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Carpal erosions in children with juvenile idiopathic arthritis: repeatability of a newly devised MR-scoring system
Peter Boavida1, Karen Lambot-Juhan2, Lil-Sofie Ording Müller3
1Department of Radiology, Great Ormond Street Hospital for Children, London, UK.
Insights
Assessing carpal bone erosions in juvenile idiopathic arthritis (JIA) using MRI revealed the 0-4 scale offers better reliability than the 0-10 scale for individual bone assessment, though aggregate scores showed variability.
Area of Science:
- Pediatric Rheumatology
- Musculoskeletal Radiology
- Medical Imaging Analysis
Background:
- Juvenile idiopathic arthritis (JIA) involves synovial inflammation and risks progressive joint destruction.
- Current JIA treatment lacks validated markers to monitor disease activity and treatment response.
- Accurate assessment of JIA-related joint damage is crucial for personalized treatment strategies.
Purpose of the Study:
- To evaluate the reliability of two semi-quantitative scoring systems for carpal bone erosions on MRI in pediatric JIA patients.
- To compare the performance of a 0-4 scale versus a 0-10 scale in assessing JIA-related carpal bone erosion.
- To determine the intra- and inter-observer agreement for these scoring systems.
Main Methods:
- Two independent pediatric musculoskeletal radiologists scored 1,236 carpal bones from 91 JIA wrist MRIs.
- Bone erosions were assessed using a 0-4 scale (bone volume loss) and a 0-10 scale.
- Aggregate erosion scores were calculated by summing individual bone scores for each examination.
Main Results:
- The 0-4 scale demonstrated good intra-reader and moderate-to-good inter-observer agreement for individual bone erosions.
- The 0-10 scale showed only fair inter-reader and moderate intra-reader agreement for individual bone erosions.
- Both scoring systems exhibited significant variability in aggregate scores, particularly for inter-reader agreement.
Conclusions:
- The 0-4 scoring system appears more reliable for assessing individual carpal bone erosions in JIA than the 0-10 scale.
- Further research is needed to analyze erosive disease patterns and develop improved methods for quantifying JIA progression.
- Development of alternative, more reliable quantitative measures for JIA disease activity is essential.
Background:
Juvenile idiopathic arthritis (JIA) is characterized by synovial inflammation, with potential risk of developing progressive joint destruction. Personalized state-of-the-art treatment depends on valid markers for disease activity to monitor response; however, no such markers exist.
Objective:
To evaluate the reliability of scoring of carpal bone erosions on MR in children with JIA using two semi-quantitative scoring systems.
Materials And Methods:
A total of 1,236 carpal bones (91 MR wrist examinations) were scored twice by two independent pediatric musculoskeletal radiologists. Bony erosions were scored according to estimated bone volume loss using a 0-4 scale and a 0-10 scale. An aggregate erosion score comprising the sum total carpal bone volume loss was calculated for each examination.
Results:
The 0-4 scoring system resulted in good intra-reader agreement and moderate to good inter-observer agreement in the assessment of individual bones. Fair and moderate agreement were achieved for inter-reader and intra-reader agreement, respectively, using the 0-10 scale. Intra- and particularly inter-reader aggregate score variability were much less favorable, with wide limits of agreement.
Conclusion:
Further analysis of erosive disease patterns compared with normal subjects is required, and to facilitate the development of an alternative means of quantifying disease.
