Contrast-enhanced MRI of the knee in children unaffected by clinical arthritis compared to clinically active juvenile idiopathic arthritis patients

Abstract

Objectives: To evaluate enhancing synovial thickness upon contrast-enhanced magnetic resonance imaging (MRI) of the knee in children unaffected by clinical arthritis compared with clinically active juvenile idiopathic arthritis (JIA) patients. A secondary objective was optimization of the scoring method based on maximizing differences on MRI between these groups.

Methods: Twenty-five children without history of joint complaints nor any clinical signs of joint inflammation were age/sex-matched with 25 clinically active JIA patients with arthritis of at least one knee. Two trained radiologists, blinded for clinical status, independently evaluated location and extent of enhancing synovial thickness with the validated Juvenile Arthritis MRI Scoring system (JAMRIS) on contrast-enhanced axial fat-saturated T1-weighted MRI of the knee.

Results: Enhancing synovium (≥2 mm) was present in 13 (52 %) unaffected children. Using the total JAMRIS score for synovial thickening, no significant difference was found between unaffected children and active JIA patients (p = 0.091). Additional weighting of synovial thickening at the JIA-specific locations enabled more sensitive discrimination (p = 0.011).

Conclusions: Mild synovial thickening is commonly present in the knee of children unaffected by clinical arthritis. The infrapatellar and cruciate ligament synovial involvement were specific for JIA, which-in a revised JAMRIS-increases the ability to discriminate between JIA and unaffected children.

Key points: • Synovial inflammation is the primary disease feature in juvenile idiopathic arthritis (JIA). • Appearance of the synovium on contrast-enhanced MRI in unaffected children is unknown. • Validation of existing scoring methods requires comparison between JIA and unaffected children. • Mild enhancing synovial thickening was detected in half of the unaffected children. • Location-weighting for JIA-specific locations increased discriminative value of the scoring methods (p = 0.011).

Keywords: Control group; Juvenile idiopathic arthritis; Knee; Magnetic resonance imaging; Synovium.

Fig. 1

The locations at which enhancing synovial thickening on MRI of the knee is scored according to the Juvenile Arthritis MRI Scoring system (JAMRIS) [5]. On a sagittal T1-weighted sequence (a) and an axial fat-saturated T1-weighted sequence (b) of the knee the six locations are exemplified with different colours: blue suprapatellar, red patellofemoral, green infrapatellar, yellow cruciate ligaments, purple medial and lateral posterior condyle

Fig. 2

A 12-year-old boy unaffected by JIA shows presence of enhancing synovial thickening greater than 2 mm on an axial T1-weighted MR image of the knee

Fig. 3

The total JAMRIS scores for synovial thickening with mean and standard error of the mean (represented by the black lines) in the unaffected children (orange) and active JIA patients (blue)

Fig. 4

An example of the axial T1-weighted MRI sequence of the knee in a 15-year-old clinically active JIA patient with typical enhancing and thickened synovium at the cruciate ligament location (thick arrow) and the infrapatellar location (thin arrow)

Fig. 5

The total revised JAMRIS scores for synovial thickening with mean and standard error of the mean (represented by the black lines) in the unaffected children (orange) and active JIA patients (blue). The revised JAMRIS score comprised a weighting of the isolated presence of synovial thickening at the infrapatellar and/or cruciate ligament location