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Research ArticleAccepted Article

Whole-body MRI Quantification for Assessment of Bone Lesions in CNO Patients Treated with Pamidronate: A Prevalence, Reproducibility, and Responsiveness Study

Jyoti Panwar, Mirkamal Tolend, Lillian Lim, Shirley M. Tse, Andrea S. Doria, Ronald M. Laxer and Jennifer Stimec
The Journal of Rheumatology September 2020, jrheum.200329; DOI: https://doi.org/10.3899/jrheum.200329
Jyoti Panwar
From the Department of Radiodiagnosis, Christian Medical College and Hospital, Vellore, India; Department of Diagnostic Imaging, The Hospital for Sick Children, Department of Medical Imaging, University of Toronto, Toronto, ON, Canada; Division of Pediatric Rheumatology, Department of Pediatrics, University of Alberta; Edmonton, AB, Canada; Division of Rheumatology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada. Address correspondence to Jyoti Panwar, MD, FRCR, Professor, Department of Radiodiagnosis, Christian Medical College and Hospital, Vellore, India, Phone: +91-638-5209-311. Department of Diagnostic Imaging, The Hospital for Sick Children, Department of Medical Imaging, University of Toronto, Toronto, ON, Canada. Email: drjyoticmch@gmail.com, jyoti.panwar@sickkids.ca
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Mirkamal Tolend
From the Department of Radiodiagnosis, Christian Medical College and Hospital, Vellore, India; Department of Diagnostic Imaging, The Hospital for Sick Children, Department of Medical Imaging, University of Toronto, Toronto, ON, Canada; Division of Pediatric Rheumatology, Department of Pediatrics, University of Alberta; Edmonton, AB, Canada; Division of Rheumatology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada. Address correspondence to Jyoti Panwar, MD, FRCR, Professor, Department of Radiodiagnosis, Christian Medical College and Hospital, Vellore, India, Phone: +91-638-5209-311. Department of Diagnostic Imaging, The Hospital for Sick Children, Department of Medical Imaging, University of Toronto, Toronto, ON, Canada. Email: drjyoticmch@gmail.com, jyoti.panwar@sickkids.ca
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Lillian Lim
From the Department of Radiodiagnosis, Christian Medical College and Hospital, Vellore, India; Department of Diagnostic Imaging, The Hospital for Sick Children, Department of Medical Imaging, University of Toronto, Toronto, ON, Canada; Division of Pediatric Rheumatology, Department of Pediatrics, University of Alberta; Edmonton, AB, Canada; Division of Rheumatology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada. Address correspondence to Jyoti Panwar, MD, FRCR, Professor, Department of Radiodiagnosis, Christian Medical College and Hospital, Vellore, India, Phone: +91-638-5209-311. Department of Diagnostic Imaging, The Hospital for Sick Children, Department of Medical Imaging, University of Toronto, Toronto, ON, Canada. Email: drjyoticmch@gmail.com, jyoti.panwar@sickkids.ca
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Shirley M. Tse
From the Department of Radiodiagnosis, Christian Medical College and Hospital, Vellore, India; Department of Diagnostic Imaging, The Hospital for Sick Children, Department of Medical Imaging, University of Toronto, Toronto, ON, Canada; Division of Pediatric Rheumatology, Department of Pediatrics, University of Alberta; Edmonton, AB, Canada; Division of Rheumatology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada. Address correspondence to Jyoti Panwar, MD, FRCR, Professor, Department of Radiodiagnosis, Christian Medical College and Hospital, Vellore, India, Phone: +91-638-5209-311. Department of Diagnostic Imaging, The Hospital for Sick Children, Department of Medical Imaging, University of Toronto, Toronto, ON, Canada. Email: drjyoticmch@gmail.com, jyoti.panwar@sickkids.ca
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Andrea S. Doria
From the Department of Radiodiagnosis, Christian Medical College and Hospital, Vellore, India; Department of Diagnostic Imaging, The Hospital for Sick Children, Department of Medical Imaging, University of Toronto, Toronto, ON, Canada; Division of Pediatric Rheumatology, Department of Pediatrics, University of Alberta; Edmonton, AB, Canada; Division of Rheumatology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada. Address correspondence to Jyoti Panwar, MD, FRCR, Professor, Department of Radiodiagnosis, Christian Medical College and Hospital, Vellore, India, Phone: +91-638-5209-311. Department of Diagnostic Imaging, The Hospital for Sick Children, Department of Medical Imaging, University of Toronto, Toronto, ON, Canada. Email: drjyoticmch@gmail.com, jyoti.panwar@sickkids.ca
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Ronald M. Laxer
From the Department of Radiodiagnosis, Christian Medical College and Hospital, Vellore, India; Department of Diagnostic Imaging, The Hospital for Sick Children, Department of Medical Imaging, University of Toronto, Toronto, ON, Canada; Division of Pediatric Rheumatology, Department of Pediatrics, University of Alberta; Edmonton, AB, Canada; Division of Rheumatology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada. Address correspondence to Jyoti Panwar, MD, FRCR, Professor, Department of Radiodiagnosis, Christian Medical College and Hospital, Vellore, India, Phone: +91-638-5209-311. Department of Diagnostic Imaging, The Hospital for Sick Children, Department of Medical Imaging, University of Toronto, Toronto, ON, Canada. Email: drjyoticmch@gmail.com, jyoti.panwar@sickkids.ca
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Jennifer Stimec
From the Department of Radiodiagnosis, Christian Medical College and Hospital, Vellore, India; Department of Diagnostic Imaging, The Hospital for Sick Children, Department of Medical Imaging, University of Toronto, Toronto, ON, Canada; Division of Pediatric Rheumatology, Department of Pediatrics, University of Alberta; Edmonton, AB, Canada; Division of Rheumatology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada. Address correspondence to Jyoti Panwar, MD, FRCR, Professor, Department of Radiodiagnosis, Christian Medical College and Hospital, Vellore, India, Phone: +91-638-5209-311. Department of Diagnostic Imaging, The Hospital for Sick Children, Department of Medical Imaging, University of Toronto, Toronto, ON, Canada. Email: drjyoticmch@gmail.com, jyoti.panwar@sickkids.ca
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Abstract

Objective The purpose of this study was 1) to assess the inter-reader reliability in detecting and scoring the inflammatory bone lesions in pediatric patients with chronic nonbacterial osteomyelitis (CNO) by using WB-MRI, and 2) to evaluate the responsiveness of the MRIdetected CNO lesions to pamidronate therapy.

Methods Eighty-eight WB-MRI examinations were independently reviewed and scored by two radiologists blinded to clinical details in 32 retrospectively enrolled pediatric patients with CNO. Inflammatory bone lesions, soft tissue abnormality, and bony structural changes were scored before and after pamidronate therapy. Lesion responsiveness was calculated by using standardized response mean and inter-reader reliability was assessed by kappa statistics.

Results There was good to excellent inter-reader agreement for the detection and quantification of bone lesions. After the first cycle of pamidronate in all 32 patients, 96 of the 279 lesions (34%) (after excluding 108 lesions of hand and feet) resolved, while in a subset of 11 patients with two or more cycles, 76% of lesions resolved after the second cycle. Twenty-one (7.5%) lesions worsened and 46 (16.4%) new lesions developed after one cycle in all 32 patients. In these 11 patients, the number of worsened lesions reduced to 2 (2%) and new lesions to 14 (14.9%) after the second cycle as detected on MRI. Vertebral lesions had the highest response to treatment.

Conclusion WB-MRI is a reliable tool for objective quantification and assessment of response to treatment of pediatric CNO bone lesions and could be used to monitor disease activity for clinical and research purposes.

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The Journal of Rheumatology
Vol. 48, Issue 3
1 Mar 2021
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Accepted manuscript
Whole-body MRI Quantification for Assessment of Bone Lesions in CNO Patients Treated with Pamidronate: A Prevalence, Reproducibility, and Responsiveness Study
Jyoti Panwar, Mirkamal Tolend, Lillian Lim, Shirley M. Tse, Andrea S. Doria, Ronald M. Laxer, Jennifer Stimec
The Journal of Rheumatology Sep 2020, jrheum.200329; DOI: 10.3899/jrheum.200329

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Accepted manuscript
Whole-body MRI Quantification for Assessment of Bone Lesions in CNO Patients Treated with Pamidronate: A Prevalence, Reproducibility, and Responsiveness Study
Jyoti Panwar, Mirkamal Tolend, Lillian Lim, Shirley M. Tse, Andrea S. Doria, Ronald M. Laxer, Jennifer Stimec
The Journal of Rheumatology Sep 2020, jrheum.200329; DOI: 10.3899/jrheum.200329
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