title: Preliminary validation of the Knee Inflammation MRI Scoring System (KIMRISS) for grading bone marrow lesions in osteoarthritis of the knee: data from the Osteoarthritis Initiative.
abstract: OBJECTIVE
  Bone marrow lesions (BML) are an MRI feature of osteoarthritis (OA) offering a potential target for therapy. We developed the Knee Inflammation MRI Scoring System (KIMRISS) to semiquantitatively score BML with high sensitivity to small changes, and compared feasibility, reliability and responsiveness versus the established MRI Osteoarthritis Knee Score (MOAKS).
  
  
  METHODS
  KIMRISS incorporates a web-based graphic overlay to facilitate detailed regional BML scoring. Observers scored BML by MOAKS and KIMRISS on sagittal fluid-sensitive sequences. Exercise 1 focused on interobserver reliability in Osteoarthritis Initiative observational data, with 4 readers (two experienced/two new to KIMRISS) scoring BML in 80 patients (baseline/1 year). Exercise 2 focused on responsiveness in an open-label trial of adalimumab, with 2 experienced readers scoring BML in 16 patients (baseline/12 weeks).
  
  
  RESULTS
  Scoring time was similar for KIMRISS and MOAKS. Interobserver reliability of KIMRISS was equivalent to MOAKS for BML status (ICC=0.84 vs 0.79), but consistently better than MOAKS for change in BML: Exercise 1 (ICC 0.82 vs 0.53), Exercise 2 (ICC 0.90 vs 0.32), and in new readers (0.87-0.92 vs 0.32-0.51). KIMRISS BML was more responsive than MOAKS BML: post-treatment BML improvement in Exercise 2 reached statistical significance for KIMRISS (SRM -0.69, p=0.015), but not MOAKS (SRM -0.12, p=0.625). KIMRISS BML also more strongly correlated to WOMAC scores than MOAKS BML (r=0.80 vs 0.58, p<0.05).
  
  
  CONCLUSIONS
  KIMRISS BML scoring was highly feasible, and was more reliable for assessment of change and more responsive to change than MOAKS BML for expert and new readers.
authors.affiliation: Department of Radiology & Diagnostic Imaging , University of Alberta Hospital , Edmonton, Alberta , Canada.
authors.forename: Jacob L
authors.identifier: 0000-0001-5314-2297
authors.initials: JL
authors.lastname: Jaremko
authors.affiliation: Department of Radiology & Diagnostic Imaging , University of Alberta Hospital , Edmonton, Alberta , Canada.
authors.forename: Dean
authors.initials: D
authors.lastname: Jeffery
authors.affiliation: Department of Radiology & Diagnostic Imaging , University of Alberta Hospital , Edmonton, Alberta , Canada.
authors.forename: M
authors.initials: M
authors.lastname: Buller
authors.affiliation: Faculty of Medicine, Division of Rheumatology , University of Alberta Hospital , Edmonton, Alberta , Canada.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Wichuk
authors.affiliation: Department of Radiology & Diagnostic Imaging , University of Alberta Hospital , Edmonton, Alberta , Canada.
authors.forename: Dave
authors.initials: D
authors.lastname: McDougall
authors.affiliation: Department of Radiology & Diagnostic Imaging , University of Alberta Hospital , Edmonton, Alberta , Canada.
authors.forename: Robert Gw
authors.initials: RG
authors.lastname: Lambert
authors.affiliation: Faculty of Medicine, Division of Rheumatology , University of Alberta Hospital , Edmonton, Alberta , Canada.
authors.forename: Walter P
authors.initials: WP
authors.lastname: Maksymowych
keywords: Knee Osteoarthritis; Magnetic Resonance Imaging; Osteoarthritis