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?

Østergaard, Mikkel; Conaghan, Philip G.; O’Connor, Philip; Szkudlarek, Marcin; Klarlund, Mette; Emery, P; Peterfy, Charles; Genant, Harry K.; McQueen, Fiona; Bird, Paul; Lassere, Marissa; Ejbjerg, Bo

doi:10.3899/jrheum.090350

Cited by 90 publications

(60 citation statements)

References 7 publications

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“…In knee OA synovitis is commonly assessed without contrast, although contrast-enhanced MRI appears to be a more reliable and valid measure of synovial inflammation, with the ability to differentiate inflamed synovium from effusion (11,12). Østergaard et al found that omitting contrast from MRI examination of synovitis in the metacarpophalangeal and wrist joints in rheumatoid arthritis patients decreased reliability (13). In our sample reliability was good using both contrast and non-contrast images.…”

Section: Discussionmentioning

confidence: 84%

Iterative Development and Reliability of the OMERACT Hand Osteoarthritis MRI Scoring System

et al. 2013

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Objective.To develop and test the interreader reliability of the OMERACT Hand Osteoarthritis Magnetic Resonance Scoring System (HOAMRIS) for assessment of structural and inflammatory hand OA features in the interphalangeal joints.Methods.The HOAMRIS was developed through an iterative process. Selection of features and their scaling was agreed upon through consensus by members of the OMERACT Magnetic Resonance Imaging (MRI) Task Force, using the Oslo Hand Osteoarthritis (OA) MRI Score system as a template. Two reliability exercises were performed, in which 6 and 4 readers participated, respectively. After the first exercise, an atlas was developed and used in the second exercise to facilitate reading. In each exercise, readers independently scored 8 MRI scans from the Oslo Hand OA cohort (coronal/axial short-tau inversion recovery and coronal/axial/sagittal T1-weighted fat-suppressed pre-/post-Gadolinium images). Interreader reliability was assessed by intraclass correlation coefficients (ICC), percentage exact and close agreement (PEA/PCA).Results.The preliminary OMERACT HOAMRIS included assessment of synovitis, erosive damage, cysts, osteophytes, cartilage space loss, malalignment, and bone marrow lesions (BML), of which all were scored on a 0–3 scale for normal, mild, moderate, and severe (increments of 0.5 for synovitis, erosive damage, and BML). In the first exercise, most features showed good to very good ICC values (0.64–0.94), except synovitis (0.34). In the second exercise using the atlas, the ICC values were > 0.74 for all MRI features, and the PEA/PCA values were higher than in the first exercise.Conclusion.A preliminary HOAMRIS with good to very good interreader reliability was developed. Longitudinal studies are needed to assess its sensitivity to change.

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Section: Discussionmentioning

confidence: 84%

Iterative Development and Reliability of the OMERACT Hand Osteoarthritis MRI Scoring System

et al. 2013

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“…To avoid misinterpretation due to the "magic angle" effect, we relied on long TE pulse sequence for the assessment of tendon or ligament fibers. In case of disagreements, the findings were discussed according to the previous standards until agreement was reached 7 .…”

Section: Severitymentioning

confidence: 99%

“…We chose the agreement method 7 , which is less robust. We followed a "gold standard" interpretation of all MRI findings and all findings were individually discussed until agreement was reached.…”

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confidence: 99%

Knee Enthesitis and Synovitis on Magnetic Resonance Imaging in Patients with Psoriasis without Arthritic Symptoms

et al. 2012

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ABSTRACT. Objective. This case-control study was designed to evaluate magnetic resonance imaging (MRI) findings of knee joints in patients with psoriasis without clinical peripheral or axial joint involvement, and to correlate MRI findings with disease and demographic variables. Methods. In total 48 patients with psoriasis and no clinical evidence of synovitis or enthesitis in any peripheral or axial joints were enrolled. A random sample of 20 healthy subjects without knee or other joint complaints and matched for age and sex served as controls. All patients and controls underwent enhanced MRI studies of both knee joints, and MRI findings were compared. Results. Among 48 patients (96 knees), a total of 90 entheseal lesions were detected, with no enthesitis in 2 cases (6.3%). Signs of continuing inflammation bilaterally were frequently found: soft tissue edema (STE; n = 52), bone marrow edema (BME; n = 20), perientheseal BME (n = 3), cartilaginous erosions (n = 42), and bone erosions (n = 27). In controls, 2 (10%) subjects had BME and another 5 (25%) showed cartilaginous erosions. None showed evidence of enthesitis. Significant correlations were observed between the number of entheseal lesions of both knees vs STE (present vs absent; r = 0.314, p = 0.030) and STE (number of lesions; r = 0.351, p = 0.014). Enthesitis (unilateral vs bilateral) was significantly and positively correlated with STE (r = 0.304, p = 0.036), cartilaginous erosions (r = 0.304, p = 0.036), and villous projections (r = 0.347, p = 0.016). Conclusion. Subclinical synovitis and enthesitis are frequently found in the knee joint of patients with psoriasis. These may be an early sign of psoriatic

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“…MRI is a 3-D imaging tool, and limiting its evaluation to one plane impedes its functionality. RAMRIS also recommends gadolinium contrast to facilitate assessment of synovitis [15][16][17] . Olech evaluated images in a single plane (coronal) and did not use contrast.…”

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confidence: 99%

Are Reporting Standards of Diagnostic Test Evaluation Unrealistic?

Lassere¹

2010

J Rheumatol

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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?

Abstract: Omitting IV contrast injection did not change scores of bone erosions and bone edema, but decreased the reliability of synovitis scores. However, this disadvantage may for some purposes be outweighed by the possibility to assess more joints and/or greater feasibility.

Cited by 90 publications

References 7 publications

Iterative Development and Reliability of the OMERACT Hand Osteoarthritis MRI Scoring System

Iterative Development and Reliability of the OMERACT Hand Osteoarthritis MRI Scoring System

Knee Enthesitis and Synovitis on Magnetic Resonance Imaging in Patients with Psoriasis without Arthritic Symptoms

Are Reporting Standards of Diagnostic Test Evaluation Unrealistic?

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