Measuring synovial thickness on knee MRI in pediatric patients with arthritis: is contrast necessary?
Child
Contrast
Juvenile idiopathic arthritis (JIA)
Magnetic resonance imaging (MRI)
Synovial thickness
Synovitis
Journal
Pediatric radiology
ISSN: 1432-1998
Titre abrégé: Pediatr Radiol
Pays: Germany
ID NLM: 0365332
Informations de publication
Date de publication:
19 Apr 2024
19 Apr 2024
Historique:
received:
22
12
2023
accepted:
08
04
2024
revised:
06
04
2024
medline:
20
4
2024
pubmed:
20
4
2024
entrez:
19
4
2024
Statut:
aheadofprint
Résumé
The use of contrast-enhanced imaging has long been standard for magnetic resonance imaging (MRI) assessments of synovitis in juvenile idiopathic arthritis (JIA). However, advancements in MRI technology have allowed for reliable identification of synovium without contrast. To assess the equivalence of unenhanced MRI with contrast-enhanced MRI in evaluating synovial thickness. This is an institutional review board approved, retrospective study performed in a tertiary children's hospital. Pediatric JIA patients under 21 years old were included who underwent knee MRI scans (1.5 T or 3 T) without and with contrast between January 2012 and January 2022. Two radiologists independently measured synovial thickness at 6 knee sites on contrast-enhanced and unenhanced sequences. Numerical measurements and ordinal scores based on juvenile idiopathic arthritis magnetic resonance imaging scoring (JAMRIS) system were recorded, and tests of equivalence were conducted, as well as between-reader and within-reader reliability by concordance correlation coefficient (CCC). All tests were considered significant at the 5% level. A total of 38 studies from 35 patients (25 females, median age 14 years; interquartile range 7 to 15.7) were included. Equivalence was demonstrated at each of the 6 sites for both continuous measurements (P-values < 0.05) and ordinal scores (P-values < 0.05) based on the average over readers. Within-reader reliability was moderate to high (CCC 0.50-0.89), except for the cruciate ligaments site. Averaged over the 6 sites, reliability between readers was low for unenhanced (CCC 0.47, with 95% CI: [0.41, 0.53]) and moderate for contrast-enhanced (CCC 0.64, with 95% CI: [0.59, 0.69]) sequences. Unenhanced knee MRI is equivalent to contrast-enhanced MRI in assessment of synovial thickness using conventional MRI sequences. Contrast material helped improve inter-reader reliability.
Sections du résumé
BACKGROUND
BACKGROUND
The use of contrast-enhanced imaging has long been standard for magnetic resonance imaging (MRI) assessments of synovitis in juvenile idiopathic arthritis (JIA). However, advancements in MRI technology have allowed for reliable identification of synovium without contrast.
OBJECTIVE
OBJECTIVE
To assess the equivalence of unenhanced MRI with contrast-enhanced MRI in evaluating synovial thickness.
MATERIALS AND METHODS
METHODS
This is an institutional review board approved, retrospective study performed in a tertiary children's hospital. Pediatric JIA patients under 21 years old were included who underwent knee MRI scans (1.5 T or 3 T) without and with contrast between January 2012 and January 2022. Two radiologists independently measured synovial thickness at 6 knee sites on contrast-enhanced and unenhanced sequences. Numerical measurements and ordinal scores based on juvenile idiopathic arthritis magnetic resonance imaging scoring (JAMRIS) system were recorded, and tests of equivalence were conducted, as well as between-reader and within-reader reliability by concordance correlation coefficient (CCC). All tests were considered significant at the 5% level.
RESULTS
RESULTS
A total of 38 studies from 35 patients (25 females, median age 14 years; interquartile range 7 to 15.7) were included. Equivalence was demonstrated at each of the 6 sites for both continuous measurements (P-values < 0.05) and ordinal scores (P-values < 0.05) based on the average over readers. Within-reader reliability was moderate to high (CCC 0.50-0.89), except for the cruciate ligaments site. Averaged over the 6 sites, reliability between readers was low for unenhanced (CCC 0.47, with 95% CI: [0.41, 0.53]) and moderate for contrast-enhanced (CCC 0.64, with 95% CI: [0.59, 0.69]) sequences.
CONCLUSION
CONCLUSIONS
Unenhanced knee MRI is equivalent to contrast-enhanced MRI in assessment of synovial thickness using conventional MRI sequences. Contrast material helped improve inter-reader reliability.
Identifiants
pubmed: 38641735
doi: 10.1007/s00247-024-05929-1
pii: 10.1007/s00247-024-05929-1
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
Références
Ravelli A, Martini A (2007) Juvenile idiopathic arthritis. Lancet 369:767–778.
doi: 10.1016/S0140-6736(07)60363-8
pubmed: 17336654
Gabriel SE, Michaud K (2009) Epidemiological studies in incidence, prevalence, mortality, and comorbidity of the rheumatic diseases. Arthritis Res Ther 11:229.
doi: 10.1186/ar2669
pubmed: 19519924
pmcid: 2714099
Hemke R, Doria AS, Tzaribachev N et al (2014) Selecting magnetic resonance imaging (MRI) outcome measures for juvenile idiopathic arthritis (JIA) clinical trials: first report of the MRI in JIA special interest group. J Rheumatol 41:354–358.
doi: 10.3899/jrheum.131081
pubmed: 24187109
Selvaag AM, Flato B, Dale K et al (2006) Radiographic and clinical outcome in early juvenile rheumatoid arthritis and juvenile spondyloarthropathy: a 3-year prospective study. J Rheumatol 33:1382–1391
pubmed: 16758503
Wallace CA, Giannini EH, Spalding SJ et al (2014) Clinically inactive disease in a cohort of children with new-onset polyarticular juvenile idiopathic arthritis treated with early aggressive therapy: time to achievement, total duration, and predictors. J Rheumatol 41:1163–1170.
doi: 10.3899/jrheum.131503
pubmed: 24786928
Johnson K (2006) Imaging of juvenile idiopathic arthritis. Pediatr Radiol 36:743–758.
doi: 10.1007/s00247-006-0199-x
pubmed: 16741713
Magni-Manzoni S, Malattia C, Lanni S, Ravelli A (2012) Advances and challenges in imaging in juvenile idiopathic arthritis. Nat Rev Rheumatol 8:329–336.
doi: 10.1038/nrrheum.2012.30
pubmed: 22450553
Hemke R, Maas M, van Veenendaal M et al (2014) Contrast-enhanced MRI compared with the physical examination in the evaluation of disease activity in juvenile idiopathic arthritis. Eur Radiol 24:327–334.
doi: 10.1007/s00330-013-3036-2
pubmed: 24101236
Gylys-Morin VM, Graham TB, Blebea JS et al (2001) Knee in early juvenile rheumatoid arthritis: MR imaging findings. Radiology 220:696–706.
doi: 10.1148/radiol.2203000461
pubmed: 11526269
Malattia C, Damasio MB, Magnaguagno F et al (2008) Magnetic resonance imaging, ultrasonography, and conventional radiography in the assessment of bone erosions in juvenile idiopathic arthritis. Arthritis Rheum 59:1764–1772.
doi: 10.1002/art.24313
pubmed: 19035414
Miller E, Uleryk E, Doria AS (2009) Evidence-based outcomes of studies addressing diagnostic accuracy of MRI of juvenile idiopathic arthritis. AJR Am J Roentgenol 192:1209–1218.
doi: 10.2214/AJR.08.2304
pubmed: 19380543
Hemke R, van Veenendaal M, Kuijpers TW et al (2012) Increasing feasibility and patient comfort of MRI in children with juvenile idiopathic arthritis. Pediatr Radiol 42:440–448.
doi: 10.1007/s00247-011-2306-x
pubmed: 22246410
pmcid: 3316772
Tanturri de Horatio L, Damasio MB, Barbuti D et al (2012) MRI assessment of bone marrow in children with juvenile idiopathic arthritis: intra- and inter-observer variability. Pediatr Radiol 42:714–720.
doi: 10.1007/s00247-012-2345-y
pubmed: 22426566
Hemke R, van Rossum MA, van Veenendaal M et al (2013) Reliability and responsiveness of the Juvenile Arthritis MRI Scoring (JAMRIS) system for the knee. Eur Radiol 23:1075–1083.
doi: 10.1007/s00330-012-2684-y
pubmed: 23085866
Hemke R, Tzaribachev N, Nusman CM et al (2017) Magnetic Resonance Imaging (MRI) of the knee as an Outcome measure in Juvenile Idiopathic Arthritis: an OMERACT reliability study on MRI scales. J Rheumatol 44:1224–1230.
doi: 10.3899/jrheum.160821
pubmed: 28572469
Hemke R, van den Berg JM, Nusman CM et al (2018) Contrast-enhanced MRI findings of the knee in healthy children; establishing normal values. Eur Radiol 28:1167–1174.
doi: 10.1007/s00330-017-5067-6
pubmed: 28986634
Herve-Somma CM, Sebag GH, Prieur AM et al (1992) Juvenile rheumatoid arthritis of the knee: MR evaluation with Gd-DOTA. Radiology 182:93–98.
doi: 10.1148/radiology.182.1.1727317
pubmed: 1727317
Lamer S, Sebag GH (2000) MRI and ultrasound in children with juvenile chronic arthritis. Eur J Radiol 33:85–93.
doi: 10.1016/s0720-048x(99)00158-8
pubmed: 10711509
Uhl M, Krauss M, Kern S et al (2001) The knee joint in early juvenile idiopathic arthritis. An ROC study for evaluating the diagnostic accuracy of contrast-enhanced MR imaging. Acta Radiol 42:6–9
pubmed: 11167323
Johnson K, Wittkop B, Haigh F et al (2002) The early magnetic resonance imaging features of the knee in juvenile idiopathic arthritis. Clin Radiol 57:466–471.
doi: 10.1053/crad.2001.0876
pubmed: 12069461
Hemke R, Kuijpers TW, van den Berg JM et al (2013) The diagnostic accuracy of unenhanced MRI in the assessment of joint abnormalities in juvenile idiopathic arthritis. Eur Radiol 23:1998–2004.
doi: 10.1007/s00330-013-2770-9
pubmed: 23370941
Stomp W, Krabben A, van der Heijde D et al (2015) Aiming for a simpler early arthritis MRI protocol: can Gd contrast administration be eliminated? Eur Radiol 25:1520–1527.
doi: 10.1007/s00330-014-3522-1
pubmed: 25636414
Eshed I, Krabbe S, Ostergaard M et al (2015) Influence of field strength, coil type and image resolution on assessment of synovitis by unenhanced MRI–a comparison with contrast-enhanced MRI. Eur Radiol 25:1059–1067.
doi: 10.1007/s00330-014-3470-9
pubmed: 25537977
Nusman CM, Ording Muller LS, Hemke R et al (2016) Current status of efforts on standardizing magnetic resonance imaging of Juvenile Idiopathic Arthritis: Report from the OMERACT MRI in JIA Working Group and Health-e-Child. J Rheumatol 43:239–244.
doi: 10.3899/jrheum.141276
pubmed: 25979714
White CM, Kesler WW, Miner L, Flemming D (2022) MR imaging knee Synovitis and Synovial Pathology. Magn Reson Imaging Clin N Am 30:277–291.
doi: 10.1016/j.mric.2021.11.007
pubmed: 35512890
Bhargava R, Hahn G, Hirsch W et al (2013) Contrast-enhanced magnetic resonance imaging in pediatric patients: review and recommendations for current practice. Magn Reson Insights 6:95–111.
doi: 10.4137/MRI.S12561
pubmed: 25114547
pmcid: 4089734
Ostergaard M, Conaghan PG, O’Connor P et al (2009) Reducing invasiveness, duration, and cost of magnetic resonance imaging in rheumatoid arthritis by omitting intravenous contrast injection -- does it change the assessment of inflammatory and destructive joint changes by the OMERACT RAMRIS? J Rheumatol 36:1806–1810.
doi: 10.3899/jrheum.090350
pubmed: 19671817
Tamai M, Kawakami A, Uetani M et al (2012) Magnetic resonance imaging (MRI) detection of synovitis and bone lesions of the wrists and finger joints in early-stage rheumatoid arthritis: comparison of the accuracy of plain MRI-based findings and gadolinium-diethylenetriamine pentaacetic acid-enhanced MRI-based findings. Mod Rheumatol 22:654–658.
doi: 10.1007/s10165-011-0575-8
pubmed: 22203216
Burke CJ, Alizai H, Beltran LS, Regatte RR (2019) MRI of synovitis and joint fluid. J Magn Reson Imaging 49:1512–1527.
doi: 10.1002/jmri.26618
pubmed: 30618151
pmcid: 6504589
Vo Chieu VD, Vo Chieu V, Dressler F et al (2023) Juvenile idiopathic arthritis of the knee: is contrast needed to score disease activity when using an augmented MRI protocol comprising PD-weighted sequences? Eur Radiol 33:3775–3784.
doi: 10.1007/s00330-022-09292-3
pubmed: 36472701
Milks KS, Singh J, Benedict JA, Rees MA (2023) Fluid-attenuated inversion-recovery sequence with fat suppression as an alternative to contrast-enhanced MRI in pediatric synovitis. Pediatr Radiol.
doi: 10.1007/s00247-023-05804-5
pubmed: 37962605
Fitzmaurice GM (2011) Applied longitudinal analysis. Wiley, Hoboken, New Jersey
doi: 10.1002/9781119513469
SAS Institute Inc (2015) SAS/IML® 14.1 user’s guide. Cary NSII
Lin LI (1989) A concordance correlation coefficient to evaluate reproducibility. Biometrics 45:255–268
doi: 10.2307/2532051
pubmed: 2720055
Everitt BS (1981) Statistical Methods for Rates and Proportions. Biometric Society, pp 867–867
Ostergaard M, Klarlund M (2001) Importance of timing of post-contrast MRI in rheumatoid arthritis: what happens during the first 60 minutes after IV gadolinium-DTPA? Ann Rheum Dis 60:1050–1054.
doi: 10.1136/ard.60.11.1050
pubmed: 11602477
pmcid: 1753422