title: Validation of a Knowledge Transfer Tool for the Knee Inflammation MRI Scoring System for Bone Marrow Lesions According to the OMERACT Filter: Data from the Osteoarthritis Initiative.
abstract: OBJECTIVE
  To assess feasibility and reliability of scoring bone marrow lesions (BML) on knee magnetic resonance imaging (MRI) in osteoarthritis using the Outcome Measures in Rheumatology Knee Inflammation MRI Scoring System (KIMRISS), with a Web-based interface and online training with real-time iterative calibration.
  
  
  METHODS
  Six readers new to the KIMRISS (3 radiologists, 3 rheumatologists) scored sagittal T2-weighted fat-saturated MRI in 20 subjects randomly selected from the Osteoarthritis Initiative data, at baseline and 1-year followup. In the KIMRISS, the reader moves a transparent overlay grid within a Web-based interface to fit bones, then clicks or touches each region containing BML per slice, to score 1 if BML is present. Regional and total scores are automatically calculated. Outcomes include the interreader intraclass correlation coefficients (ICC) and the smallest detectable change (SDC).
  
  
  RESULTS
  Scoring took 3-12 min per scan and all readers rated the process as moderately to very user friendly. Despite a low BML burden (average score 2.8% of maximum possible) and small changes, interobserver reliability was moderate to high for BML status and change in the femur and tibia (ICC 0.78-0.88). Four readers also scored the patella reliably, whereas 2 readers were outliers, likely because of image artifacts. SDC of 1.5-5.6 represented 0.7% of the maximum possible score.
  
  
  CONCLUSIONS
  We confirmed feasibility of knee BML scoring by new readers using interactive training and a Web-based touch-sensitive overlay system, finding high reliability and sensitivity to change. Further work will include adjustments to training materials regarding patellar scoring, and study in therapeutic trial datasets with higher burden of BML and larger changes.
authors.affiliation: From the Department of Radiology and Diagnostic Imaging, and the Division of Rheumatology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; Division of Medicine, University of New South Wales, Sydney, Australia; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Department of Radiology and Medical Imaging, Ghent University Hospital, Ghent, Belgium; King Christian 10th Hospital for Rheumatic Diseases, Gråsten; Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark; Department of Radiology, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, UK; Department of Radiology, Balgrist University Hospital, Zurich, Switzerland. jjaremko@ualberta.ca.|J.L. Jaremko, MD, PhD, FRCPC, Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta; O. Azmat, MB, FRCP, Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta; R.G. Lambert, MB, FRCPC, Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta; P. Bird, MD, Division of Medicine, University of New South Wales; I.K. Haugen, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; L. Jans, MD, PhD, Department of Radiology and Medical Imaging, Ghent University Hospital; U. Weber, MD, King Christian 10th Hospital for Rheumatic Diseases, and Institute of Regional Health Research, University of Southern Denmark; N. Winn, MBBS, FRCR, Department of Radiology, Robert Jones and Agnes Hunt Orthopaedic Hospital; V. Zubler, MD, Department of Radiology, Balgrist University Hospital; W.P. Maksymowych, MB ChB, FRCP(C), FACP, Division of Rheumatology, Faculty of Medicine and Dentistry, University of Alberta. jjaremko@ualberta.ca.
authors.forename: Jacob L
authors.initials: JL
authors.lastname: Jaremko
authors.affiliation: From the Department of Radiology and Diagnostic Imaging, and the Division of Rheumatology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; Division of Medicine, University of New South Wales, Sydney, Australia; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Department of Radiology and Medical Imaging, Ghent University Hospital, Ghent, Belgium; King Christian 10th Hospital for Rheumatic Diseases, Gråsten; Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark; Department of Radiology, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, UK; Department of Radiology, Balgrist University Hospital, Zurich, Switzerland.|J.L. Jaremko, MD, PhD, FRCPC, Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta; O. Azmat, MB, FRCP, Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta; R.G. Lambert, MB, FRCPC, Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta; P. Bird, MD, Division of Medicine, University of New South Wales; I.K. Haugen, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; L. Jans, MD, PhD, Department of Radiology and Medical Imaging, Ghent University Hospital; U. Weber, MD, King Christian 10th Hospital for Rheumatic Diseases, and Institute of Regional Health Research, University of Southern Denmark; N. Winn, MBBS, FRCR, Department of Radiology, Robert Jones and Agnes Hunt Orthopaedic Hospital; V. Zubler, MD, Department of Radiology, Balgrist University Hospital; W.P. Maksymowych, MB ChB, FRCP(C), FACP, Division of Rheumatology, Faculty of Medicine and Dentistry, University of Alberta.
authors.forename: Omar
authors.initials: O
authors.lastname: Azmat
authors.affiliation: From the Department of Radiology and Diagnostic Imaging, and the Division of Rheumatology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; Division of Medicine, University of New South Wales, Sydney, Australia; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Department of Radiology and Medical Imaging, Ghent University Hospital, Ghent, Belgium; King Christian 10th Hospital for Rheumatic Diseases, Gråsten; Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark; Department of Radiology, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, UK; Department of Radiology, Balgrist University Hospital, Zurich, Switzerland.|J.L. Jaremko, MD, PhD, FRCPC, Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta; O. Azmat, MB, FRCP, Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta; R.G. Lambert, MB, FRCPC, Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta; P. Bird, MD, Division of Medicine, University of New South Wales; I.K. Haugen, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; L. Jans, MD, PhD, Department of Radiology and Medical Imaging, Ghent University Hospital; U. Weber, MD, King Christian 10th Hospital for Rheumatic Diseases, and Institute of Regional Health Research, University of Southern Denmark; N. Winn, MBBS, FRCR, Department of Radiology, Robert Jones and Agnes Hunt Orthopaedic Hospital; V. Zubler, MD, Department of Radiology, Balgrist University Hospital; W.P. Maksymowych, MB ChB, FRCP(C), FACP, Division of Rheumatology, Faculty of Medicine and Dentistry, University of Alberta.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Lambert
authors.affiliation: From the Department of Radiology and Diagnostic Imaging, and the Division of Rheumatology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; Division of Medicine, University of New South Wales, Sydney, Australia; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Department of Radiology and Medical Imaging, Ghent University Hospital, Ghent, Belgium; King Christian 10th Hospital for Rheumatic Diseases, Gråsten; Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark; Department of Radiology, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, UK; Department of Radiology, Balgrist University Hospital, Zurich, Switzerland.|J.L. Jaremko, MD, PhD, FRCPC, Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta; O. Azmat, MB, FRCP, Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta; R.G. Lambert, MB, FRCPC, Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta; P. Bird, MD, Division of Medicine, University of New South Wales; I.K. Haugen, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; L. Jans, MD, PhD, Department of Radiology and Medical Imaging, Ghent University Hospital; U. Weber, MD, King Christian 10th Hospital for Rheumatic Diseases, and Institute of Regional Health Research, University of Southern Denmark; N. Winn, MBBS, FRCR, Department of Radiology, Robert Jones and Agnes Hunt Orthopaedic Hospital; V. Zubler, MD, Department of Radiology, Balgrist University Hospital; W.P. Maksymowych, MB ChB, FRCP(C), FACP, Division of Rheumatology, Faculty of Medicine and Dentistry, University of Alberta.
authors.forename: Paul
authors.initials: P
authors.lastname: Bird
authors.affiliation: From the Department of Radiology and Diagnostic Imaging, and the Division of Rheumatology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; Division of Medicine, University of New South Wales, Sydney, Australia; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Department of Radiology and Medical Imaging, Ghent University Hospital, Ghent, Belgium; King Christian 10th Hospital for Rheumatic Diseases, Gråsten; Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark; Department of Radiology, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, UK; Department of Radiology, Balgrist University Hospital, Zurich, Switzerland.|J.L. Jaremko, MD, PhD, FRCPC, Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta; O. Azmat, MB, FRCP, Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta; R.G. Lambert, MB, FRCPC, Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta; P. Bird, MD, Division of Medicine, University of New South Wales; I.K. Haugen, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; L. Jans, MD, PhD, Department of Radiology and Medical Imaging, Ghent University Hospital; U. Weber, MD, King Christian 10th Hospital for Rheumatic Diseases, and Institute of Regional Health Research, University of Southern Denmark; N. Winn, MBBS, FRCR, Department of Radiology, Robert Jones and Agnes Hunt Orthopaedic Hospital; V. Zubler, MD, Department of Radiology, Balgrist University Hospital; W.P. Maksymowych, MB ChB, FRCP(C), FACP, Division of Rheumatology, Faculty of Medicine and Dentistry, University of Alberta.
authors.forename: Ida K
authors.initials: IK
authors.lastname: Haugen
authors.affiliation: From the Department of Radiology and Diagnostic Imaging, and the Division of Rheumatology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; Division of Medicine, University of New South Wales, Sydney, Australia; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Department of Radiology and Medical Imaging, Ghent University Hospital, Ghent, Belgium; King Christian 10th Hospital for Rheumatic Diseases, Gråsten; Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark; Department of Radiology, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, UK; Department of Radiology, Balgrist University Hospital, Zurich, Switzerland.|J.L. Jaremko, MD, PhD, FRCPC, Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta; O. Azmat, MB, FRCP, Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta; R.G. Lambert, MB, FRCPC, Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta; P. Bird, MD, Division of Medicine, University of New South Wales; I.K. Haugen, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; L. Jans, MD, PhD, Department of Radiology and Medical Imaging, Ghent University Hospital; U. Weber, MD, King Christian 10th Hospital for Rheumatic Diseases, and Institute of Regional Health Research, University of Southern Denmark; N. Winn, MBBS, FRCR, Department of Radiology, Robert Jones and Agnes Hunt Orthopaedic Hospital; V. Zubler, MD, Department of Radiology, Balgrist University Hospital; W.P. Maksymowych, MB ChB, FRCP(C), FACP, Division of Rheumatology, Faculty of Medicine and Dentistry, University of Alberta.
authors.forename: Lennart
authors.initials: L
authors.lastname: Jans
authors.affiliation: From the Department of Radiology and Diagnostic Imaging, and the Division of Rheumatology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; Division of Medicine, University of New South Wales, Sydney, Australia; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Department of Radiology and Medical Imaging, Ghent University Hospital, Ghent, Belgium; King Christian 10th Hospital for Rheumatic Diseases, Gråsten; Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark; Department of Radiology, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, UK; Department of Radiology, Balgrist University Hospital, Zurich, Switzerland.|J.L. Jaremko, MD, PhD, FRCPC, Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta; O. Azmat, MB, FRCP, Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta; R.G. Lambert, MB, FRCPC, Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta; P. Bird, MD, Division of Medicine, University of New South Wales; I.K. Haugen, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; L. Jans, MD, PhD, Department of Radiology and Medical Imaging, Ghent University Hospital; U. Weber, MD, King Christian 10th Hospital for Rheumatic Diseases, and Institute of Regional Health Research, University of Southern Denmark; N. Winn, MBBS, FRCR, Department of Radiology, Robert Jones and Agnes Hunt Orthopaedic Hospital; V. Zubler, MD, Department of Radiology, Balgrist University Hospital; W.P. Maksymowych, MB ChB, FRCP(C), FACP, Division of Rheumatology, Faculty of Medicine and Dentistry, University of Alberta.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Weber
authors.affiliation: From the Department of Radiology and Diagnostic Imaging, and the Division of Rheumatology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; Division of Medicine, University of New South Wales, Sydney, Australia; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Department of Radiology and Medical Imaging, Ghent University Hospital, Ghent, Belgium; King Christian 10th Hospital for Rheumatic Diseases, Gråsten; Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark; Department of Radiology, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, UK; Department of Radiology, Balgrist University Hospital, Zurich, Switzerland.|J.L. Jaremko, MD, PhD, FRCPC, Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta; O. Azmat, MB, FRCP, Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta; R.G. Lambert, MB, FRCPC, Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta; P. Bird, MD, Division of Medicine, University of New South Wales; I.K. Haugen, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; L. Jans, MD, PhD, Department of Radiology and Medical Imaging, Ghent University Hospital; U. Weber, MD, King Christian 10th Hospital for Rheumatic Diseases, and Institute of Regional Health Research, University of Southern Denmark; N. Winn, MBBS, FRCR, Department of Radiology, Robert Jones and Agnes Hunt Orthopaedic Hospital; V. Zubler, MD, Department of Radiology, Balgrist University Hospital; W.P. Maksymowych, MB ChB, FRCP(C), FACP, Division of Rheumatology, Faculty of Medicine and Dentistry, University of Alberta.
authors.forename: Naomi
authors.initials: N
authors.lastname: Winn
authors.affiliation: From the Department of Radiology and Diagnostic Imaging, and the Division of Rheumatology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; Division of Medicine, University of New South Wales, Sydney, Australia; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Department of Radiology and Medical Imaging, Ghent University Hospital, Ghent, Belgium; King Christian 10th Hospital for Rheumatic Diseases, Gråsten; Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark; Department of Radiology, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, UK; Department of Radiology, Balgrist University Hospital, Zurich, Switzerland.|J.L. Jaremko, MD, PhD, FRCPC, Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta; O. Azmat, MB, FRCP, Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta; R.G. Lambert, MB, FRCPC, Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta; P. Bird, MD, Division of Medicine, University of New South Wales; I.K. Haugen, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; L. Jans, MD, PhD, Department of Radiology and Medical Imaging, Ghent University Hospital; U. Weber, MD, King Christian 10th Hospital for Rheumatic Diseases, and Institute of Regional Health Research, University of Southern Denmark; N. Winn, MBBS, FRCR, Department of Radiology, Robert Jones and Agnes Hunt Orthopaedic Hospital; V. Zubler, MD, Department of Radiology, Balgrist University Hospital; W.P. Maksymowych, MB ChB, FRCP(C), FACP, Division of Rheumatology, Faculty of Medicine and Dentistry, University of Alberta.
authors.forename: Veronika
authors.initials: V
authors.lastname: Zubler
authors.affiliation: From the Department of Radiology and Diagnostic Imaging, and the Division of Rheumatology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; Division of Medicine, University of New South Wales, Sydney, Australia; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Department of Radiology and Medical Imaging, Ghent University Hospital, Ghent, Belgium; King Christian 10th Hospital for Rheumatic Diseases, Gråsten; Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark; Department of Radiology, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, UK; Department of Radiology, Balgrist University Hospital, Zurich, Switzerland.|J.L. Jaremko, MD, PhD, FRCPC, Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta; O. Azmat, MB, FRCP, Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta; R.G. Lambert, MB, FRCPC, Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta; P. Bird, MD, Division of Medicine, University of New South Wales; I.K. Haugen, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; L. Jans, MD, PhD, Department of Radiology and Medical Imaging, Ghent University Hospital; U. Weber, MD, King Christian 10th Hospital for Rheumatic Diseases, and Institute of Regional Health Research, University of Southern Denmark; N. Winn, MBBS, FRCR, Department of Radiology, Robert Jones and Agnes Hunt Orthopaedic Hospital; V. Zubler, MD, Department of Radiology, Balgrist University Hospital; W.P. Maksymowych, MB ChB, FRCP(C), FACP, Division of Rheumatology, Faculty of Medicine and Dentistry, University of Alberta.
authors.forename: Walter P
authors.initials: WP
authors.lastname: Maksymowych
mesh_terms: D000368:Aged; D001853:Bone Marrow / Q000000981:diagnostic imaging*; D005260:Female; D005269:Femur / Q000000981:diagnostic imaging; D005500:Follow-Up Studies; D006801:Humans; D007249:Inflammation / Q000000981:diagnostic imaging*; D007719:Knee Joint / Q000000981:diagnostic imaging*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000000981:diagnostic imaging*; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D013977:Tibia / Q000000981:diagnostic imaging
keywords: BONE MARROW LESION; KNEE JOINT; MRI; OMERACT; OSTEOARTHRITIS; SCORING METHODS