Readout-segmented multi-shot diffusion-weighted MRI of the knee joint in patients with juvenile idiopathic arthritis
Abstract Background Diffusion-weighted MRI has been proposed as a new technique for imaging synovitis without intravenous contrast application. We investigated diagnostic utility of multi-shot readout-segmented diffusion-weighted MRI (multi-shot DWI) for synovial imaging of the knee joint in patient...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2017-10-01
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| Series: | Pediatric Rheumatology Online Journal |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12969-017-0203-z |
| _version_ | 1819205691423850496 |
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| author | Alexander Sauer Mengxia Li Annette Holl-Wieden Thomas Pabst Henning Neubauer |
| author_facet | Alexander Sauer Mengxia Li Annette Holl-Wieden Thomas Pabst Henning Neubauer |
| author_sort | Alexander Sauer |
| collection | DOAJ |
| description | Abstract Background Diffusion-weighted MRI has been proposed as a new technique for imaging synovitis without intravenous contrast application. We investigated diagnostic utility of multi-shot readout-segmented diffusion-weighted MRI (multi-shot DWI) for synovial imaging of the knee joint in patients with juvenile idiopathic arthritis (JIA). Methods Thirty-two consecutive patients with confirmed or suspected JIA (21 girls, median age 13 years) underwent routine 1.5 T MRI with contrast-enhanced T1w imaging (contrast-enhanced MRI) and with multi-shot DWI (RESOLVE, b-values 0–50 and 800 s/mm2). Contrast-enhanced MRI, representing the diagnostic standard, and diffusion-weighted images at b = 800 s/mm2 were separately rated by three independent blinded readers at different levels of expertise for the presence and the degree of synovitis on a modified 5-item Likert scale along with the level of subjective diagnostic confidence. Results Fourteen (44%) patients had active synovitis and joint effusion, nine (28%) patients showed mild synovial enhancement not qualifying for arthritis and another nine (28%) patients had no synovial signal alterations on contrast-enhanced imaging. Ratings by the 1st reader on contrast-enhanced MRI and on DWI showed substantial agreement (κ = 0.74). Inter-observer-agreement was high for diagnosing, or ruling out, active arthritis of the knee joint on contrast-enhanced MRI and on DWI, showing full agreement between 1st and 2nd reader and disagreement in one case (3%) between 1st and 3rd reader. In contrast, ratings in cases of absent vs. little synovial inflammation were markedly inconsistent on DWI. Diagnostic confidence was lower on DWI, compared to contrast-enhanced imaging. Conclusion Multi-shot DWI of the knee joint is feasible in routine imaging and reliably diagnoses, or rules out, active arthritis of the knee joint in paediatric patients without the need of gadolinium-based i.v. contrast injection. Possibly due to “T2w shine-through” artifacts, DWI does not reliably differentiate non-inflamed joints from knee joints with mild synovial irritation. |
| first_indexed | 2024-12-23T04:55:44Z |
| format | Article |
| id | doaj.art-7be87d7044fb494aa83474800109df69 |
| institution | Directory Open Access Journal |
| issn | 1546-0096 |
| language | English |
| last_indexed | 2024-12-23T04:55:44Z |
| publishDate | 2017-10-01 |
| publisher | BMC |
| record_format | Article |
| series | Pediatric Rheumatology Online Journal |
| spelling | doaj.art-7be87d7044fb494aa83474800109df692022-12-21T17:59:22ZengBMCPediatric Rheumatology Online Journal1546-00962017-10-011511910.1186/s12969-017-0203-zReadout-segmented multi-shot diffusion-weighted MRI of the knee joint in patients with juvenile idiopathic arthritisAlexander Sauer0Mengxia Li1Annette Holl-Wieden2Thomas Pabst3Henning Neubauer4Department of Diagnostic and Interventional Radiology, University Hospital WuerzburgDepartment of Radiation Oncology, University Hospital WuerzburgDepartment of Paediatrics, University Hospital WuerzburgDepartment of Diagnostic and Interventional Radiology, University Hospital WuerzburgDepartment of Diagnostic and Interventional Radiology, University Hospital WuerzburgAbstract Background Diffusion-weighted MRI has been proposed as a new technique for imaging synovitis without intravenous contrast application. We investigated diagnostic utility of multi-shot readout-segmented diffusion-weighted MRI (multi-shot DWI) for synovial imaging of the knee joint in patients with juvenile idiopathic arthritis (JIA). Methods Thirty-two consecutive patients with confirmed or suspected JIA (21 girls, median age 13 years) underwent routine 1.5 T MRI with contrast-enhanced T1w imaging (contrast-enhanced MRI) and with multi-shot DWI (RESOLVE, b-values 0–50 and 800 s/mm2). Contrast-enhanced MRI, representing the diagnostic standard, and diffusion-weighted images at b = 800 s/mm2 were separately rated by three independent blinded readers at different levels of expertise for the presence and the degree of synovitis on a modified 5-item Likert scale along with the level of subjective diagnostic confidence. Results Fourteen (44%) patients had active synovitis and joint effusion, nine (28%) patients showed mild synovial enhancement not qualifying for arthritis and another nine (28%) patients had no synovial signal alterations on contrast-enhanced imaging. Ratings by the 1st reader on contrast-enhanced MRI and on DWI showed substantial agreement (κ = 0.74). Inter-observer-agreement was high for diagnosing, or ruling out, active arthritis of the knee joint on contrast-enhanced MRI and on DWI, showing full agreement between 1st and 2nd reader and disagreement in one case (3%) between 1st and 3rd reader. In contrast, ratings in cases of absent vs. little synovial inflammation were markedly inconsistent on DWI. Diagnostic confidence was lower on DWI, compared to contrast-enhanced imaging. Conclusion Multi-shot DWI of the knee joint is feasible in routine imaging and reliably diagnoses, or rules out, active arthritis of the knee joint in paediatric patients without the need of gadolinium-based i.v. contrast injection. Possibly due to “T2w shine-through” artifacts, DWI does not reliably differentiate non-inflamed joints from knee joints with mild synovial irritation.http://link.springer.com/article/10.1186/s12969-017-0203-zDiffusion-weighted MRIJuvenile idiopathic arthritisSynovitis |
| spellingShingle | Alexander Sauer Mengxia Li Annette Holl-Wieden Thomas Pabst Henning Neubauer Readout-segmented multi-shot diffusion-weighted MRI of the knee joint in patients with juvenile idiopathic arthritis Pediatric Rheumatology Online Journal Diffusion-weighted MRI Juvenile idiopathic arthritis Synovitis |
| title | Readout-segmented multi-shot diffusion-weighted MRI of the knee joint in patients with juvenile idiopathic arthritis |
| title_full | Readout-segmented multi-shot diffusion-weighted MRI of the knee joint in patients with juvenile idiopathic arthritis |
| title_fullStr | Readout-segmented multi-shot diffusion-weighted MRI of the knee joint in patients with juvenile idiopathic arthritis |
| title_full_unstemmed | Readout-segmented multi-shot diffusion-weighted MRI of the knee joint in patients with juvenile idiopathic arthritis |
| title_short | Readout-segmented multi-shot diffusion-weighted MRI of the knee joint in patients with juvenile idiopathic arthritis |
| title_sort | readout segmented multi shot diffusion weighted mri of the knee joint in patients with juvenile idiopathic arthritis |
| topic | Diffusion-weighted MRI Juvenile idiopathic arthritis Synovitis |
| url | http://link.springer.com/article/10.1186/s12969-017-0203-z |
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