Magnetic resonance imaging, ultrasonography, and conventional radiography in the assessment of bone erosions in juvenile idiopathic arthritis

Abstract

Objective. To compare magnetic resonance imaging (MRI), conventional radiography, and ultrasonography in identifying bone erosions in patients with juvenile idiopathic arthritis (JIA), and to determine the validity and reliability of an MRI scale in detecting and grading joint damage. Methods. In 26 JIA patients, the clinically more affected wrist was studied with MRI, radiography, and ultrasonography, coupled with standard clinical assessment and biochemical analysis. MR images were assessed independently by 2 readers according to an apposite devised scoring system. Results. Of 26 patients, 25 (96.1%) had 1 or more erosions as detected by MRI, whereas conventional radiography and ultrasonography revealed erosions in 13 (50%) of 26 and 12 (50%) of 24 patients, respectively. The ability of MRI to detect erosive changes was significantly higher with respect to conventional radiography (P ‫؍‬ 0.002 with Bonferroni correction [P B ]) and ultrasonography (P B ‫؍‬ 0.0002) in the group of patients with <3 years' disease duration. Ultrasonography and conventional radiography were of equivalent value for the detection of destructive changes. Wrist MRI score correlated highly with radiographic erosion score (r s ‫؍‬ 0.82) and with wrist limited range of motion score (r s ‫؍‬ 0.69). The interreader intraclass correlation coefficient (ICC) for MRI score was excellent (0.97); intrareader ICCs were good for both investigators (0.97 and 0.79). Conclusion. MRI seems to be a powerful tool to detect early structural damage in JIA. The proposed MRI scale for bone erosions appears promising in terms of reliability and construct validity. The pathophysiologic meaning and the prognostic value of bone erosions revealed only by MRI remain to be established in longitudinal studies.

Takatomo Mine, Michiko Fukami, Koichiro Ihara, Hiroyuki Kawamura, Ryutaro Kuriyama and Ryo Date

“…MRI also reveals a high frequency of bone marrow edema and bone erosions early in the course of this disease. Johnson stated that hypervascular synovium, joint effusion, irregularity of the infrapatellar fat pad, soft tissue swelling, and popliteal lymphadenopathy, all of which can be observed by MRI, are important in the early diagnosis of JIA, emphasizing the need for imaging with gadolinium contrast medium [6]. However, it is difficult to make a definite diagnosis of JIA from MRI alone.…”

Outcome Measures in Pediatric Rheumatology

“…This would need validation, as data from adult RA patients give contrary results and suggests that erosions detected by MRI provide low specificity for RA. Bone marrow edema in this study was the most specific MRI lesion for RA in this setting [23,24].…”

Juvenile idiopathic arthritis: what is the utility of ultrasound?

“…Although MRI is superior, ultrasound is at least as good if not better than plain radiography for detection of cortical erosions in accessible regions. 49 Semi-quantitative scoring systems have been applied to only adults with RA where PD signal in synovitis showed good correlation with histopathology and intraoperative appearances. 50 Ultrasound can locate the anatomical abnormality and guide injection of intra-articular steroid with reduced rates of complications such as subcutaneous atrophy.…”