Advertisement

Pediatric Radiology

, Volume 42, Issue 6, pp 714–720 | Cite as

MRI assessment of bone marrow in children with juvenile idiopathic arthritis: intra- and inter-observer variability

  • Laura Tanturri de HoratioEmail author
  • Maria Beatrice Damasio
  • Domenico Barbuti
  • Claudia Bracaglia
  • Karen Lambot-Juhan
  • Peter Boavida
  • Lil-Sofie Ording Müller
  • Clara Malattia
  • Lucilla Ravà
  • Karen Rosendahl
  • Paolo Tomà
Original Article

Abstract

Background

Bone marrow oedema (BMO) is included in MRI-based scoring systems of disease activity in adults with rheumatoid arthritis. Similar systems in juvenile idiopathic arthritis (JIA) are lacking.

Objective

To assess the reproducibility in a multi-centre setting of an MRI BMO scoring system in children with JIA.

Materials and methods

Seventy-six wrist MRIs were read twice, independently, by two experienced paediatric radiologists. BMO was defined as ill-defined lesions within the trabecular bone, returning high and low signal on T2- and T1-weighted images respectively, with or without contrast enhancement. BMO extension was scored for each of 14 bones at the wrist from 0 (none) to 3 (extensive).

Results

The intra-observer agreement was moderate to excellent, with weighted kappa ranging from 0.85 to 1.0 and 0.49 to 1.0 (readers 1 and 2 respectively), while the inter-observer agreement ranged from 0.41 to 0.79. The intra- and inter-observer intraclass correlation coefficients were excellent and satisfactory, respectively.

Conclusion

The scoring system was reliable and may be used for grading bone marrow abnormality in JIA. The relatively large variability in aggregate scores, particularly between readers, underscores the need for thorough standardisation.

Keywords

MRI Juvenile idiopathic arthritis Wrist Bone marrow oedema 

References

  1. 1.
    Jordan A, McDonagh JE (2006) Juvenile idiopathic arthritis: the paediatric perspective. Pediatr Radiol 36:734–742PubMedCrossRefGoogle Scholar
  2. 2.
    Johnson K (2006) Imaging of juvenile idiopathic arthritis. Pediatr Radiol 36:743–758PubMedCrossRefGoogle Scholar
  3. 3.
    McQueen FM (2000) Magnetic resonance imaging in early inflammatory arthritis: what is its role? Rheumatology 39:700–706PubMedCrossRefGoogle Scholar
  4. 4.
    Haavardsholm EA, Bøyesen P, Østergaard M et al (2008) Magnetic resonance imaging findings in 84 patients with early rheumatoid arthritis: bone marrow oedema predicts erosive progression. Ann Rheum Dis 67:794–800PubMedCrossRefGoogle Scholar
  5. 5.
    Foster K, Chapman S, Johnson K (2004) MRI of the marrow in the paediatric skeleton. Clin Radiol 58:651–673CrossRefGoogle Scholar
  6. 6.
    Laor T, Jaramillo D (2009) MR imaging insights into skeletal maturation: what is normal? Radiology 250:28–38PubMedCrossRefGoogle Scholar
  7. 7.
    Thomson W, Barrett JH, Donn R et al (2002) Juvenile idiopathic arthritis classified by the ILAR criteria: HLA associations in UK patients. Rheumatology (Oxford) 41:1183–1189CrossRefGoogle Scholar
  8. 8.
    Cohen J (1960) A coefficient of agreement for nominal scales. Edu Psycol Meas 20:37–46CrossRefGoogle Scholar
  9. 9.
    Landis R, Koch G (1977) An application of the hierarchical kappa-type statistic in the assessment of majority agreement among multiple observers. Biometrics 33:363–374PubMedCrossRefGoogle Scholar
  10. 10.
    Bland JM, Altman DG (1986) Statistical methods for assessing agreement between methods of clinical measurement. Lancet 8476:307–310CrossRefGoogle Scholar
  11. 11.
    Peterfy C, Edmonds J, Lassere M et al (2003) OMERACT Rheumatoid Arthritis MRI Studies Module. J Rheumatol 30:1364–1365PubMedGoogle Scholar
  12. 12.
    Lassere M, McQueen F, Østergaard M et al (2003) OMERACT Rheumatoid Arthritis Magnetic Resonance Imaging Studies. Exercise 3: an international multicenter reliability study using the RA-MRI Score. J Rheumatol 30:1366–1375PubMedGoogle Scholar
  13. 13.
    Conaghan P, Lassere M, Østergaard M et al (2003) OMERACT Rheumatoid Arthritis Magnetic Resonance Imaging Studies. Exercise 4: an international multicenter longitudinal study using the RA-MRI Score. J Rheumatol 30:1376–1379PubMedGoogle Scholar
  14. 14.
    Østergaard M, Peterfy C, Conaghan P et al (2003) OMERACT Rheumatoid Arthritis Magnetic Resonance Imaging Studies. Core set of MRI acquisitions, joint pathology definitions, and the OMERACT RA-MRI scoring system. J Rheumatol 30:1385–1386, Erratum in: J Rheumatol (2004) 31:198PubMedGoogle Scholar
  15. 15.
    McQueen F, Lassere M, Edmonds J et al (2003) OMERACT Rheumatoid Arthritis Magnetic Resonance Imaging Studies. Summary of OMERACT 6 MR Imaging Module. J Rheumatol 30:1387–1392PubMedGoogle Scholar
  16. 16.
    Ostergaard M, McQueen FM, Bird P et al (2005) OMERACT 7 Special Interest Group. Magnetic resonance imaging in rheumatoid arthritis advances and research priorities. Rheumatol 32:2462–2464Google Scholar
  17. 17.
    Hetland ML, Ejbjerg B, Hørslev-Petersen K (2009) CIMESTRA study group. MRI bone oedema is the strongest predictor of subsequent radiographic progression in early rheumatoid arthritis. Results from a 2-year randomised controlled trial (CIMESTRA). Ann Rheum Dis 68:384–390PubMedCrossRefGoogle Scholar
  18. 18.
    Lamer S, Sebag GH (2000) MRI and ultrasound in children with juvenile chronic arthritis. Eur J Radiol 33:85–93PubMedCrossRefGoogle Scholar
  19. 19.
    Burdiles A, Babyn PS (2009) Pediatric bone marrow MRI imaging. Magn Reson Imaging Clin N Am 17:391–409PubMedCrossRefGoogle Scholar
  20. 20.
    Jaramillo D, Laor T, Hoffer FA et al (1991) Epiphyseal marrow in infancy: MR imaging. Radiology 180:809–812PubMedGoogle Scholar
  21. 21.
    Shabshin N, Schweitzer ME, Morrison WB et al (2006) High-signal T2 changes of the bone marrow of the foot and ankle in children: red marrow or traumatic changes? Pediatr Radiol 36:670–676PubMedCrossRefGoogle Scholar
  22. 22.
    Shabshin N, Schweitzer ME (2009) Age dependent T2 changes of bone marrow in pediatric wrist MRI. Skeletal Radiol 38:1163–1168PubMedCrossRefGoogle Scholar
  23. 23.
    Ording Müller LS, Avenarius D, Damasio B et al (2011) The paediatric wrist revisited: redefining MR findings in healthy children. Ann Rheum Dis Apr 70:605–610CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Laura Tanturri de Horatio
    • 1
    Email author
  • Maria Beatrice Damasio
    • 2
  • Domenico Barbuti
    • 1
  • Claudia Bracaglia
    • 3
  • Karen Lambot-Juhan
    • 4
  • Peter Boavida
    • 5
  • Lil-Sofie Ording Müller
    • 6
  • Clara Malattia
    • 7
  • Lucilla Ravà
    • 8
  • Karen Rosendahl
    • 5
    • 9
  • Paolo Tomà
    • 1
  1. 1.Department of RadiologyOspedale Pediatrico Bambino GesùRomeItaly
  2. 2.Department of RadiologyOspedale G. GasliniGenoaItaly
  3. 3.Department of PaediatricsOspedale Pediatrico Bambino GesùRomeItaly
  4. 4.Department of RadiologyHôpital Necker-Enfants MaladesParisFrance
  5. 5.Department of RadiologyGreat Ormond Street HospitalLondonUnited Kingdom
  6. 6.Department of RadiologyUniversity Hospital North NorwayTromsøNorway
  7. 7.Department of PediatricsOspedale G. GasliniGenoaItaly
  8. 8.Department of EpidemiologyOspedale Pediatrico Bambino GesùRomeItaly
  9. 9.Department of Pediatric RadiologyHaukeland University HospitalBergenNorway

Personalised recommendations