Assessing the Reliability of the OMERACT Juvenile Idiopathic Arthritis Magnetic Resonance Scoring System for Temporomandibular Joints (JAMRIS-TMJ)

Abstract

Contrast-enhanced magnetic resonance imaging (MRI) remains the most comprehensive modality to assess juvenile idiopathic arthritis (JIA)-related inflammation and osteochondral damage in the temporomandibular joints (TMJ). This study tested the reliability of a new JIA MRI scoring system for TMJ (JAMRIS-TMJ) and the impact of variations in calibration and reader specialty. Thirty-one MRI exams of bilateral TMJs were scored independently using the JAMRIS-TMJ by 20 readers consisting of radiologists and non-radiologist clinicians in three reading groups, with or without a calibrating atlas and/or tutorial. The inter-reader reliability in the multidisciplinary cohort assessed by the generalizability coefficient was 0.61–0.67 for the inflammatory and 0.66–0.74 for the damage domain. The atlas and tutorial did not improve agreement within radiologists, but improved the agreement between radiologist and non-radiologist groups. Agreements between different calibration levels were 0.02 to 0.08 lower by the generalizability coefficient compared to agreement within calibration levels; agreement between specialty groups was 0.04 to 0.10 lower than within specialty groups. Averaging two radiologists raised the reliability above 0.8 for both domains. Therefore, the reliability of JAMRIS-TMJ was moderate-to-good depending on the presence of specialty and calibration differences. The atlas and tutorial are necessary to improve reliability when the reader cohort consists of multiple specialties.

Management of Orofacial Manifestations of Juvenile Idiopathic Arthritis: Interdisciplinary Consensus‐Based Recommendations

“…This recommendation specifies “active” TMJ inflammation to differentiate from TMJ involvement without active inflammation (Table 1 ) ( 15 ). The use of JIA‐specific TMJ MRI protocols and scoring systems is recommended ( 22 , 23 , 24 , 25 ). It is recognized that the interpretation of MRI findings has an element of subjectivity and is influenced by the technique and equipment used for image capture, as well as by the expertise of the reader.…”

The Role of Ultrasound in Temporomandibular Joint Disorders: An Update and Future Perspectives

“…MRI is currently regarded as the gold standard imaging technique for the evaluation of TMJ pathology, as it can accurately identify both the active and chronic arthritic sequelae ( 65 ). This opinion is based on reliable parameters in terms of sensitivity and specificity from numerous studies and systematic reviews of the literature ( 21 , 25 , 28 , 64 ); only the EULAR guidelines for JIA management recommend MRI for the diagnosis and follow-up evaluation of TMJ ( 80 ).…”

“…Therefore, MRI is now regarded as the current imaging “gold standard” for the evaluation of inflammatory processes in TMJ pathology, as it can identify both active arthritis changes as well as arthritic sequelae, showing a moderate-to-good reliability ( 21 , 25 , 26 , 28 , 41 , 63 – 65 ).…”

Advances in Musculoskeletal Imaging in Juvenile Idiopathic Arthritis

“…Both closed- and open-mouth views can be performed for the optimal assessment of the mandibular condyle morphology, and the disc position and function, although recent studies have suggested that only closed-mouth views suffice. MRI scoring systems for TMJ involvement by JIA are available [ 57 , 58 , 59 ]. MRI definitely improved patient management, whereas US, despite efforts to prove its diagnostic relevance [ 60 , 61 ], has lagged behind: not only is US insensitive to small amounts of effusion and synovitis, it does not provide any information on BME when it may be the only pathology.…”