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Assessment of disease activity using a whole-body MRI derived radiological activity index in chronic nonbacterial
Martina Capponi1, Denise Pires Marafon1, Flaminia Rivosecchi2
1Division of Rheumatology, Ospedale Pediatrico Bambino Gesù, IRCCS (ERN-RITA center), Rome, Italy.
Background:
Based on the recently developed ChRonic nonbacterial Osteomyelitis MRI Scoring tool (CROMRIS), we developed a radiological activity index (RAI-CROMRIS) to obtain a quantification of the overall bone involvement in individual patients.
Methods:
Whole Body Magnetic Resonance Imaging (WB-MRI) images were scored according to parameters included in the RAI-CROMRIS: bone marrow hyperintensity, signal extension, soft tissue/periosteal hyperintensity, bony expansion, vertebral collapse. These parameters were evaluated for each bone unit yielding a score from 0 to 7 and summed up as RAI-CROMRIS including all bone units. We assessed clinical disease activity using a physician global assessment (PGA) and radiological findings in 76 treatment-naïve patients; 46 of 76 were evaluated at 6 and 12 months after initial WB-MRI. Quantitative variables were compared using the Mann-Whitney U test for unmatched groups and the Wilcoxon signed-rank test for paired groups. Correlation was evaluated using Spearman's rank coefficient (rs).
Results:
There was a significant correlation between RAI-CROMRIS and PGA (rs = 0.32; p = 0.0055), between RAI-CROMRIS and presence of elevated erythrocyte sedimentation rate (p = 0.013) and C-reactive protein (p = 0.0001) at baseline. The RAI-CROMRIS decreased from a median of 17 at baseline to 12 at 6 months (p = 0.004) and remained stable (median 11) at 12 months. A correlation between the RAI-CROMRIS and the PGA was observed at baseline (rs = 0.41; p = 0.004) and during follow up at 6 months (rs = 0.33; p = 0.025) and 12 months (rs = 0.38; p = 0.010). The baseline RAI-CROMRIS (median 20) was significantly higher in patients who subsequently received bisphosphonates than in patients who received other treatments (median 12) and decreased significantly after bisphosphonates (p = 0.008).
Conclusions:
The RAI-CROMRIS was correlated with clinical and laboratory measures of disease activity showing significant short-term changes following treatment with bisphosphonates. This tool could be used in clinical practice and clinical trials after validation.
Insights
The Radiological Activity Index (RAI-CROMRIS) quantifies bone involvement in nonbacterial osteomyelitis, correlating with clinical and lab markers. This MRI-based tool shows promise for clinical practice and trials.
Area of Science:
- Radiology
- Medical Imaging
- Osteomyelitis Research
Background:
- Nonbacterial osteomyelitis presents diagnostic challenges.
- The ChRonic nonbacterial Osteomyelitis MRI Scoring tool (CROMRIS) was recently developed.
- A need existed for a quantitative measure of overall bone involvement.
Purpose of the Study:
- To develop and validate the Radiological Activity Index (RAI-CROMRIS).
- To quantify overall bone involvement in nonbacterial osteomyelitis using MRI.
- To assess the correlation of RAI-CROMRIS with clinical and laboratory disease activity measures.
Main Methods:
- Whole Body Magnetic Resonance Imaging (WB-MRI) was utilized.
- RAI-CROMRIS parameters included bone marrow hyperintensity, signal extension, soft tissue/periosteal hyperintensity, bony expansion, and vertebral collapse.
- 76 treatment-naïve patients were assessed, with 46 followed for 12 months. Statistical analysis included Mann-Whitney U and Wilcoxon signed-rank tests, and Spearman's rank correlation.
Main Results:
- RAI-CROMRIS significantly correlated with physician global assessment (PGA) and inflammatory markers (ESR, CRP) at baseline.
- RAI-CROMRIS scores decreased significantly from baseline to 6 and 12 months post-treatment.
- Higher baseline RAI-CROMRIS was observed in patients treated with bisphosphonates, with significant reduction post-treatment.
Conclusions:
- RAI-CROMRIS effectively correlates with clinical and laboratory measures of disease activity in nonbacterial osteomyelitis.
- The tool demonstrated significant short-term changes following bisphosphonate treatment.
- RAI-CROMRIS shows potential utility in clinical practice and trials for nonbacterial osteomyelitis management.
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