European Radiology

, Volume 24, Issue 2, pp 327–334 | Cite as

Contrast-enhanced MRI compared with the physical examination in the evaluation of disease activity in juvenile idiopathic arthritis

  • Robert HemkeEmail author
  • Mario Maas
  • Mira van Veenendaal
  • Koert M. Dolman
  • Marion A. J. van Rossum
  • J. Merlijn van den Berg
  • Taco W. Kuijpers



To assess the value of magnetic resonance imaging (MRI) in discriminating between active and inactive juvenile idiopathic arthritis (JIA) patients and to compare physical examination outcomes with MRI outcomes in the assessment of disease status in JIA patients.


Consecutive JIA patients with knee involvement were prospectively studied using an open-bore MRI. Imaging findings from 146 JIA patients were analysed (59.6 % female; mean age, 12.9 years). Patients were classified as clinically active or inactive. MRI features were evaluated using the JAMRIS system, comprising validated scores for synovial hypertrophy, bone marrow oedema, cartilage lesions and bone erosions.


Inter-reader reliability was good for all MRI features (intra-class correlation coefficient [ICC] = 0.87–0.94). No differences were found between the two groups regarding MRI scores of bone marrow oedema, cartilage lesions or bone erosions. Synovial hypertrophy scores differed significantly between groups (P = 0.016). Nonetheless, synovial hypertrophy was also present in 14 JIA patients (35.9 %) with clinically inactive disease. Of JIA patients considered clinically active, 48.6 % showed no signs of MRI-based synovitis.


MRI can discriminate between clinically active and inactive JIA patients. However, physical examination is neither very sensitive nor specific in evaluating JIA disease activity compared with MRI. Subclinical synovitis was present in >35 % of presumed clinically inactive patients.

Key points

MRI is sensitive for evaluating juvenile idiopathic arthritis (JIA) disease activity.

Contrast-enhanced MRI can distinguish clinically active and inactive JIA patients.

Subclinical synovitis is present in 35.9 % of presumed clinically inactive patients.

Physical examination is neither sensitive nor specific in evaluating JIA disease activity.


Juvenile idiopathic arthritis Magnetic Resonance Imaging Physical examination Knee joint Synovitis Discriminative value 



This work was supported by a research grant received from the Dutch Arthritis Association (Reumafonds, Amsterdam, The Netherlands). The Dutch Arthritis Association was not involved in designing and conducting this study, did not have access to the data and was not involved in data analysis or preparation of this manuscript.


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Copyright information

© European Society of Radiology 2013

Authors and Affiliations

  • Robert Hemke
    • 1
    Email author
  • Mario Maas
    • 1
  • Mira van Veenendaal
    • 2
  • Koert M. Dolman
    • 3
    • 4
  • Marion A. J. van Rossum
    • 2
    • 3
  • J. Merlijn van den Berg
    • 2
    • 3
  • Taco W. Kuijpers
    • 2
  1. 1.Department of RadiologyAcademic Medical Centre, University of AmsterdamAmsterdamThe Netherlands
  2. 2.Department of Paediatric Haematology, Immunology, Rheumatology and Infectious Disease, Emma Children’s Hospital AMCUniversity of AmsterdamAmsterdamThe Netherlands
  3. 3.Department of Paediatric RheumatologyAmsterdamThe Netherlands
  4. 4.Department of PaediatricsSt. Lucas Andreas HospitalAmsterdamThe Netherlands

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