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European Radiology
Published in: European Radiology 4/2016

Open Access 01-04-2016 | Paediatric

Contrast-enhanced MRI of the knee in children unaffected by clinical arthritis compared to clinically active juvenile idiopathic arthritis patients

Authors: Charlotte M. Nusman, Robert Hemke, Marc A. Benninga, Dieneke Schonenberg-Meinema, Angelika Kindermann, Marion A. J. van Rossum, J. Merlijn van den Berg, Mario Maas, Taco W. Kuijpers

Published in: European Radiology | Issue 4/2016

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Abstract

Objectives

To evaluate enhancing synovial thickness upon contrast-enhanced magnetic resonance imaging (MRI) of the knee in children unaffected by clinical arthritis compared with clinically active juvenile idiopathic arthritis (JIA) patients. A secondary objective was optimization of the scoring method based on maximizing differences on MRI between these groups.

Methods

Twenty-five children without history of joint complaints nor any clinical signs of joint inflammation were age/sex-matched with 25 clinically active JIA patients with arthritis of at least one knee. Two trained radiologists, blinded for clinical status, independently evaluated location and extent of enhancing synovial thickness with the validated Juvenile Arthritis MRI Scoring system (JAMRIS) on contrast-enhanced axial fat-saturated T1-weighted MRI of the knee.

Results

Enhancing synovium (≥2 mm) was present in 13 (52 %) unaffected children. Using the total JAMRIS score for synovial thickening, no significant difference was found between unaffected children and active JIA patients (p = 0.091). Additional weighting of synovial thickening at the JIA-specific locations enabled more sensitive discrimination (p = 0.011).

Conclusions

Mild synovial thickening is commonly present in the knee of children unaffected by clinical arthritis. The infrapatellar and cruciate ligament synovial involvement were specific for JIA, which—in a revised JAMRIS—increases the ability to discriminate between JIA and unaffected children.

Key Points

• Synovial inflammation is the primary disease feature in juvenile idiopathic arthritis (JIA).
• Appearance of the synovium on contrast-enhanced MRI in unaffected children is unknown.
• Validation of existing scoring methods requires comparison between JIA and unaffected children.
• Mild enhancing synovial thickening was detected in half of the unaffected children.
• Location-weighting for JIA-specific locations increased discriminative value of the scoring methods (p = 0.011).
Appendix
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Metadata
Title
Contrast-enhanced MRI of the knee in children unaffected by clinical arthritis compared to clinically active juvenile idiopathic arthritis patients
Authors
Charlotte M. Nusman
Robert Hemke
Marc A. Benninga
Dieneke Schonenberg-Meinema
Angelika Kindermann
Marion A. J. van Rossum
J. Merlijn van den Berg
Mario Maas
Taco W. Kuijpers
Publication date
01-04-2016
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 4/2016
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-015-3912-z

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