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Development of a Scoring Tool for Chronic Nonbacterial Osteomyelitis Magnetic Resonance Imaging and Evaluation of its
Yongdong Zhao1,2, T Shawn Sato3,4, Sabrina M Nielsen3,4
1From the Seattle Children's Hospital, Department of Pediatrics, and Department of Radiology, University of Washington; Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington; Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA; Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen; The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark, Odense, Denmark; Department of Diagnostic and Interventional Radiology, University Hospital of Ulm, Ulm, Germany; Department of Radiology, Stony Brook University Hospital, Stony Brook, New York; Department of Radiology, Hackensack University Medical Center, Hackensack, New Jersey, USA; Department of Medical Imaging, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Radiology, Christian Medical College and Hospital, Vellore, India; Department of Imaging, Bambino Gesù Children's Hospital, Institute for Research and Health Care (IRCCS), Rome, Italy; Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia; Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA. yongdong.zhao@seattlechildrens.org.
Objective:
Serial magnetic resonance imaging (MRI) examinations are often needed in chronic nonbacterial osteomyelitis (CNO) to determine the objective response to treatment. Our objectives in this study were (1) to develop a consensus-based MRI scoring tool for clinical and research use in CNO; and (2) to evaluate interrater reliability and agreement using whole-body (WB)-MRI from children with CNO.
Methods:
Eleven pediatric radiologists discussed definitions and grading of signal intensity, size of signal abnormality within bone marrow, and associated features on MRI through monthly conference calls and a consensus meeting, using a nominal group technique in July 2017. WB-MRI scans from children with CNO were deidentified for training reading and an interrater reliability study. The reading by each radiologist was conducted in a randomized order. Interrater reliability for abnormal signal and severity were assessed using free-marginal κ statistics.
Results:
Radiologists reached a consensus on grading CNO-specific MRI findings and on describing bone units based on anatomy. A total of 45 sets of WB-MRI scans, including 4 sets of non-CNO MRI examinations, were selected for the final reading. The mean κ of each category of bones was > 0.7 with majority > 0.9 demonstrating substantial/almost perfect interrater reliability of readings among radiologists. The agreement on signal intensity and the size of signal abnormality within the most commonly affected bones (femur and tibia) were lower than those of other bones.
Conclusion:
The chronic nonbacterial osteomyelitis magnetic resonance imaging scoring (CROMRIS) tool is a comprehensive standardized scoring tool for MRI in children with CNO. Our interrater study demonstrated good interrater reliability and agreement of readings.
