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SAT0671 (2018)
Initial development of a whole-body magnetic resonance imaging inflammation index for active disease of peripheral joints and entheses in patients with inflammatory arthritis
S. Krabbe1,2, P. Bird3, I. Eshed4, V. Foltz5, F. Gandjbakhch5,6, D. Glinatsi1, J.L. Jaremko7, R.G. Lambert7, W.P. Maksymowych8, A.J. Mathew9, S.J. Pedersen1, R. Poggenborg1, M.S. Stoenoiu10, P.G. Conaghan11, C.E. Althoff12, C. Peterfy13, K.-G. Hermann14, M. Østergaard1,2, on behalf of OMERACT MRI Working Group
1Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet
2Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
3Division of Medicine, University of New South Wales, Sydney, Australia
4Department of Diagnostic Imaging, Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
5Hôpitaux Universitaires Pitié Salpêtrière
6Paris 6 University, GRC-UPMC 08, Pierre Louis Institute of Epidemiology and Public Health, Paris, France
7Department of Radiology and Diagnostic Imaging, University of Alberta
8CaRE (Canadian Research Education) Arthritis and Department of Medicine, University of Alberta, Edmonton, Canada
9Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India
10Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain, Brussels, Belgium
11Faculty of Medicine and Health, University of Leeds, UK
12Institut und Klinik für Radiologie CCM und CVK Charité – Universitätsmedizin, Berlin, Germany
13Spire Sciences, Inc., San Francisco, USA
14Department of Radiology, Arthritis Imaging Research Group, University Hospital Charité, Berlin, Germany

 

Background: Magnetic resonance imaging (MRI) allows objective assessment of inflammation in peripheral joints and entheses. MRI scoring systems have until now focused on assessing specific parts of the musculoskeletal system in detail, e.g. the Rheumatoid Arthritis MRI Scoring System (RAMRIS), which is applied to wrist and metacarpophalangeal joints and adjacent tendon sheaths. The interest in a whole-body MRI approach is growing as modern MRI scanners now permit whole-body scanning within an acceptable time frame, and future improvements in MRI hardware and pulse sequences are expected to improve scan time and image resolution further.

Objectives: To develop a whole-body MRI scoring system for inflammation of peripheral joints and entheses and to investigate its feasibility and reliability.

Methods: Definitions of the key pathologies and locations for assessment have been agreed upon in the OMERACT MRI Working Group1. In a first round in June 2017, 9 readers (AJM/DG/FG/IE/MØ/PB/SJP/SK/WPM) scored MR images of 2 patients with spondyloarthritis using a draft web-based scoring system. Results were discussed and the scoring system was slightly modified. Hereafter, in a second round in October 2017, 14 MRI readers (3 musculoskeletal radiologist (IE/JLJ/RGL) and 11 rheumatologists with varying exposure to MRI (AJM/DG/FG/MS/MØ/PB/RP/SJP/SK/VF/WPM), scored 5 similar patients by the modified scoring system. Using a semiquantitative scale 0–3 (none/mild/moderate/severe), synovitis and osteitis were scored separately for 83 joints, and soft tissue inflammation and osteitis were scored separately for 33 entheses. Discrepancies between readers were discussed during an online meeting to obtain consensus, to train inexperienced readers, and to identify potential pitfalls when applying the scoring system.

Results: Inter-reader reliability was overall moderate for joint scores and poor for enthesis scores; however, among the 3 musculoskeletal radiologists, enthesis scores were as reliable as joint scores (Table). Reliability did not improve between the first and second round, possibly because patients with several very conspicuous inflammatory lesions were selected as cases in the first round.

Abstract SAT0671 – Table 1 Inter-reader reliability of scoring inflammation of peripheral joints and enthuses (Cohen’s kappa with squared weights for individual scores, ICC(3,1), agreement, for sum scores). All values are median (IQR; range) of all reader pairs (36 reader pairs for 9 readers, 91 reader pairs for 14 readers, 3 reader pairs for 3 readers [values for 3 reader pairs provided]).

abs_ZRQQRRVU_T001.jpg

Conclusions: It is feasible to perform online multi-reader scoring exercises of whole-body MRI using a web-based scoring interface. MRI readers need to be further trained and calibrated in the semiquantitative scoring approach used to increase inter-reader reliability.

Reference:

  1. Østergaard M, et al. J Rheumatol 2017;44:1699–1705.

Disclosure of Interest: None declared

DOI: 10.1136/annrheumdis-2018-eular.6191


Citation: Ann Rheum Dis, volume 77, supplement Suppl, year 2018, page A1183
Session: Diagnostics and imaging procedures