Mirkamal A Tolend1, Marinka Twilt2, Randy Q Cron3, Nikolay Tzaribachev4, Saurabh Guleria5, Thekla von Kalle6, Bernd Koos7, Elka Miller8, Jennifer Stimec1, Yoginder Vaid3, Tore A Larheim9, Troels Herlin10, Lynn Spiegel1, Emilio J Inarejos Clemente11, Rahim Moineddin12, Marion A van Rossum13, Rotraud K Saurenmann14, Andrea S Doria1, Christian J Kellenberger14. 1. The Hospital for Sick Children, Toronto, Ontario, Canada. 2. Alberta Children's Hospital, Calgary, Alberta, Canada. 3. Children's Hospital of Alabama, Birmingham. 4. Pediatric Rheumatology Research Institute, Bad Bramstedt, Germany. 5. Austin Radiological Association, Austin, Texas. 6. Olgahospital Klinikum Stuttgart, Stuttgart, Germany. 7. University Hospital Tübingen, Tübingen, Germany. 8. Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada. 9. University of Oslo, Blindern, Oslo, Norway. 10. Aarhus University Hospital, Aarhus, Denmark. 11. Hospital Sant Joan de Deu, Barcelona, Spain. 12. University of Toronto, Toronto, Ontario, Canada. 13. Emma Children's Hospital, Academic Medical Centre, and Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, The Netherlands. 14. University Children's Hospital, Zürich, Switzerland.
Abstract
OBJECTIVE: The temporomandibular joints (TMJs) are frequently affected in children with juvenile idiopathic arthritis (JIA). Early detection is challenging, as major variation is present in scoring TMJ pathology on magnetic resonance imaging (MRI). Consensus-driven development and validation of an MRI scoring system for TMJs has important clinical utility in timely improvement of diagnosis and serving as an outcome measure. We report on a multi-institutional collaboration toward developing a TMJ MRI scoring system for JIA. METHODS: Seven readers independently assessed MRI scans from 21 patients (42 TMJs, from patients ages 6-16 years) using 3 existing MRI scoring systems from American, German, and Swiss institutions. Reliability scores, scoring system definitions, and items were discussed among 10 JIA experts through 2 rounds of Delphi surveys, nominal group voting, and subsequent consensus meetings to create a novel TMJ MRI scoring system. RESULTS: Average-measure absolute agreement intraclass correlation coefficients (avICCs) for the total scores of all 3 scoring systems were highly reliable at 0.96 each. Osteochondral items showed higher reliability than inflammatory items. An additive system was deemed preferable for assessing minor joint changes over time. Eight items were considered sufficiently reliable and/or important for integration into the consensus scoring system: bone marrow edema and enhancement (avICC 0.57-0.61, smallest detectable difference [SDD] ± 45-63% prior to redefining), condylar flattening (avICC 0.95-0.96, SDD ± 23-28%), effusions (avICC 0.85-0.88, SDD ± 25-26%), erosions (avICC 0.94, SDD ± 20%), synovial enhancement and thickening (previously combined, avICC 0.90-0.91, SDD ± 33%), and disk abnormalities (avICC 0.90, SDD ± 19%). CONCLUSION: A novel TMJ MRI scoring system was developed by consensus. Further iterative refinements and reliability testing are warranted in upcoming studies.
OBJECTIVE: The temporomandibular joints (TMJs) are frequently affected in children with juvenile idiopathic arthritis (JIA). Early detection is challenging, as major variation is present in scoring TMJ pathology on magnetic resonance imaging (MRI). Consensus-driven development and validation of an MRI scoring system for TMJs has important clinical utility in timely improvement of diagnosis and serving as an outcome measure. We report on a multi-institutional collaboration toward developing a TMJ MRI scoring system for JIA. METHODS: Seven readers independently assessed MRI scans from 21 patients (42 TMJs, from patients ages 6-16 years) using 3 existing MRI scoring systems from American, German, and Swiss institutions. Reliability scores, scoring system definitions, and items were discussed among 10 JIA experts through 2 rounds of Delphi surveys, nominal group voting, and subsequent consensus meetings to create a novel TMJ MRI scoring system. RESULTS: Average-measure absolute agreement intraclass correlation coefficients (avICCs) for the total scores of all 3 scoring systems were highly reliable at 0.96 each. Osteochondral items showed higher reliability than inflammatory items. An additive system was deemed preferable for assessing minor joint changes over time. Eight items were considered sufficiently reliable and/or important for integration into the consensus scoring system: bone marrow edema and enhancement (avICC 0.57-0.61, smallest detectable difference [SDD] ± 45-63% prior to redefining), condylar flattening (avICC 0.95-0.96, SDD ± 23-28%), effusions (avICC 0.85-0.88, SDD ± 25-26%), erosions (avICC 0.94, SDD ± 20%), synovial enhancement and thickening (previously combined, avICC 0.90-0.91, SDD ± 33%), and disk abnormalities (avICC 0.90, SDD ± 19%). CONCLUSION: A novel TMJ MRI scoring system was developed by consensus. Further iterative refinements and reliability testing are warranted in upcoming studies.
Authors: Elka Miller; Emilio J Inarejos Clemente; Nikolay Tzaribachev; Saurabh Guleria; Mirkamal Tolend; Arthur B Meyers; Thekla von Kalle; Jennifer Stimec; Bernd Koos; Simone Appenzeller; Linda Z Arvidsson; Eva Kirkhus; Andrea S Doria; Christian J Kellenberger; Tore A Larheim Journal: Pediatr Radiol Date: 2018-05-08
Authors: Christopher Schmidt; Taila Ertel; Martin Arbogast; Boris Hügle; Thekla von Kalle; Andreas Neff Journal: Dtsch Arztebl Int Date: 2022-01-28 Impact factor: 8.251
Authors: Christopher Schmidt; Rudolf Reich; Bernd Koos; Taila Ertel; Marcus Oliver Ahlers; Martin Arbogast; Ima Feurer; Mario Habermann-Krebs; Tim Hilgenfeld; Christian Hirsch; Boris Hügle; Thekla von Kalle; Johannes Kleinheinz; Andreas Kolk; Peter Ottl; Christoph Pautke; Merle Riechmann; Andreas Schön; Linda Skroch; Marcus Teschke; Wolfgang Wuest; Andreas Neff Journal: J Clin Med Date: 2022-03-22 Impact factor: 4.241
Authors: Charlotte M Nusman; Laura Tanturri de Horatio; Robert Hemke; E Charlotte van Gulik; Lil-Sofie Ording Müller; Clara Malattia; Derk Avenarius; Paolo Toma; Johannes Roth; Nikolay Tzaribachev; Silvia Magni-Manzoni; Mario Maas; Andrea S Doria; Karen Rosendahl Journal: Pediatr Radiol Date: 2018-01-13
Authors: Paula Frid; Thomas A Augdal; Tore A Larheim; Josefine Halbig; Veronika Rypdal; Nils Thomas Songstad; Annika Rosén; Karin B Tylleskär; Johanna Rykke Berstad; Berit Flatø; Peter Stoustrup; Karen Rosendahl; Eva Kirkhus; Ellen Nordal Journal: Pediatr Rheumatol Online J Date: 2020-10-01 Impact factor: 3.054