Jyoti Panwar1, Mirkamal Tolend2, Bernadette Redd3, Hemalatha Srinivasalu4, Robert A Colbert5, Jonathan Akikusa6, Simone Appenzeller7, John A Carrino8, Nele Herregods9, Lennart Jans9, Kerri Highmore10, Thekla von Kalle11, Eva Kirkhus12, Dax G Rumsey13, Jacob L Jaremko14, Inarejos Emilio J Clemente15, Marion A van Rossum16, Jennifer Stimec2, Shirley M Tse17, Marinka Twilt18, Nikolay Tzaribachev19, Iwona Sudol-Szopinska20, Arthur B Meyers21, Andrea S Doria22. 1. Department of Radiology, Christian Medical College, Vellore, India. 2. Department of Diagnostic Imaging, Research Institute, The Hospital for Sick Children, Department of Medical Imaging, University of Toronto, Toronto, ON, Canada. 3. Department of Radiology, Clinical Center, NIH, Bethesda, Maryland, United States. 4. Division of Rheumatology, Children's National Hospital and George Washington University School of Medicine, Washington, DC, United States. 5. Pediatric Translational Research Branch, Musculoskeletal and Skin Diseases, National Institute of Arthritis, NIH, Bethesda, MD, United States. 6. Rheumatology Service, Department of General Medicine, Royal Children's Hospital Melbourne, Australia. 7. Faculty of Medical Sciences, University of Campinas, Campinas, Brazil. 8. Department of Radiology, Hospital for Special Surgery, New York, United States. 9. Department of Radiology, Ghent University, Ghent, Belgium. 10. Department of Radiology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada. 11. RadiologischesInstitut, Olga Hospital Klinikum, Stuttgart, Germany. 12. Department of Radiology, Oslo University Hospital, Oslo, Norway. 13. Division of Rheumatology, Stollery Children's Hospital, University of Alberta, Canada. 14. Department of Radiology & Diagnostic Imaging, Stollery Children's Hospital, University of Alberta, Canada. 15. Department of Radiology, Hospital Sant Joan de Deu, Barcelona, Spain. 16. Amsterdam Rheumatology and Immunology Center, Reade, and Emma Children's Hospital Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands. 17. Division of Rheumatology, The Hospital for Sick Children, Toronto, ON, Canada. 18. Department of Pediatrics, Division of Rheumatology, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. 19. Pediatric Rheumatology Research Institute, Bad Bramstedt, Germany. 20. National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw,Poland. 21. Department of Radiology, Cincinnati Children's Hospital, Cincinnati, OH, United States. 22. Department of Diagnostic Imaging, Research Institute, The Hospital for Sick Children, Department of Medical Imaging, University of Toronto, Toronto, ON, Canada. Electronic address: andrea.doria@sickkids.ca.
Abstract
OBJECTIVES: Whole body-MRI is helpful in directing diagnostic and treatment approaches, and as a research outcome measure. We describe our initial consensus-driven phase towards developing a whole body-MRI scoring system for juvenile idiopathic arthritis. METHODS: An iterative approach using three rounds of anonymous Delphi surveys followed by a consensus meeting was used to draft the structure of the whole body-MRI scoring system, including the relevant anatomic joints and entheses for assessment, diagnostic item selection, definition and grading, and selection of appropriate MRI planes and sequences. The surveys were completed independently by an international expert group consisting of pediatric radiologists and rheumatologists. RESULTS: Twenty-two experts participated in at least one of three rounds of Delphi surveys and a concluding consensus meeting. A first iteration scoring system was developed which ultimately included the assessment of 100 peripheral, 23 chest, and 76 axial joints, and 64 entheses, with 2-4 diagnostic items graded in each of the items, using binary (presence/absence) and 2-3-level ordinal scores. Recommendations on anatomic MRI planes and sequences were specified as the minimally necessary imaging protocol for the scoring system. CONCLUSION: A novel whole body-MRI scoring system for juvenile idiopathic arthritis was developed by consensus among members of MRI in JIA OMERACT working group. Further iterative refinements, reliability testing, and responsiveness are warranted in upcoming studies.
OBJECTIVES: Whole body-MRI is helpful in directing diagnostic and treatment approaches, and as a research outcome measure. We describe our initial consensus-driven phase towards developing a whole body-MRI scoring system for juvenile idiopathic arthritis. METHODS: An iterative approach using three rounds of anonymous Delphi surveys followed by a consensus meeting was used to draft the structure of the whole body-MRI scoring system, including the relevant anatomic joints and entheses for assessment, diagnostic item selection, definition and grading, and selection of appropriate MRI planes and sequences. The surveys were completed independently by an international expert group consisting of pediatric radiologists and rheumatologists. RESULTS: Twenty-two experts participated in at least one of three rounds of Delphi surveys and a concluding consensus meeting. A first iteration scoring system was developed which ultimately included the assessment of 100 peripheral, 23 chest, and 76 axial joints, and 64 entheses, with 2-4 diagnostic items graded in each of the items, using binary (presence/absence) and 2-3-level ordinal scores. Recommendations on anatomic MRI planes and sequences were specified as the minimally necessary imaging protocol for the scoring system. CONCLUSION: A novel whole body-MRI scoring system for juvenile idiopathic arthritis was developed by consensus among members of MRI in JIA OMERACT working group. Further iterative refinements, reliability testing, and responsiveness are warranted in upcoming studies.
Authors: Laura Tanturri de Horatio; Susan C Shelmerdine; Paola d'Angelo; Pier Luigi Di Paolo; Silvia Magni-Manzoni; Clara Malattia; Maria Beatrice Damasio; Paolo Tomà; Derk Avenarius; Karen Rosendahl Journal: Pediatr Radiol Date: 2022-09-23