Abstract：
OBJECTIVE: To introduce and evaluate a simple method for assessing joint inflammation and structural damage on whole-body MRI (WBMRI) in juvenile idiopathic arthritis (JIA), which is usable in clinical practice.
METHODS: The proposed system utilises post-contrast Dixon WBMRI scans. Joints are assessed for synovitis (grade 0-2) and structural damage (present/absent) at 81 sites. The synovitis grading is based on features including above-normal intensity synovial enhancement, synovial hypertrophy, joint effusion, subarticular bone marrow oedema and peri-articular soft tissue oedema.This system was evaluated in a prospective study of 60 young people (47 patients with JIA and 13 controls with non-inflammatory musculoskeletal pain) who underwent a WBMRI. Three readers (blinded to diagnosis) independently reviewed all images and re-reviewed 20 individual scans. The intra- and inter-reader overall agreement (OA) and the intra- and inter-reader Gwet\'s agreement coefficients 2 (GAC2) were measured for the detection of a) participants with ≥1 joint with inflammation or structural damage and b) joint inflammation or structural damage for each joint.
RESULTS: The inter-reader OA for detecting patients with ≥1 joint with inflammation, defined as grade 2 synovitis (G2), and ≥1 joint with structural damage were 80% and 73%, respectively. The intra-reader OA for readers 1-3 were 80-90% and 75-90% respectively. The inter-reader OA and GAC2 for joint inflammation (G2) at each joint were both ≥85% for all joints but were lower if grade 1 synovitis was included as positive.
CONCLUSIONS: The intra- and inter-reader agreements of this WBMRI assessment system are adequate for assessing objective joint inflammation and damage in JIA.
METHODS: The proposed system utilises post-contrast Dixon WBMRI scans. Joints are assessed for synovitis (grade 0-2) and structural damage (present/absent) at 81 sites. The synovitis grading is based on features including above-normal intensity synovial enhancement, synovial hypertrophy, joint effusion, subarticular bone marrow oedema and peri-articular soft tissue oedema.This system was evaluated in a prospective study of 60 young people (47 patients with JIA and 13 controls with non-inflammatory musculoskeletal pain) who underwent a WBMRI. Three readers (blinded to diagnosis) independently reviewed all images and re-reviewed 20 individual scans. The intra- and inter-reader overall agreement (OA) and the intra- and inter-reader Gwet\'s agreement coefficients 2 (GAC2) were measured for the detection of a) participants with ≥1 joint with inflammation or structural damage and b) joint inflammation or structural damage for each joint.
RESULTS: The inter-reader OA for detecting patients with ≥1 joint with inflammation, defined as grade 2 synovitis (G2), and ≥1 joint with structural damage were 80% and 73%, respectively. The intra-reader OA for readers 1-3 were 80-90% and 75-90% respectively. The inter-reader OA and GAC2 for joint inflammation (G2) at each joint were both ≥85% for all joints but were lower if grade 1 synovitis was included as positive.
CONCLUSIONS: The intra- and inter-reader agreements of this WBMRI assessment system are adequate for assessing objective joint inflammation and damage in JIA.
摘要：
目的：介绍并评估一种在全身MRI（WBMRI）上评估幼年特发性关节炎（JIA）关节炎症和结构损伤的简单方法，可用于临床实践。
方法：所提出的系统利用对比后DixonWBMRI扫描。评估81个部位的关节滑膜炎(0-2级)和结构损伤(存在/不存在)。滑膜炎分级基于包括正常强度以上滑膜增强的特征，滑膜肥大,关节积液,关节下骨髓水肿和关节周围软组织水肿。在一项对60名接受WBMRI的年轻人（47名JIA患者和13名非炎症性肌肉骨骼疼痛的对照）进行的前瞻性研究中，对该系统进行了评估。三名读者(对诊断视而不见)独立地审查了所有图像并重新审查了20次单独的扫描。测量读者内部和读者之间的总体一致性（OA）以及读者内部和读者之间的一致性系数2（GAC2），以检测a）具有≥1个关节的炎症或结构损伤的参与者以及b）关节炎症或每个关节的结构损伤。
结果：用于检测≥1个关节炎症患者的阅读器间OA，定义为2级滑膜炎（G2），≥1个接头的结构损伤分别为80%和73%，分别。读者1-3的读者内部OA分别为80-90%和75-90%。每个关节的关节炎症（G2）的读取器间OA和GAC2对于所有关节均≥85％，但如果包括1级滑膜炎为阳性，则更低。
结论：此WBMRI评估系统的读者内部和读者之间的协议足以评估JIA中的客观关节炎症和损伤。
方法：所提出的系统利用对比后DixonWBMRI扫描。评估81个部位的关节滑膜炎(0-2级)和结构损伤(存在/不存在)。滑膜炎分级基于包括正常强度以上滑膜增强的特征，滑膜肥大,关节积液,关节下骨髓水肿和关节周围软组织水肿。在一项对60名接受WBMRI的年轻人（47名JIA患者和13名非炎症性肌肉骨骼疼痛的对照）进行的前瞻性研究中，对该系统进行了评估。三名读者(对诊断视而不见)独立地审查了所有图像并重新审查了20次单独的扫描。测量读者内部和读者之间的总体一致性（OA）以及读者内部和读者之间的一致性系数2（GAC2），以检测a）具有≥1个关节的炎症或结构损伤的参与者以及b）关节炎症或每个关节的结构损伤。
结果：用于检测≥1个关节炎症患者的阅读器间OA，定义为2级滑膜炎（G2），≥1个接头的结构损伤分别为80%和73%，分别。读者1-3的读者内部OA分别为80-90%和75-90%。每个关节的关节炎症（G2）的读取器间OA和GAC2对于所有关节均≥85％，但如果包括1级滑膜炎为阳性，则更低。
结论：此WBMRI评估系统的读者内部和读者之间的协议足以评估JIA中的客观关节炎症和损伤。
