Inter- and intra-observer reliability of contrast-enhanced magnetic resonance imaging parameters in children with suspected juvenile idiopathic arthritis of the hip
Abstract:There were large differences across variables and only moderate agreement between observers. The most reliable parameters were presence of joint effusion and bone marrow oedema and subjective assessment of synovium.
“…Imaging is regularly used as a diagnostic adjunct in JIA to support clinical evaluation [ 25 ]. Plain radiographs have previously been the traditional first-line imaging of choice.…”
Section: Diagnosis Of Jiamentioning
confidence: 99%
“…Plain radiographs have previously been the traditional first-line imaging of choice. However, increasingly more varied imaging techniques are being employed to detect active inflammation such as musculoskeletal ultrasonography and contrast enhanced magnetic resonance imaging (MRI) [ 25 ]. These imaging tools contribute greater diagnostic value than plain radiograph imaging, but they are relatively expensive and remain less accessible than is needed for routine use in the outpatient clinic setting.…”
Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease of childhood and is characterized by an often insidious onset and a chronic relapsing–remitting course, once diagnosed. With successive flares of joint inflammation, joint damage accrues, often associated with pain and functional disability. The progressive nature and potential for chronic damage and disability caused by JIA emphasizes the critical need for a prompt and accurate diagnosis. This article provides a review of recent studies related to diagnosis, monitoring and management of JIA and outlines recent novel tools and techniques (infrared thermal imaging, three-dimensional imaging, accelerometry, artificial neural networks and fuzzy logic) which have demonstrated potential value in assessment and monitoring of JIA. The emergence of novel techniques to assist clinicians’ assessments for diagnosis and monitoring of JIA has demonstrated promise; however, further research is required to confirm their clinical utility.
“…Imaging is regularly used as a diagnostic adjunct in JIA to support clinical evaluation [ 25 ]. Plain radiographs have previously been the traditional first-line imaging of choice.…”
Section: Diagnosis Of Jiamentioning
confidence: 99%
“…Plain radiographs have previously been the traditional first-line imaging of choice. However, increasingly more varied imaging techniques are being employed to detect active inflammation such as musculoskeletal ultrasonography and contrast enhanced magnetic resonance imaging (MRI) [ 25 ]. These imaging tools contribute greater diagnostic value than plain radiograph imaging, but they are relatively expensive and remain less accessible than is needed for routine use in the outpatient clinic setting.…”
Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease of childhood and is characterized by an often insidious onset and a chronic relapsing–remitting course, once diagnosed. With successive flares of joint inflammation, joint damage accrues, often associated with pain and functional disability. The progressive nature and potential for chronic damage and disability caused by JIA emphasizes the critical need for a prompt and accurate diagnosis. This article provides a review of recent studies related to diagnosis, monitoring and management of JIA and outlines recent novel tools and techniques (infrared thermal imaging, three-dimensional imaging, accelerometry, artificial neural networks and fuzzy logic) which have demonstrated potential value in assessment and monitoring of JIA. The emergence of novel techniques to assist clinicians’ assessments for diagnosis and monitoring of JIA has demonstrated promise; however, further research is required to confirm their clinical utility.
“…Currently, a validated MRI scoring system for the hips has not been established (Table 2 ). Porter-Young et al [ 85 ] have shown the most reliable MRI parameters on which a scoring system might be based. Fig.…”
Section: Paediatric-specific Items Per Jointmentioning
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.
“…For children, however, although several scoring systems have been proposed [ 12 – 16 ], no child- and hip-specific scoring system including both inflammatory and permanent changes has been validated [ 17 ]. In one study including 79 children with hip involvement, of whom 22 had confirmed JIA, the inter- and intraobserver agreement of several selected parameters were addressed using a simplified MR-based scoring system on a 0–1 scale [ 14 ]. The most reliable features were the presence of joint effusion, bone marrow edema and the subjective assessment of synovium [ 14 ].…”
Background
Hip involvement predicts severe disease in juvenile idiopathic arthritis (JIA) and is accurately assessed by MRI. However, a child-specific hip MRI scoring system has not been validated.
Objective
To test the intra- and interobserver agreement of several MRI markers for active and chronic hip changes in children and young adults with JIA and to examine the precision of measurements commonly used for the assessment of growth abnormalities.
Materials and methods
Hip MRIs from 60 consecutive children, adolescents and young adults with JIA were scored independently by two sets of radiologists. One set scored the same MRIs twice. Features of active and chronic changes, growth abnormalities and secondary post-inflammatory changes were scored. We used kappa statistics to analyze inter- and intraobserver agreement for categorical variables and a Bland–Altman approach to test the precision of continuous variables.
Results
Among active changes, there was good intra- and interobserver agreement for grading overall inflammation (kappa 0.6–0.7). Synovial enhancement showed a good intraobserver agreement (kappa 0.7–0.8), while the interobserver agreement was moderate (kappa 0.4–0.5).
Regarding acetabular erosions on a 0–3 scale, the intraobserver agreement was 0.6 for the right hip and 0.7 for the left hip, while the interobserver agreement was 0.6 for both hips. Measurements of joint space width, caput–collum–diaphyseal angle, femoral neck–head length, femoral width and trochanteric distance were imprecise.
Conclusion
We identified a set of MRI markers for active and chronic changes in JIA and suggest that the more robust markers be included in future studies addressing clinical validity and long-term patient outcomes.
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