Reliability and sensitivity to change of the OMERACT rheumatoid arthritis magnetic resonance imaging score in a multireader, longitudinal setting

Haavardsholm, Espen A; Østergaard, Mikkel; Ejbjerg, Bo; Kvan, Nils P.; Uhlig, Till; Lilleås, Finn; Kvien, Tore K

doi:10.1002/art.21493

Cited by 167 publications

(105 citation statements)

References 21 publications

(23 reference statements)

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“…Interobserver ICCs were excellent at $0.97 for all measurements. These compare favourably with ICCs for measuring inflammation in synovium and bone in arthritis using the well-validated RAMRIS (rheumatoid arthritis MRI score) scoring system [18][19][20][21], and are also superior to those reported for semiquantitative measures of tendinopathy using ultrasound [22]. This may be because in this study observer input was restricted to outlining the Achilles tendon and the measurements (which depend on the entire tendon area) are relatively insensitive to small differences in the perimeter.…”

Section: Discussionmentioning

confidence: 99%

Quantitative MRI measurements of the Achilles tendon in spondyloarthritis using ultrashort echo times

Hodgson

Menon²,

Grainger³

et al. 2012

BJR

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Objectives: Tendon involvement is common in spondyloarthritis. The MRI signal from the Achilles tendon has been used to quantify mechanical tendinopathy; however, conventional MRI is limited by the short T 2 of normal tendon. Short and ultrashort echo time (UTE) MRI have the potential to better measure signal intensity reflecting changes in T 2 or gadolinium enhancement. Furthermore, UTE images could be used for normalisation to reduce variability. The aim of this work was to investigate such techniques in patients with spondyloarthritis (SpA). Methods: The Achilles tendons of 14 healthy volunteers and 24 patients with symptomatic spondyloarthritis were studied. Combined UTE (TE50.07 ms) and gradient echo (TE54.9 ms) images were acquired before and after intravenous gadolinium together with pre-contrast gradient echo images (TE52 ms). The signal intensity from a region of interest in the Achilles tendon above the calcaneus was measured. The relative enhancement at echo times of 0.07 ms (RE 0.1 ) and 4.9 ms (RE 5 ) were calculated. The ratios of the signal intensities from both 4.9 ms and 2 ms gradient echo images to the signal intensity from the UTE image were calculated (RTE 5 and RTE 2 respectively). Results: Interobserver intraclass correlation coefficients were excellent ($0.97). The contrast-to-noise ratio was higher for enhancement on UTE images than on gradient echo images. RE 0.1 , RTE 5 and RTE 2 were significantly higher in SpA patients than controls. Conclusion: Signal intensity ratios using UTE images allow quantitative measurements to be made which are sensitive to tendon T 2 or contrast enhancement and which are increased in spondyloarthritis. They therefore have the potential for use as measures of tendon disease in spondyloarthritis.

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Section: Discussionmentioning

confidence: 99%

Quantitative MRI measurements of the Achilles tendon in spondyloarthritis using ultrashort echo times

Hodgson

Menon²,

Grainger³

et al. 2012

BJR

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“…Using the RAMRIS, very good intrareader reliability, good interreader reliability, and a high level of sensitivity to change have been reported, demonstrating that the OMER-ACT RAMRIS system, after proper training and calibration of readers, is suitable for monitoring joint inflammation and destruction in RA [89,90]. A EULAR-OMERACT RA MRI reference image atlas has been developed, providing an easy-to-use tool for standardized RAMRIS scoring of MR images for RA activity and damage by comparison with reference images [91].…”

Section: Monitoring Disease Activity and Structural Damagementioning

confidence: 95%

The impact of MRI on the clinical management of inflammatory arthritides

et al. 2011

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In the past two decades, MRI has gained a major role in research and clinical management of patients with inflammatory arthritides, particularly in spondyloarthritis (SpA), rheumatoid arthritis (RA), and osteoarthritis (OA). MRI is regarded as the most sensitive imaging modality for detecting early SpA in young patients with inflammatory back pain and normal radiographs of the sacroiliac joints. The recently published Assessment of SpondyloArthritis International Society classification criteria for axial SpA include for the first time a positive MRI demonstrating sacroiliitis as an imaging criterion indicative of SpA together with at least one clinical feature of SpA. Recent data show that systematic assessment of sacroiliitis displayed on MRI has much greater diagnostic utility than previously reported and highlight the diagnostic relevance of structural lesions. In RA, MRI has predictive value for the development of disease in new onset undifferentiated arthritis, and MR pathology at disease onset is a highly significant predictor of radiographic erosions. Consequently MRI has been credited with an important role in the new ACR/EULAR 2010 classification criteria for RA. In OA, bone marrow edema (BME) and synovitis may serve as biomarkers in interventional trials. Treatment interventions targeting BME and synovitis observed on MRI in inflammatory arthritides may have a disease-modifying effect as these lesions are potentially reversible and have been shown to be associated with structural progression. Research should focus on the prognostic significance of MRI lesions in larger cohorts and whether adding MRI to routine care improves clinical and radiographic outcome in patients with inflammatory arthritides.

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“…Erosions, bone edema, and synovitis depicted by MRI have been shown to cover all aspects of truth 12,13,14,15,16,17 , and the RA MRI score (RAMRIS) for erosions, bone edema, and synovitis has also demonstrated responsiveness and discrimination 18,19,20,21,22 . Although feasibility issues such as accessibility, time, cost, and patient compliance may cause limitations in clinical practice, MRI is acceptable for clinical trials.…”

Section: Imaging and Soluble Biomarkers In Ramentioning

confidence: 99%

Updating the OMERACT Filter: Implications for Imaging and Soluble Biomarkers

D'Agostino

Boers²,

Kirwan³

et al. 2014

J Rheumatol

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Objective. The Outcome Measures in Rheumatology (OMERACT) Filter provides a framework for the validation of outcome measures for use in rheumatology clinical research. However, imaging and biochemical measures may face additional validation challenges because of their technical nature. The Imaging and Soluble Biomarker Session at OMERACT 11 aimed to provide a guide for the iterative development of an imaging or biochemical measurement instrument so it can be used in therapeutic assessment. Methods. A hierarchical structure was proposed, reflecting 3 dimensions needed for validating an imaging or biochemical measurement instrument: outcome domain(s), study setting, and performance of the instrument. Movement along the axes in any dimension reflects increasing validation. For a given test instrument, the 3-axis structure assesses the extent to which the instrument is a validated measure for the chosen domain, whether it assesses a patient-centered or disease-centered variable, and whether its technical performance is adequate in the context of its application. Some currently used imaging and soluble biomarkers for rheumatoid arthritis, spondy-loarthritis, and knee osteoarthritis were then evaluated using the original OMERACT Filter and the newly proposed structure. Breakout groups critically reviewed the extent to which the candidate biomarkers complied with the proposed stepwise approach, as a way of examining the utility of the proposed 3-dimensional structure. Results. Although there was a broad acceptance of the value of the proposed structure in general, some areas for improvement were suggested including clarification of criteria for achieving a certain level of validation and how to deal with extension of the structure to areas beyond clinical trials. Conclusion. General support was obtained for a proposed tri-axis structure to assess validation of imaging and soluble biomarkers; nevertheless, additional work is required to better evaluate its place within the OMERACT Filter 2.0

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Reliability and sensitivity to change of the OMERACT rheumatoid arthritis magnetic resonance imaging score in a multireader, longitudinal setting

Abstract: Conclusion. The RAMRIS showed very good intrareader reliability, good interreader reliability, and a high level of sensitivity to change. The results suggest that the RAMRIS may be a suitable system for use in monitoring joint inflammation and destruction in RA.

Cited by 167 publications

References 21 publications

Quantitative MRI measurements of the Achilles tendon in spondyloarthritis using ultrashort echo times

Quantitative MRI measurements of the Achilles tendon in spondyloarthritis using ultrashort echo times

The impact of MRI on the clinical management of inflammatory arthritides

Updating the OMERACT Filter: Implications for Imaging and Soluble Biomarkers

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