Rheumatology Department, Pitié Salpêtrière University Hospital; S.J. Pedersen, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; P. Bird, MD, PhD, Division of Medicine, University of New South Wales; A.J. Mathew, MD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, and Department of Clinical Immunology and Rheumatology, Christian Medical College; R.G. Lambert, MD, Department of Radiology and Diagnostic Imaging, University of Alberta; W.P. Maksymowych, MD, CaRE Arthritis, and Department of Medicine, University of Alberta; D. Glinatsi, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.S. Stoenoiu, MD, PhD, Department of Rheumatology, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain; R. Poggenborg, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; L. Jans, MD, PhD, Department of Radiology, Ghent University Hospital; J.L. Jaremko, MD, PhD, Department of Radiology and Diagnostic Imaging, University of Alberta; N. Herregods, MD, PhD, Department of Radiology, Ghent University Hospital; V. Foltz, MD, University Pierre et Marie Curie - Paris 6, Sorbonne Universités, GRC-08 (EEMOIS), and AP-HP, Rheumatology Department, Pitié Salpêtrière University Hospital; P.G. Conaghan, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospital NHS Trust; C.E. Althoff, MD, Department of Radiology, Arthritis Imaging Research Group, University Hospital Charité; J. Paschke, BSc, CaRE Arthritis; C. Peterfy, MD, PhD, Spire Sciences Inc.; K.A. Hermann, MD, PhD, Department of Radiology, Arthritis Imaging Research Group, University Hospital Charité; M. Østergaard, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen
| | - Ashish J Mathew
- From the Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Diagnostic Imaging, Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; University Pierre et Marie Curie - Paris 6, Sorbonne Universités, GRC-08 (EEMOIS); AP-HP, Rheumatology Department, Pitié Salpêtrière University Hospital, Paris, France; Division of Medicine, University of New South Wales, Sydney, Australia; Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India; Department of Radiology and Diagnostic Imaging, and Department of Medicine, University of Alberta; CaRE Arthritis, Edmonton, Canada; Department of Rheumatology, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain, Brussels; Department of Radiology, Ghent University Hospital, Ghent, Belgium; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds Teaching Hospital National Health Service (NHS) Trust, UK; Department of Radiology, Arthritis Imaging Research Group, University Hospital Charité, Berlin, Germany; Spire Sciences Inc., Boca Raton, Florida, USA.,S. Krabbe, MD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen; I. Eshed, MD, Department of Diagnostic Imaging, Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University; F. Gandjbakhch, MD, University Pierre et Marie Curie - Paris 6, Sorbonne Universités, GRC-08 (EEMOIS), and AP-HP, Rheumatology Department, Pitié Salpêtrière University Hospital; S.J. Pedersen, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; P. Bird, MD, PhD, Division of Medicine, University of New South Wales; A.J. Mathew, MD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, and Department of Clinical Immunology and Rheumatology, Christian Medical College; R.G. Lambert, MD, Department of Radiology and Diagnostic Imaging, University of Alberta; W.P. Maksymowych, MD, CaRE Arthritis, and Department of Medicine, University of Alberta; D. Glinatsi, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.S. Stoenoiu, MD, PhD, Department of Rheumatology, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain; R. Poggenborg, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; L. Jans, MD, PhD, Department of Radiology, Ghent University Hospital; J.L. Jaremko, MD, PhD, Department of Radiology and Diagnostic Imaging, University of Alberta; N. Herregods, MD, PhD, Department of Radiology, Ghent University Hospital; V. Foltz, MD, University Pierre et Marie Curie - Paris 6, Sorbonne Universités, GRC-08 (EEMOIS), and AP-HP, Rheumatology Department, Pitié Salpêtrière University Hospital; P.G. Conaghan, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospital NHS Trust; C.E. Althoff, MD, Department of Radiology, Arthritis Imaging Research Group, University Hospital Charité; J. Paschke, BSc, CaRE Arthritis; C. Peterfy, MD, PhD, Spire Sciences Inc.; K.A. Hermann, MD, PhD, Department of Radiology, Arthritis Imaging Research Group, University Hospital Charité; M. Østergaard, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen
| | - Robert G Lambert
- From the Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Diagnostic Imaging, Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; University Pierre et Marie Curie - Paris 6, Sorbonne Universités, GRC-08 (EEMOIS); AP-HP, Rheumatology Department, Pitié Salpêtrière University Hospital, Paris, France; Division of Medicine, University of New South Wales, Sydney, Australia; Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India; Department of Radiology and Diagnostic Imaging, and Department of Medicine, University of Alberta; CaRE Arthritis, Edmonton, Canada; Department of Rheumatology, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain, Brussels; Department of Radiology, Ghent University Hospital, Ghent, Belgium; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds Teaching Hospital National Health Service (NHS) Trust, UK; Department of Radiology, Arthritis Imaging Research Group, University Hospital Charité, Berlin, Germany; Spire Sciences Inc., Boca Raton, Florida, USA.,S. Krabbe, MD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen; I. Eshed, MD, Department of Diagnostic Imaging, Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University; F. Gandjbakhch, MD, University Pierre et Marie Curie - Paris 6, Sorbonne Universités, GRC-08 (EEMOIS), and AP-HP, Rheumatology Department, Pitié Salpêtrière University Hospital; S.J. Pedersen, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; P. Bird, MD, PhD, Division of Medicine, University of New South Wales; A.J. Mathew, MD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, and Department of Clinical Immunology and Rheumatology, Christian Medical College; R.G. Lambert, MD, Department of Radiology and Diagnostic Imaging, University of Alberta; W.P. Maksymowych, MD, CaRE Arthritis, and Department of Medicine, University of Alberta; D. Glinatsi, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.S. Stoenoiu, MD, PhD, Department of Rheumatology, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain; R. Poggenborg, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; L. Jans, MD, PhD, Department of Radiology, Ghent University Hospital; J.L. Jaremko, MD, PhD, Department of Radiology and Diagnostic Imaging, University of Alberta; N. Herregods, MD, PhD, Department of Radiology, Ghent University Hospital; V. Foltz, MD, University Pierre et Marie Curie - Paris 6, Sorbonne Universités, GRC-08 (EEMOIS), and AP-HP, Rheumatology Department, Pitié Salpêtrière University Hospital; P.G. Conaghan, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospital NHS Trust; C.E. Althoff, MD, Department of Radiology, Arthritis Imaging Research Group, University Hospital Charité; J. Paschke, BSc, CaRE Arthritis; C. Peterfy, MD, PhD, Spire Sciences Inc.; K.A. Hermann, MD, PhD, Department of Radiology, Arthritis Imaging Research Group, University Hospital Charité; M. Østergaard, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen
| | - Walter P Maksymowych
- From the Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Diagnostic Imaging, Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; University Pierre et Marie Curie - Paris 6, Sorbonne Universités, GRC-08 (EEMOIS); AP-HP, Rheumatology Department, Pitié Salpêtrière University Hospital, Paris, France; Division of Medicine, University of New South Wales, Sydney, Australia; Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India; Department of Radiology and Diagnostic Imaging, and Department of Medicine, University of Alberta; CaRE Arthritis, Edmonton, Canada; Department of Rheumatology, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain, Brussels; Department of Radiology, Ghent University Hospital, Ghent, Belgium; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds Teaching Hospital National Health Service (NHS) Trust, UK; Department of Radiology, Arthritis Imaging Research Group, University Hospital Charité, Berlin, Germany; Spire Sciences Inc., Boca Raton, Florida, USA.,S. Krabbe, MD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen; I. Eshed, MD, Department of Diagnostic Imaging, Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University; F. Gandjbakhch, MD, University Pierre et Marie Curie - Paris 6, Sorbonne Universités, GRC-08 (EEMOIS), and AP-HP, Rheumatology Department, Pitié Salpêtrière University Hospital; S.J. Pedersen, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; P. Bird, MD, PhD, Division of Medicine, University of New South Wales; A.J. Mathew, MD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, and Department of Clinical Immunology and Rheumatology, Christian Medical College; R.G. Lambert, MD, Department of Radiology and Diagnostic Imaging, University of Alberta; W.P. Maksymowych, MD, CaRE Arthritis, and Department of Medicine, University of Alberta; D. Glinatsi, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.S. Stoenoiu, MD, PhD, Department of Rheumatology, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain; R. Poggenborg, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; L. Jans, MD, PhD, Department of Radiology, Ghent University Hospital; J.L. Jaremko, MD, PhD, Department of Radiology and Diagnostic Imaging, University of Alberta; N. Herregods, MD, PhD, Department of Radiology, Ghent University Hospital; V. Foltz, MD, University Pierre et Marie Curie - Paris 6, Sorbonne Universités, GRC-08 (EEMOIS), and AP-HP, Rheumatology Department, Pitié Salpêtrière University Hospital; P.G. Conaghan, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospital NHS Trust; C.E. Althoff, MD, Department of Radiology, Arthritis Imaging Research Group, University Hospital Charité; J. Paschke, BSc, CaRE Arthritis; C. Peterfy, MD, PhD, Spire Sciences Inc.; K.A. Hermann, MD, PhD, Department of Radiology, Arthritis Imaging Research Group, University Hospital Charité; M. Østergaard, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen
| | - Daniel Glinatsi
- From the Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Diagnostic Imaging, Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; University Pierre et Marie Curie - Paris 6, Sorbonne Universités, GRC-08 (EEMOIS); AP-HP, Rheumatology Department, Pitié Salpêtrière University Hospital, Paris, France; Division of Medicine, University of New South Wales, Sydney, Australia; Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India; Department of Radiology and Diagnostic Imaging, and Department of Medicine, University of Alberta; CaRE Arthritis, Edmonton, Canada; Department of Rheumatology, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain, Brussels; Department of Radiology, Ghent University Hospital, Ghent, Belgium; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds Teaching Hospital National Health Service (NHS) Trust, UK; Department of Radiology, Arthritis Imaging Research Group, University Hospital Charité, Berlin, Germany; Spire Sciences Inc., Boca Raton, Florida, USA.,S. Krabbe, MD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen; I. Eshed, MD, Department of Diagnostic Imaging, Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University; F. Gandjbakhch, MD, University Pierre et Marie Curie - Paris 6, Sorbonne Universités, GRC-08 (EEMOIS), and AP-HP, Rheumatology Department, Pitié Salpêtrière University Hospital; S.J. Pedersen, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; P. Bird, MD, PhD, Division of Medicine, University of New South Wales; A.J. Mathew, MD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, and Department of Clinical Immunology and Rheumatology, Christian Medical College; R.G. Lambert, MD, Department of Radiology and Diagnostic Imaging, University of Alberta; W.P. Maksymowych, MD, CaRE Arthritis, and Department of Medicine, University of Alberta; D. Glinatsi, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.S. Stoenoiu, MD, PhD, Department of Rheumatology, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain; R. Poggenborg, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; L. Jans, MD, PhD, Department of Radiology, Ghent University Hospital; J.L. Jaremko, MD, PhD, Department of Radiology and Diagnostic Imaging, University of Alberta; N. Herregods, MD, PhD, Department of Radiology, Ghent University Hospital; V. Foltz, MD, University Pierre et Marie Curie - Paris 6, Sorbonne Universités, GRC-08 (EEMOIS), and AP-HP, Rheumatology Department, Pitié Salpêtrière University Hospital; P.G. Conaghan, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospital NHS Trust; C.E. Althoff, MD, Department of Radiology, Arthritis Imaging Research Group, University Hospital Charité; J. Paschke, BSc, CaRE Arthritis; C. Peterfy, MD, PhD, Spire Sciences Inc.; K.A. Hermann, MD, PhD, Department of Radiology, Arthritis Imaging Research Group, University Hospital Charité; M. Østergaard, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen
| | - Maria S Stoenoiu
- From the Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Diagnostic Imaging, Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; University Pierre et Marie Curie - Paris 6, Sorbonne Universités, GRC-08 (EEMOIS); AP-HP, Rheumatology Department, Pitié Salpêtrière University Hospital, Paris, France; Division of Medicine, University of New South Wales, Sydney, Australia; Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India; Department of Radiology and Diagnostic Imaging, and Department of Medicine, University of Alberta; CaRE Arthritis, Edmonton, Canada; Department of Rheumatology, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain, Brussels; Department of Radiology, Ghent University Hospital, Ghent, Belgium; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds Teaching Hospital National Health Service (NHS) Trust, UK; Department of Radiology, Arthritis Imaging Research Group, University Hospital Charité, Berlin, Germany; Spire Sciences Inc., Boca Raton, Florida, USA.,S. Krabbe, MD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen; I. Eshed, MD, Department of Diagnostic Imaging, Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University; F. Gandjbakhch, MD, University Pierre et Marie Curie - Paris 6, Sorbonne Universités, GRC-08 (EEMOIS), and AP-HP, Rheumatology Department, Pitié Salpêtrière University Hospital; S.J. Pedersen, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; P. Bird, MD, PhD, Division of Medicine, University of New South Wales; A.J. Mathew, MD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, and Department of Clinical Immunology and Rheumatology, Christian Medical College; R.G. Lambert, MD, Department of Radiology and Diagnostic Imaging, University of Alberta; W.P. Maksymowych, MD, CaRE Arthritis, and Department of Medicine, University of Alberta; D. Glinatsi, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.S. Stoenoiu, MD, PhD, Department of Rheumatology, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain; R. Poggenborg, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; L. Jans, MD, PhD, Department of Radiology, Ghent University Hospital; J.L. Jaremko, MD, PhD, Department of Radiology and Diagnostic Imaging, University of Alberta; N. Herregods, MD, PhD, Department of Radiology, Ghent University Hospital; V. Foltz, MD, University Pierre et Marie Curie - Paris 6, Sorbonne Universités, GRC-08 (EEMOIS), and AP-HP, Rheumatology Department, Pitié Salpêtrière University Hospital; P.G. Conaghan, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospital NHS Trust; C.E. Althoff, MD, Department of Radiology, Arthritis Imaging Research Group, University Hospital Charité; J. Paschke, BSc, CaRE Arthritis; C. Peterfy, MD, PhD, Spire Sciences Inc.; K.A. Hermann, MD, PhD, Department of Radiology, Arthritis Imaging Research Group, University Hospital Charité; M. Østergaard, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen
| | - René Poggenborg
- From the Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Diagnostic Imaging, Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; University Pierre et Marie Curie - Paris 6, Sorbonne Universités, GRC-08 (EEMOIS); AP-HP, Rheumatology Department, Pitié Salpêtrière University Hospital, Paris, France; Division of Medicine, University of New South Wales, Sydney, Australia; Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India; Department of Radiology and Diagnostic Imaging, and Department of Medicine, University of Alberta; CaRE Arthritis, Edmonton, Canada; Department of Rheumatology, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain, Brussels; Department of Radiology, Ghent University Hospital, Ghent, Belgium; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds Teaching Hospital National Health Service (NHS) Trust, UK; Department of Radiology, Arthritis Imaging Research Group, University Hospital Charité, Berlin, Germany; Spire Sciences Inc., Boca Raton, Florida, USA.,S. Krabbe, MD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen; I. Eshed, MD, Department of Diagnostic Imaging, Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University; F. Gandjbakhch, MD, University Pierre et Marie Curie - Paris 6, Sorbonne Universités, GRC-08 (EEMOIS), and AP-HP, Rheumatology Department, Pitié Salpêtrière University Hospital; S.J. Pedersen, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; P. Bird, MD, PhD, Division of Medicine, University of New South Wales; A.J. Mathew, MD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, and Department of Clinical Immunology and Rheumatology, Christian Medical College; R.G. Lambert, MD, Department of Radiology and Diagnostic Imaging, University of Alberta; W.P. Maksymowych, MD, CaRE Arthritis, and Department of Medicine, University of Alberta; D. Glinatsi, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.S. Stoenoiu, MD, PhD, Department of Rheumatology, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain; R. Poggenborg, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; L. Jans, MD, PhD, Department of Radiology, Ghent University Hospital; J.L. Jaremko, MD, PhD, Department of Radiology and Diagnostic Imaging, University of Alberta; N. Herregods, MD, PhD, Department of Radiology, Ghent University Hospital; V. Foltz, MD, University Pierre et Marie Curie - Paris 6, Sorbonne Universités, GRC-08 (EEMOIS), and AP-HP, Rheumatology Department, Pitié Salpêtrière University Hospital; P.G. Conaghan, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospital NHS Trust; C.E. Althoff, MD, Department of Radiology, Arthritis Imaging Research Group, University Hospital Charité; J. Paschke, BSc, CaRE Arthritis; C. Peterfy, MD, PhD, Spire Sciences Inc.; K.A. Hermann, MD, PhD, Department of Radiology, Arthritis Imaging Research Group, University Hospital Charité; M. Østergaard, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen
| | - Lennart Jans
- From the Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Diagnostic Imaging, Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; University Pierre et Marie Curie - Paris 6, Sorbonne Universités, GRC-08 (EEMOIS); AP-HP, Rheumatology Department, Pitié Salpêtrière University Hospital, Paris, France; Division of Medicine, University of New South Wales, Sydney, Australia; Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India; Department of Radiology and Diagnostic Imaging, and Department of Medicine, University of Alberta; CaRE Arthritis, Edmonton, Canada; Department of Rheumatology, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain, Brussels; Department of Radiology, Ghent University Hospital, Ghent, Belgium; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds Teaching Hospital National Health Service (NHS) Trust, UK; Department of Radiology, Arthritis Imaging Research Group, University Hospital Charité, Berlin, Germany; Spire Sciences Inc., Boca Raton, Florida, USA.,S. Krabbe, MD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen; I. Eshed, MD, Department of Diagnostic Imaging, Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University; F. Gandjbakhch, MD, University Pierre et Marie Curie - Paris 6, Sorbonne Universités, GRC-08 (EEMOIS), and AP-HP, Rheumatology Department, Pitié Salpêtrière University Hospital; S.J. Pedersen, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; P. Bird, MD, PhD, Division of Medicine, University of New South Wales; A.J. Mathew, MD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, and Department of Clinical Immunology and Rheumatology, Christian Medical College; R.G. Lambert, MD, Department of Radiology and Diagnostic Imaging, University of Alberta; W.P. Maksymowych, MD, CaRE Arthritis, and Department of Medicine, University of Alberta; D. Glinatsi, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.S. Stoenoiu, MD, PhD, Department of Rheumatology, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain; R. Poggenborg, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; L. Jans, MD, PhD, Department of Radiology, Ghent University Hospital; J.L. Jaremko, MD, PhD, Department of Radiology and Diagnostic Imaging, University of Alberta; N. Herregods, MD, PhD, Department of Radiology, Ghent University Hospital; V. Foltz, MD, University Pierre et Marie Curie - Paris 6, Sorbonne Universités, GRC-08 (EEMOIS), and AP-HP, Rheumatology Department, Pitié Salpêtrière University Hospital; P.G. Conaghan, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospital NHS Trust; C.E. Althoff, MD, Department of Radiology, Arthritis Imaging Research Group, University Hospital Charité; J. Paschke, BSc, CaRE Arthritis; C. Peterfy, MD, PhD, Spire Sciences Inc.; K.A. Hermann, MD, PhD, Department of Radiology, Arthritis Imaging Research Group, University Hospital Charité; M. Østergaard, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen
| | - Jacob L Jaremko
- From the Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Diagnostic Imaging, Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; University Pierre et Marie Curie - Paris 6, Sorbonne Universités, GRC-08 (EEMOIS); AP-HP, Rheumatology Department, Pitié Salpêtrière University Hospital, Paris, France; Division of Medicine, University of New South Wales, Sydney, Australia; Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India; Department of Radiology and Diagnostic Imaging, and Department of Medicine, University of Alberta; CaRE Arthritis, Edmonton, Canada; Department of Rheumatology, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain, Brussels; Department of Radiology, Ghent University Hospital, Ghent, Belgium; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds Teaching Hospital National Health Service (NHS) Trust, UK; Department of Radiology, Arthritis Imaging Research Group, University Hospital Charité, Berlin, Germany; Spire Sciences Inc., Boca Raton, Florida, USA.,S. Krabbe, MD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen; I. Eshed, MD, Department of Diagnostic Imaging, Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University; F. Gandjbakhch, MD, University Pierre et Marie Curie - Paris 6, Sorbonne Universités, GRC-08 (EEMOIS), and AP-HP, Rheumatology Department, Pitié Salpêtrière University Hospital; S.J. Pedersen, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; P. Bird, MD, PhD, Division of Medicine, University of New South Wales; A.J. Mathew, MD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, and Department of Clinical Immunology and Rheumatology, Christian Medical College; R.G. Lambert, MD, Department of Radiology and Diagnostic Imaging, University of Alberta; W.P. Maksymowych, MD, CaRE Arthritis, and Department of Medicine, University of Alberta; D. Glinatsi, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.S. Stoenoiu, MD, PhD, Department of Rheumatology, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain; R. Poggenborg, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; L. Jans, MD, PhD, Department of Radiology, Ghent University Hospital; J.L. Jaremko, MD, PhD, Department of Radiology and Diagnostic Imaging, University of Alberta; N. Herregods, MD, PhD, Department of Radiology, Ghent University Hospital; V. Foltz, MD, University Pierre et Marie Curie - Paris 6, Sorbonne Universités, GRC-08 (EEMOIS), and AP-HP, Rheumatology Department, Pitié Salpêtrière University Hospital; P.G. Conaghan, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospital NHS Trust; C.E. Althoff, MD, Department of Radiology, Arthritis Imaging Research Group, University Hospital Charité; J. Paschke, BSc, CaRE Arthritis; C. Peterfy, MD, PhD, Spire Sciences Inc.; K.A. Hermann, MD, PhD, Department of Radiology, Arthritis Imaging Research Group, University Hospital Charité; M. Østergaard, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen
| | - Nele Herregods
- From the Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Diagnostic Imaging, Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; University Pierre et Marie Curie - Paris 6, Sorbonne Universités, GRC-08 (EEMOIS); AP-HP, Rheumatology Department, Pitié Salpêtrière University Hospital, Paris, France; Division of Medicine, University of New South Wales, Sydney, Australia; Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India; Department of Radiology and Diagnostic Imaging, and Department of Medicine, University of Alberta; CaRE Arthritis, Edmonton, Canada; Department of Rheumatology, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain, Brussels; Department of Radiology, Ghent University Hospital, Ghent, Belgium; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds Teaching Hospital National Health Service (NHS) Trust, UK; Department of Radiology, Arthritis Imaging Research Group, University Hospital Charité, Berlin, Germany; Spire Sciences Inc., Boca Raton, Florida, USA.,S. Krabbe, MD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen; I. Eshed, MD, Department of Diagnostic Imaging, Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University; F. Gandjbakhch, MD, University Pierre et Marie Curie - Paris 6, Sorbonne Universités, GRC-08 (EEMOIS), and AP-HP, Rheumatology Department, Pitié Salpêtrière University Hospital; S.J. Pedersen, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; P. Bird, MD, PhD, Division of Medicine, University of New South Wales; A.J. Mathew, MD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, and Department of Clinical Immunology and Rheumatology, Christian Medical College; R.G. Lambert, MD, Department of Radiology and Diagnostic Imaging, University of Alberta; W.P. Maksymowych, MD, CaRE Arthritis, and Department of Medicine, University of Alberta; D. Glinatsi, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.S. Stoenoiu, MD, PhD, Department of Rheumatology, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain; R. Poggenborg, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; L. Jans, MD, PhD, Department of Radiology, Ghent University Hospital; J.L. Jaremko, MD, PhD, Department of Radiology and Diagnostic Imaging, University of Alberta; N. Herregods, MD, PhD, Department of Radiology, Ghent University Hospital; V. Foltz, MD, University Pierre et Marie Curie - Paris 6, Sorbonne Universités, GRC-08 (EEMOIS), and AP-HP, Rheumatology Department, Pitié Salpêtrière University Hospital; P.G. Conaghan, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospital NHS Trust; C.E. Althoff, MD, Department of Radiology, Arthritis Imaging Research Group, University Hospital Charité; J. Paschke, BSc, CaRE Arthritis; C. Peterfy, MD, PhD, Spire Sciences Inc.; K.A. Hermann, MD, PhD, Department of Radiology, Arthritis Imaging Research Group, University Hospital Charité; M. Østergaard, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen
| | - Violaine Foltz
- From the Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Diagnostic Imaging, Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; University Pierre et Marie Curie - Paris 6, Sorbonne Universités, GRC-08 (EEMOIS); AP-HP, Rheumatology Department, Pitié Salpêtrière University Hospital, Paris, France; Division of Medicine, University of New South Wales, Sydney, Australia; Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India; Department of Radiology and Diagnostic Imaging, and Department of Medicine, University of Alberta; CaRE Arthritis, Edmonton, Canada; Department of Rheumatology, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain, Brussels; Department of Radiology, Ghent University Hospital, Ghent, Belgium; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds Teaching Hospital National Health Service (NHS) Trust, UK; Department of Radiology, Arthritis Imaging Research Group, University Hospital Charité, Berlin, Germany; Spire Sciences Inc., Boca Raton, Florida, USA.,S. Krabbe, MD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen; I. Eshed, MD, Department of Diagnostic Imaging, Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University; F. Gandjbakhch, MD, University Pierre et Marie Curie - Paris 6, Sorbonne Universités, GRC-08 (EEMOIS), and AP-HP, Rheumatology Department, Pitié Salpêtrière University Hospital; S.J. Pedersen, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; P. Bird, MD, PhD, Division of Medicine, University of New South Wales; A.J. Mathew, MD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, and Department of Clinical Immunology and Rheumatology, Christian Medical College; R.G. Lambert, MD, Department of Radiology and Diagnostic Imaging, University of Alberta; W.P. Maksymowych, MD, CaRE Arthritis, and Department of Medicine, University of Alberta; D. Glinatsi, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.S. Stoenoiu, MD, PhD, Department of Rheumatology, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain; R. Poggenborg, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; L. Jans, MD, PhD, Department of Radiology, Ghent University Hospital; J.L. Jaremko, MD, PhD, Department of Radiology and Diagnostic Imaging, University of Alberta; N. Herregods, MD, PhD, Department of Radiology, Ghent University Hospital; V. Foltz, MD, University Pierre et Marie Curie - Paris 6, Sorbonne Universités, GRC-08 (EEMOIS), and AP-HP, Rheumatology Department, Pitié Salpêtrière University Hospital; P.G. Conaghan, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospital NHS Trust; C.E. Althoff, MD, Department of Radiology, Arthritis Imaging Research Group, University Hospital Charité; J. Paschke, BSc, CaRE Arthritis; C. Peterfy, MD, PhD, Spire Sciences Inc.; K.A. Hermann, MD, PhD, Department of Radiology, Arthritis Imaging Research Group, University Hospital Charité; M. Østergaard, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen
| | - Philip G Conaghan
- From the Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Diagnostic Imaging, Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; University Pierre et Marie Curie - Paris 6, Sorbonne Universités, GRC-08 (EEMOIS); AP-HP, Rheumatology Department, Pitié Salpêtrière University Hospital, Paris, France; Division of Medicine, University of New South Wales, Sydney, Australia; Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India; Department of Radiology and Diagnostic Imaging, and Department of Medicine, University of Alberta; CaRE Arthritis, Edmonton, Canada; Department of Rheumatology, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain, Brussels; Department of Radiology, Ghent University Hospital, Ghent, Belgium; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds Teaching Hospital National Health Service (NHS) Trust, UK; Department of Radiology, Arthritis Imaging Research Group, University Hospital Charité, Berlin, Germany; Spire Sciences Inc., Boca Raton, Florida, USA.,S. Krabbe, MD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen; I. Eshed, MD, Department of Diagnostic Imaging, Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University; F. Gandjbakhch, MD, University Pierre et Marie Curie - Paris 6, Sorbonne Universités, GRC-08 (EEMOIS), and AP-HP, Rheumatology Department, Pitié Salpêtrière University Hospital; S.J. Pedersen, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; P. Bird, MD, PhD, Division of Medicine, University of New South Wales; A.J. Mathew, MD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, and Department of Clinical Immunology and Rheumatology, Christian Medical College; R.G. Lambert, MD, Department of Radiology and Diagnostic Imaging, University of Alberta; W.P. Maksymowych, MD, CaRE Arthritis, and Department of Medicine, University of Alberta; D. Glinatsi, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.S. Stoenoiu, MD, PhD, Department of Rheumatology, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain; R. Poggenborg, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; L. Jans, MD, PhD, Department of Radiology, Ghent University Hospital; J.L. Jaremko, MD, PhD, Department of Radiology and Diagnostic Imaging, University of Alberta; N. Herregods, MD, PhD, Department of Radiology, Ghent University Hospital; V. Foltz, MD, University Pierre et Marie Curie - Paris 6, Sorbonne Universités, GRC-08 (EEMOIS), and AP-HP, Rheumatology Department, Pitié Salpêtrière University Hospital; P.G. Conaghan, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospital NHS Trust; C.E. Althoff, MD, Department of Radiology, Arthritis Imaging Research Group, University Hospital Charité; J. Paschke, BSc, CaRE Arthritis; C. Peterfy, MD, PhD, Spire Sciences Inc.; K.A. Hermann, MD, PhD, Department of Radiology, Arthritis Imaging Research Group, University Hospital Charité; M. Østergaard, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen
| | - Christian E Althoff
- From the Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Diagnostic Imaging, Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; University Pierre et Marie Curie - Paris 6, Sorbonne Universités, GRC-08 (EEMOIS); AP-HP, Rheumatology Department, Pitié Salpêtrière University Hospital, Paris, France; Division of Medicine, University of New South Wales, Sydney, Australia; Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India; Department of Radiology and Diagnostic Imaging, and Department of Medicine, University of Alberta; CaRE Arthritis, Edmonton, Canada; Department of Rheumatology, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain, Brussels; Department of Radiology, Ghent University Hospital, Ghent, Belgium; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds Teaching Hospital National Health Service (NHS) Trust, UK; Department of Radiology, Arthritis Imaging Research Group, University Hospital Charité, Berlin, Germany; Spire Sciences Inc., Boca Raton, Florida, USA.,S. Krabbe, MD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen; I. Eshed, MD, Department of Diagnostic Imaging, Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University; F. Gandjbakhch, MD, University Pierre et Marie Curie - Paris 6, Sorbonne Universités, GRC-08 (EEMOIS), and AP-HP, Rheumatology Department, Pitié Salpêtrière University Hospital; S.J. Pedersen, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; P. Bird, MD, PhD, Division of Medicine, University of New South Wales; A.J. Mathew, MD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, and Department of Clinical Immunology and Rheumatology, Christian Medical College; R.G. Lambert, MD, Department of Radiology and Diagnostic Imaging, University of Alberta; W.P. Maksymowych, MD, CaRE Arthritis, and Department of Medicine, University of Alberta; D. Glinatsi, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.S. Stoenoiu, MD, PhD, Department of Rheumatology, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain; R. Poggenborg, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; L. Jans, MD, PhD, Department of Radiology, Ghent University Hospital; J.L. Jaremko, MD, PhD, Department of Radiology and Diagnostic Imaging, University of Alberta; N. Herregods, MD, PhD, Department of Radiology, Ghent University Hospital; V. Foltz, MD, University Pierre et Marie Curie - Paris 6, Sorbonne Universités, GRC-08 (EEMOIS), and AP-HP, Rheumatology Department, Pitié Salpêtrière University Hospital; P.G. Conaghan, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospital NHS Trust; C.E. Althoff, MD, Department of Radiology, Arthritis Imaging Research Group, University Hospital Charité; J. Paschke, BSc, CaRE Arthritis; C. Peterfy, MD, PhD, Spire Sciences Inc.; K.A. Hermann, MD, PhD, Department of Radiology, Arthritis Imaging Research Group, University Hospital Charité; M. Østergaard, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen
| | - Joel Paschke
- From the Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Diagnostic Imaging, Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; University Pierre et Marie Curie - Paris 6, Sorbonne Universités, GRC-08 (EEMOIS); AP-HP, Rheumatology Department, Pitié Salpêtrière University Hospital, Paris, France; Division of Medicine, University of New South Wales, Sydney, Australia; Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India; Department of Radiology and Diagnostic Imaging, and Department of Medicine, University of Alberta; CaRE Arthritis, Edmonton, Canada; Department of Rheumatology, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain, Brussels; Department of Radiology, Ghent University Hospital, Ghent, Belgium; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds Teaching Hospital National Health Service (NHS) Trust, UK; Department of Radiology, Arthritis Imaging Research Group, University Hospital Charité, Berlin, Germany; Spire Sciences Inc., Boca Raton, Florida, USA.,S. Krabbe, MD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen; I. Eshed, MD, Department of Diagnostic Imaging, Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University; F. Gandjbakhch, MD, University Pierre et Marie Curie - Paris 6, Sorbonne Universités, GRC-08 (EEMOIS), and AP-HP, Rheumatology Department, Pitié Salpêtrière University Hospital; S.J. Pedersen, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; P. Bird, MD, PhD, Division of Medicine, University of New South Wales; A.J. Mathew, MD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, and Department of Clinical Immunology and Rheumatology, Christian Medical College; R.G. Lambert, MD, Department of Radiology and Diagnostic Imaging, University of Alberta; W.P. Maksymowych, MD, CaRE Arthritis, and Department of Medicine, University of Alberta; D. Glinatsi, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.S. Stoenoiu, MD, PhD, Department of Rheumatology, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain; R. Poggenborg, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; L. Jans, MD, PhD, Department of Radiology, Ghent University Hospital; J.L. Jaremko, MD, PhD, Department of Radiology and Diagnostic Imaging, University of Alberta; N. Herregods, MD, PhD, Department of Radiology, Ghent University Hospital; V. Foltz, MD, University Pierre et Marie Curie - Paris 6, Sorbonne Universités, GRC-08 (EEMOIS), and AP-HP, Rheumatology Department, Pitié Salpêtrière University Hospital; P.G. Conaghan, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospital NHS Trust; C.E. Althoff, MD, Department of Radiology, Arthritis Imaging Research Group, University Hospital Charité; J. Paschke, BSc, CaRE Arthritis; C. Peterfy, MD, PhD, Spire Sciences Inc.; K.A. Hermann, MD, PhD, Department of Radiology, Arthritis Imaging Research Group, University Hospital Charité; M. Østergaard, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen
| | - Charles Peterfy
- From the Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Diagnostic Imaging, Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; University Pierre et Marie Curie - Paris 6, Sorbonne Universités, GRC-08 (EEMOIS); AP-HP, Rheumatology Department, Pitié Salpêtrière University Hospital, Paris, France; Division of Medicine, University of New South Wales, Sydney, Australia; Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India; Department of Radiology and Diagnostic Imaging, and Department of Medicine, University of Alberta; CaRE Arthritis, Edmonton, Canada; Department of Rheumatology, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain, Brussels; Department of Radiology, Ghent University Hospital, Ghent, Belgium; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds Teaching Hospital National Health Service (NHS) Trust, UK; Department of Radiology, Arthritis Imaging Research Group, University Hospital Charité, Berlin, Germany; Spire Sciences Inc., Boca Raton, Florida, USA.,S. Krabbe, MD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen; I. Eshed, MD, Department of Diagnostic Imaging, Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University; F. Gandjbakhch, MD, University Pierre et Marie Curie - Paris 6, Sorbonne Universités, GRC-08 (EEMOIS), and AP-HP, Rheumatology Department, Pitié Salpêtrière University Hospital; S.J. Pedersen, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; P. Bird, MD, PhD, Division of Medicine, University of New South Wales; A.J. Mathew, MD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, and Department of Clinical Immunology and Rheumatology, Christian Medical College; R.G. Lambert, MD, Department of Radiology and Diagnostic Imaging, University of Alberta; W.P. Maksymowych, MD, CaRE Arthritis, and Department of Medicine, University of Alberta; D. Glinatsi, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.S. Stoenoiu, MD, PhD, Department of Rheumatology, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain; R. Poggenborg, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; L. Jans, MD, PhD, Department of Radiology, Ghent University Hospital; J.L. Jaremko, MD, PhD, Department of Radiology and Diagnostic Imaging, University of Alberta; N. Herregods, MD, PhD, Department of Radiology, Ghent University Hospital; V. Foltz, MD, University Pierre et Marie Curie - Paris 6, Sorbonne Universités, GRC-08 (EEMOIS), and AP-HP, Rheumatology Department, Pitié Salpêtrière University Hospital; P.G. Conaghan, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospital NHS Trust; C.E. Althoff, MD, Department of Radiology, Arthritis Imaging Research Group, University Hospital Charité; J. Paschke, BSc, CaRE Arthritis; C. Peterfy, MD, PhD, Spire Sciences Inc.; K.A. Hermann, MD, PhD, Department of Radiology, Arthritis Imaging Research Group, University Hospital Charité; M. Østergaard, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen
| | - Kay-Geert A Hermann
- From the Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Diagnostic Imaging, Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; University Pierre et Marie Curie - Paris 6, Sorbonne Universités, GRC-08 (EEMOIS); AP-HP, Rheumatology Department, Pitié Salpêtrière University Hospital, Paris, France; Division of Medicine, University of New South Wales, Sydney, Australia; Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India; Department of Radiology and Diagnostic Imaging, and Department of Medicine, University of Alberta; CaRE Arthritis, Edmonton, Canada; Department of Rheumatology, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain, Brussels; Department of Radiology, Ghent University Hospital, Ghent, Belgium; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds Teaching Hospital National Health Service (NHS) Trust, UK; Department of Radiology, Arthritis Imaging Research Group, University Hospital Charité, Berlin, Germany; Spire Sciences Inc., Boca Raton, Florida, USA.,S. Krabbe, MD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen; I. Eshed, MD, Department of Diagnostic Imaging, Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University; F. Gandjbakhch, MD, University Pierre et Marie Curie - Paris 6, Sorbonne Universités, GRC-08 (EEMOIS), and AP-HP, Rheumatology Department, Pitié Salpêtrière University Hospital; S.J. Pedersen, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; P. Bird, MD, PhD, Division of Medicine, University of New South Wales; A.J. Mathew, MD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, and Department of Clinical Immunology and Rheumatology, Christian Medical College; R.G. Lambert, MD, Department of Radiology and Diagnostic Imaging, University of Alberta; W.P. Maksymowych, MD, CaRE Arthritis, and Department of Medicine, University of Alberta; D. Glinatsi, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.S. Stoenoiu, MD, PhD, Department of Rheumatology, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain; R. Poggenborg, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; L. Jans, MD, PhD, Department of Radiology, Ghent University Hospital; J.L. Jaremko, MD, PhD, Department of Radiology and Diagnostic Imaging, University of Alberta; N. Herregods, MD, PhD, Department of Radiology, Ghent University Hospital; V. Foltz, MD, University Pierre et Marie Curie - Paris 6, Sorbonne Universités, GRC-08 (EEMOIS), and AP-HP, Rheumatology Department, Pitié Salpêtrière University Hospital; P.G. Conaghan, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospital NHS Trust; C.E. Althoff, MD, Department of Radiology, Arthritis Imaging Research Group, University Hospital Charité; J. Paschke, BSc, CaRE Arthritis; C. Peterfy, MD, PhD, Spire Sciences Inc.; K.A. Hermann, MD, PhD, Department of Radiology, Arthritis Imaging Research Group, University Hospital Charité; M. Østergaard, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen
| | | | | |
Collapse
|
48
|
Otobo TM, Conaghan PG, Maksymowych WP, van der Heijde D, Weiss P, Sudol-Szopinska I, Herregods N, Jaremko JL, Meyers AB, Rumsey D, Inarejos EC, Kirkhus E, Stimec J, Panwar J, Thorpe K, Jans L, van Rossum MA, Tolend M, Perez M, Tzaribachev N, Sandhya P, Tse S, Simone A, Swami VG, Touma Z, Lambert R, Doria AS. Preliminary Definitions for Sacroiliac Joint Pathologies in the OMERACT Juvenile Idiopathic Arthritis Magnetic Resonance Imaging Score (OMERACT JAMRIS-SIJ). J Rheumatol 2019; 46:1192-1197. [PMID: 30770500 DOI: 10.3899/jrheum.181115] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To develop definitions for the assessment of magnetic resonance imaging (MRI) pathologies of the sacroiliac joints (SIJ) in juvenile idiopathic arthritis. METHODS An Outcome Measures in Rheumatology (OMERACT) consensus-driven methodology consisting of iterative surveys and focus group meetings within an international group of rheumatologists and radiologists. RESULTS Two domains, inflammation and structural, were identified. Definitions for bone marrow edema, joint space inflammation, capsulitis, and enthesitis were derived for joint inflammation; sclerosis, erosion, fatty lesion, and ankylosis were defined for assessing structural joint changes. CONCLUSION Preliminary consensus-driven definitions for inflammation and structural elements have been derived, underpinning the ongoing development of the OMERACT Juvenile Arthritis MRI SIJ scoring system (OMERACT JAMRIS-SIJ).
Collapse
Affiliation(s)
- Tarimobo M Otobo
- From the Institute of Medical Sciences, Faculty of Medicine, University of Toronto; Department of Diagnostic Imaging, The Hospital for Sick Children; Department of Translational Medicine, SickKids Research Institute, Peter Gilgan Center for Research and Learning; Dalla Lana School of Public Health, University of Toronto; Division of Rheumatology, The Hospital for Sick Children, University of Toronto; Department of Medical Imaging, University of Toronto; Department of Rheumatology, Center for Prognosis Studies in Rheumatologic Diseases, Toronto Western Hospital, Toronto, Ontario; Department of Rheumatology, University of Alberta; Department of Radiology and Diagnostic Imaging, University of Alberta; Division of Pediatric Rheumatology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds Teaching Hospitals National Health Service (NHS) Trust, Leeds, UK; Department of Rheumatology, Leiden University Medical Center, Leiden; Reade
- Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; University of Pennsylvania Perelman School of Medicine, Division of Rheumatology, Children's Hospital of Philadelphia and Departments of Pediatric and Epidemiology, Philadelphia, Pennsylvania; Department of Radiology, Nemours Children's Hospital and Health System, Orlando, Florida, USA; Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland; Department of Radiology and Medical Imaging, Ghent University Hospital, Ghent, Belgium; Department of Radiology, Hospital Sant Joan de Deu, Barcelona, Spain; Department of Radiology, Rikshospitalet, Oslo University Hospital, Oslo, Norway; Pediatric Rheumatology Research Institute, Bad Bramstedt, Germany; Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India; State University of Campina-UNICAMP, Department of Internal Medicine, Cidade Universitaria, Sao Paulo, Brazil.,T.M. Otobo, MD, MSc, BMedSc, Institute of Medical Sciences, Faculty of Medicine, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children, and Department of Translational Medicine, SickKids Research Institute, Peter Gilgan Center for Research and Learning; P.G. Conaghan, PhD, MB BS, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust; W.P. Maksymowych, PhD, MB BS, FRACP, FRCP, Department of Rheumatology, University of Alberta; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center; P. Weiss, MD, MSCE, University of Pennsylvania Perelman School of Medicine, Division of Rheumatology, Children's Hospital of Philadelphia and Departments of Pediatric and Epidemiology; I. Sudol-Szopinska, MD, PhD, Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation; N. Herregods, MD, PhD, Department of Radiology and Medical Imaging, Ghent University Hospital; J.L. Jaremko, MD, PhD, FRCPC, Department of Radiology and Diagnostic Imaging, University of Alberta; A.B. Meyers, MD, Department of Radiology, Nemours Children's Hospital and Health System; D. Rumsey, MD, FRCPC, Division of Pediatric Rheumatology, Department of Pediatrics, University of Alberta; E.C. Inarejos, MD, Department of Radiology, Hospital Sant Joan de Deu; E. Kirkhus, MD, PhD, Department of Radiology, Rikshospitalet, Oslo University Hospital; J. Stimec, MD, FRCPC, Department of Diagnostic Imaging, The Hospital for Sick Children; J. Panwar, MD, Department of Diagnostic Imaging, The Hospital for Sick Children; K. Thorpe, BMath, MMath, Dalla Lana School of Public Health, University of Toronto; L. Jans, MD, PhD, Department of Radiology and Medical Imaging, Ghent University Hospital; M.A. van Rossum, MD, PhD, Reade
- Emma Children's Hospital/Academic Medical Center; M. Tolend, BSc, Institute of Medical Sciences, Faculty of Medicine, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children, and Department of Translational Medicine, SickKids Research Institute, Peter Gilgan Center for Research and Learning; M. Perez, MD, Department of Diagnostic Imaging, The Hospital for Sick Children; N. Tzaribachev, MD, Pediatric Rheumatology Research Institute; P. Sandhya, MD, Department of Clinical Immunology and Rheumatology, Christian Medical College; S. Tse, MD, FRCPC, Division of Rheumatology, The Hospital for Sick Children, University of Toronto; A. Simone, MD, PhD, State University of Campina-UNICAMP, Department of Internal Medicine, Cidade Universitaria; V.G. Swami, MD, BSc, Department of Medical Imaging, University of Toronto; Z. Touma, MD, PhD, FACP, FACR, Department of Rheumatology, Center for Prognosis Studies in Rheumatologic Diseases, Toronto Western Hospital; R. Lambert, MB BCh, FRCR, FRCPC, Department of Radiology and Diagnostic Imaging, University of Alberta; A.S. Doria, MD, PhD, MSc, Institute of Medical Sciences, Faculty of Medicine, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children, and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, and Department of Medical Imaging, University of Toronto
| | - Philip G Conaghan
- From the Institute of Medical Sciences, Faculty of Medicine, University of Toronto; Department of Diagnostic Imaging, The Hospital for Sick Children; Department of Translational Medicine, SickKids Research Institute, Peter Gilgan Center for Research and Learning; Dalla Lana School of Public Health, University of Toronto; Division of Rheumatology, The Hospital for Sick Children, University of Toronto; Department of Medical Imaging, University of Toronto; Department of Rheumatology, Center for Prognosis Studies in Rheumatologic Diseases, Toronto Western Hospital, Toronto, Ontario; Department of Rheumatology, University of Alberta; Department of Radiology and Diagnostic Imaging, University of Alberta; Division of Pediatric Rheumatology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds Teaching Hospitals National Health Service (NHS) Trust, Leeds, UK; Department of Rheumatology, Leiden University Medical Center, Leiden; Reade
- Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; University of Pennsylvania Perelman School of Medicine, Division of Rheumatology, Children's Hospital of Philadelphia and Departments of Pediatric and Epidemiology, Philadelphia, Pennsylvania; Department of Radiology, Nemours Children's Hospital and Health System, Orlando, Florida, USA; Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland; Department of Radiology and Medical Imaging, Ghent University Hospital, Ghent, Belgium; Department of Radiology, Hospital Sant Joan de Deu, Barcelona, Spain; Department of Radiology, Rikshospitalet, Oslo University Hospital, Oslo, Norway; Pediatric Rheumatology Research Institute, Bad Bramstedt, Germany; Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India; State University of Campina-UNICAMP, Department of Internal Medicine, Cidade Universitaria, Sao Paulo, Brazil.,T.M. Otobo, MD, MSc, BMedSc, Institute of Medical Sciences, Faculty of Medicine, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children, and Department of Translational Medicine, SickKids Research Institute, Peter Gilgan Center for Research and Learning; P.G. Conaghan, PhD, MB BS, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust; W.P. Maksymowych, PhD, MB BS, FRACP, FRCP, Department of Rheumatology, University of Alberta; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center; P. Weiss, MD, MSCE, University of Pennsylvania Perelman School of Medicine, Division of Rheumatology, Children's Hospital of Philadelphia and Departments of Pediatric and Epidemiology; I. Sudol-Szopinska, MD, PhD, Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation; N. Herregods, MD, PhD, Department of Radiology and Medical Imaging, Ghent University Hospital; J.L. Jaremko, MD, PhD, FRCPC, Department of Radiology and Diagnostic Imaging, University of Alberta; A.B. Meyers, MD, Department of Radiology, Nemours Children's Hospital and Health System; D. Rumsey, MD, FRCPC, Division of Pediatric Rheumatology, Department of Pediatrics, University of Alberta; E.C. Inarejos, MD, Department of Radiology, Hospital Sant Joan de Deu; E. Kirkhus, MD, PhD, Department of Radiology, Rikshospitalet, Oslo University Hospital; J. Stimec, MD, FRCPC, Department of Diagnostic Imaging, The Hospital for Sick Children; J. Panwar, MD, Department of Diagnostic Imaging, The Hospital for Sick Children; K. Thorpe, BMath, MMath, Dalla Lana School of Public Health, University of Toronto; L. Jans, MD, PhD, Department of Radiology and Medical Imaging, Ghent University Hospital; M.A. van Rossum, MD, PhD, Reade
- Emma Children's Hospital/Academic Medical Center; M. Tolend, BSc, Institute of Medical Sciences, Faculty of Medicine, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children, and Department of Translational Medicine, SickKids Research Institute, Peter Gilgan Center for Research and Learning; M. Perez, MD, Department of Diagnostic Imaging, The Hospital for Sick Children; N. Tzaribachev, MD, Pediatric Rheumatology Research Institute; P. Sandhya, MD, Department of Clinical Immunology and Rheumatology, Christian Medical College; S. Tse, MD, FRCPC, Division of Rheumatology, The Hospital for Sick Children, University of Toronto; A. Simone, MD, PhD, State University of Campina-UNICAMP, Department of Internal Medicine, Cidade Universitaria; V.G. Swami, MD, BSc, Department of Medical Imaging, University of Toronto; Z. Touma, MD, PhD, FACP, FACR, Department of Rheumatology, Center for Prognosis Studies in Rheumatologic Diseases, Toronto Western Hospital; R. Lambert, MB BCh, FRCR, FRCPC, Department of Radiology and Diagnostic Imaging, University of Alberta; A.S. Doria, MD, PhD, MSc, Institute of Medical Sciences, Faculty of Medicine, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children, and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, and Department of Medical Imaging, University of Toronto
| | - Walter P Maksymowych
- From the Institute of Medical Sciences, Faculty of Medicine, University of Toronto; Department of Diagnostic Imaging, The Hospital for Sick Children; Department of Translational Medicine, SickKids Research Institute, Peter Gilgan Center for Research and Learning; Dalla Lana School of Public Health, University of Toronto; Division of Rheumatology, The Hospital for Sick Children, University of Toronto; Department of Medical Imaging, University of Toronto; Department of Rheumatology, Center for Prognosis Studies in Rheumatologic Diseases, Toronto Western Hospital, Toronto, Ontario; Department of Rheumatology, University of Alberta; Department of Radiology and Diagnostic Imaging, University of Alberta; Division of Pediatric Rheumatology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds Teaching Hospitals National Health Service (NHS) Trust, Leeds, UK; Department of Rheumatology, Leiden University Medical Center, Leiden; Reade
- Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; University of Pennsylvania Perelman School of Medicine, Division of Rheumatology, Children's Hospital of Philadelphia and Departments of Pediatric and Epidemiology, Philadelphia, Pennsylvania; Department of Radiology, Nemours Children's Hospital and Health System, Orlando, Florida, USA; Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland; Department of Radiology and Medical Imaging, Ghent University Hospital, Ghent, Belgium; Department of Radiology, Hospital Sant Joan de Deu, Barcelona, Spain; Department of Radiology, Rikshospitalet, Oslo University Hospital, Oslo, Norway; Pediatric Rheumatology Research Institute, Bad Bramstedt, Germany; Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India; State University of Campina-UNICAMP, Department of Internal Medicine, Cidade Universitaria, Sao Paulo, Brazil.,T.M. Otobo, MD, MSc, BMedSc, Institute of Medical Sciences, Faculty of Medicine, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children, and Department of Translational Medicine, SickKids Research Institute, Peter Gilgan Center for Research and Learning; P.G. Conaghan, PhD, MB BS, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust; W.P. Maksymowych, PhD, MB BS, FRACP, FRCP, Department of Rheumatology, University of Alberta; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center; P. Weiss, MD, MSCE, University of Pennsylvania Perelman School of Medicine, Division of Rheumatology, Children's Hospital of Philadelphia and Departments of Pediatric and Epidemiology; I. Sudol-Szopinska, MD, PhD, Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation; N. Herregods, MD, PhD, Department of Radiology and Medical Imaging, Ghent University Hospital; J.L. Jaremko, MD, PhD, FRCPC, Department of Radiology and Diagnostic Imaging, University of Alberta; A.B. Meyers, MD, Department of Radiology, Nemours Children's Hospital and Health System; D. Rumsey, MD, FRCPC, Division of Pediatric Rheumatology, Department of Pediatrics, University of Alberta; E.C. Inarejos, MD, Department of Radiology, Hospital Sant Joan de Deu; E. Kirkhus, MD, PhD, Department of Radiology, Rikshospitalet, Oslo University Hospital; J. Stimec, MD, FRCPC, Department of Diagnostic Imaging, The Hospital for Sick Children; J. Panwar, MD, Department of Diagnostic Imaging, The Hospital for Sick Children; K. Thorpe, BMath, MMath, Dalla Lana School of Public Health, University of Toronto; L. Jans, MD, PhD, Department of Radiology and Medical Imaging, Ghent University Hospital; M.A. van Rossum, MD, PhD, Reade
- Emma Children's Hospital/Academic Medical Center; M. Tolend, BSc, Institute of Medical Sciences, Faculty of Medicine, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children, and Department of Translational Medicine, SickKids Research Institute, Peter Gilgan Center for Research and Learning; M. Perez, MD, Department of Diagnostic Imaging, The Hospital for Sick Children; N. Tzaribachev, MD, Pediatric Rheumatology Research Institute; P. Sandhya, MD, Department of Clinical Immunology and Rheumatology, Christian Medical College; S. Tse, MD, FRCPC, Division of Rheumatology, The Hospital for Sick Children, University of Toronto; A. Simone, MD, PhD, State University of Campina-UNICAMP, Department of Internal Medicine, Cidade Universitaria; V.G. Swami, MD, BSc, Department of Medical Imaging, University of Toronto; Z. Touma, MD, PhD, FACP, FACR, Department of Rheumatology, Center for Prognosis Studies in Rheumatologic Diseases, Toronto Western Hospital; R. Lambert, MB BCh, FRCR, FRCPC, Department of Radiology and Diagnostic Imaging, University of Alberta; A.S. Doria, MD, PhD, MSc, Institute of Medical Sciences, Faculty of Medicine, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children, and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, and Department of Medical Imaging, University of Toronto
| | - Desiree van der Heijde
- From the Institute of Medical Sciences, Faculty of Medicine, University of Toronto; Department of Diagnostic Imaging, The Hospital for Sick Children; Department of Translational Medicine, SickKids Research Institute, Peter Gilgan Center for Research and Learning; Dalla Lana School of Public Health, University of Toronto; Division of Rheumatology, The Hospital for Sick Children, University of Toronto; Department of Medical Imaging, University of Toronto; Department of Rheumatology, Center for Prognosis Studies in Rheumatologic Diseases, Toronto Western Hospital, Toronto, Ontario; Department of Rheumatology, University of Alberta; Department of Radiology and Diagnostic Imaging, University of Alberta; Division of Pediatric Rheumatology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds Teaching Hospitals National Health Service (NHS) Trust, Leeds, UK; Department of Rheumatology, Leiden University Medical Center, Leiden; Reade
- Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; University of Pennsylvania Perelman School of Medicine, Division of Rheumatology, Children's Hospital of Philadelphia and Departments of Pediatric and Epidemiology, Philadelphia, Pennsylvania; Department of Radiology, Nemours Children's Hospital and Health System, Orlando, Florida, USA; Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland; Department of Radiology and Medical Imaging, Ghent University Hospital, Ghent, Belgium; Department of Radiology, Hospital Sant Joan de Deu, Barcelona, Spain; Department of Radiology, Rikshospitalet, Oslo University Hospital, Oslo, Norway; Pediatric Rheumatology Research Institute, Bad Bramstedt, Germany; Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India; State University of Campina-UNICAMP, Department of Internal Medicine, Cidade Universitaria, Sao Paulo, Brazil.,T.M. Otobo, MD, MSc, BMedSc, Institute of Medical Sciences, Faculty of Medicine, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children, and Department of Translational Medicine, SickKids Research Institute, Peter Gilgan Center for Research and Learning; P.G. Conaghan, PhD, MB BS, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust; W.P. Maksymowych, PhD, MB BS, FRACP, FRCP, Department of Rheumatology, University of Alberta; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center; P. Weiss, MD, MSCE, University of Pennsylvania Perelman School of Medicine, Division of Rheumatology, Children's Hospital of Philadelphia and Departments of Pediatric and Epidemiology; I. Sudol-Szopinska, MD, PhD, Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation; N. Herregods, MD, PhD, Department of Radiology and Medical Imaging, Ghent University Hospital; J.L. Jaremko, MD, PhD, FRCPC, Department of Radiology and Diagnostic Imaging, University of Alberta; A.B. Meyers, MD, Department of Radiology, Nemours Children's Hospital and Health System; D. Rumsey, MD, FRCPC, Division of Pediatric Rheumatology, Department of Pediatrics, University of Alberta; E.C. Inarejos, MD, Department of Radiology, Hospital Sant Joan de Deu; E. Kirkhus, MD, PhD, Department of Radiology, Rikshospitalet, Oslo University Hospital; J. Stimec, MD, FRCPC, Department of Diagnostic Imaging, The Hospital for Sick Children; J. Panwar, MD, Department of Diagnostic Imaging, The Hospital for Sick Children; K. Thorpe, BMath, MMath, Dalla Lana School of Public Health, University of Toronto; L. Jans, MD, PhD, Department of Radiology and Medical Imaging, Ghent University Hospital; M.A. van Rossum, MD, PhD, Reade
- Emma Children's Hospital/Academic Medical Center; M. Tolend, BSc, Institute of Medical Sciences, Faculty of Medicine, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children, and Department of Translational Medicine, SickKids Research Institute, Peter Gilgan Center for Research and Learning; M. Perez, MD, Department of Diagnostic Imaging, The Hospital for Sick Children; N. Tzaribachev, MD, Pediatric Rheumatology Research Institute; P. Sandhya, MD, Department of Clinical Immunology and Rheumatology, Christian Medical College; S. Tse, MD, FRCPC, Division of Rheumatology, The Hospital for Sick Children, University of Toronto; A. Simone, MD, PhD, State University of Campina-UNICAMP, Department of Internal Medicine, Cidade Universitaria; V.G. Swami, MD, BSc, Department of Medical Imaging, University of Toronto; Z. Touma, MD, PhD, FACP, FACR, Department of Rheumatology, Center for Prognosis Studies in Rheumatologic Diseases, Toronto Western Hospital; R. Lambert, MB BCh, FRCR, FRCPC, Department of Radiology and Diagnostic Imaging, University of Alberta; A.S. Doria, MD, PhD, MSc, Institute of Medical Sciences, Faculty of Medicine, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children, and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, and Department of Medical Imaging, University of Toronto
| | - Pamela Weiss
- From the Institute of Medical Sciences, Faculty of Medicine, University of Toronto; Department of Diagnostic Imaging, The Hospital for Sick Children; Department of Translational Medicine, SickKids Research Institute, Peter Gilgan Center for Research and Learning; Dalla Lana School of Public Health, University of Toronto; Division of Rheumatology, The Hospital for Sick Children, University of Toronto; Department of Medical Imaging, University of Toronto; Department of Rheumatology, Center for Prognosis Studies in Rheumatologic Diseases, Toronto Western Hospital, Toronto, Ontario; Department of Rheumatology, University of Alberta; Department of Radiology and Diagnostic Imaging, University of Alberta; Division of Pediatric Rheumatology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds Teaching Hospitals National Health Service (NHS) Trust, Leeds, UK; Department of Rheumatology, Leiden University Medical Center, Leiden; Reade
- Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; University of Pennsylvania Perelman School of Medicine, Division of Rheumatology, Children's Hospital of Philadelphia and Departments of Pediatric and Epidemiology, Philadelphia, Pennsylvania; Department of Radiology, Nemours Children's Hospital and Health System, Orlando, Florida, USA; Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland; Department of Radiology and Medical Imaging, Ghent University Hospital, Ghent, Belgium; Department of Radiology, Hospital Sant Joan de Deu, Barcelona, Spain; Department of Radiology, Rikshospitalet, Oslo University Hospital, Oslo, Norway; Pediatric Rheumatology Research Institute, Bad Bramstedt, Germany; Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India; State University of Campina-UNICAMP, Department of Internal Medicine, Cidade Universitaria, Sao Paulo, Brazil.,T.M. Otobo, MD, MSc, BMedSc, Institute of Medical Sciences, Faculty of Medicine, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children, and Department of Translational Medicine, SickKids Research Institute, Peter Gilgan Center for Research and Learning; P.G. Conaghan, PhD, MB BS, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust; W.P. Maksymowych, PhD, MB BS, FRACP, FRCP, Department of Rheumatology, University of Alberta; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center; P. Weiss, MD, MSCE, University of Pennsylvania Perelman School of Medicine, Division of Rheumatology, Children's Hospital of Philadelphia and Departments of Pediatric and Epidemiology; I. Sudol-Szopinska, MD, PhD, Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation; N. Herregods, MD, PhD, Department of Radiology and Medical Imaging, Ghent University Hospital; J.L. Jaremko, MD, PhD, FRCPC, Department of Radiology and Diagnostic Imaging, University of Alberta; A.B. Meyers, MD, Department of Radiology, Nemours Children's Hospital and Health System; D. Rumsey, MD, FRCPC, Division of Pediatric Rheumatology, Department of Pediatrics, University of Alberta; E.C. Inarejos, MD, Department of Radiology, Hospital Sant Joan de Deu; E. Kirkhus, MD, PhD, Department of Radiology, Rikshospitalet, Oslo University Hospital; J. Stimec, MD, FRCPC, Department of Diagnostic Imaging, The Hospital for Sick Children; J. Panwar, MD, Department of Diagnostic Imaging, The Hospital for Sick Children; K. Thorpe, BMath, MMath, Dalla Lana School of Public Health, University of Toronto; L. Jans, MD, PhD, Department of Radiology and Medical Imaging, Ghent University Hospital; M.A. van Rossum, MD, PhD, Reade
- Emma Children's Hospital/Academic Medical Center; M. Tolend, BSc, Institute of Medical Sciences, Faculty of Medicine, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children, and Department of Translational Medicine, SickKids Research Institute, Peter Gilgan Center for Research and Learning; M. Perez, MD, Department of Diagnostic Imaging, The Hospital for Sick Children; N. Tzaribachev, MD, Pediatric Rheumatology Research Institute; P. Sandhya, MD, Department of Clinical Immunology and Rheumatology, Christian Medical College; S. Tse, MD, FRCPC, Division of Rheumatology, The Hospital for Sick Children, University of Toronto; A. Simone, MD, PhD, State University of Campina-UNICAMP, Department of Internal Medicine, Cidade Universitaria; V.G. Swami, MD, BSc, Department of Medical Imaging, University of Toronto; Z. Touma, MD, PhD, FACP, FACR, Department of Rheumatology, Center for Prognosis Studies in Rheumatologic Diseases, Toronto Western Hospital; R. Lambert, MB BCh, FRCR, FRCPC, Department of Radiology and Diagnostic Imaging, University of Alberta; A.S. Doria, MD, PhD, MSc, Institute of Medical Sciences, Faculty of Medicine, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children, and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, and Department of Medical Imaging, University of Toronto
| | - Iwona Sudol-Szopinska
- From the Institute of Medical Sciences, Faculty of Medicine, University of Toronto; Department of Diagnostic Imaging, The Hospital for Sick Children; Department of Translational Medicine, SickKids Research Institute, Peter Gilgan Center for Research and Learning; Dalla Lana School of Public Health, University of Toronto; Division of Rheumatology, The Hospital for Sick Children, University of Toronto; Department of Medical Imaging, University of Toronto; Department of Rheumatology, Center for Prognosis Studies in Rheumatologic Diseases, Toronto Western Hospital, Toronto, Ontario; Department of Rheumatology, University of Alberta; Department of Radiology and Diagnostic Imaging, University of Alberta; Division of Pediatric Rheumatology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds Teaching Hospitals National Health Service (NHS) Trust, Leeds, UK; Department of Rheumatology, Leiden University Medical Center, Leiden; Reade
- Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; University of Pennsylvania Perelman School of Medicine, Division of Rheumatology, Children's Hospital of Philadelphia and Departments of Pediatric and Epidemiology, Philadelphia, Pennsylvania; Department of Radiology, Nemours Children's Hospital and Health System, Orlando, Florida, USA; Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland; Department of Radiology and Medical Imaging, Ghent University Hospital, Ghent, Belgium; Department of Radiology, Hospital Sant Joan de Deu, Barcelona, Spain; Department of Radiology, Rikshospitalet, Oslo University Hospital, Oslo, Norway; Pediatric Rheumatology Research Institute, Bad Bramstedt, Germany; Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India; State University of Campina-UNICAMP, Department of Internal Medicine, Cidade Universitaria, Sao Paulo, Brazil.,T.M. Otobo, MD, MSc, BMedSc, Institute of Medical Sciences, Faculty of Medicine, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children, and Department of Translational Medicine, SickKids Research Institute, Peter Gilgan Center for Research and Learning; P.G. Conaghan, PhD, MB BS, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust; W.P. Maksymowych, PhD, MB BS, FRACP, FRCP, Department of Rheumatology, University of Alberta; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center; P. Weiss, MD, MSCE, University of Pennsylvania Perelman School of Medicine, Division of Rheumatology, Children's Hospital of Philadelphia and Departments of Pediatric and Epidemiology; I. Sudol-Szopinska, MD, PhD, Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation; N. Herregods, MD, PhD, Department of Radiology and Medical Imaging, Ghent University Hospital; J.L. Jaremko, MD, PhD, FRCPC, Department of Radiology and Diagnostic Imaging, University of Alberta; A.B. Meyers, MD, Department of Radiology, Nemours Children's Hospital and Health System; D. Rumsey, MD, FRCPC, Division of Pediatric Rheumatology, Department of Pediatrics, University of Alberta; E.C. Inarejos, MD, Department of Radiology, Hospital Sant Joan de Deu; E. Kirkhus, MD, PhD, Department of Radiology, Rikshospitalet, Oslo University Hospital; J. Stimec, MD, FRCPC, Department of Diagnostic Imaging, The Hospital for Sick Children; J. Panwar, MD, Department of Diagnostic Imaging, The Hospital for Sick Children; K. Thorpe, BMath, MMath, Dalla Lana School of Public Health, University of Toronto; L. Jans, MD, PhD, Department of Radiology and Medical Imaging, Ghent University Hospital; M.A. van Rossum, MD, PhD, Reade
- Emma Children's Hospital/Academic Medical Center; M. Tolend, BSc, Institute of Medical Sciences, Faculty of Medicine, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children, and Department of Translational Medicine, SickKids Research Institute, Peter Gilgan Center for Research and Learning; M. Perez, MD, Department of Diagnostic Imaging, The Hospital for Sick Children; N. Tzaribachev, MD, Pediatric Rheumatology Research Institute; P. Sandhya, MD, Department of Clinical Immunology and Rheumatology, Christian Medical College; S. Tse, MD, FRCPC, Division of Rheumatology, The Hospital for Sick Children, University of Toronto; A. Simone, MD, PhD, State University of Campina-UNICAMP, Department of Internal Medicine, Cidade Universitaria; V.G. Swami, MD, BSc, Department of Medical Imaging, University of Toronto; Z. Touma, MD, PhD, FACP, FACR, Department of Rheumatology, Center for Prognosis Studies in Rheumatologic Diseases, Toronto Western Hospital; R. Lambert, MB BCh, FRCR, FRCPC, Department of Radiology and Diagnostic Imaging, University of Alberta; A.S. Doria, MD, PhD, MSc, Institute of Medical Sciences, Faculty of Medicine, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children, and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, and Department of Medical Imaging, University of Toronto
| | - Nele Herregods
- From the Institute of Medical Sciences, Faculty of Medicine, University of Toronto; Department of Diagnostic Imaging, The Hospital for Sick Children; Department of Translational Medicine, SickKids Research Institute, Peter Gilgan Center for Research and Learning; Dalla Lana School of Public Health, University of Toronto; Division of Rheumatology, The Hospital for Sick Children, University of Toronto; Department of Medical Imaging, University of Toronto; Department of Rheumatology, Center for Prognosis Studies in Rheumatologic Diseases, Toronto Western Hospital, Toronto, Ontario; Department of Rheumatology, University of Alberta; Department of Radiology and Diagnostic Imaging, University of Alberta; Division of Pediatric Rheumatology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds Teaching Hospitals National Health Service (NHS) Trust, Leeds, UK; Department of Rheumatology, Leiden University Medical Center, Leiden; Reade
- Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; University of Pennsylvania Perelman School of Medicine, Division of Rheumatology, Children's Hospital of Philadelphia and Departments of Pediatric and Epidemiology, Philadelphia, Pennsylvania; Department of Radiology, Nemours Children's Hospital and Health System, Orlando, Florida, USA; Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland; Department of Radiology and Medical Imaging, Ghent University Hospital, Ghent, Belgium; Department of Radiology, Hospital Sant Joan de Deu, Barcelona, Spain; Department of Radiology, Rikshospitalet, Oslo University Hospital, Oslo, Norway; Pediatric Rheumatology Research Institute, Bad Bramstedt, Germany; Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India; State University of Campina-UNICAMP, Department of Internal Medicine, Cidade Universitaria, Sao Paulo, Brazil.,T.M. Otobo, MD, MSc, BMedSc, Institute of Medical Sciences, Faculty of Medicine, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children, and Department of Translational Medicine, SickKids Research Institute, Peter Gilgan Center for Research and Learning; P.G. Conaghan, PhD, MB BS, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust; W.P. Maksymowych, PhD, MB BS, FRACP, FRCP, Department of Rheumatology, University of Alberta; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center; P. Weiss, MD, MSCE, University of Pennsylvania Perelman School of Medicine, Division of Rheumatology, Children's Hospital of Philadelphia and Departments of Pediatric and Epidemiology; I. Sudol-Szopinska, MD, PhD, Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation; N. Herregods, MD, PhD, Department of Radiology and Medical Imaging, Ghent University Hospital; J.L. Jaremko, MD, PhD, FRCPC, Department of Radiology and Diagnostic Imaging, University of Alberta; A.B. Meyers, MD, Department of Radiology, Nemours Children's Hospital and Health System; D. Rumsey, MD, FRCPC, Division of Pediatric Rheumatology, Department of Pediatrics, University of Alberta; E.C. Inarejos, MD, Department of Radiology, Hospital Sant Joan de Deu; E. Kirkhus, MD, PhD, Department of Radiology, Rikshospitalet, Oslo University Hospital; J. Stimec, MD, FRCPC, Department of Diagnostic Imaging, The Hospital for Sick Children; J. Panwar, MD, Department of Diagnostic Imaging, The Hospital for Sick Children; K. Thorpe, BMath, MMath, Dalla Lana School of Public Health, University of Toronto; L. Jans, MD, PhD, Department of Radiology and Medical Imaging, Ghent University Hospital; M.A. van Rossum, MD, PhD, Reade
- Emma Children's Hospital/Academic Medical Center; M. Tolend, BSc, Institute of Medical Sciences, Faculty of Medicine, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children, and Department of Translational Medicine, SickKids Research Institute, Peter Gilgan Center for Research and Learning; M. Perez, MD, Department of Diagnostic Imaging, The Hospital for Sick Children; N. Tzaribachev, MD, Pediatric Rheumatology Research Institute; P. Sandhya, MD, Department of Clinical Immunology and Rheumatology, Christian Medical College; S. Tse, MD, FRCPC, Division of Rheumatology, The Hospital for Sick Children, University of Toronto; A. Simone, MD, PhD, State University of Campina-UNICAMP, Department of Internal Medicine, Cidade Universitaria; V.G. Swami, MD, BSc, Department of Medical Imaging, University of Toronto; Z. Touma, MD, PhD, FACP, FACR, Department of Rheumatology, Center for Prognosis Studies in Rheumatologic Diseases, Toronto Western Hospital; R. Lambert, MB BCh, FRCR, FRCPC, Department of Radiology and Diagnostic Imaging, University of Alberta; A.S. Doria, MD, PhD, MSc, Institute of Medical Sciences, Faculty of Medicine, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children, and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, and Department of Medical Imaging, University of Toronto
| | - Jacob L Jaremko
- From the Institute of Medical Sciences, Faculty of Medicine, University of Toronto; Department of Diagnostic Imaging, The Hospital for Sick Children; Department of Translational Medicine, SickKids Research Institute, Peter Gilgan Center for Research and Learning; Dalla Lana School of Public Health, University of Toronto; Division of Rheumatology, The Hospital for Sick Children, University of Toronto; Department of Medical Imaging, University of Toronto; Department of Rheumatology, Center for Prognosis Studies in Rheumatologic Diseases, Toronto Western Hospital, Toronto, Ontario; Department of Rheumatology, University of Alberta; Department of Radiology and Diagnostic Imaging, University of Alberta; Division of Pediatric Rheumatology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds Teaching Hospitals National Health Service (NHS) Trust, Leeds, UK; Department of Rheumatology, Leiden University Medical Center, Leiden; Reade
- Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; University of Pennsylvania Perelman School of Medicine, Division of Rheumatology, Children's Hospital of Philadelphia and Departments of Pediatric and Epidemiology, Philadelphia, Pennsylvania; Department of Radiology, Nemours Children's Hospital and Health System, Orlando, Florida, USA; Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland; Department of Radiology and Medical Imaging, Ghent University Hospital, Ghent, Belgium; Department of Radiology, Hospital Sant Joan de Deu, Barcelona, Spain; Department of Radiology, Rikshospitalet, Oslo University Hospital, Oslo, Norway; Pediatric Rheumatology Research Institute, Bad Bramstedt, Germany; Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India; State University of Campina-UNICAMP, Department of Internal Medicine, Cidade Universitaria, Sao Paulo, Brazil.,T.M. Otobo, MD, MSc, BMedSc, Institute of Medical Sciences, Faculty of Medicine, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children, and Department of Translational Medicine, SickKids Research Institute, Peter Gilgan Center for Research and Learning; P.G. Conaghan, PhD, MB BS, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust; W.P. Maksymowych, PhD, MB BS, FRACP, FRCP, Department of Rheumatology, University of Alberta; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center; P. Weiss, MD, MSCE, University of Pennsylvania Perelman School of Medicine, Division of Rheumatology, Children's Hospital of Philadelphia and Departments of Pediatric and Epidemiology; I. Sudol-Szopinska, MD, PhD, Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation; N. Herregods, MD, PhD, Department of Radiology and Medical Imaging, Ghent University Hospital; J.L. Jaremko, MD, PhD, FRCPC, Department of Radiology and Diagnostic Imaging, University of Alberta; A.B. Meyers, MD, Department of Radiology, Nemours Children's Hospital and Health System; D. Rumsey, MD, FRCPC, Division of Pediatric Rheumatology, Department of Pediatrics, University of Alberta; E.C. Inarejos, MD, Department of Radiology, Hospital Sant Joan de Deu; E. Kirkhus, MD, PhD, Department of Radiology, Rikshospitalet, Oslo University Hospital; J. Stimec, MD, FRCPC, Department of Diagnostic Imaging, The Hospital for Sick Children; J. Panwar, MD, Department of Diagnostic Imaging, The Hospital for Sick Children; K. Thorpe, BMath, MMath, Dalla Lana School of Public Health, University of Toronto; L. Jans, MD, PhD, Department of Radiology and Medical Imaging, Ghent University Hospital; M.A. van Rossum, MD, PhD, Reade
- Emma Children's Hospital/Academic Medical Center; M. Tolend, BSc, Institute of Medical Sciences, Faculty of Medicine, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children, and Department of Translational Medicine, SickKids Research Institute, Peter Gilgan Center for Research and Learning; M. Perez, MD, Department of Diagnostic Imaging, The Hospital for Sick Children; N. Tzaribachev, MD, Pediatric Rheumatology Research Institute; P. Sandhya, MD, Department of Clinical Immunology and Rheumatology, Christian Medical College; S. Tse, MD, FRCPC, Division of Rheumatology, The Hospital for Sick Children, University of Toronto; A. Simone, MD, PhD, State University of Campina-UNICAMP, Department of Internal Medicine, Cidade Universitaria; V.G. Swami, MD, BSc, Department of Medical Imaging, University of Toronto; Z. Touma, MD, PhD, FACP, FACR, Department of Rheumatology, Center for Prognosis Studies in Rheumatologic Diseases, Toronto Western Hospital; R. Lambert, MB BCh, FRCR, FRCPC, Department of Radiology and Diagnostic Imaging, University of Alberta; A.S. Doria, MD, PhD, MSc, Institute of Medical Sciences, Faculty of Medicine, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children, and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, and Department of Medical Imaging, University of Toronto
| | - Arthur B Meyers
- From the Institute of Medical Sciences, Faculty of Medicine, University of Toronto; Department of Diagnostic Imaging, The Hospital for Sick Children; Department of Translational Medicine, SickKids Research Institute, Peter Gilgan Center for Research and Learning; Dalla Lana School of Public Health, University of Toronto; Division of Rheumatology, The Hospital for Sick Children, University of Toronto; Department of Medical Imaging, University of Toronto; Department of Rheumatology, Center for Prognosis Studies in Rheumatologic Diseases, Toronto Western Hospital, Toronto, Ontario; Department of Rheumatology, University of Alberta; Department of Radiology and Diagnostic Imaging, University of Alberta; Division of Pediatric Rheumatology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds Teaching Hospitals National Health Service (NHS) Trust, Leeds, UK; Department of Rheumatology, Leiden University Medical Center, Leiden; Reade
- Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; University of Pennsylvania Perelman School of Medicine, Division of Rheumatology, Children's Hospital of Philadelphia and Departments of Pediatric and Epidemiology, Philadelphia, Pennsylvania; Department of Radiology, Nemours Children's Hospital and Health System, Orlando, Florida, USA; Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland; Department of Radiology and Medical Imaging, Ghent University Hospital, Ghent, Belgium; Department of Radiology, Hospital Sant Joan de Deu, Barcelona, Spain; Department of Radiology, Rikshospitalet, Oslo University Hospital, Oslo, Norway; Pediatric Rheumatology Research Institute, Bad Bramstedt, Germany; Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India; State University of Campina-UNICAMP, Department of Internal Medicine, Cidade Universitaria, Sao Paulo, Brazil.,T.M. Otobo, MD, MSc, BMedSc, Institute of Medical Sciences, Faculty of Medicine, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children, and Department of Translational Medicine, SickKids Research Institute, Peter Gilgan Center for Research and Learning; P.G. Conaghan, PhD, MB BS, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust; W.P. Maksymowych, PhD, MB BS, FRACP, FRCP, Department of Rheumatology, University of Alberta; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center; P. Weiss, MD, MSCE, University of Pennsylvania Perelman School of Medicine, Division of Rheumatology, Children's Hospital of Philadelphia and Departments of Pediatric and Epidemiology; I. Sudol-Szopinska, MD, PhD, Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation; N. Herregods, MD, PhD, Department of Radiology and Medical Imaging, Ghent University Hospital; J.L. Jaremko, MD, PhD, FRCPC, Department of Radiology and Diagnostic Imaging, University of Alberta; A.B. Meyers, MD, Department of Radiology, Nemours Children's Hospital and Health System; D. Rumsey, MD, FRCPC, Division of Pediatric Rheumatology, Department of Pediatrics, University of Alberta; E.C. Inarejos, MD, Department of Radiology, Hospital Sant Joan de Deu; E. Kirkhus, MD, PhD, Department of Radiology, Rikshospitalet, Oslo University Hospital; J. Stimec, MD, FRCPC, Department of Diagnostic Imaging, The Hospital for Sick Children; J. Panwar, MD, Department of Diagnostic Imaging, The Hospital for Sick Children; K. Thorpe, BMath, MMath, Dalla Lana School of Public Health, University of Toronto; L. Jans, MD, PhD, Department of Radiology and Medical Imaging, Ghent University Hospital; M.A. van Rossum, MD, PhD, Reade
- Emma Children's Hospital/Academic Medical Center; M. Tolend, BSc, Institute of Medical Sciences, Faculty of Medicine, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children, and Department of Translational Medicine, SickKids Research Institute, Peter Gilgan Center for Research and Learning; M. Perez, MD, Department of Diagnostic Imaging, The Hospital for Sick Children; N. Tzaribachev, MD, Pediatric Rheumatology Research Institute; P. Sandhya, MD, Department of Clinical Immunology and Rheumatology, Christian Medical College; S. Tse, MD, FRCPC, Division of Rheumatology, The Hospital for Sick Children, University of Toronto; A. Simone, MD, PhD, State University of Campina-UNICAMP, Department of Internal Medicine, Cidade Universitaria; V.G. Swami, MD, BSc, Department of Medical Imaging, University of Toronto; Z. Touma, MD, PhD, FACP, FACR, Department of Rheumatology, Center for Prognosis Studies in Rheumatologic Diseases, Toronto Western Hospital; R. Lambert, MB BCh, FRCR, FRCPC, Department of Radiology and Diagnostic Imaging, University of Alberta; A.S. Doria, MD, PhD, MSc, Institute of Medical Sciences, Faculty of Medicine, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children, and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, and Department of Medical Imaging, University of Toronto
| | - Dax Rumsey
- From the Institute of Medical Sciences, Faculty of Medicine, University of Toronto; Department of Diagnostic Imaging, The Hospital for Sick Children; Department of Translational Medicine, SickKids Research Institute, Peter Gilgan Center for Research and Learning; Dalla Lana School of Public Health, University of Toronto; Division of Rheumatology, The Hospital for Sick Children, University of Toronto; Department of Medical Imaging, University of Toronto; Department of Rheumatology, Center for Prognosis Studies in Rheumatologic Diseases, Toronto Western Hospital, Toronto, Ontario; Department of Rheumatology, University of Alberta; Department of Radiology and Diagnostic Imaging, University of Alberta; Division of Pediatric Rheumatology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds Teaching Hospitals National Health Service (NHS) Trust, Leeds, UK; Department of Rheumatology, Leiden University Medical Center, Leiden; Reade
- Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; University of Pennsylvania Perelman School of Medicine, Division of Rheumatology, Children's Hospital of Philadelphia and Departments of Pediatric and Epidemiology, Philadelphia, Pennsylvania; Department of Radiology, Nemours Children's Hospital and Health System, Orlando, Florida, USA; Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland; Department of Radiology and Medical Imaging, Ghent University Hospital, Ghent, Belgium; Department of Radiology, Hospital Sant Joan de Deu, Barcelona, Spain; Department of Radiology, Rikshospitalet, Oslo University Hospital, Oslo, Norway; Pediatric Rheumatology Research Institute, Bad Bramstedt, Germany; Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India; State University of Campina-UNICAMP, Department of Internal Medicine, Cidade Universitaria, Sao Paulo, Brazil.,T.M. Otobo, MD, MSc, BMedSc, Institute of Medical Sciences, Faculty of Medicine, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children, and Department of Translational Medicine, SickKids Research Institute, Peter Gilgan Center for Research and Learning; P.G. Conaghan, PhD, MB BS, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust; W.P. Maksymowych, PhD, MB BS, FRACP, FRCP, Department of Rheumatology, University of Alberta; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center; P. Weiss, MD, MSCE, University of Pennsylvania Perelman School of Medicine, Division of Rheumatology, Children's Hospital of Philadelphia and Departments of Pediatric and Epidemiology; I. Sudol-Szopinska, MD, PhD, Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation; N. Herregods, MD, PhD, Department of Radiology and Medical Imaging, Ghent University Hospital; J.L. Jaremko, MD, PhD, FRCPC, Department of Radiology and Diagnostic Imaging, University of Alberta; A.B. Meyers, MD, Department of Radiology, Nemours Children's Hospital and Health System; D. Rumsey, MD, FRCPC, Division of Pediatric Rheumatology, Department of Pediatrics, University of Alberta; E.C. Inarejos, MD, Department of Radiology, Hospital Sant Joan de Deu; E. Kirkhus, MD, PhD, Department of Radiology, Rikshospitalet, Oslo University Hospital; J. Stimec, MD, FRCPC, Department of Diagnostic Imaging, The Hospital for Sick Children; J. Panwar, MD, Department of Diagnostic Imaging, The Hospital for Sick Children; K. Thorpe, BMath, MMath, Dalla Lana School of Public Health, University of Toronto; L. Jans, MD, PhD, Department of Radiology and Medical Imaging, Ghent University Hospital; M.A. van Rossum, MD, PhD, Reade
- Emma Children's Hospital/Academic Medical Center; M. Tolend, BSc, Institute of Medical Sciences, Faculty of Medicine, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children, and Department of Translational Medicine, SickKids Research Institute, Peter Gilgan Center for Research and Learning; M. Perez, MD, Department of Diagnostic Imaging, The Hospital for Sick Children; N. Tzaribachev, MD, Pediatric Rheumatology Research Institute; P. Sandhya, MD, Department of Clinical Immunology and Rheumatology, Christian Medical College; S. Tse, MD, FRCPC, Division of Rheumatology, The Hospital for Sick Children, University of Toronto; A. Simone, MD, PhD, State University of Campina-UNICAMP, Department of Internal Medicine, Cidade Universitaria; V.G. Swami, MD, BSc, Department of Medical Imaging, University of Toronto; Z. Touma, MD, PhD, FACP, FACR, Department of Rheumatology, Center for Prognosis Studies in Rheumatologic Diseases, Toronto Western Hospital; R. Lambert, MB BCh, FRCR, FRCPC, Department of Radiology and Diagnostic Imaging, University of Alberta; A.S. Doria, MD, PhD, MSc, Institute of Medical Sciences, Faculty of Medicine, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children, and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, and Department of Medical Imaging, University of Toronto
| | - Emilio C Inarejos
- From the Institute of Medical Sciences, Faculty of Medicine, University of Toronto; Department of Diagnostic Imaging, The Hospital for Sick Children; Department of Translational Medicine, SickKids Research Institute, Peter Gilgan Center for Research and Learning; Dalla Lana School of Public Health, University of Toronto; Division of Rheumatology, The Hospital for Sick Children, University of Toronto; Department of Medical Imaging, University of Toronto; Department of Rheumatology, Center for Prognosis Studies in Rheumatologic Diseases, Toronto Western Hospital, Toronto, Ontario; Department of Rheumatology, University of Alberta; Department of Radiology and Diagnostic Imaging, University of Alberta; Division of Pediatric Rheumatology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds Teaching Hospitals National Health Service (NHS) Trust, Leeds, UK; Department of Rheumatology, Leiden University Medical Center, Leiden; Reade
- Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; University of Pennsylvania Perelman School of Medicine, Division of Rheumatology, Children's Hospital of Philadelphia and Departments of Pediatric and Epidemiology, Philadelphia, Pennsylvania; Department of Radiology, Nemours Children's Hospital and Health System, Orlando, Florida, USA; Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland; Department of Radiology and Medical Imaging, Ghent University Hospital, Ghent, Belgium; Department of Radiology, Hospital Sant Joan de Deu, Barcelona, Spain; Department of Radiology, Rikshospitalet, Oslo University Hospital, Oslo, Norway; Pediatric Rheumatology Research Institute, Bad Bramstedt, Germany; Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India; State University of Campina-UNICAMP, Department of Internal Medicine, Cidade Universitaria, Sao Paulo, Brazil.,T.M. Otobo, MD, MSc, BMedSc, Institute of Medical Sciences, Faculty of Medicine, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children, and Department of Translational Medicine, SickKids Research Institute, Peter Gilgan Center for Research and Learning; P.G. Conaghan, PhD, MB BS, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust; W.P. Maksymowych, PhD, MB BS, FRACP, FRCP, Department of Rheumatology, University of Alberta; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center; P. Weiss, MD, MSCE, University of Pennsylvania Perelman School of Medicine, Division of Rheumatology, Children's Hospital of Philadelphia and Departments of Pediatric and Epidemiology; I. Sudol-Szopinska, MD, PhD, Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation; N. Herregods, MD, PhD, Department of Radiology and Medical Imaging, Ghent University Hospital; J.L. Jaremko, MD, PhD, FRCPC, Department of Radiology and Diagnostic Imaging, University of Alberta; A.B. Meyers, MD, Department of Radiology, Nemours Children's Hospital and Health System; D. Rumsey, MD, FRCPC, Division of Pediatric Rheumatology, Department of Pediatrics, University of Alberta; E.C. Inarejos, MD, Department of Radiology, Hospital Sant Joan de Deu; E. Kirkhus, MD, PhD, Department of Radiology, Rikshospitalet, Oslo University Hospital; J. Stimec, MD, FRCPC, Department of Diagnostic Imaging, The Hospital for Sick Children; J. Panwar, MD, Department of Diagnostic Imaging, The Hospital for Sick Children; K. Thorpe, BMath, MMath, Dalla Lana School of Public Health, University of Toronto; L. Jans, MD, PhD, Department of Radiology and Medical Imaging, Ghent University Hospital; M.A. van Rossum, MD, PhD, Reade
- Emma Children's Hospital/Academic Medical Center; M. Tolend, BSc, Institute of Medical Sciences, Faculty of Medicine, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children, and Department of Translational Medicine, SickKids Research Institute, Peter Gilgan Center for Research and Learning; M. Perez, MD, Department of Diagnostic Imaging, The Hospital for Sick Children; N. Tzaribachev, MD, Pediatric Rheumatology Research Institute; P. Sandhya, MD, Department of Clinical Immunology and Rheumatology, Christian Medical College; S. Tse, MD, FRCPC, Division of Rheumatology, The Hospital for Sick Children, University of Toronto; A. Simone, MD, PhD, State University of Campina-UNICAMP, Department of Internal Medicine, Cidade Universitaria; V.G. Swami, MD, BSc, Department of Medical Imaging, University of Toronto; Z. Touma, MD, PhD, FACP, FACR, Department of Rheumatology, Center for Prognosis Studies in Rheumatologic Diseases, Toronto Western Hospital; R. Lambert, MB BCh, FRCR, FRCPC, Department of Radiology and Diagnostic Imaging, University of Alberta; A.S. Doria, MD, PhD, MSc, Institute of Medical Sciences, Faculty of Medicine, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children, and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, and Department of Medical Imaging, University of Toronto
| | - Eva Kirkhus
- From the Institute of Medical Sciences, Faculty of Medicine, University of Toronto; Department of Diagnostic Imaging, The Hospital for Sick Children; Department of Translational Medicine, SickKids Research Institute, Peter Gilgan Center for Research and Learning; Dalla Lana School of Public Health, University of Toronto; Division of Rheumatology, The Hospital for Sick Children, University of Toronto; Department of Medical Imaging, University of Toronto; Department of Rheumatology, Center for Prognosis Studies in Rheumatologic Diseases, Toronto Western Hospital, Toronto, Ontario; Department of Rheumatology, University of Alberta; Department of Radiology and Diagnostic Imaging, University of Alberta; Division of Pediatric Rheumatology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds Teaching Hospitals National Health Service (NHS) Trust, Leeds, UK; Department of Rheumatology, Leiden University Medical Center, Leiden; Reade
- Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; University of Pennsylvania Perelman School of Medicine, Division of Rheumatology, Children's Hospital of Philadelphia and Departments of Pediatric and Epidemiology, Philadelphia, Pennsylvania; Department of Radiology, Nemours Children's Hospital and Health System, Orlando, Florida, USA; Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland; Department of Radiology and Medical Imaging, Ghent University Hospital, Ghent, Belgium; Department of Radiology, Hospital Sant Joan de Deu, Barcelona, Spain; Department of Radiology, Rikshospitalet, Oslo University Hospital, Oslo, Norway; Pediatric Rheumatology Research Institute, Bad Bramstedt, Germany; Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India; State University of Campina-UNICAMP, Department of Internal Medicine, Cidade Universitaria, Sao Paulo, Brazil.,T.M. Otobo, MD, MSc, BMedSc, Institute of Medical Sciences, Faculty of Medicine, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children, and Department of Translational Medicine, SickKids Research Institute, Peter Gilgan Center for Research and Learning; P.G. Conaghan, PhD, MB BS, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust; W.P. Maksymowych, PhD, MB BS, FRACP, FRCP, Department of Rheumatology, University of Alberta; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center; P. Weiss, MD, MSCE, University of Pennsylvania Perelman School of Medicine, Division of Rheumatology, Children's Hospital of Philadelphia and Departments of Pediatric and Epidemiology; I. Sudol-Szopinska, MD, PhD, Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation; N. Herregods, MD, PhD, Department of Radiology and Medical Imaging, Ghent University Hospital; J.L. Jaremko, MD, PhD, FRCPC, Department of Radiology and Diagnostic Imaging, University of Alberta; A.B. Meyers, MD, Department of Radiology, Nemours Children's Hospital and Health System; D. Rumsey, MD, FRCPC, Division of Pediatric Rheumatology, Department of Pediatrics, University of Alberta; E.C. Inarejos, MD, Department of Radiology, Hospital Sant Joan de Deu; E. Kirkhus, MD, PhD, Department of Radiology, Rikshospitalet, Oslo University Hospital; J. Stimec, MD, FRCPC, Department of Diagnostic Imaging, The Hospital for Sick Children; J. Panwar, MD, Department of Diagnostic Imaging, The Hospital for Sick Children; K. Thorpe, BMath, MMath, Dalla Lana School of Public Health, University of Toronto; L. Jans, MD, PhD, Department of Radiology and Medical Imaging, Ghent University Hospital; M.A. van Rossum, MD, PhD, Reade
- Emma Children's Hospital/Academic Medical Center; M. Tolend, BSc, Institute of Medical Sciences, Faculty of Medicine, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children, and Department of Translational Medicine, SickKids Research Institute, Peter Gilgan Center for Research and Learning; M. Perez, MD, Department of Diagnostic Imaging, The Hospital for Sick Children; N. Tzaribachev, MD, Pediatric Rheumatology Research Institute; P. Sandhya, MD, Department of Clinical Immunology and Rheumatology, Christian Medical College; S. Tse, MD, FRCPC, Division of Rheumatology, The Hospital for Sick Children, University of Toronto; A. Simone, MD, PhD, State University of Campina-UNICAMP, Department of Internal Medicine, Cidade Universitaria; V.G. Swami, MD, BSc, Department of Medical Imaging, University of Toronto; Z. Touma, MD, PhD, FACP, FACR, Department of Rheumatology, Center for Prognosis Studies in Rheumatologic Diseases, Toronto Western Hospital; R. Lambert, MB BCh, FRCR, FRCPC, Department of Radiology and Diagnostic Imaging, University of Alberta; A.S. Doria, MD, PhD, MSc, Institute of Medical Sciences, Faculty of Medicine, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children, and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, and Department of Medical Imaging, University of Toronto
| | - Jennifer Stimec
- From the Institute of Medical Sciences, Faculty of Medicine, University of Toronto; Department of Diagnostic Imaging, The Hospital for Sick Children; Department of Translational Medicine, SickKids Research Institute, Peter Gilgan Center for Research and Learning; Dalla Lana School of Public Health, University of Toronto; Division of Rheumatology, The Hospital for Sick Children, University of Toronto; Department of Medical Imaging, University of Toronto; Department of Rheumatology, Center for Prognosis Studies in Rheumatologic Diseases, Toronto Western Hospital, Toronto, Ontario; Department of Rheumatology, University of Alberta; Department of Radiology and Diagnostic Imaging, University of Alberta; Division of Pediatric Rheumatology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds Teaching Hospitals National Health Service (NHS) Trust, Leeds, UK; Department of Rheumatology, Leiden University Medical Center, Leiden; Reade
- Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; University of Pennsylvania Perelman School of Medicine, Division of Rheumatology, Children's Hospital of Philadelphia and Departments of Pediatric and Epidemiology, Philadelphia, Pennsylvania; Department of Radiology, Nemours Children's Hospital and Health System, Orlando, Florida, USA; Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland; Department of Radiology and Medical Imaging, Ghent University Hospital, Ghent, Belgium; Department of Radiology, Hospital Sant Joan de Deu, Barcelona, Spain; Department of Radiology, Rikshospitalet, Oslo University Hospital, Oslo, Norway; Pediatric Rheumatology Research Institute, Bad Bramstedt, Germany; Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India; State University of Campina-UNICAMP, Department of Internal Medicine, Cidade Universitaria, Sao Paulo, Brazil.,T.M. Otobo, MD, MSc, BMedSc, Institute of Medical Sciences, Faculty of Medicine, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children, and Department of Translational Medicine, SickKids Research Institute, Peter Gilgan Center for Research and Learning; P.G. Conaghan, PhD, MB BS, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust; W.P. Maksymowych, PhD, MB BS, FRACP, FRCP, Department of Rheumatology, University of Alberta; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center; P. Weiss, MD, MSCE, University of Pennsylvania Perelman School of Medicine, Division of Rheumatology, Children's Hospital of Philadelphia and Departments of Pediatric and Epidemiology; I. Sudol-Szopinska, MD, PhD, Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation; N. Herregods, MD, PhD, Department of Radiology and Medical Imaging, Ghent University Hospital; J.L. Jaremko, MD, PhD, FRCPC, Department of Radiology and Diagnostic Imaging, University of Alberta; A.B. Meyers, MD, Department of Radiology, Nemours Children's Hospital and Health System; D. Rumsey, MD, FRCPC, Division of Pediatric Rheumatology, Department of Pediatrics, University of Alberta; E.C. Inarejos, MD, Department of Radiology, Hospital Sant Joan de Deu; E. Kirkhus, MD, PhD, Department of Radiology, Rikshospitalet, Oslo University Hospital; J. Stimec, MD, FRCPC, Department of Diagnostic Imaging, The Hospital for Sick Children; J. Panwar, MD, Department of Diagnostic Imaging, The Hospital for Sick Children; K. Thorpe, BMath, MMath, Dalla Lana School of Public Health, University of Toronto; L. Jans, MD, PhD, Department of Radiology and Medical Imaging, Ghent University Hospital; M.A. van Rossum, MD, PhD, Reade
- Emma Children's Hospital/Academic Medical Center; M. Tolend, BSc, Institute of Medical Sciences, Faculty of Medicine, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children, and Department of Translational Medicine, SickKids Research Institute, Peter Gilgan Center for Research and Learning; M. Perez, MD, Department of Diagnostic Imaging, The Hospital for Sick Children; N. Tzaribachev, MD, Pediatric Rheumatology Research Institute; P. Sandhya, MD, Department of Clinical Immunology and Rheumatology, Christian Medical College; S. Tse, MD, FRCPC, Division of Rheumatology, The Hospital for Sick Children, University of Toronto; A. Simone, MD, PhD, State University of Campina-UNICAMP, Department of Internal Medicine, Cidade Universitaria; V.G. Swami, MD, BSc, Department of Medical Imaging, University of Toronto; Z. Touma, MD, PhD, FACP, FACR, Department of Rheumatology, Center for Prognosis Studies in Rheumatologic Diseases, Toronto Western Hospital; R. Lambert, MB BCh, FRCR, FRCPC, Department of Radiology and Diagnostic Imaging, University of Alberta; A.S. Doria, MD, PhD, MSc, Institute of Medical Sciences, Faculty of Medicine, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children, and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, and Department of Medical Imaging, University of Toronto
| | - Jyoti Panwar
- From the Institute of Medical Sciences, Faculty of Medicine, University of Toronto; Department of Diagnostic Imaging, The Hospital for Sick Children; Department of Translational Medicine, SickKids Research Institute, Peter Gilgan Center for Research and Learning; Dalla Lana School of Public Health, University of Toronto; Division of Rheumatology, The Hospital for Sick Children, University of Toronto; Department of Medical Imaging, University of Toronto; Department of Rheumatology, Center for Prognosis Studies in Rheumatologic Diseases, Toronto Western Hospital, Toronto, Ontario; Department of Rheumatology, University of Alberta; Department of Radiology and Diagnostic Imaging, University of Alberta; Division of Pediatric Rheumatology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds Teaching Hospitals National Health Service (NHS) Trust, Leeds, UK; Department of Rheumatology, Leiden University Medical Center, Leiden; Reade
- Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; University of Pennsylvania Perelman School of Medicine, Division of Rheumatology, Children's Hospital of Philadelphia and Departments of Pediatric and Epidemiology, Philadelphia, Pennsylvania; Department of Radiology, Nemours Children's Hospital and Health System, Orlando, Florida, USA; Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland; Department of Radiology and Medical Imaging, Ghent University Hospital, Ghent, Belgium; Department of Radiology, Hospital Sant Joan de Deu, Barcelona, Spain; Department of Radiology, Rikshospitalet, Oslo University Hospital, Oslo, Norway; Pediatric Rheumatology Research Institute, Bad Bramstedt, Germany; Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India; State University of Campina-UNICAMP, Department of Internal Medicine, Cidade Universitaria, Sao Paulo, Brazil.,T.M. Otobo, MD, MSc, BMedSc, Institute of Medical Sciences, Faculty of Medicine, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children, and Department of Translational Medicine, SickKids Research Institute, Peter Gilgan Center for Research and Learning; P.G. Conaghan, PhD, MB BS, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust; W.P. Maksymowych, PhD, MB BS, FRACP, FRCP, Department of Rheumatology, University of Alberta; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center; P. Weiss, MD, MSCE, University of Pennsylvania Perelman School of Medicine, Division of Rheumatology, Children's Hospital of Philadelphia and Departments of Pediatric and Epidemiology; I. Sudol-Szopinska, MD, PhD, Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation; N. Herregods, MD, PhD, Department of Radiology and Medical Imaging, Ghent University Hospital; J.L. Jaremko, MD, PhD, FRCPC, Department of Radiology and Diagnostic Imaging, University of Alberta; A.B. Meyers, MD, Department of Radiology, Nemours Children's Hospital and Health System; D. Rumsey, MD, FRCPC, Division of Pediatric Rheumatology, Department of Pediatrics, University of Alberta; E.C. Inarejos, MD, Department of Radiology, Hospital Sant Joan de Deu; E. Kirkhus, MD, PhD, Department of Radiology, Rikshospitalet, Oslo University Hospital; J. Stimec, MD, FRCPC, Department of Diagnostic Imaging, The Hospital for Sick Children; J. Panwar, MD, Department of Diagnostic Imaging, The Hospital for Sick Children; K. Thorpe, BMath, MMath, Dalla Lana School of Public Health, University of Toronto; L. Jans, MD, PhD, Department of Radiology and Medical Imaging, Ghent University Hospital; M.A. van Rossum, MD, PhD, Reade
- Emma Children's Hospital/Academic Medical Center; M. Tolend, BSc, Institute of Medical Sciences, Faculty of Medicine, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children, and Department of Translational Medicine, SickKids Research Institute, Peter Gilgan Center for Research and Learning; M. Perez, MD, Department of Diagnostic Imaging, The Hospital for Sick Children; N. Tzaribachev, MD, Pediatric Rheumatology Research Institute; P. Sandhya, MD, Department of Clinical Immunology and Rheumatology, Christian Medical College; S. Tse, MD, FRCPC, Division of Rheumatology, The Hospital for Sick Children, University of Toronto; A. Simone, MD, PhD, State University of Campina-UNICAMP, Department of Internal Medicine, Cidade Universitaria; V.G. Swami, MD, BSc, Department of Medical Imaging, University of Toronto; Z. Touma, MD, PhD, FACP, FACR, Department of Rheumatology, Center for Prognosis Studies in Rheumatologic Diseases, Toronto Western Hospital; R. Lambert, MB BCh, FRCR, FRCPC, Department of Radiology and Diagnostic Imaging, University of Alberta; A.S. Doria, MD, PhD, MSc, Institute of Medical Sciences, Faculty of Medicine, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children, and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, and Department of Medical Imaging, University of Toronto
| | - Kevin Thorpe
- From the Institute of Medical Sciences, Faculty of Medicine, University of Toronto; Department of Diagnostic Imaging, The Hospital for Sick Children; Department of Translational Medicine, SickKids Research Institute, Peter Gilgan Center for Research and Learning; Dalla Lana School of Public Health, University of Toronto; Division of Rheumatology, The Hospital for Sick Children, University of Toronto; Department of Medical Imaging, University of Toronto; Department of Rheumatology, Center for Prognosis Studies in Rheumatologic Diseases, Toronto Western Hospital, Toronto, Ontario; Department of Rheumatology, University of Alberta; Department of Radiology and Diagnostic Imaging, University of Alberta; Division of Pediatric Rheumatology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds Teaching Hospitals National Health Service (NHS) Trust, Leeds, UK; Department of Rheumatology, Leiden University Medical Center, Leiden; Reade
- Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; University of Pennsylvania Perelman School of Medicine, Division of Rheumatology, Children's Hospital of Philadelphia and Departments of Pediatric and Epidemiology, Philadelphia, Pennsylvania; Department of Radiology, Nemours Children's Hospital and Health System, Orlando, Florida, USA; Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland; Department of Radiology and Medical Imaging, Ghent University Hospital, Ghent, Belgium; Department of Radiology, Hospital Sant Joan de Deu, Barcelona, Spain; Department of Radiology, Rikshospitalet, Oslo University Hospital, Oslo, Norway; Pediatric Rheumatology Research Institute, Bad Bramstedt, Germany; Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India; State University of Campina-UNICAMP, Department of Internal Medicine, Cidade Universitaria, Sao Paulo, Brazil.,T.M. Otobo, MD, MSc, BMedSc, Institute of Medical Sciences, Faculty of Medicine, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children, and Department of Translational Medicine, SickKids Research Institute, Peter Gilgan Center for Research and Learning; P.G. Conaghan, PhD, MB BS, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust; W.P. Maksymowych, PhD, MB BS, FRACP, FRCP, Department of Rheumatology, University of Alberta; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center; P. Weiss, MD, MSCE, University of Pennsylvania Perelman School of Medicine, Division of Rheumatology, Children's Hospital of Philadelphia and Departments of Pediatric and Epidemiology; I. Sudol-Szopinska, MD, PhD, Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation; N. Herregods, MD, PhD, Department of Radiology and Medical Imaging, Ghent University Hospital; J.L. Jaremko, MD, PhD, FRCPC, Department of Radiology and Diagnostic Imaging, University of Alberta; A.B. Meyers, MD, Department of Radiology, Nemours Children's Hospital and Health System; D. Rumsey, MD, FRCPC, Division of Pediatric Rheumatology, Department of Pediatrics, University of Alberta; E.C. Inarejos, MD, Department of Radiology, Hospital Sant Joan de Deu; E. Kirkhus, MD, PhD, Department of Radiology, Rikshospitalet, Oslo University Hospital; J. Stimec, MD, FRCPC, Department of Diagnostic Imaging, The Hospital for Sick Children; J. Panwar, MD, Department of Diagnostic Imaging, The Hospital for Sick Children; K. Thorpe, BMath, MMath, Dalla Lana School of Public Health, University of Toronto; L. Jans, MD, PhD, Department of Radiology and Medical Imaging, Ghent University Hospital; M.A. van Rossum, MD, PhD, Reade
- Emma Children's Hospital/Academic Medical Center; M. Tolend, BSc, Institute of Medical Sciences, Faculty of Medicine, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children, and Department of Translational Medicine, SickKids Research Institute, Peter Gilgan Center for Research and Learning; M. Perez, MD, Department of Diagnostic Imaging, The Hospital for Sick Children; N. Tzaribachev, MD, Pediatric Rheumatology Research Institute; P. Sandhya, MD, Department of Clinical Immunology and Rheumatology, Christian Medical College; S. Tse, MD, FRCPC, Division of Rheumatology, The Hospital for Sick Children, University of Toronto; A. Simone, MD, PhD, State University of Campina-UNICAMP, Department of Internal Medicine, Cidade Universitaria; V.G. Swami, MD, BSc, Department of Medical Imaging, University of Toronto; Z. Touma, MD, PhD, FACP, FACR, Department of Rheumatology, Center for Prognosis Studies in Rheumatologic Diseases, Toronto Western Hospital; R. Lambert, MB BCh, FRCR, FRCPC, Department of Radiology and Diagnostic Imaging, University of Alberta; A.S. Doria, MD, PhD, MSc, Institute of Medical Sciences, Faculty of Medicine, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children, and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, and Department of Medical Imaging, University of Toronto
| | - Lennart Jans
- From the Institute of Medical Sciences, Faculty of Medicine, University of Toronto; Department of Diagnostic Imaging, The Hospital for Sick Children; Department of Translational Medicine, SickKids Research Institute, Peter Gilgan Center for Research and Learning; Dalla Lana School of Public Health, University of Toronto; Division of Rheumatology, The Hospital for Sick Children, University of Toronto; Department of Medical Imaging, University of Toronto; Department of Rheumatology, Center for Prognosis Studies in Rheumatologic Diseases, Toronto Western Hospital, Toronto, Ontario; Department of Rheumatology, University of Alberta; Department of Radiology and Diagnostic Imaging, University of Alberta; Division of Pediatric Rheumatology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds Teaching Hospitals National Health Service (NHS) Trust, Leeds, UK; Department of Rheumatology, Leiden University Medical Center, Leiden; Reade
- Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; University of Pennsylvania Perelman School of Medicine, Division of Rheumatology, Children's Hospital of Philadelphia and Departments of Pediatric and Epidemiology, Philadelphia, Pennsylvania; Department of Radiology, Nemours Children's Hospital and Health System, Orlando, Florida, USA; Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland; Department of Radiology and Medical Imaging, Ghent University Hospital, Ghent, Belgium; Department of Radiology, Hospital Sant Joan de Deu, Barcelona, Spain; Department of Radiology, Rikshospitalet, Oslo University Hospital, Oslo, Norway; Pediatric Rheumatology Research Institute, Bad Bramstedt, Germany; Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India; State University of Campina-UNICAMP, Department of Internal Medicine, Cidade Universitaria, Sao Paulo, Brazil.,T.M. Otobo, MD, MSc, BMedSc, Institute of Medical Sciences, Faculty of Medicine, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children, and Department of Translational Medicine, SickKids Research Institute, Peter Gilgan Center for Research and Learning; P.G. Conaghan, PhD, MB BS, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust; W.P. Maksymowych, PhD, MB BS, FRACP, FRCP, Department of Rheumatology, University of Alberta; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center; P. Weiss, MD, MSCE, University of Pennsylvania Perelman School of Medicine, Division of Rheumatology, Children's Hospital of Philadelphia and Departments of Pediatric and Epidemiology; I. Sudol-Szopinska, MD, PhD, Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation; N. Herregods, MD, PhD, Department of Radiology and Medical Imaging, Ghent University Hospital; J.L. Jaremko, MD, PhD, FRCPC, Department of Radiology and Diagnostic Imaging, University of Alberta; A.B. Meyers, MD, Department of Radiology, Nemours Children's Hospital and Health System; D. Rumsey, MD, FRCPC, Division of Pediatric Rheumatology, Department of Pediatrics, University of Alberta; E.C. Inarejos, MD, Department of Radiology, Hospital Sant Joan de Deu; E. Kirkhus, MD, PhD, Department of Radiology, Rikshospitalet, Oslo University Hospital; J. Stimec, MD, FRCPC, Department of Diagnostic Imaging, The Hospital for Sick Children; J. Panwar, MD, Department of Diagnostic Imaging, The Hospital for Sick Children; K. Thorpe, BMath, MMath, Dalla Lana School of Public Health, University of Toronto; L. Jans, MD, PhD, Department of Radiology and Medical Imaging, Ghent University Hospital; M.A. van Rossum, MD, PhD, Reade
- Emma Children's Hospital/Academic Medical Center; M. Tolend, BSc, Institute of Medical Sciences, Faculty of Medicine, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children, and Department of Translational Medicine, SickKids Research Institute, Peter Gilgan Center for Research and Learning; M. Perez, MD, Department of Diagnostic Imaging, The Hospital for Sick Children; N. Tzaribachev, MD, Pediatric Rheumatology Research Institute; P. Sandhya, MD, Department of Clinical Immunology and Rheumatology, Christian Medical College; S. Tse, MD, FRCPC, Division of Rheumatology, The Hospital for Sick Children, University of Toronto; A. Simone, MD, PhD, State University of Campina-UNICAMP, Department of Internal Medicine, Cidade Universitaria; V.G. Swami, MD, BSc, Department of Medical Imaging, University of Toronto; Z. Touma, MD, PhD, FACP, FACR, Department of Rheumatology, Center for Prognosis Studies in Rheumatologic Diseases, Toronto Western Hospital; R. Lambert, MB BCh, FRCR, FRCPC, Department of Radiology and Diagnostic Imaging, University of Alberta; A.S. Doria, MD, PhD, MSc, Institute of Medical Sciences, Faculty of Medicine, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children, and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, and Department of Medical Imaging, University of Toronto
| | - M A van Rossum
- From the Institute of Medical Sciences, Faculty of Medicine, University of Toronto; Department of Diagnostic Imaging, The Hospital for Sick Children; Department of Translational Medicine, SickKids Research Institute, Peter Gilgan Center for Research and Learning; Dalla Lana School of Public Health, University of Toronto; Division of Rheumatology, The Hospital for Sick Children, University of Toronto; Department of Medical Imaging, University of Toronto; Department of Rheumatology, Center for Prognosis Studies in Rheumatologic Diseases, Toronto Western Hospital, Toronto, Ontario; Department of Rheumatology, University of Alberta; Department of Radiology and Diagnostic Imaging, University of Alberta; Division of Pediatric Rheumatology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds Teaching Hospitals National Health Service (NHS) Trust, Leeds, UK; Department of Rheumatology, Leiden University Medical Center, Leiden; Reade
- Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; University of Pennsylvania Perelman School of Medicine, Division of Rheumatology, Children's Hospital of Philadelphia and Departments of Pediatric and Epidemiology, Philadelphia, Pennsylvania; Department of Radiology, Nemours Children's Hospital and Health System, Orlando, Florida, USA; Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland; Department of Radiology and Medical Imaging, Ghent University Hospital, Ghent, Belgium; Department of Radiology, Hospital Sant Joan de Deu, Barcelona, Spain; Department of Radiology, Rikshospitalet, Oslo University Hospital, Oslo, Norway; Pediatric Rheumatology Research Institute, Bad Bramstedt, Germany; Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India; State University of Campina-UNICAMP, Department of Internal Medicine, Cidade Universitaria, Sao Paulo, Brazil.,T.M. Otobo, MD, MSc, BMedSc, Institute of Medical Sciences, Faculty of Medicine, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children, and Department of Translational Medicine, SickKids Research Institute, Peter Gilgan Center for Research and Learning; P.G. Conaghan, PhD, MB BS, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust; W.P. Maksymowych, PhD, MB BS, FRACP, FRCP, Department of Rheumatology, University of Alberta; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center; P. Weiss, MD, MSCE, University of Pennsylvania Perelman School of Medicine, Division of Rheumatology, Children's Hospital of Philadelphia and Departments of Pediatric and Epidemiology; I. Sudol-Szopinska, MD, PhD, Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation; N. Herregods, MD, PhD, Department of Radiology and Medical Imaging, Ghent University Hospital; J.L. Jaremko, MD, PhD, FRCPC, Department of Radiology and Diagnostic Imaging, University of Alberta; A.B. Meyers, MD, Department of Radiology, Nemours Children's Hospital and Health System; D. Rumsey, MD, FRCPC, Division of Pediatric Rheumatology, Department of Pediatrics, University of Alberta; E.C. Inarejos, MD, Department of Radiology, Hospital Sant Joan de Deu; E. Kirkhus, MD, PhD, Department of Radiology, Rikshospitalet, Oslo University Hospital; J. Stimec, MD, FRCPC, Department of Diagnostic Imaging, The Hospital for Sick Children; J. Panwar, MD, Department of Diagnostic Imaging, The Hospital for Sick Children; K. Thorpe, BMath, MMath, Dalla Lana School of Public Health, University of Toronto; L. Jans, MD, PhD, Department of Radiology and Medical Imaging, Ghent University Hospital; M.A. van Rossum, MD, PhD, Reade
- Emma Children's Hospital/Academic Medical Center; M. Tolend, BSc, Institute of Medical Sciences, Faculty of Medicine, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children, and Department of Translational Medicine, SickKids Research Institute, Peter Gilgan Center for Research and Learning; M. Perez, MD, Department of Diagnostic Imaging, The Hospital for Sick Children; N. Tzaribachev, MD, Pediatric Rheumatology Research Institute; P. Sandhya, MD, Department of Clinical Immunology and Rheumatology, Christian Medical College; S. Tse, MD, FRCPC, Division of Rheumatology, The Hospital for Sick Children, University of Toronto; A. Simone, MD, PhD, State University of Campina-UNICAMP, Department of Internal Medicine, Cidade Universitaria; V.G. Swami, MD, BSc, Department of Medical Imaging, University of Toronto; Z. Touma, MD, PhD, FACP, FACR, Department of Rheumatology, Center for Prognosis Studies in Rheumatologic Diseases, Toronto Western Hospital; R. Lambert, MB BCh, FRCR, FRCPC, Department of Radiology and Diagnostic Imaging, University of Alberta; A.S. Doria, MD, PhD, MSc, Institute of Medical Sciences, Faculty of Medicine, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children, and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, and Department of Medical Imaging, University of Toronto
| | - Mirkamal Tolend
- From the Institute of Medical Sciences, Faculty of Medicine, University of Toronto; Department of Diagnostic Imaging, The Hospital for Sick Children; Department of Translational Medicine, SickKids Research Institute, Peter Gilgan Center for Research and Learning; Dalla Lana School of Public Health, University of Toronto; Division of Rheumatology, The Hospital for Sick Children, University of Toronto; Department of Medical Imaging, University of Toronto; Department of Rheumatology, Center for Prognosis Studies in Rheumatologic Diseases, Toronto Western Hospital, Toronto, Ontario; Department of Rheumatology, University of Alberta; Department of Radiology and Diagnostic Imaging, University of Alberta; Division of Pediatric Rheumatology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds Teaching Hospitals National Health Service (NHS) Trust, Leeds, UK; Department of Rheumatology, Leiden University Medical Center, Leiden; Reade
- Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; University of Pennsylvania Perelman School of Medicine, Division of Rheumatology, Children's Hospital of Philadelphia and Departments of Pediatric and Epidemiology, Philadelphia, Pennsylvania; Department of Radiology, Nemours Children's Hospital and Health System, Orlando, Florida, USA; Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland; Department of Radiology and Medical Imaging, Ghent University Hospital, Ghent, Belgium; Department of Radiology, Hospital Sant Joan de Deu, Barcelona, Spain; Department of Radiology, Rikshospitalet, Oslo University Hospital, Oslo, Norway; Pediatric Rheumatology Research Institute, Bad Bramstedt, Germany; Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India; State University of Campina-UNICAMP, Department of Internal Medicine, Cidade Universitaria, Sao Paulo, Brazil.,T.M. Otobo, MD, MSc, BMedSc, Institute of Medical Sciences, Faculty of Medicine, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children, and Department of Translational Medicine, SickKids Research Institute, Peter Gilgan Center for Research and Learning; P.G. Conaghan, PhD, MB BS, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust; W.P. Maksymowych, PhD, MB BS, FRACP, FRCP, Department of Rheumatology, University of Alberta; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center; P. Weiss, MD, MSCE, University of Pennsylvania Perelman School of Medicine, Division of Rheumatology, Children's Hospital of Philadelphia and Departments of Pediatric and Epidemiology; I. Sudol-Szopinska, MD, PhD, Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation; N. Herregods, MD, PhD, Department of Radiology and Medical Imaging, Ghent University Hospital; J.L. Jaremko, MD, PhD, FRCPC, Department of Radiology and Diagnostic Imaging, University of Alberta; A.B. Meyers, MD, Department of Radiology, Nemours Children's Hospital and Health System; D. Rumsey, MD, FRCPC, Division of Pediatric Rheumatology, Department of Pediatrics, University of Alberta; E.C. Inarejos, MD, Department of Radiology, Hospital Sant Joan de Deu; E. Kirkhus, MD, PhD, Department of Radiology, Rikshospitalet, Oslo University Hospital; J. Stimec, MD, FRCPC, Department of Diagnostic Imaging, The Hospital for Sick Children; J. Panwar, MD, Department of Diagnostic Imaging, The Hospital for Sick Children; K. Thorpe, BMath, MMath, Dalla Lana School of Public Health, University of Toronto; L. Jans, MD, PhD, Department of Radiology and Medical Imaging, Ghent University Hospital; M.A. van Rossum, MD, PhD, Reade
- Emma Children's Hospital/Academic Medical Center; M. Tolend, BSc, Institute of Medical Sciences, Faculty of Medicine, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children, and Department of Translational Medicine, SickKids Research Institute, Peter Gilgan Center for Research and Learning; M. Perez, MD, Department of Diagnostic Imaging, The Hospital for Sick Children; N. Tzaribachev, MD, Pediatric Rheumatology Research Institute; P. Sandhya, MD, Department of Clinical Immunology and Rheumatology, Christian Medical College; S. Tse, MD, FRCPC, Division of Rheumatology, The Hospital for Sick Children, University of Toronto; A. Simone, MD, PhD, State University of Campina-UNICAMP, Department of Internal Medicine, Cidade Universitaria; V.G. Swami, MD, BSc, Department of Medical Imaging, University of Toronto; Z. Touma, MD, PhD, FACP, FACR, Department of Rheumatology, Center for Prognosis Studies in Rheumatologic Diseases, Toronto Western Hospital; R. Lambert, MB BCh, FRCR, FRCPC, Department of Radiology and Diagnostic Imaging, University of Alberta; A.S. Doria, MD, PhD, MSc, Institute of Medical Sciences, Faculty of Medicine, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children, and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, and Department of Medical Imaging, University of Toronto
| | - Manuela Perez
- From the Institute of Medical Sciences, Faculty of Medicine, University of Toronto; Department of Diagnostic Imaging, The Hospital for Sick Children; Department of Translational Medicine, SickKids Research Institute, Peter Gilgan Center for Research and Learning; Dalla Lana School of Public Health, University of Toronto; Division of Rheumatology, The Hospital for Sick Children, University of Toronto; Department of Medical Imaging, University of Toronto; Department of Rheumatology, Center for Prognosis Studies in Rheumatologic Diseases, Toronto Western Hospital, Toronto, Ontario; Department of Rheumatology, University of Alberta; Department of Radiology and Diagnostic Imaging, University of Alberta; Division of Pediatric Rheumatology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds Teaching Hospitals National Health Service (NHS) Trust, Leeds, UK; Department of Rheumatology, Leiden University Medical Center, Leiden; Reade
- Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; University of Pennsylvania Perelman School of Medicine, Division of Rheumatology, Children's Hospital of Philadelphia and Departments of Pediatric and Epidemiology, Philadelphia, Pennsylvania; Department of Radiology, Nemours Children's Hospital and Health System, Orlando, Florida, USA; Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland; Department of Radiology and Medical Imaging, Ghent University Hospital, Ghent, Belgium; Department of Radiology, Hospital Sant Joan de Deu, Barcelona, Spain; Department of Radiology, Rikshospitalet, Oslo University Hospital, Oslo, Norway; Pediatric Rheumatology Research Institute, Bad Bramstedt, Germany; Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India; State University of Campina-UNICAMP, Department of Internal Medicine, Cidade Universitaria, Sao Paulo, Brazil.,T.M. Otobo, MD, MSc, BMedSc, Institute of Medical Sciences, Faculty of Medicine, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children, and Department of Translational Medicine, SickKids Research Institute, Peter Gilgan Center for Research and Learning; P.G. Conaghan, PhD, MB BS, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust; W.P. Maksymowych, PhD, MB BS, FRACP, FRCP, Department of Rheumatology, University of Alberta; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center; P. Weiss, MD, MSCE, University of Pennsylvania Perelman School of Medicine, Division of Rheumatology, Children's Hospital of Philadelphia and Departments of Pediatric and Epidemiology; I. Sudol-Szopinska, MD, PhD, Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation; N. Herregods, MD, PhD, Department of Radiology and Medical Imaging, Ghent University Hospital; J.L. Jaremko, MD, PhD, FRCPC, Department of Radiology and Diagnostic Imaging, University of Alberta; A.B. Meyers, MD, Department of Radiology, Nemours Children's Hospital and Health System; D. Rumsey, MD, FRCPC, Division of Pediatric Rheumatology, Department of Pediatrics, University of Alberta; E.C. Inarejos, MD, Department of Radiology, Hospital Sant Joan de Deu; E. Kirkhus, MD, PhD, Department of Radiology, Rikshospitalet, Oslo University Hospital; J. Stimec, MD, FRCPC, Department of Diagnostic Imaging, The Hospital for Sick Children; J. Panwar, MD, Department of Diagnostic Imaging, The Hospital for Sick Children; K. Thorpe, BMath, MMath, Dalla Lana School of Public Health, University of Toronto; L. Jans, MD, PhD, Department of Radiology and Medical Imaging, Ghent University Hospital; M.A. van Rossum, MD, PhD, Reade
- Emma Children's Hospital/Academic Medical Center; M. Tolend, BSc, Institute of Medical Sciences, Faculty of Medicine, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children, and Department of Translational Medicine, SickKids Research Institute, Peter Gilgan Center for Research and Learning; M. Perez, MD, Department of Diagnostic Imaging, The Hospital for Sick Children; N. Tzaribachev, MD, Pediatric Rheumatology Research Institute; P. Sandhya, MD, Department of Clinical Immunology and Rheumatology, Christian Medical College; S. Tse, MD, FRCPC, Division of Rheumatology, The Hospital for Sick Children, University of Toronto; A. Simone, MD, PhD, State University of Campina-UNICAMP, Department of Internal Medicine, Cidade Universitaria; V.G. Swami, MD, BSc, Department of Medical Imaging, University of Toronto; Z. Touma, MD, PhD, FACP, FACR, Department of Rheumatology, Center for Prognosis Studies in Rheumatologic Diseases, Toronto Western Hospital; R. Lambert, MB BCh, FRCR, FRCPC, Department of Radiology and Diagnostic Imaging, University of Alberta; A.S. Doria, MD, PhD, MSc, Institute of Medical Sciences, Faculty of Medicine, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children, and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, and Department of Medical Imaging, University of Toronto
| | - Nikolay Tzaribachev
- From the Institute of Medical Sciences, Faculty of Medicine, University of Toronto; Department of Diagnostic Imaging, The Hospital for Sick Children; Department of Translational Medicine, SickKids Research Institute, Peter Gilgan Center for Research and Learning; Dalla Lana School of Public Health, University of Toronto; Division of Rheumatology, The Hospital for Sick Children, University of Toronto; Department of Medical Imaging, University of Toronto; Department of Rheumatology, Center for Prognosis Studies in Rheumatologic Diseases, Toronto Western Hospital, Toronto, Ontario; Department of Rheumatology, University of Alberta; Department of Radiology and Diagnostic Imaging, University of Alberta; Division of Pediatric Rheumatology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds Teaching Hospitals National Health Service (NHS) Trust, Leeds, UK; Department of Rheumatology, Leiden University Medical Center, Leiden; Reade
- Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; University of Pennsylvania Perelman School of Medicine, Division of Rheumatology, Children's Hospital of Philadelphia and Departments of Pediatric and Epidemiology, Philadelphia, Pennsylvania; Department of Radiology, Nemours Children's Hospital and Health System, Orlando, Florida, USA; Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland; Department of Radiology and Medical Imaging, Ghent University Hospital, Ghent, Belgium; Department of Radiology, Hospital Sant Joan de Deu, Barcelona, Spain; Department of Radiology, Rikshospitalet, Oslo University Hospital, Oslo, Norway; Pediatric Rheumatology Research Institute, Bad Bramstedt, Germany; Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India; State University of Campina-UNICAMP, Department of Internal Medicine, Cidade Universitaria, Sao Paulo, Brazil.,T.M. Otobo, MD, MSc, BMedSc, Institute of Medical Sciences, Faculty of Medicine, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children, and Department of Translational Medicine, SickKids Research Institute, Peter Gilgan Center for Research and Learning; P.G. Conaghan, PhD, MB BS, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust; W.P. Maksymowych, PhD, MB BS, FRACP, FRCP, Department of Rheumatology, University of Alberta; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center; P. Weiss, MD, MSCE, University of Pennsylvania Perelman School of Medicine, Division of Rheumatology, Children's Hospital of Philadelphia and Departments of Pediatric and Epidemiology; I. Sudol-Szopinska, MD, PhD, Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation; N. Herregods, MD, PhD, Department of Radiology and Medical Imaging, Ghent University Hospital; J.L. Jaremko, MD, PhD, FRCPC, Department of Radiology and Diagnostic Imaging, University of Alberta; A.B. Meyers, MD, Department of Radiology, Nemours Children's Hospital and Health System; D. Rumsey, MD, FRCPC, Division of Pediatric Rheumatology, Department of Pediatrics, University of Alberta; E.C. Inarejos, MD, Department of Radiology, Hospital Sant Joan de Deu; E. Kirkhus, MD, PhD, Department of Radiology, Rikshospitalet, Oslo University Hospital; J. Stimec, MD, FRCPC, Department of Diagnostic Imaging, The Hospital for Sick Children; J. Panwar, MD, Department of Diagnostic Imaging, The Hospital for Sick Children; K. Thorpe, BMath, MMath, Dalla Lana School of Public Health, University of Toronto; L. Jans, MD, PhD, Department of Radiology and Medical Imaging, Ghent University Hospital; M.A. van Rossum, MD, PhD, Reade
- Emma Children's Hospital/Academic Medical Center; M. Tolend, BSc, Institute of Medical Sciences, Faculty of Medicine, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children, and Department of Translational Medicine, SickKids Research Institute, Peter Gilgan Center for Research and Learning; M. Perez, MD, Department of Diagnostic Imaging, The Hospital for Sick Children; N. Tzaribachev, MD, Pediatric Rheumatology Research Institute; P. Sandhya, MD, Department of Clinical Immunology and Rheumatology, Christian Medical College; S. Tse, MD, FRCPC, Division of Rheumatology, The Hospital for Sick Children, University of Toronto; A. Simone, MD, PhD, State University of Campina-UNICAMP, Department of Internal Medicine, Cidade Universitaria; V.G. Swami, MD, BSc, Department of Medical Imaging, University of Toronto; Z. Touma, MD, PhD, FACP, FACR, Department of Rheumatology, Center for Prognosis Studies in Rheumatologic Diseases, Toronto Western Hospital; R. Lambert, MB BCh, FRCR, FRCPC, Department of Radiology and Diagnostic Imaging, University of Alberta; A.S. Doria, MD, PhD, MSc, Institute of Medical Sciences, Faculty of Medicine, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children, and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, and Department of Medical Imaging, University of Toronto
| | - Pulukool Sandhya
- From the Institute of Medical Sciences, Faculty of Medicine, University of Toronto; Department of Diagnostic Imaging, The Hospital for Sick Children; Department of Translational Medicine, SickKids Research Institute, Peter Gilgan Center for Research and Learning; Dalla Lana School of Public Health, University of Toronto; Division of Rheumatology, The Hospital for Sick Children, University of Toronto; Department of Medical Imaging, University of Toronto; Department of Rheumatology, Center for Prognosis Studies in Rheumatologic Diseases, Toronto Western Hospital, Toronto, Ontario; Department of Rheumatology, University of Alberta; Department of Radiology and Diagnostic Imaging, University of Alberta; Division of Pediatric Rheumatology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds Teaching Hospitals National Health Service (NHS) Trust, Leeds, UK; Department of Rheumatology, Leiden University Medical Center, Leiden; Reade
- Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; University of Pennsylvania Perelman School of Medicine, Division of Rheumatology, Children's Hospital of Philadelphia and Departments of Pediatric and Epidemiology, Philadelphia, Pennsylvania; Department of Radiology, Nemours Children's Hospital and Health System, Orlando, Florida, USA; Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland; Department of Radiology and Medical Imaging, Ghent University Hospital, Ghent, Belgium; Department of Radiology, Hospital Sant Joan de Deu, Barcelona, Spain; Department of Radiology, Rikshospitalet, Oslo University Hospital, Oslo, Norway; Pediatric Rheumatology Research Institute, Bad Bramstedt, Germany; Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India; State University of Campina-UNICAMP, Department of Internal Medicine, Cidade Universitaria, Sao Paulo, Brazil.,T.M. Otobo, MD, MSc, BMedSc, Institute of Medical Sciences, Faculty of Medicine, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children, and Department of Translational Medicine, SickKids Research Institute, Peter Gilgan Center for Research and Learning; P.G. Conaghan, PhD, MB BS, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust; W.P. Maksymowych, PhD, MB BS, FRACP, FRCP, Department of Rheumatology, University of Alberta; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center; P. Weiss, MD, MSCE, University of Pennsylvania Perelman School of Medicine, Division of Rheumatology, Children's Hospital of Philadelphia and Departments of Pediatric and Epidemiology; I. Sudol-Szopinska, MD, PhD, Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation; N. Herregods, MD, PhD, Department of Radiology and Medical Imaging, Ghent University Hospital; J.L. Jaremko, MD, PhD, FRCPC, Department of Radiology and Diagnostic Imaging, University of Alberta; A.B. Meyers, MD, Department of Radiology, Nemours Children's Hospital and Health System; D. Rumsey, MD, FRCPC, Division of Pediatric Rheumatology, Department of Pediatrics, University of Alberta; E.C. Inarejos, MD, Department of Radiology, Hospital Sant Joan de Deu; E. Kirkhus, MD, PhD, Department of Radiology, Rikshospitalet, Oslo University Hospital; J. Stimec, MD, FRCPC, Department of Diagnostic Imaging, The Hospital for Sick Children; J. Panwar, MD, Department of Diagnostic Imaging, The Hospital for Sick Children; K. Thorpe, BMath, MMath, Dalla Lana School of Public Health, University of Toronto; L. Jans, MD, PhD, Department of Radiology and Medical Imaging, Ghent University Hospital; M.A. van Rossum, MD, PhD, Reade
- Emma Children's Hospital/Academic Medical Center; M. Tolend, BSc, Institute of Medical Sciences, Faculty of Medicine, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children, and Department of Translational Medicine, SickKids Research Institute, Peter Gilgan Center for Research and Learning; M. Perez, MD, Department of Diagnostic Imaging, The Hospital for Sick Children; N. Tzaribachev, MD, Pediatric Rheumatology Research Institute; P. Sandhya, MD, Department of Clinical Immunology and Rheumatology, Christian Medical College; S. Tse, MD, FRCPC, Division of Rheumatology, The Hospital for Sick Children, University of Toronto; A. Simone, MD, PhD, State University of Campina-UNICAMP, Department of Internal Medicine, Cidade Universitaria; V.G. Swami, MD, BSc, Department of Medical Imaging, University of Toronto; Z. Touma, MD, PhD, FACP, FACR, Department of Rheumatology, Center for Prognosis Studies in Rheumatologic Diseases, Toronto Western Hospital; R. Lambert, MB BCh, FRCR, FRCPC, Department of Radiology and Diagnostic Imaging, University of Alberta; A.S. Doria, MD, PhD, MSc, Institute of Medical Sciences, Faculty of Medicine, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children, and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, and Department of Medical Imaging, University of Toronto
| | - Shirley Tse
- From the Institute of Medical Sciences, Faculty of Medicine, University of Toronto; Department of Diagnostic Imaging, The Hospital for Sick Children; Department of Translational Medicine, SickKids Research Institute, Peter Gilgan Center for Research and Learning; Dalla Lana School of Public Health, University of Toronto; Division of Rheumatology, The Hospital for Sick Children, University of Toronto; Department of Medical Imaging, University of Toronto; Department of Rheumatology, Center for Prognosis Studies in Rheumatologic Diseases, Toronto Western Hospital, Toronto, Ontario; Department of Rheumatology, University of Alberta; Department of Radiology and Diagnostic Imaging, University of Alberta; Division of Pediatric Rheumatology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds Teaching Hospitals National Health Service (NHS) Trust, Leeds, UK; Department of Rheumatology, Leiden University Medical Center, Leiden; Reade
- Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; University of Pennsylvania Perelman School of Medicine, Division of Rheumatology, Children's Hospital of Philadelphia and Departments of Pediatric and Epidemiology, Philadelphia, Pennsylvania; Department of Radiology, Nemours Children's Hospital and Health System, Orlando, Florida, USA; Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland; Department of Radiology and Medical Imaging, Ghent University Hospital, Ghent, Belgium; Department of Radiology, Hospital Sant Joan de Deu, Barcelona, Spain; Department of Radiology, Rikshospitalet, Oslo University Hospital, Oslo, Norway; Pediatric Rheumatology Research Institute, Bad Bramstedt, Germany; Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India; State University of Campina-UNICAMP, Department of Internal Medicine, Cidade Universitaria, Sao Paulo, Brazil.,T.M. Otobo, MD, MSc, BMedSc, Institute of Medical Sciences, Faculty of Medicine, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children, and Department of Translational Medicine, SickKids Research Institute, Peter Gilgan Center for Research and Learning; P.G. Conaghan, PhD, MB BS, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust; W.P. Maksymowych, PhD, MB BS, FRACP, FRCP, Department of Rheumatology, University of Alberta; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center; P. Weiss, MD, MSCE, University of Pennsylvania Perelman School of Medicine, Division of Rheumatology, Children's Hospital of Philadelphia and Departments of Pediatric and Epidemiology; I. Sudol-Szopinska, MD, PhD, Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation; N. Herregods, MD, PhD, Department of Radiology and Medical Imaging, Ghent University Hospital; J.L. Jaremko, MD, PhD, FRCPC, Department of Radiology and Diagnostic Imaging, University of Alberta; A.B. Meyers, MD, Department of Radiology, Nemours Children's Hospital and Health System; D. Rumsey, MD, FRCPC, Division of Pediatric Rheumatology, Department of Pediatrics, University of Alberta; E.C. Inarejos, MD, Department of Radiology, Hospital Sant Joan de Deu; E. Kirkhus, MD, PhD, Department of Radiology, Rikshospitalet, Oslo University Hospital; J. Stimec, MD, FRCPC, Department of Diagnostic Imaging, The Hospital for Sick Children; J. Panwar, MD, Department of Diagnostic Imaging, The Hospital for Sick Children; K. Thorpe, BMath, MMath, Dalla Lana School of Public Health, University of Toronto; L. Jans, MD, PhD, Department of Radiology and Medical Imaging, Ghent University Hospital; M.A. van Rossum, MD, PhD, Reade
- Emma Children's Hospital/Academic Medical Center; M. Tolend, BSc, Institute of Medical Sciences, Faculty of Medicine, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children, and Department of Translational Medicine, SickKids Research Institute, Peter Gilgan Center for Research and Learning; M. Perez, MD, Department of Diagnostic Imaging, The Hospital for Sick Children; N. Tzaribachev, MD, Pediatric Rheumatology Research Institute; P. Sandhya, MD, Department of Clinical Immunology and Rheumatology, Christian Medical College; S. Tse, MD, FRCPC, Division of Rheumatology, The Hospital for Sick Children, University of Toronto; A. Simone, MD, PhD, State University of Campina-UNICAMP, Department of Internal Medicine, Cidade Universitaria; V.G. Swami, MD, BSc, Department of Medical Imaging, University of Toronto; Z. Touma, MD, PhD, FACP, FACR, Department of Rheumatology, Center for Prognosis Studies in Rheumatologic Diseases, Toronto Western Hospital; R. Lambert, MB BCh, FRCR, FRCPC, Department of Radiology and Diagnostic Imaging, University of Alberta; A.S. Doria, MD, PhD, MSc, Institute of Medical Sciences, Faculty of Medicine, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children, and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, and Department of Medical Imaging, University of Toronto
| | - Appenzeller Simone
- From the Institute of Medical Sciences, Faculty of Medicine, University of Toronto; Department of Diagnostic Imaging, The Hospital for Sick Children; Department of Translational Medicine, SickKids Research Institute, Peter Gilgan Center for Research and Learning; Dalla Lana School of Public Health, University of Toronto; Division of Rheumatology, The Hospital for Sick Children, University of Toronto; Department of Medical Imaging, University of Toronto; Department of Rheumatology, Center for Prognosis Studies in Rheumatologic Diseases, Toronto Western Hospital, Toronto, Ontario; Department of Rheumatology, University of Alberta; Department of Radiology and Diagnostic Imaging, University of Alberta; Division of Pediatric Rheumatology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds Teaching Hospitals National Health Service (NHS) Trust, Leeds, UK; Department of Rheumatology, Leiden University Medical Center, Leiden; Reade
- Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; University of Pennsylvania Perelman School of Medicine, Division of Rheumatology, Children's Hospital of Philadelphia and Departments of Pediatric and Epidemiology, Philadelphia, Pennsylvania; Department of Radiology, Nemours Children's Hospital and Health System, Orlando, Florida, USA; Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland; Department of Radiology and Medical Imaging, Ghent University Hospital, Ghent, Belgium; Department of Radiology, Hospital Sant Joan de Deu, Barcelona, Spain; Department of Radiology, Rikshospitalet, Oslo University Hospital, Oslo, Norway; Pediatric Rheumatology Research Institute, Bad Bramstedt, Germany; Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India; State University of Campina-UNICAMP, Department of Internal Medicine, Cidade Universitaria, Sao Paulo, Brazil.,T.M. Otobo, MD, MSc, BMedSc, Institute of Medical Sciences, Faculty of Medicine, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children, and Department of Translational Medicine, SickKids Research Institute, Peter Gilgan Center for Research and Learning; P.G. Conaghan, PhD, MB BS, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust; W.P. Maksymowych, PhD, MB BS, FRACP, FRCP, Department of Rheumatology, University of Alberta; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center; P. Weiss, MD, MSCE, University of Pennsylvania Perelman School of Medicine, Division of Rheumatology, Children's Hospital of Philadelphia and Departments of Pediatric and Epidemiology; I. Sudol-Szopinska, MD, PhD, Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation; N. Herregods, MD, PhD, Department of Radiology and Medical Imaging, Ghent University Hospital; J.L. Jaremko, MD, PhD, FRCPC, Department of Radiology and Diagnostic Imaging, University of Alberta; A.B. Meyers, MD, Department of Radiology, Nemours Children's Hospital and Health System; D. Rumsey, MD, FRCPC, Division of Pediatric Rheumatology, Department of Pediatrics, University of Alberta; E.C. Inarejos, MD, Department of Radiology, Hospital Sant Joan de Deu; E. Kirkhus, MD, PhD, Department of Radiology, Rikshospitalet, Oslo University Hospital; J. Stimec, MD, FRCPC, Department of Diagnostic Imaging, The Hospital for Sick Children; J. Panwar, MD, Department of Diagnostic Imaging, The Hospital for Sick Children; K. Thorpe, BMath, MMath, Dalla Lana School of Public Health, University of Toronto; L. Jans, MD, PhD, Department of Radiology and Medical Imaging, Ghent University Hospital; M.A. van Rossum, MD, PhD, Reade
- Emma Children's Hospital/Academic Medical Center; M. Tolend, BSc, Institute of Medical Sciences, Faculty of Medicine, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children, and Department of Translational Medicine, SickKids Research Institute, Peter Gilgan Center for Research and Learning; M. Perez, MD, Department of Diagnostic Imaging, The Hospital for Sick Children; N. Tzaribachev, MD, Pediatric Rheumatology Research Institute; P. Sandhya, MD, Department of Clinical Immunology and Rheumatology, Christian Medical College; S. Tse, MD, FRCPC, Division of Rheumatology, The Hospital for Sick Children, University of Toronto; A. Simone, MD, PhD, State University of Campina-UNICAMP, Department of Internal Medicine, Cidade Universitaria; V.G. Swami, MD, BSc, Department of Medical Imaging, University of Toronto; Z. Touma, MD, PhD, FACP, FACR, Department of Rheumatology, Center for Prognosis Studies in Rheumatologic Diseases, Toronto Western Hospital; R. Lambert, MB BCh, FRCR, FRCPC, Department of Radiology and Diagnostic Imaging, University of Alberta; A.S. Doria, MD, PhD, MSc, Institute of Medical Sciences, Faculty of Medicine, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children, and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, and Department of Medical Imaging, University of Toronto
| | - Vimarsha G Swami
- From the Institute of Medical Sciences, Faculty of Medicine, University of Toronto; Department of Diagnostic Imaging, The Hospital for Sick Children; Department of Translational Medicine, SickKids Research Institute, Peter Gilgan Center for Research and Learning; Dalla Lana School of Public Health, University of Toronto; Division of Rheumatology, The Hospital for Sick Children, University of Toronto; Department of Medical Imaging, University of Toronto; Department of Rheumatology, Center for Prognosis Studies in Rheumatologic Diseases, Toronto Western Hospital, Toronto, Ontario; Department of Rheumatology, University of Alberta; Department of Radiology and Diagnostic Imaging, University of Alberta; Division of Pediatric Rheumatology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds Teaching Hospitals National Health Service (NHS) Trust, Leeds, UK; Department of Rheumatology, Leiden University Medical Center, Leiden; Reade
- Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; University of Pennsylvania Perelman School of Medicine, Division of Rheumatology, Children's Hospital of Philadelphia and Departments of Pediatric and Epidemiology, Philadelphia, Pennsylvania; Department of Radiology, Nemours Children's Hospital and Health System, Orlando, Florida, USA; Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland; Department of Radiology and Medical Imaging, Ghent University Hospital, Ghent, Belgium; Department of Radiology, Hospital Sant Joan de Deu, Barcelona, Spain; Department of Radiology, Rikshospitalet, Oslo University Hospital, Oslo, Norway; Pediatric Rheumatology Research Institute, Bad Bramstedt, Germany; Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India; State University of Campina-UNICAMP, Department of Internal Medicine, Cidade Universitaria, Sao Paulo, Brazil.,T.M. Otobo, MD, MSc, BMedSc, Institute of Medical Sciences, Faculty of Medicine, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children, and Department of Translational Medicine, SickKids Research Institute, Peter Gilgan Center for Research and Learning; P.G. Conaghan, PhD, MB BS, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust; W.P. Maksymowych, PhD, MB BS, FRACP, FRCP, Department of Rheumatology, University of Alberta; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center; P. Weiss, MD, MSCE, University of Pennsylvania Perelman School of Medicine, Division of Rheumatology, Children's Hospital of Philadelphia and Departments of Pediatric and Epidemiology; I. Sudol-Szopinska, MD, PhD, Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation; N. Herregods, MD, PhD, Department of Radiology and Medical Imaging, Ghent University Hospital; J.L. Jaremko, MD, PhD, FRCPC, Department of Radiology and Diagnostic Imaging, University of Alberta; A.B. Meyers, MD, Department of Radiology, Nemours Children's Hospital and Health System; D. Rumsey, MD, FRCPC, Division of Pediatric Rheumatology, Department of Pediatrics, University of Alberta; E.C. Inarejos, MD, Department of Radiology, Hospital Sant Joan de Deu; E. Kirkhus, MD, PhD, Department of Radiology, Rikshospitalet, Oslo University Hospital; J. Stimec, MD, FRCPC, Department of Diagnostic Imaging, The Hospital for Sick Children; J. Panwar, MD, Department of Diagnostic Imaging, The Hospital for Sick Children; K. Thorpe, BMath, MMath, Dalla Lana School of Public Health, University of Toronto; L. Jans, MD, PhD, Department of Radiology and Medical Imaging, Ghent University Hospital; M.A. van Rossum, MD, PhD, Reade
- Emma Children's Hospital/Academic Medical Center; M. Tolend, BSc, Institute of Medical Sciences, Faculty of Medicine, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children, and Department of Translational Medicine, SickKids Research Institute, Peter Gilgan Center for Research and Learning; M. Perez, MD, Department of Diagnostic Imaging, The Hospital for Sick Children; N. Tzaribachev, MD, Pediatric Rheumatology Research Institute; P. Sandhya, MD, Department of Clinical Immunology and Rheumatology, Christian Medical College; S. Tse, MD, FRCPC, Division of Rheumatology, The Hospital for Sick Children, University of Toronto; A. Simone, MD, PhD, State University of Campina-UNICAMP, Department of Internal Medicine, Cidade Universitaria; V.G. Swami, MD, BSc, Department of Medical Imaging, University of Toronto; Z. Touma, MD, PhD, FACP, FACR, Department of Rheumatology, Center for Prognosis Studies in Rheumatologic Diseases, Toronto Western Hospital; R. Lambert, MB BCh, FRCR, FRCPC, Department of Radiology and Diagnostic Imaging, University of Alberta; A.S. Doria, MD, PhD, MSc, Institute of Medical Sciences, Faculty of Medicine, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children, and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, and Department of Medical Imaging, University of Toronto
| | - Zahi Touma
- From the Institute of Medical Sciences, Faculty of Medicine, University of Toronto; Department of Diagnostic Imaging, The Hospital for Sick Children; Department of Translational Medicine, SickKids Research Institute, Peter Gilgan Center for Research and Learning; Dalla Lana School of Public Health, University of Toronto; Division of Rheumatology, The Hospital for Sick Children, University of Toronto; Department of Medical Imaging, University of Toronto; Department of Rheumatology, Center for Prognosis Studies in Rheumatologic Diseases, Toronto Western Hospital, Toronto, Ontario; Department of Rheumatology, University of Alberta; Department of Radiology and Diagnostic Imaging, University of Alberta; Division of Pediatric Rheumatology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds Teaching Hospitals National Health Service (NHS) Trust, Leeds, UK; Department of Rheumatology, Leiden University Medical Center, Leiden; Reade
- Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; University of Pennsylvania Perelman School of Medicine, Division of Rheumatology, Children's Hospital of Philadelphia and Departments of Pediatric and Epidemiology, Philadelphia, Pennsylvania; Department of Radiology, Nemours Children's Hospital and Health System, Orlando, Florida, USA; Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland; Department of Radiology and Medical Imaging, Ghent University Hospital, Ghent, Belgium; Department of Radiology, Hospital Sant Joan de Deu, Barcelona, Spain; Department of Radiology, Rikshospitalet, Oslo University Hospital, Oslo, Norway; Pediatric Rheumatology Research Institute, Bad Bramstedt, Germany; Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India; State University of Campina-UNICAMP, Department of Internal Medicine, Cidade Universitaria, Sao Paulo, Brazil.,T.M. Otobo, MD, MSc, BMedSc, Institute of Medical Sciences, Faculty of Medicine, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children, and Department of Translational Medicine, SickKids Research Institute, Peter Gilgan Center for Research and Learning; P.G. Conaghan, PhD, MB BS, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust; W.P. Maksymowych, PhD, MB BS, FRACP, FRCP, Department of Rheumatology, University of Alberta; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center; P. Weiss, MD, MSCE, University of Pennsylvania Perelman School of Medicine, Division of Rheumatology, Children's Hospital of Philadelphia and Departments of Pediatric and Epidemiology; I. Sudol-Szopinska, MD, PhD, Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation; N. Herregods, MD, PhD, Department of Radiology and Medical Imaging, Ghent University Hospital; J.L. Jaremko, MD, PhD, FRCPC, Department of Radiology and Diagnostic Imaging, University of Alberta; A.B. Meyers, MD, Department of Radiology, Nemours Children's Hospital and Health System; D. Rumsey, MD, FRCPC, Division of Pediatric Rheumatology, Department of Pediatrics, University of Alberta; E.C. Inarejos, MD, Department of Radiology, Hospital Sant Joan de Deu; E. Kirkhus, MD, PhD, Department of Radiology, Rikshospitalet, Oslo University Hospital; J. Stimec, MD, FRCPC, Department of Diagnostic Imaging, The Hospital for Sick Children; J. Panwar, MD, Department of Diagnostic Imaging, The Hospital for Sick Children; K. Thorpe, BMath, MMath, Dalla Lana School of Public Health, University of Toronto; L. Jans, MD, PhD, Department of Radiology and Medical Imaging, Ghent University Hospital; M.A. van Rossum, MD, PhD, Reade
- Emma Children's Hospital/Academic Medical Center; M. Tolend, BSc, Institute of Medical Sciences, Faculty of Medicine, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children, and Department of Translational Medicine, SickKids Research Institute, Peter Gilgan Center for Research and Learning; M. Perez, MD, Department of Diagnostic Imaging, The Hospital for Sick Children; N. Tzaribachev, MD, Pediatric Rheumatology Research Institute; P. Sandhya, MD, Department of Clinical Immunology and Rheumatology, Christian Medical College; S. Tse, MD, FRCPC, Division of Rheumatology, The Hospital for Sick Children, University of Toronto; A. Simone, MD, PhD, State University of Campina-UNICAMP, Department of Internal Medicine, Cidade Universitaria; V.G. Swami, MD, BSc, Department of Medical Imaging, University of Toronto; Z. Touma, MD, PhD, FACP, FACR, Department of Rheumatology, Center for Prognosis Studies in Rheumatologic Diseases, Toronto Western Hospital; R. Lambert, MB BCh, FRCR, FRCPC, Department of Radiology and Diagnostic Imaging, University of Alberta; A.S. Doria, MD, PhD, MSc, Institute of Medical Sciences, Faculty of Medicine, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children, and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, and Department of Medical Imaging, University of Toronto
| | - Robert Lambert
- From the Institute of Medical Sciences, Faculty of Medicine, University of Toronto; Department of Diagnostic Imaging, The Hospital for Sick Children; Department of Translational Medicine, SickKids Research Institute, Peter Gilgan Center for Research and Learning; Dalla Lana School of Public Health, University of Toronto; Division of Rheumatology, The Hospital for Sick Children, University of Toronto; Department of Medical Imaging, University of Toronto; Department of Rheumatology, Center for Prognosis Studies in Rheumatologic Diseases, Toronto Western Hospital, Toronto, Ontario; Department of Rheumatology, University of Alberta; Department of Radiology and Diagnostic Imaging, University of Alberta; Division of Pediatric Rheumatology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds Teaching Hospitals National Health Service (NHS) Trust, Leeds, UK; Department of Rheumatology, Leiden University Medical Center, Leiden; Reade
- Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; University of Pennsylvania Perelman School of Medicine, Division of Rheumatology, Children's Hospital of Philadelphia and Departments of Pediatric and Epidemiology, Philadelphia, Pennsylvania; Department of Radiology, Nemours Children's Hospital and Health System, Orlando, Florida, USA; Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland; Department of Radiology and Medical Imaging, Ghent University Hospital, Ghent, Belgium; Department of Radiology, Hospital Sant Joan de Deu, Barcelona, Spain; Department of Radiology, Rikshospitalet, Oslo University Hospital, Oslo, Norway; Pediatric Rheumatology Research Institute, Bad Bramstedt, Germany; Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India; State University of Campina-UNICAMP, Department of Internal Medicine, Cidade Universitaria, Sao Paulo, Brazil.,T.M. Otobo, MD, MSc, BMedSc, Institute of Medical Sciences, Faculty of Medicine, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children, and Department of Translational Medicine, SickKids Research Institute, Peter Gilgan Center for Research and Learning; P.G. Conaghan, PhD, MB BS, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust; W.P. Maksymowych, PhD, MB BS, FRACP, FRCP, Department of Rheumatology, University of Alberta; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center; P. Weiss, MD, MSCE, University of Pennsylvania Perelman School of Medicine, Division of Rheumatology, Children's Hospital of Philadelphia and Departments of Pediatric and Epidemiology; I. Sudol-Szopinska, MD, PhD, Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation; N. Herregods, MD, PhD, Department of Radiology and Medical Imaging, Ghent University Hospital; J.L. Jaremko, MD, PhD, FRCPC, Department of Radiology and Diagnostic Imaging, University of Alberta; A.B. Meyers, MD, Department of Radiology, Nemours Children's Hospital and Health System; D. Rumsey, MD, FRCPC, Division of Pediatric Rheumatology, Department of Pediatrics, University of Alberta; E.C. Inarejos, MD, Department of Radiology, Hospital Sant Joan de Deu; E. Kirkhus, MD, PhD, Department of Radiology, Rikshospitalet, Oslo University Hospital; J. Stimec, MD, FRCPC, Department of Diagnostic Imaging, The Hospital for Sick Children; J. Panwar, MD, Department of Diagnostic Imaging, The Hospital for Sick Children; K. Thorpe, BMath, MMath, Dalla Lana School of Public Health, University of Toronto; L. Jans, MD, PhD, Department of Radiology and Medical Imaging, Ghent University Hospital; M.A. van Rossum, MD, PhD, Reade
- Emma Children's Hospital/Academic Medical Center; M. Tolend, BSc, Institute of Medical Sciences, Faculty of Medicine, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children, and Department of Translational Medicine, SickKids Research Institute, Peter Gilgan Center for Research and Learning; M. Perez, MD, Department of Diagnostic Imaging, The Hospital for Sick Children; N. Tzaribachev, MD, Pediatric Rheumatology Research Institute; P. Sandhya, MD, Department of Clinical Immunology and Rheumatology, Christian Medical College; S. Tse, MD, FRCPC, Division of Rheumatology, The Hospital for Sick Children, University of Toronto; A. Simone, MD, PhD, State University of Campina-UNICAMP, Department of Internal Medicine, Cidade Universitaria; V.G. Swami, MD, BSc, Department of Medical Imaging, University of Toronto; Z. Touma, MD, PhD, FACP, FACR, Department of Rheumatology, Center for Prognosis Studies in Rheumatologic Diseases, Toronto Western Hospital; R. Lambert, MB BCh, FRCR, FRCPC, Department of Radiology and Diagnostic Imaging, University of Alberta; A.S. Doria, MD, PhD, MSc, Institute of Medical Sciences, Faculty of Medicine, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children, and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, and Department of Medical Imaging, University of Toronto
| | - Andrea S Doria
- From the Institute of Medical Sciences, Faculty of Medicine, University of Toronto; Department of Diagnostic Imaging, The Hospital for Sick Children; Department of Translational Medicine, SickKids Research Institute, Peter Gilgan Center for Research and Learning; Dalla Lana School of Public Health, University of Toronto; Division of Rheumatology, The Hospital for Sick Children, University of Toronto; Department of Medical Imaging, University of Toronto; Department of Rheumatology, Center for Prognosis Studies in Rheumatologic Diseases, Toronto Western Hospital, Toronto, Ontario; Department of Rheumatology, University of Alberta; Department of Radiology and Diagnostic Imaging, University of Alberta; Division of Pediatric Rheumatology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds Teaching Hospitals National Health Service (NHS) Trust, Leeds, UK; Department of Rheumatology, Leiden University Medical Center, Leiden; Reade
- Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands; University of Pennsylvania Perelman School of Medicine, Division of Rheumatology, Children's Hospital of Philadelphia and Departments of Pediatric and Epidemiology, Philadelphia, Pennsylvania; Department of Radiology, Nemours Children's Hospital and Health System, Orlando, Florida, USA; Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland; Department of Radiology and Medical Imaging, Ghent University Hospital, Ghent, Belgium; Department of Radiology, Hospital Sant Joan de Deu, Barcelona, Spain; Department of Radiology, Rikshospitalet, Oslo University Hospital, Oslo, Norway; Pediatric Rheumatology Research Institute, Bad Bramstedt, Germany; Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India; State University of Campina-UNICAMP, Department of Internal Medicine, Cidade Universitaria, Sao Paulo, Brazil. .,T.M. Otobo, MD, MSc, BMedSc, Institute of Medical Sciences, Faculty of Medicine, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children, and Department of Translational Medicine, SickKids Research Institute, Peter Gilgan Center for Research and Learning; P.G. Conaghan, PhD, MB BS, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust; W.P. Maksymowych, PhD, MB BS, FRACP, FRCP, Department of Rheumatology, University of Alberta; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center; P. Weiss, MD, MSCE, University of Pennsylvania Perelman School of Medicine, Division of Rheumatology, Children's Hospital of Philadelphia and Departments of Pediatric and Epidemiology; I. Sudol-Szopinska, MD, PhD, Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation; N. Herregods, MD, PhD, Department of Radiology and Medical Imaging, Ghent University Hospital; J.L. Jaremko, MD, PhD, FRCPC, Department of Radiology and Diagnostic Imaging, University of Alberta; A.B. Meyers, MD, Department of Radiology, Nemours Children's Hospital and Health System; D. Rumsey, MD, FRCPC, Division of Pediatric Rheumatology, Department of Pediatrics, University of Alberta; E.C. Inarejos, MD, Department of Radiology, Hospital Sant Joan de Deu; E. Kirkhus, MD, PhD, Department of Radiology, Rikshospitalet, Oslo University Hospital; J. Stimec, MD, FRCPC, Department of Diagnostic Imaging, The Hospital for Sick Children; J. Panwar, MD, Department of Diagnostic Imaging, The Hospital for Sick Children; K. Thorpe, BMath, MMath, Dalla Lana School of Public Health, University of Toronto; L. Jans, MD, PhD, Department of Radiology and Medical Imaging, Ghent University Hospital; M.A. van Rossum, MD, PhD, Reade
- Emma Children's Hospital/Academic Medical Center; M. Tolend, BSc, Institute of Medical Sciences, Faculty of Medicine, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children, and Department of Translational Medicine, SickKids Research Institute, Peter Gilgan Center for Research and Learning; M. Perez, MD, Department of Diagnostic Imaging, The Hospital for Sick Children; N. Tzaribachev, MD, Pediatric Rheumatology Research Institute; P. Sandhya, MD, Department of Clinical Immunology and Rheumatology, Christian Medical College; S. Tse, MD, FRCPC, Division of Rheumatology, The Hospital for Sick Children, University of Toronto; A. Simone, MD, PhD, State University of Campina-UNICAMP, Department of Internal Medicine, Cidade Universitaria; V.G. Swami, MD, BSc, Department of Medical Imaging, University of Toronto; Z. Touma, MD, PhD, FACP, FACR, Department of Rheumatology, Center for Prognosis Studies in Rheumatologic Diseases, Toronto Western Hospital; R. Lambert, MB BCh, FRCR, FRCPC, Department of Radiology and Diagnostic Imaging, University of Alberta; A.S. Doria, MD, PhD, MSc, Institute of Medical Sciences, Faculty of Medicine, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children, and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, and Department of Medical Imaging, University of Toronto.
| |
Collapse
|
49
|
Abstract
Juvenile spondyloarthritis may be present in at least 3 subtypes of juvenile idiopathic arthritis according to the classification of the International League of Associations for Rheumatology. By contrast with spondyloarthritis in adults, juvenile spondyloarthritis starts with inflammation of peripheral joints and entheses in the majority of children, whereas sacroiliitis and spondylitis may develop many years after the disease onset. Peripheral joint involvement makes it difficult to differentiate juvenile spondyloarthritis from other juvenile idiopathic arthritis subtypes. Sacroiliitis, and especially spondylitis, although infrequent in childhood, may manifest as low back pain. In clinical practice, radiographs of the sacroiliac joints or pelvis are performed in most of the cases even though magnetic resonance imaging offers more accurate diagnosis of sacroiliitis. Neither disease classification criteria nor imaging recommendations have taken this advantage into account in patients with juvenile spondyloarthritis. The use of magnetic resonance imaging in evaluation of children and adolescents with a clinical suspicion of sacroiliitis would improve early diagnosis, identification of inflammatory changes and treatment. In this paper, we present the imaging features of juvenile spondyloarthritis in juvenile ankylosing spondylitis, juvenile psoriatic arthritis, reactive arthritis with spondyloarthritis, and juvenile arthropathies associated with inflammatory bowel disease.
Collapse
Affiliation(s)
- Iwona Sudoł-Szopińska
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Iris Eshed
- Department of Radiology, Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lennart Jans
- Department of Radiology, Ghent University Hospital, Ghent, Belgium
| | - Nele Herregods
- Nele Herregods, Ghent University Hospital, Ghent, Belgium
| | - James Teh
- Department of Radiology, Nuffield Orthopedic Center, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Jelena Vojinovic
- University of Nis, Faculty of Medicine, Department of Pediatric Rheumatology and Immunology, Serbia
| |
Collapse
|
50
|
Jans L, De Kock I, Herregods N, Verstraete KL, Van den Bosch FE, Carron P, Oei EH, Elewaut D, Jacques P. Response to: 'Use of dual-energy CT to detect and depict bone marrow oedema in rheumatoid arthritis: is it ready to substitute MRI?' by Wu et al. Ann Rheum Dis 2018; 78:e90. [PMID: 30002086 DOI: 10.1136/annrheumdis-2018-213960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 06/28/2018] [Indexed: 11/04/2022]
Affiliation(s)
- Lennart Jans
- Department of Radiology, Ghent University Hospital, Ghent, Belgium
| | - Isabelle De Kock
- Department of Radiology, Ghent University Hospital, Ghent, Belgium
| | - Nele Herregods
- Department of Radiology, Ghent University Hospital, Ghent, Belgium
| | | | - Filip E Van den Bosch
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium.,Department of Rheumatology and VIB Inflammation Research Center, Unit for Molecular Immunology and Inflammation, Ghent University Hospital, Ghent, Belgium
| | - Philippe Carron
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium.,Department of Rheumatology and VIB Inflammation Research Center, Unit for Molecular Immunology and Inflammation, Ghent University Hospital, Ghent, Belgium
| | - Edwin H Oei
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Dirk Elewaut
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium.,Department of Rheumatology and VIB Inflammation Research Center, Unit for Molecular Immunology and Inflammation, Ghent University Hospital, Ghent, Belgium
| | - Peggy Jacques
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium.,Department of Rheumatology and VIB Inflammation Research Center, Unit for Molecular Immunology and Inflammation, Ghent University Hospital, Ghent, Belgium
| |
Collapse
|