Pamela F Weiss1, Timothy G Brandon2, John Bohnsack3, Merav Heshin-Bekenstein4, Michael L Francavilla1, Jacob L Jaremko5, Lester Liao5, Anne McHugh6, Edward J Oberle7, Dax Rumsey5, Hemalatha Srinivasalu8, Matthew L Stoll9, Nancy A Chauvin10. 1. Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia. 2. Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. 3. University of Utah, Salt Lake City. 4. University of California, San Francisco and Dana Children's Hospital of Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel. 5. University of Alberta, Edmonton, Alberta, Canada. 6. Stanford University, Stanford, California, and Wright State University Boonshoft School of Medicine, Dayton, Ohio. 7. Ohio State University College of Medicine and Nationwide Children's Hospital, Columbus, Ohio. 8. Children's National Health System, Washington, DC. 9. University of Alabama at Birmingham. 10. Penn State Milton S. Hershey Children's Hospital, Hershey, Pennsylvania.
Abstract
OBJECTIVE: Magnetic resonance imaging (MRI) is pivotal in the assessment of early sacroiliitis in children. We aimed to evaluate the agreement between local radiology reports and central imaging reviewers for active inflammation and structural damage at the sacroiliac (SI) joints. METHODS: Eight hospitals each contributed up to 20 cases of consecutively imaged children and adolescents with juvenile idiopathic arthritis and suspected sacroiliitis. Studies were independently reviewed by 3 experienced musculoskeletal pediatric radiologists. Local assessments of global impression and lesions were coded from the local radiology reports by 2 study team members. Test properties of local reports were calculated using the central imaging team's majority as the reference standard. RESULTS: For 120 evaluable subjects, the median age was 14 years, half of the cases were male, and median disease duration at the time of imaging was 0.8 years (interquartile range 0-2). Sensitivity of local reports for inflammation was high, 93.5% (95% confidence interval [95% CI] 78.6-99.2), and specificity was moderate, 69.7% (95% CI 59.0-79.0), but positive predictive value (PPV) was low, 51.8% (95% CI 38.0-65.3). Twenty-seven cases (23%) had active inflammation reported locally but rated normal at the central reading, 19 (70%) with subsequent medication changes. The sensitivity of local reports detecting structural damage was low, 45.7% (95% CI 28.8-63.4), and specificity was high, 88.2% (95% CI 79.4-94.2); PPV was low, 61.5% (95% CI 40.6-79.8). CONCLUSION: Substantial variation exists in the interpretation of inflammatory and structural lesions at the SI joints in children. To reliably identify pathology, additional training in the MRI appearance of the maturing SI joint is greatly needed.
OBJECTIVE: Magnetic resonance imaging (MRI) is pivotal in the assessment of early sacroiliitis in children. We aimed to evaluate the agreement between local radiology reports and central imaging reviewers for active inflammation and structural damage at the sacroiliac (SI) joints. METHODS: Eight hospitals each contributed up to 20 cases of consecutively imaged children and adolescents with juvenile idiopathic arthritis and suspected sacroiliitis. Studies were independently reviewed by 3 experienced musculoskeletal pediatric radiologists. Local assessments of global impression and lesions were coded from the local radiology reports by 2 study team members. Test properties of local reports were calculated using the central imaging team's majority as the reference standard. RESULTS: For 120 evaluable subjects, the median age was 14 years, half of the cases were male, and median disease duration at the time of imaging was 0.8 years (interquartile range 0-2). Sensitivity of local reports for inflammation was high, 93.5% (95% confidence interval [95% CI] 78.6-99.2), and specificity was moderate, 69.7% (95% CI 59.0-79.0), but positive predictive value (PPV) was low, 51.8% (95% CI 38.0-65.3). Twenty-seven cases (23%) had active inflammation reported locally but rated normal at the central reading, 19 (70%) with subsequent medication changes. The sensitivity of local reports detecting structural damage was low, 45.7% (95% CI 28.8-63.4), and specificity was high, 88.2% (95% CI 79.4-94.2); PPV was low, 61.5% (95% CI 40.6-79.8). CONCLUSION: Substantial variation exists in the interpretation of inflammatory and structural lesions at the SI joints in children. To reliably identify pathology, additional training in the MRI appearance of the maturing SI joint is greatly needed.
Authors: Zachary Patel; Jennifer A Schroeder; Paul M Bunch; Joni K Evans; Cole R Steber; Adam G Johnson; Joshua C Farris; Ryan T Hughes Journal: JAMA Otolaryngol Head Neck Surg Date: 2022-10-01 Impact factor: 8.961
Authors: Pamela F Weiss; Robert C Fuhlbrigge; Emily von Scheven; Daniel J Lovell; Robert A Colbert; Hermine I Brunner Journal: Arthritis Care Res (Hoboken) Date: 2022-04-15 Impact factor: 5.178