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Readout-segmented multi-shot diffusion-weighted MRI of the knee joint in patients with juvenile idiopathic arthritis

Alexander Sauer1, Mengxia Li2, Annette Holl-Wieden3

  • 1Department of Diagnostic and Interventional Radiology, University Hospital Wuerzburg, 97080, Wuerzburg, Germany.

Pediatric Rheumatology Online Journal
|October 14, 2017
PubMed
Abstract

Insights

Multi-shot diffusion-weighted MRI (DWI) effectively diagnoses active knee arthritis in children with juvenile idiopathic arthritis (JIA) without contrast. However, DWI struggles to distinguish mild synovitis from normal joints due to potential artifacts.

Area of Science:

  • Radiology
  • Pediatric Imaging
  • Rheumatology

Background:

  • Diffusion-weighted MRI (DWI) offers a contrast-free method for imaging synovitis.
  • Juvenile idiopathic arthritis (JIA) diagnosis often requires sensitive imaging techniques.

Purpose of the Study:

  • To evaluate the diagnostic utility of multi-shot readout-segmented DWI for assessing knee joint synovitis in pediatric patients with JIA.
  • To compare DWI performance against contrast-enhanced MRI, the current diagnostic standard.

Main Methods:

  • Thirty-two pediatric patients with JIA underwent 1.5T MRI, including contrast-enhanced T1w imaging and multi-shot DWI (RESOLVE).
  • Three blinded readers assessed synovitis presence and severity using a Likert scale on both imaging modalities.
  • Inter-observer agreement and diagnostic confidence levels were analyzed.

Main Results:

  • Multi-shot DWI demonstrated substantial agreement (κ=0.74) with contrast-enhanced MRI for diagnosing active arthritis.
  • High inter-observer agreement was noted for diagnosing or ruling out active arthritis on both DWI and contrast-enhanced MRI.
  • DWI showed inconsistency in differentiating mild synovial irritation from non-inflamed joints, likely due to T2w shine-through artifacts.
  • Diagnostic confidence was lower with DWI compared to contrast-enhanced MRI.

Conclusions:

  • Multi-shot DWI is a feasible and reliable technique for diagnosing or excluding active knee arthritis in pediatric JIA patients without intravenous contrast.
  • DWI's inability to reliably differentiate mild synovitis from normal joints necessitates further investigation or complementary imaging techniques.
Keywords:
Diffusion-weighted MRIJuvenile idiopathic arthritisSynovitis

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