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Open Access 01-12-2021 | Magnetic Resonance Imaging | Research article

Assessment of disease activity using a whole-body MRI derived radiological activity index in chronic nonbacterial osteomyelitis

Authors: Martina Capponi, Denise Pires Marafon, Flaminia Rivosecchi, Yongdong Zhao, Manuela Pardeo, Virginia Messia, Laura Tanturri de Horatio, Paolo Tomà, Fabrizio De Benedetti, Antonella Insalaco

Published in: Pediatric Rheumatology | Issue 1/2021

Abstract

Background

Based on the recently developed ChRonic nonbacterial Osteomyelitis MRI Scoring tool (CROMRIS), we developed a radiological activity index (RAI-CROMRIS) to obtain a quantification of the overall bone involvement in individual patients.

Methods

Whole Body Magnetic Resonance Imaging (WB-MRI) images were scored according to parameters included in the RAI-CROMRIS: bone marrow hyperintensity, signal extension, soft tissue/periosteal hyperintensity, bony expansion, vertebral collapse. These parameters were evaluated for each bone unit yielding a score from 0 to 7 and summed up as RAI-CROMRIS including all bone units. We assessed clinical disease activity using a physician global assessment (PGA) and radiological findings in 76 treatment-naïve patients; 46 of 76 were evaluated at 6 and 12 months after initial WB-MRI. Quantitative variables were compared using the Mann-Whitney U test for unmatched groups and the Wilcoxon signed-rank test for paired groups. Correlation was evaluated using Spearman’s rank coefficient (r_s).

Results

There was a significant correlation between RAI-CROMRIS and PGA (r_s = 0.32; p = 0.0055), between RAI-CROMRIS and presence of elevated erythrocyte sedimentation rate (p = 0.013) and C-reactive protein (p = 0.0001) at baseline. The RAI-CROMRIS decreased from a median of 17 at baseline to 12 at 6 months (p = 0.004) and remained stable (median 11) at 12 months. A correlation between the RAI-CROMRIS and the PGA was observed at baseline (r_s = 0.41; p = 0.004) and during follow up at 6 months (r_s = 0.33; p = 0.025) and 12 months (r_s = 0.38; p = 0.010). The baseline RAI-CROMRIS (median 20) was significantly higher in patients who subsequently received bisphosphonates than in patients who received other treatments (median 12) and decreased significantly after bisphosphonates (p = 0.008).

Conclusions

The RAI-CROMRIS was correlated with clinical and laboratory measures of disease activity showing significant short-term changes following treatment with bisphosphonates. This tool could be used in clinical practice and clinical trials after validation.

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Title: Assessment of disease activity using a whole-body MRI derived radiological activity index in chronic nonbacterial osteomyelitis
Authors: Martina Capponi
Denise Pires Marafon
Flaminia Rivosecchi
Yongdong Zhao
Manuela Pardeo
Virginia Messia
Laura Tanturri de Horatio
Paolo Tomà
Fabrizio De Benedetti
Antonella Insalaco
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Magnetic Resonance Imaging
Magnetic Resonance Imaging
Bisphosphonate
Osteomyelitis
Published in: Pediatric Rheumatology / Issue 1/2021
Electronic ISSN: 1546-0096
DOI: https://doi.org/10.1186/s12969-021-00620-3

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Assessment of disease activity using a whole-body MRI derived radiological activity index in chronic nonbacterial osteomyelitis

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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