Francesca Magnaguagno

Dynamic contrast-enhanced magnetic resonance imaging in the assessment of disease activity in patients with juvenile idiopathic arthritis

OBJECTIVE To determine the capability and reliability of dynamic contrast-enhanced MRI (DCE-MRI) in the assessment of disease activity in juvenile idiopathic arthritis (JIA). METHODS DCE-MRI of the clinically more affected wrist or hip joints was undertaken in 21 patients, coupled with standard clinical assessment and biochemical analysis. Synovial inflammation was assessed by computing the maximum level of synovial enhancement (ME), the maximum rate of enhancement (MV) and the rate of early enhancement (REE) from the enhancement curves generated from region of interest independently delineated by two readers in the area of the ME. Correlations between dynamic parameters and clinical measures of disease activity, and static MRI synovitis score were investigated. RESULTS In patients with wrist arthritis, REE correlated with the wrist swelling score (r(s) = 0.72), ESR (r(s) = 0.69), pain assessment scale (r(s) = 0.63) and childhood HAQ (r(s) = 0.60). In patients with hip arthritis, ME correlated with the hip limitation of motion (r(s) = 0.69). Static MRI synovitis score based on post-gadolinium enhancement correlated with MV (r(s) = 0.63) in patients with wrist arthritis and with ME (r = 0.68) in those with hip arthritis. The inter-reader agreement assessed by intra-class correlation coefficient (ICC) for ME, MV and REE (ICC = 0.98, 0.97 and 0.84, respectively) was excellent. CONCLUSIONS DCE-MRI represents a promising method for the assessment of disease activity in JIA, especially in patients with wrist arthritis. As far as we know, this study is the first to demonstrate the feasibility, reliability and construct validity of DCE-MRI in JIA. These results should be confirmed in large-scale longitudinal studies in view of its further application in therapeutic decision making and in clinical trials.

Whole-body MRI: non-oncological applications in paediatrics

Abstract Whole-body magnetic resonance imaging (WBMRI) is a fast and accurate method for detecting and monitoring of diseases throughout the entire body without exposure to ionizing radiation. Among emerging non-oncological potential applications of WBMRI, rheumatological diseases play an important role. Rheumatological WBMRI applications include the evaluation of chronic multifocal recurrent osteomyelitis, dermatomyositis, fever of unknown origin, arthritis, and connective tissue diseases. Aim of this review is to give an overview of the use of WBMRI in rheumatological field.

Delineating the Application of Ultrasound in Detecting Synovial Abnormalities of the Subtalar Joint in Juvenile Idiopathic Arthritis

To investigate the frequency of ultrasound (US)–detectable involvement of the subtalar joint (STJ), to compare clinical versus US assessment of the STJ, and to compare different scanning approaches to the STJ in juvenile idiopathic arthritis (JIA).

Musculoskeletal ultrasound versus magnetic resonance in supporting clinical management of juvenile idiopathic arthritis

Over the last decade the use of musculoskeletal ultrasound (MSUS) for the assessment of juvenile idiopathic arthritis (JIA) has increased considerably. However, little is known about the potential of MSUS in supporting the clinical management of JIA, when compared to magnetic resonance (MR).

Agreement Among Musculoskeletal Pediatric Specialists in the Assessment of Radiographic Joint Damage in Juvenile Idiopathic Arthritis

To evaluate agreement among musculoskeletal pediatric specialists in assessing radiographic joint damage in juvenile idiopathic arthritis (JIA).

Effect of the Inclusion of the Metacarpophalangeal Joints on the Wrist Magnetic Resonance Imaging Scoring System in Juvenile Idiopathic Arthritis

Objective. To extend the magnetic resonance imaging (MRI) score for assessment of wrist synovitis in juvenile idiopathic arthritis (JIA) by inclusion of the metacarpophalangeal (MCP) joints, and to compare the metric properties of the original and the extended score. Methods. Wrist MRI of 70 patients with JIA were scored by 3 independent readers according to (1) the wrist component of the rheumatoid arthritis MRI synovitis score (comprising distal radioulnar, radiocarpal, and combined midcarpal and carpometacarpal joints); and (2) an extended score including the MCP joints. Thirty-eight patients had a 1-year MRI followup. The concordance between the readers [intraclass correlation coefficient (ICC), 95% limits of agreement (LOA), and weighted Cohen’s κ], correlations with clinical variables (Spearman’s ϱ), and the sensitivity to change [standardized response mean (SRM)] were calculated for both scores. Results. The interreader agreement was moderate for the original score (ICC 0.77; 95% CI 0.68–0.84) and good for the extended score (ICC 0.86; 95% CI 0.80–0.91). Using 95% LOA, the aggregate score variability was less favorable with relatively wide LOA. Weighted Cohen’s κ of the individual joints indicated good agreement for the original score and good to excellent agreement for the extended score. Correlations with clinical variables reflecting disease activity improved for the extended score and its SRM was higher compared to that of the original score. Conclusion. The extended score showed better reliability, construct validity, and sensitivity to change than the original. Inclusion of the MCP joints should be considered for a more accurate assessment of disease activity and treatment efficacy in JIA.

Is it worth including subtalar joint in ultrasound ankle assessment of patients with juvenile idiopathic arthritis

None of the controls showed US STJ synovitis. US detected synovitis in 27 (54%) STJs of patients. Agreement between clinical and US assessment for presence and absence of STJ involvement was found in 17 (34%) and 16 (32%) ankles, respectively. In 10 (20%) STJs not considered to be clinically affected, synovitis was found on US. In 7 (14%) ankles labelled as having STJ involvement on clinical examination US was negative for STJ, but showed the involvement of different anatomical sites (midfoot, tibiotalar joint, tendons). Overall, the concordance between clinical and US evaluation was poor (k=0.32). The Cohen-kappa value for inter-observer reliability of STJ involvement on US was high (k= 0.92). All patients having US findings in the medial and/or posterior side of STJ presented also with US findings using the lateral scanning approach, but the reverse was not true. Conclusion US is more sensitive than clinical evaluation in the assessment of STJ in ankles with active disease. The high frequency of its involvement may suggest to include the assessment of STJ in US scanning protocols. In this perspective, the lateral approach to the joint seems to be more appropriate for US evaluation of STJ involvement.

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

Results Twenty-five out of 26 patients (96.1%), had one or more erosions as detected by MRI, while conventional radiography and ultrasonography revealed erosions in 13/26 (50%) and 12/24 (50%) patients respectively. The ability of MRI to detect erosive changes was significant higher with respect to conventional radiography (PB = 0.003) and ultrasonography (PB = 0.0003) in the group of patients with < 4 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 (rs = 0.82) and with wrist limited range of motion score (rs = 0.69). The inter-reader intraclass correlation coefficient (ICC) for MRI score was excellent (0.97); intra-reader ICCs were good for both investigators (0.97 and 0.79).

Quantitative assessment of synovitis in juvenile idiopathic arthritis using Dynamic Contrast-Enhanced Magnetic Resonance Imaging

Methods In 22 JIA patients 12 wrists and 10 hips were studied with DCE-MRI. A 3D FFE Dynamic sequence was acquired after contrast injection. Two readers delineated independently a region of interest (ROI) in the area of maximal synovial enhancement. Enhancement curves were obtained plotting pixel intensity against time from the ROIs. Maximum level of synovial enhancement (ME), maximum rate of enhancement (MV) and rate of early enhancement (REE) were obtained from the curves. Correlations with clinical parameters of disease activity and with static MRI synovitis score were investigated.