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Fluid-attenuated inversion-recovery sequence with fat suppression as an alternative to contrast-enhanced MRI in pediatric synovitis

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Abstract

Background

Non-contrast magnetic resonance imaging (MRI) fluid-attenuated inversion-recovery sequence (FLAIR) with fat suppression (FS) has not been validated in children.

Objective

Compare FLAIR to T1-weighted post contrast (T1CE) in the detection of knee synovitis.

Methods and materials

Institutional review board (IRB) waived consent. Children who underwent T1CE and FLAIR sequences of the knee on a 3-T magnet from April 2021 to December 2021 were included. Two pediatric radiologists assessed axial FLAIR and T1CE images for synovitis and synovial thickness. Reliability and agreement were assessed. Sensitivities, specificities, and accuracy were calculated for FLAIR using T1CE as reference standard.

Results

In total, 42 knees (39 patients) were assessed (median age 12.9 years (2.3–17.8 years); 62% male, 38% female). Readers judged 20/42 (48%) knees to have synovitis. Sensitivity of FLAIR for reader 1 was 79% (19/24; 95% CI 0.58, 0.93) and 84% (16/19; 95% CI 0.60, 0.97) for reader 2. Specificity of FLAIR for reader 1 was 94% (17/18; 95% CI 0.73, 1) and 83% (19/23; 95% CI 0.61, 0.95) for reader 2. Accuracy for readers 1 and 2 was 86% (36/42; 95% CI 0.71, 0.95) and 83% (35/42; 95% CI 0.69, 0.93), respectively. Inter-reader reliability was good (0.75–0.90) for synovial measurements for FLAIR (ICC = 0.80; 95% CI 0.71, 0.86) and moderate for T1 CE (ICC = 0.62 (95% CI 0.48, 0.73)).

Conclusion

FLAIR FS depicts synovium in the pediatric knee with similar reliability to T1 CE and may be an acceptable alternative to contrast in the initial diagnosis of synovitis.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author upon reasonable request.

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Authors and Affiliations

  1. Department of Radiology, Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH, 43215, USA

    Kathryn S. Milks, Jasmeet Singh & Mitchell A. Rees

  2. Department of Biostatistics, The Ohio State University Wexner Medical Center, Columbus, OH, USA

    Jason A. Benedict

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  1. Kathryn S. Milks
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  2. Jasmeet Singh
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Correspondence to Kathryn S. Milks.

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Milks, K.S., Singh, J., Benedict, J.A. et al. Fluid-attenuated inversion-recovery sequence with fat suppression as an alternative to contrast-enhanced MRI in pediatric synovitis. Pediatr Radiol 54, 96–104 (2024). https://doi.org/10.1007/s00247-023-05804-5

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