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Pediatric Radiology

, Volume 43, Issue 7, pp 785–795 | Cite as

MRI of the wrist in juvenile idiopathic arthritis: erosions or normal variants? A prospective case-control study

  • Lil-Sofie Ording MullerEmail author
  • Peter Boavida
  • Derk Avenarius
  • Beatrice Damasio
  • Odd Petter Eldevik
  • Clara Malattia
  • Karen Lambot-Juhan
  • Laura Tanturri
  • Catherine M. Owens
  • Karen Rosendahl
Original Article

Abstract

Background

Bony depressions at the wrist resembling erosions are frequently seen on MRI in healthy children. The accuracy of MRI in detecting early bony destruction is therefore questionable. We compared findings on MRI of the wrist in healthy children and those with juvenile idiopathic arthritis (JIA) to investigate markers for true disease.

Materials and methods

We compared the number and localisation of bony depressions at the wrist in 85 healthy children and 68 children with JIA, ages 5–15 years. The size of the wrist was assessed from a radiograph of the wrist performed on the same day as the MRI.

Results

No significant difference in the number of bony depressions in the carpal bones was seen between healthy children and children with JIA at any age. Depressions are found in similar locations in the two groups, except for a few sites, where bony depressions were seen exclusively in the JIA group, particularly at the CMC joints. The wrist was significantly smaller in children with JIA (P < 0.001).

Conclusions

Using adult scoring systems and standard MR sequences in the assessment of bone destruction in children may lead to overstaging or understaging of disease. At present, standard MRI sequences cannot easily be used for assessment of early signs of erosions in children.

Keywords

Wrist MRI Children Normal Juvenile idiopathic arthritis JIA Erosions 

Notes

Acknowledgments

We wish to thank Dr. Clarissa Pilkington, Dr. Sandrine Lacassagne and Professor Pierre Quartier for providing the clinical data for the children from Great Ormond Street Hospital and NEM. This study was funded, in part, by a grant from the European Union, Health-e-Child Integrated Project (IST 2004-027749).

References

  1. 1.
    Ruperto N, Lovell DJ, Cuttica R et al (2010) Long-term efficacy and safety of infliximab plus methotrexate for the treatment of polyarticular course juvenile rheumatoid arthritis: findings from an open-label treatment extension. Ann Rheum Dis 69:718–722PubMedCrossRefGoogle Scholar
  2. 2.
    Ruperto N, Lovell DJ, Cuttica R et al (2007) A randomized, placebo-controlled trial of infliximab plus methotrexate for the treatment of polyarticular-course juvenile rheumatoid arthritis. Arthritis Rheum 56:3096–3106PubMedCrossRefGoogle Scholar
  3. 3.
    Ringold S, Wallace CA (2007) Measuring clinical response and remission in juvenile idiopathic arthritis. Curr Opin Rheumatol 19:471–476PubMedCrossRefGoogle Scholar
  4. 4.
    Oen K, Malleson PN, Cabral DA et al (2002) Disease course and outcome of juvenile rheumatoid arthritis in a multicenter cohort. J Rheumatol 29:1989–1999PubMedGoogle Scholar
  5. 5.
    Poznanski AK, Hernandez RJ, Guire KE et al (1978) Carpal length in children—a useful measurement in the diagnosis of rheumatoid arthritis and some concenital malformation syndromes. Radiology 129:661–668PubMedGoogle Scholar
  6. 6.
    Johnson K (2006) Imaging of juvenile idiopathic arthritis. Pediatr Radiol 36:743–758PubMedCrossRefGoogle Scholar
  7. 7.
    Ravelli A, Ioseliani M, Norambuena X et al (2007) Adapted versions of the Sharp/van der Heijde score are reliable and valid for assessment of radiographic progression in juvenile idiopathic arthritis. Arthritis Rheum 56:3087–3095PubMedCrossRefGoogle Scholar
  8. 8.
    Rossi F, Di Dia F, Galipo O et al (2006) Use of the Sharp and Larsen scoring methods in the assessment of radiographic progression in juvenile idiopathic arthritis. Arthritis Rheum 55:717–723PubMedCrossRefGoogle Scholar
  9. 9.
    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 59:1764–1772PubMedCrossRefGoogle Scholar
  10. 10.
    Muller LS, Avenarius D, Damasio B et al (2011) The paediatric wrist revisited: redefining MR findings in healthy children. Ann Rheum Dis 70:605–610PubMedCrossRefGoogle Scholar
  11. 11.
    Ostergaard M, Edmonds J, McQueen F et al (2005) An introduction to the EULAR-OMERACT rheumatoid arthritis MRI reference image atlas. Ann Rheum Dis 64(Suppl 1):i3–i7PubMedCrossRefGoogle Scholar
  12. 12.
    Ostergaard 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 30:1385–1386PubMedGoogle Scholar
  13. 13.
    Malattia C, Damasio MB, Pistorio A et al (2011) Development and preliminary validation of a paediatric-targeted MRI scoring system for the assessment of disease activity and damage in juvenile idiopathic arthritis. Ann Rheum Dis 70:440–446PubMedCrossRefGoogle Scholar
  14. 14.
    Petty RE, Southwood TR, Manners P et al (2004) International League of Associations for Rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001. J Rheumatol 31:390–392PubMedGoogle Scholar
  15. 15.
    Ejbjerg B, McQueen F, Lassere M et al (2005) The EULAR-OMERACT rheumatoid arthritis MRI reference image atlas: the wrist joint. Ann Rheum Dis 64(Suppl 1):i23–i147PubMedCrossRefGoogle Scholar
  16. 16.
    Avenarius DM, Ording Muller LS, Eldevik P et al (2012) The paediatric wrist revisited-findings of bony depressions in healthy children on radiographs compared to MRI. Pediatr Radiol 42:791–798PubMedCrossRefGoogle Scholar
  17. 17.
    Boavida P, Hargunani R, Owens CM et al (2012) Magnetic resonance imaging and radiographic assessment of carpal depressions in children with juvenile idiopathic arthritis: normal variants or erosions? J Rheumatol 39:645–650PubMedCrossRefGoogle Scholar
  18. 18.
    Nanno M, Buford WL Jr, Patterson RM et al (2007) Three-dimensional analysis of the ligamentous attachments of the second through fifth carpometacarpal joints. Clin Anat 20:530–544PubMedCrossRefGoogle Scholar
  19. 19.
    Pyle SI, Waterhouse AM, Greulich WW (1971) Attributes of the radiographic standard of reference for the National Health Examination Survey. Am J Phys Anthropol 35:331–337PubMedCrossRefGoogle Scholar
  20. 20.
    Kight AC, Dardzinski BJ, Laor T et al (2004) Magnetic resonance imaging evaluation of the effects of juvenile rheumatoid arthritis on distal femoral weight-bearing cartilage. Arthritis Rheum 50:901–905PubMedCrossRefGoogle Scholar
  21. 21.
    Borrero CG, Mountz JM, Mountz JD (2011) Emerging MRI methods in rheumatoid arthritis. Nat Rev Rheumatol 7:85–95PubMedCrossRefGoogle Scholar
  22. 22.
    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 22:654–658PubMedCrossRefGoogle Scholar
  23. 23.
    Goldbach-Mansky R, Woodburn J, Yao L et al (2003) Magnetic resonance imaging in the evaluation of bone damage in rheumatoid arthritis: a more precise image or just a more expensive one? Arthritis Rheum 48:585–589PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  • Lil-Sofie Ording Muller
    • 1
    • 2
    • 11
    Email author
  • Peter Boavida
    • 3
  • Derk Avenarius
    • 1
  • Beatrice Damasio
    • 4
  • Odd Petter Eldevik
    • 1
  • Clara Malattia
    • 5
  • Karen Lambot-Juhan
    • 6
  • Laura Tanturri
    • 7
  • Catherine M. Owens
    • 2
    • 8
  • Karen Rosendahl
    • 2
    • 8
    • 9
    • 10
  1. 1.Department of RadiologyUniversity Hospital North NorwayTromsøNorway
  2. 2.Department of RadiologyGreat Ormond Street Hospital for ChildrenLondonUK
  3. 3.Department of RadiologyHomerton University HospitalLondonUK
  4. 4.Department of RadiologyOspedale Pediatrico GasliniGenoaItaly
  5. 5.Department of RhematologyOspedale Pediatrico GasliniGenoaItaly
  6. 6.Department of RadiologyHopital Necker Enfants MaladesParisFrance
  7. 7.Department of RadiologyOspedale Pediatrico Bambino GesuRomeItaly
  8. 8.Institute of Child HealthUCLLondonUK
  9. 9.Department of RadiologyHaukeland University HospitalBergenNorway
  10. 10.Department of Surgical SciencesUniversity of BergenBergenNorway
  11. 11.OsloNorway

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