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


CONCLUSIONS
• 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.
Department of Radiology (G1-235), Academic Medical Center, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands. r.hemke@amc.nl
Robert
R
Hemke
Taco W
TW
Kuijpers
J Merlijn
JM
van den Berg
Mira
M
van Veenendaal
Koert M
KM
Dolman
Marion A J
MA
van Rossum
Mario
M
Maas
D000293:Adolescent; D001171:Arthritis, Juvenile / Q000150:complications* / Q000473:pathology; D001853:Bone Marrow / Q000473:pathology; D001842:Bone and Bones / Q000473:pathology; D002356:Cartilage / Q000473:pathology; D002648:Child; D003287:Contrast Media; D005260:Female; D005682:Gadolinium; D006801:Humans; D007592:Joint Diseases / Q000175:diagnosis* / Q000473:pathology; D007719:Knee Joint / Q000473:pathology*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D015588:Observer Variation; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012015:Reference Standards; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
D003287:Contrast Media; D005682:Gadolinium