Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Pediatric Radiology

19-04-2024 | Magnetic Resonance Imaging | Original Article

Measuring synovial thickness on knee MRI in pediatric patients with arthritis: is contrast necessary?

Authors: Atsuhiko Handa, M Alejandra Bedoya, Jade Iwasaka-Neder, Patrick R. Johnston, Mindy S. Lo, Sarah D. Bixby

Published in: Pediatric Radiology

Login to get access

Abstract

Background

The use of contrast-enhanced imaging has long been standard for magnetic resonance imaging (MRI) assessments of synovitis in juvenile idiopathic arthritis (JIA). However, advancements in MRI technology have allowed for reliable identification of synovium without contrast.

Objective

To assess the equivalence of unenhanced MRI with contrast-enhanced MRI in evaluating synovial thickness.

Materials and methods

This is an institutional review board approved, retrospective study performed in a tertiary children’s hospital. Pediatric JIA patients under 21 years old were included who underwent knee MRI scans (1.5 T or 3 T) without and with contrast between January 2012 and January 2022. Two radiologists independently measured synovial thickness at 6 knee sites on contrast-enhanced and unenhanced sequences. Numerical measurements and ordinal scores based on juvenile idiopathic arthritis magnetic resonance imaging scoring (JAMRIS) system were recorded, and tests of equivalence were conducted, as well as between-reader and within-reader reliability by concordance correlation coefficient (CCC). All tests were considered significant at the 5% level.

Results

A total of 38 studies from 35 patients (25 females, median age 14 years; interquartile range 7 to 15.7) were included. Equivalence was demonstrated at each of the 6 sites for both continuous measurements (P-values < 0.05) and ordinal scores (P-values < 0.05) based on the average over readers. Within-reader reliability was moderate to high (CCC 0.50–0.89), except for the cruciate ligaments site. Averaged over the 6 sites, reliability between readers was low for unenhanced (CCC 0.47, with 95% CI: [0.41, 0.53]) and moderate for contrast-enhanced (CCC 0.64, with 95% CI: [0.59, 0.69]) sequences.

Conclusion

Unenhanced knee MRI is equivalent to contrast-enhanced MRI in assessment of synovial thickness using conventional MRI sequences. Contrast material helped improve inter-reader reliability.

Graphical abstract

Appendix
Available only for authorised users
Literature
1.
2.
Gabriel SE, Michaud K (2009) Epidemiological studies in incidence, prevalence, mortality, and comorbidity of the rheumatic diseases. Arthritis Res Ther 11:229.CrossRefPubMedPubMedCentral
3.
Hemke R, Doria AS, Tzaribachev N et al (2014) Selecting magnetic resonance imaging (MRI) outcome measures for juvenile idiopathic arthritis (JIA) clinical trials: first report of the MRI in JIA special interest group. J Rheumatol 41:354–358.CrossRefPubMed
4.
Selvaag AM, Flato B, Dale K et al (2006) Radiographic and clinical outcome in early juvenile rheumatoid arthritis and juvenile spondyloarthropathy: a 3-year prospective study. J Rheumatol 33:1382–1391PubMed
5.
Wallace CA, Giannini EH, Spalding SJ et al (2014) Clinically inactive disease in a cohort of children with new-onset polyarticular juvenile idiopathic arthritis treated with early aggressive therapy: time to achievement, total duration, and predictors. J Rheumatol 41:1163–1170.CrossRefPubMed
6.
7.
Magni-Manzoni S, Malattia C, Lanni S, Ravelli A (2012) Advances and challenges in imaging in juvenile idiopathic arthritis. Nat Rev Rheumatol 8:329–336.CrossRefPubMed
8.
Hemke R, Maas M, van Veenendaal M et al (2014) Contrast-enhanced MRI compared with the physical examination in the evaluation of disease activity in juvenile idiopathic arthritis. Eur Radiol 24:327–334.CrossRefPubMed
9.
Gylys-Morin VM, Graham TB, Blebea JS et al (2001) Knee in early juvenile rheumatoid arthritis: MR imaging findings. Radiology 220:696–706.CrossRefPubMed
10.
Malattia C, Damasio MB, Magnaguagno F et al (2008) Magnetic resonance imaging, ultrasonography, and conventional radiography in the assessment of bone erosions in juvenile idiopathic arthritis. Arthritis Rheum 59:1764–1772.CrossRefPubMed
11.
Miller E, Uleryk E, Doria AS (2009) Evidence-based outcomes of studies addressing diagnostic accuracy of MRI of juvenile idiopathic arthritis. AJR Am J Roentgenol 192:1209–1218.CrossRefPubMed
12.
Hemke R, van Veenendaal M, Kuijpers TW et al (2012) Increasing feasibility and patient comfort of MRI in children with juvenile idiopathic arthritis. Pediatr Radiol 42:440–448.CrossRefPubMedPubMedCentral
13.
Tanturri de Horatio L, Damasio MB, Barbuti D et al (2012) MRI assessment of bone marrow in children with juvenile idiopathic arthritis: intra- and inter-observer variability. Pediatr Radiol 42:714–720.CrossRefPubMed
14.
Hemke R, van Rossum MA, van Veenendaal M et al (2013) Reliability and responsiveness of the Juvenile Arthritis MRI Scoring (JAMRIS) system for the knee. Eur Radiol 23:1075–1083.CrossRefPubMed
15.
Hemke R, Tzaribachev N, Nusman CM et al (2017) Magnetic Resonance Imaging (MRI) of the knee as an Outcome measure in Juvenile Idiopathic Arthritis: an OMERACT reliability study on MRI scales. J Rheumatol 44:1224–1230.CrossRefPubMed
16.
Hemke R, van den Berg JM, Nusman CM et al (2018) Contrast-enhanced MRI findings of the knee in healthy children; establishing normal values. Eur Radiol 28:1167–1174.CrossRefPubMed
17.
Herve-Somma CM, Sebag GH, Prieur AM et al (1992) Juvenile rheumatoid arthritis of the knee: MR evaluation with Gd-DOTA. Radiology 182:93–98.CrossRefPubMed
18.
Lamer S, Sebag GH (2000) MRI and ultrasound in children with juvenile chronic arthritis. Eur J Radiol 33:85–93.CrossRefPubMed
19.
Uhl M, Krauss M, Kern S et al (2001) The knee joint in early juvenile idiopathic arthritis. An ROC study for evaluating the diagnostic accuracy of contrast-enhanced MR imaging. Acta Radiol 42:6–9PubMed
20.
Johnson K, Wittkop B, Haigh F et al (2002) The early magnetic resonance imaging features of the knee in juvenile idiopathic arthritis. Clin Radiol 57:466–471.CrossRefPubMed
21.
Hemke R, Kuijpers TW, van den Berg JM et al (2013) The diagnostic accuracy of unenhanced MRI in the assessment of joint abnormalities in juvenile idiopathic arthritis. Eur Radiol 23:1998–2004.CrossRefPubMed
22.
Stomp W, Krabben A, van der Heijde D et al (2015) Aiming for a simpler early arthritis MRI protocol: can Gd contrast administration be eliminated? Eur Radiol 25:1520–1527.CrossRefPubMed
23.
Eshed I, Krabbe S, Ostergaard M et al (2015) Influence of field strength, coil type and image resolution on assessment of synovitis by unenhanced MRI–a comparison with contrast-enhanced MRI. Eur Radiol 25:1059–1067.CrossRefPubMed
24.
Nusman CM, Ording Muller LS, Hemke R et al (2016) Current status of efforts on standardizing magnetic resonance imaging of Juvenile Idiopathic Arthritis: Report from the OMERACT MRI in JIA Working Group and Health-e-Child. J Rheumatol 43:239–244. CrossRefPubMed
25.
White CM, Kesler WW, Miner L, Flemming D (2022) MR imaging knee Synovitis and Synovial Pathology. Magn Reson Imaging Clin N Am 30:277–291.CrossRefPubMed
26.
Bhargava R, Hahn G, Hirsch W et al (2013) Contrast-enhanced magnetic resonance imaging in pediatric patients: review and recommendations for current practice. Magn Reson Insights 6:95–111.CrossRefPubMedPubMedCentral
27.
Ostergaard M, Conaghan PG, O’Connor P et al (2009) 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? J Rheumatol 36:1806–1810.CrossRefPubMed
28.
Tamai M, Kawakami A, Uetani M et al (2012) Magnetic resonance imaging (MRI) detection of synovitis and bone lesions of the wrists and finger joints in early-stage rheumatoid arthritis: comparison of the accuracy of plain MRI-based findings and gadolinium-diethylenetriamine pentaacetic acid-enhanced MRI-based findings. Mod Rheumatol 22:654–658.CrossRefPubMed
29.
30.
Vo Chieu VD, Vo Chieu V, Dressler F et al (2023) Juvenile idiopathic arthritis of the knee: is contrast needed to score disease activity when using an augmented MRI protocol comprising PD-weighted sequences? Eur Radiol 33:3775–3784.CrossRefPubMed
31.
Milks KS, Singh J, Benedict JA, Rees MA (2023) Fluid-attenuated inversion-recovery sequence with fat suppression as an alternative to contrast-enhanced MRI in pediatric synovitis. Pediatr Radiol.CrossRefPubMed
32.
Fitzmaurice GM (2011) Applied longitudinal analysis. Wiley, Hoboken, New JerseyCrossRef
33.
SAS Institute Inc (2015) SAS/IML® 14.1 user’s guide. Cary NSII
34.
Lin LI (1989) A concordance correlation coefficient to evaluate reproducibility. Biometrics 45:255–268CrossRefPubMed
35.
Everitt BS (1981) Statistical Methods for Rates and Proportions. Biometric Society, pp 867–867
36.
Ostergaard M, Klarlund M (2001) Importance of timing of post-contrast MRI in rheumatoid arthritis: what happens during the first 60 minutes after IV gadolinium-DTPA? Ann Rheum Dis 60:1050–1054.CrossRefPubMedPubMedCentral
Metadata
Title
Measuring synovial thickness on knee MRI in pediatric patients with arthritis: is contrast necessary?
Authors
Atsuhiko Handa
M Alejandra Bedoya
Jade Iwasaka-Neder
Patrick R. Johnston
Mindy S. Lo
Sarah D. Bixby
Publication date
19-04-2024
Publisher
Springer Berlin Heidelberg
Published in
Pediatric Radiology
Print ISSN: 0301-0449
Electronic ISSN: 1432-1998
DOI
https://doi.org/10.1007/s00247-024-05929-1