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The diagnostic accuracy of unenhanced MRI in the assessment of joint abnormalities in juvenile idiopathic arthritis

  • Pediatric
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Abstract

Objectives

To assess the diagnostic accuracy and reliability of MRI without contrast enhancement in the evaluation of JIA knee joint abnormalities.

Methods

JIA patients with clinically active knee involvement were prospectively studied using an 1-T open-bore magnet. MRI features were independently evaluated by two readers using the JAMRIS system. The first reading included unenhanced images, whereas complete image sets were available for the second reading.

Results

Imaging findings from 73 patients were analysed. Agreement between Gd-enhanced (+Gd) and Gd-unenhanced (−Gd) MRI scores of bone marrow changes, cartilage lesions and bone erosions was good concerning sensitivity, specificity, negative predictive value and positive predictive value. Inter-observer agreement was good for both −Gd and +Gd scores (ICC = 0.91–1.00, 0.93–1.00, respectively). Regarding the assessment of synovial hypertrophy, specificity of −Gd was high (0.97), but the sensitivity of unenhanced MRI was only 0.62. Inter-reader agreement for +Gd MRI was ICC = 0.94; however, omitting post-Gd acquisitions increased inter-reader variation (ICC = 0.86).

Conclusions

If Gd-enhanced MRI is the reference standard, omitting Gd contrast medium is irrelevant for the assessment of bone marrow changes, cartilage lesions and bone erosions as joint abnormalities in JIA. Omitting intravenous Gd in the MRI assessment of joints in JIA is inadvisable, because it decreases the reliability of detecting synovial disease.

Key Points

• Magnetic resonance imaging is increasingly used to assess juvenile idiopathic arthritis.

• Synovial hypertrophy, a marker of JIA activity, is well shown by MRI.

• Omitting intravenous contrast medium decreases the reliability of synovial hypertrophy scores.

• Bone marrow, cartilage and erosions can be reliably evaluated without contrast enhancement.

• In the evaluation of JIA disease activity, unenhanced MRI is inadvisable.

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Acknowledgment

This work was supported by a research grant received from the Reumafonds, Dutch Arthritis Association (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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Authors and Affiliations

  1. Department of Radiology (G1-235), Academic Medical Center, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands

    Robert Hemke & Mario Maas

  2. Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children’s Hospital AMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands

    Robert Hemke, Taco W. Kuijpers, J. Merlijn van den Berg, Mira van Veenendaal & Marion A. J. van Rossum

  3. Department of Pediatric Rheumatology, Reade, Dr. Jan van Breemenstraat 2, Amsterdam, The Netherlands

    J. Merlijn van den Berg, Koert M. Dolman & Marion A. J. van Rossum

  4. Department of Pediatric Rheumatology, St. Lucas Andreas Hospital, Jan Tooropstraat 164, Amsterdam, The Netherlands

    Koert M. Dolman

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  1. Robert Hemke
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  2. Taco W. Kuijpers
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  3. J. Merlijn van den Berg
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  4. Mira van Veenendaal
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  5. Koert M. Dolman
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  6. Marion A. J. van Rossum
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  7. Mario Maas
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Correspondence to Robert Hemke.

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Hemke, R., Kuijpers, T.W., van den Berg, J.M. et al. The diagnostic accuracy of unenhanced MRI in the assessment of joint abnormalities in juvenile idiopathic arthritis. Eur Radiol 23, 1998–2004 (2013). https://doi.org/10.1007/s00330-013-2770-9

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  • DOI: https://doi.org/10.1007/s00330-013-2770-9

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