Atlas of the OMERACT Heel Enthesitis MRI Scoring System (HEMRIS)

Objective: Assessment of enthesitis, a key feature in spondyloarthritis (SpA) and psoriatic arthritis (PsA), using objective and sensitive methods is pivotal in clinical trials. MRI allows detection of both soft tissue and intra-osseous changes of enthesitis. This article presents an atlas for the Outcome Measures in Rheumatology (OMERACT) Heel Enthesitis Magnetic Resonance ImagingMRI Scoring System (HEMRIS). Methods: Following a preliminary selection of potential examples of each grade, as per HEMRIS definitions, the images along with detailed definitions and reader rules were discussed at web-based, interactive meetings between the members of the OMERACT MRI in Arthritis Working Group. Results: Reference images of each grade of the MRI features to be assessed using HEMRIS, along with reader rules and recommended MRI sequences are depicted. Conclusion: The presented reference images can be used to guide scoring Achilles tendon and plantar fascia (plantar aponeurosis) enthesitis according to the OMERACT HEMRIS in clinical trials and cohorts in which MRI enthesitis is used as an outcome

Development and Validation of the OMERACT Rheumatoid Arthritis Magnetic Resonance Tenosynovitis Scoring System in a Multireader Exercise

Objective. To develop and validate a magnetic resonance imaging (MRI) tenosynovitis (TS) score for tendons at the wrist and metacarpophalangeal (MCP) joint levels in patients with rheumatoid arthritis (RA). Methods. Axial T1-weighted precontrast and postcontrast fat-saturated MR image sets of the hands of 43 patients with RA initiating rituximab therapy were obtained at baseline and after 14, 26, 38, or 52 weeks. The MR images were scored twice by 4 readers. Nine tendon compartments of the wrist and 4 flexor tendon compartments at the MCP joints were assessed. Tenosynovitis was scored as follows: 0: No; 1: < 1.5 mm; 2: ≥ 1.5 mm but < 3 mm; 3: ≥ 3 mm peritendinous effusion and/or postcontrast enhancement. Intrareader and interreader intraclass correlation coefficients (ICC), smallest detectable change (SDC), percentage of exact and close agreement (PEA/PCA), and standardized response mean (SRM) were calculated. Results. Intrareader and interreader ICC for status and change scores were very good (≥ 0.80) for total scores for all readers. Intrareader SDC was ≤ 3.0 and interreader SDC was < 2.0. The overall PEA/PCA intrareader and interreader agreements for change scores in all tendons were 73.8%/97.6% and 47.9%/85.0%, respectively. Average SRM was moderate for total scores and 60.5% of the patients had a tenosynovitis change score ≥ SDC. Conclusion. The TS score showed high intrareader and interreader agreement for wrist and finger tendons, with moderate responsiveness, and the majority of the patients showed a change above the SDC. This scoring system may be included as a component of the RAMRIS

AB1350 CAN DIFFUSION-WEIGHTED MRI REPLACE INTRAVENOUS GADOLINIUM CONTRAST-ENHANCED MRI FOR ASSESSMENT OF SYNOVITIS?

BackgroundIn clinical trials of rheumatoid arthritis (RA) patients, intravenous gadolinium contrast injection is the gold standard method for MRI assessment of synovitis, e.g. by the OMERACT RA MRI Scoring method (RAMRIS). It has been shown that diffusion-weighted MRI (DW-MRI) allows visualization of synovitis1.ObjectivesTo establish a method for measuring MRI-derived apparent diffusion coefficient (ADC) from DW-MRI and to test its correlation with RAMRIS synovitis scoring.MethodsMRI including diffusion-weighting of the dominant hand was performed in a cohort of RA patients in clinical remission (disease activity score in 28 joints-C-reactive protein [DAS28-CRP] &lt;3.2 and no swollen joints). ADC measurements of the synovium were assessed in 7 areas (3 wrist joint areas and 4 metacarpophalangeal (MCP) joints), similar to the RAMRIS. Intra-observer agreement for the ADC reading was determined using the intraclass correlation coefficient (ICC). Spearman’s rho (ρ) was calculated for the correlation of ADC with RAMRIS Synovitis. Differences in mean ADC between the individual RAMRIS synovitis grades were examined using ANOVA with Bonferroni correction for multiple tests.ResultsIn 63 patients (67% females, age mean 61.0 years (range 36-78 years), disease duration 11.9 years, 0-59 years), DAS28-CRP 2.1 (1.6-3.0) the total RAMRIS synovitis was mean 5.8 (range 0-18). The mean ADC was 0.98x10-3 mm2/s (0.11-2.80). Correlations between RAMRIS synovitis and ADC in the 7 joint areas and mean differences in ADC between RAMRIS synovitis grades are presented in the Table 1. When all 7 joints were pooled the mean ADC and RAMRIS synovitis were moderately positively correlated, ρ=0.49; p&lt;0.01. Statistically significant differences (p&lt;0.01) in mean ADC were observed between all RAMRIS synovitis grades (0 vs 1, 0 vs 2, etc) except for the difference between grade 2 and 3. Good intra-observer (ICC = 0.62 (95%CI 0.49-0.72)) was found.Table 1.All jointsRUJRCJCMCJMCP2MCP3MCP4MCP5RAMRIS synovitis vs ADC correlation, (Spearman’s rho)0.49; p&lt;0.010.39; p&lt;0.010.34; p=0.010.37; p&lt;0.010.59; p&lt;0.010.46; p&lt;0.010.69; p&lt;0.010.42; p&lt;0.01Mean differences in ADC [x10-3 mm2/s]between RAMRIS synovitis grades(ANOVA with Bonferroni correction)0-1-0.20, p&lt;0.01-0.29, p=0.310.09, p=1.00-0.14, p=1.00-0.04, p=1.000.02, p=1.00-0.42, p&lt;0.01n/a0-2-0.55, p&lt;0.01-0.28, p=0.91-0.15, p=1.00-0.27, p=0.43-0.38, p=0.03-0.47, p&lt;0.01-0.62, p&lt;0.01n/a0-3-0.79, p&lt;0.01-0.87, p&lt;0.01-0.20, p=1.00-0.01, p=1.00-0.72, p&lt;0.01-0.57, p&lt;0,01-0.93, p&lt;0.01n/a1-2-0.34, p&lt;0.010.14, p=1.00-0.25, p=0.70-0.13, p=1.00-0.34, p=0.1-0.49, p&lt;0,01-0.19, p=1.00n/a1-3-0.59, p&lt;0.01-0.58, p=0.26-0.29, p=1.000.13, p=1.00-0.68, p&lt;0.01-0.59, p&lt;0.01-0.51, p=0.02n/a2-3-0.24, p=0.09-0.60, p=0.24-0.05, p=1.000.26, p=1.00-0.34, p=0.120.10, p=1.00-0.31, p=0.63n/aIntra-observer ICC (95%CI)0,62 (0,49:0,72)0.70 (0.34:0.89)0.57 (0.14:0.82)0.39 (0.14:0.74)0.81 (0.53:0.93)0.70 (0.34:0.89)(0.81 (0.51:0.93)0.40 (0.18:0.74)ADC: Apparent diffusion coefficient, CI: confidence interval, CMCJ: carpo-metacarpal joint, ICC: intraclass correlation coefficient, MCP: metacarpo-phalangeal joint, RCJ: radio-carpal joint, RUJ: radio-ulnar jointConclusionADC, determined from DWI-MRI, may be used to grade synovitis without the use of gadolinium contrast injection.References[1]Li et al Magn Reson Imaging. 2014 May;32:350-3.Disclosure of InterestsJakob Møllenbach Møller: None declared, Karen Lind Gandrup: None declared, Mikkel Østergaard Speakers bureau: Abbvie, BMS, Celgene, Eli-Lilly, Galapagos, Gilead, Janssen, Merck, Novartis, Orion, Pfizer, Roche and UCB, Consultant of: Abbvie, BMS, Boehringer-Ingelheim, Celgene, Eli-Lilly, Hospira, Janssen, Merck, Novartis, Novo, Orion, Pfizer, Regeneron, Roche, Sandoz, Sanofi and UCB, Grant/research support from: Abbvie, Amgen, BMS, Merck, Celgene and Novartis, Daniel Glinatsi Speakers bureau: Eli Lilly, Consultant of: AbbVie, Ole Madsen: None declared, Kim Hørslev-Petersen: None declared, Signe Møller-Bisgaard: None declared</jats:sec