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Pediatric Radiology

19.04.2024 | Original Article

Measuring synovial thickness on knee MRI in pediatric patients with arthritis: is contrast necessary?

verfasst von: Atsuhiko Handa, M Alejandra Bedoya, Jade Iwasaka-Neder, Patrick R. Johnston, Mindy S. Lo, Sarah D. Bixby

Erschienen in: Pediatric Radiology

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Abstract

Background

The use of contrast-enhanced imaging has long been standard for magnetic resonance imaging (MRI) assessments of synovitis in juvenile idiopathic arthritis (JIA). However, advancements in MRI technology have allowed for reliable identification of synovium without contrast.

Objective

To assess the equivalence of unenhanced MRI with contrast-enhanced MRI in evaluating synovial thickness.

Materials and methods

This is an institutional review board approved, retrospective study performed in a tertiary children’s hospital. Pediatric JIA patients under 21 years old were included who underwent knee MRI scans (1.5 T or 3 T) without and with contrast between January 2012 and January 2022. Two radiologists independently measured synovial thickness at 6 knee sites on contrast-enhanced and unenhanced sequences. Numerical measurements and ordinal scores based on juvenile idiopathic arthritis magnetic resonance imaging scoring (JAMRIS) system were recorded, and tests of equivalence were conducted, as well as between-reader and within-reader reliability by concordance correlation coefficient (CCC). All tests were considered significant at the 5% level.

Results

A total of 38 studies from 35 patients (25 females, median age 14 years; interquartile range 7 to 15.7) were included. Equivalence was demonstrated at each of the 6 sites for both continuous measurements (P-values < 0.05) and ordinal scores (P-values < 0.05) based on the average over readers. Within-reader reliability was moderate to high (CCC 0.50–0.89), except for the cruciate ligaments site. Averaged over the 6 sites, reliability between readers was low for unenhanced (CCC 0.47, with 95% CI: [0.41, 0.53]) and moderate for contrast-enhanced (CCC 0.64, with 95% CI: [0.59, 0.69]) sequences.

Conclusion

Unenhanced knee MRI is equivalent to contrast-enhanced MRI in assessment of synovial thickness using conventional MRI sequences. Contrast material helped improve inter-reader reliability.

Graphical abstract

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Metadaten
Titel
Measuring synovial thickness on knee MRI in pediatric patients with arthritis: is contrast necessary?
verfasst von
Atsuhiko Handa
M Alejandra Bedoya
Jade Iwasaka-Neder
Patrick R. Johnston
Mindy S. Lo
Sarah D. Bixby
Publikationsdatum
19.04.2024
Verlag
Springer Berlin Heidelberg
Erschienen in
Pediatric Radiology
Print ISSN: 0301-0449
Elektronische ISSN: 1432-1998
DOI
https://doi.org/10.1007/s00247-024-05929-1

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