Development and Validation of an OMERACT MRI Whole-Body Score for Inflammation in Peripheral Joints and Entheses in Inflammatory Arthritis (MRI-WIPE)

Objective: To develop a whole-body MRI-scoring system for peripheral arthritis and enthesitis. Methods: After consensus on definitions/locations of MRI pathologies, four multi-reader exercises were performed. Eighty-three joints were scored 0-3 separately for synovitis and osteitis, thirty-three entheses 0-3 separately for soft tissue inflammation and osteitis. Results: In the last exercise, reliability was moderate-good for musculoskeletal radiologists and rheumatologists with previously demonstrated good scoring proficiency. Median pairwise single-measure/average-measure ICCs were 0.67/0.80 for status scores and 0.69/0.82 for change scores; kappas ranged 0.35-0.77. Conclusion: WBMRI scoring of peripheral arthritis and enthesitis is reliable which encourages further testing and refinement in clinical trials

Whole-body MRI in inflammatory arthritis - Systematic literature review and first steps towards standardization and an OMERACT scoring system

Objective: Whole-body magnetic resonance imaging (WB-MRI) is a relatively new technique that can enable assessment of the overall inflammatory status of people with arthritis, but standards for image acquisition, definitions of key pathologies, and a quantification system are required. Our aim was to perform a systematic literature review (SLR) and to develop consensus definitions of key pathologies, anatomical locations for assessment, a set of MRI sequences and imaging planes for the different body regions, and a preliminary scoring system for WB-MRI in inflammatory arthritis. Methods: An SLR was initially performed, searching for WB-MRI studies in arthritis, osteoarthritis, spondyloarthritis, or enthesitis. These results were presented to a meeting of the MRI in Arthritis Working Group together with an MR image review. Following this, preliminary standards for WB-MRI in inflammatory arthritides were developed with further iteration at the Working Group meetings at the Outcome Measures in Rheumatology (OMERACT) 2016. Results: The SLR identified 10 relevant original articles (7 cross-sectional and 3 longitudinal, mostly focusing on synovitis and/or enthesitis in spondyloarthritis, 4 with reproducibility data). The Working Group decided on inflammation in peripheral joints and entheses as primary focus areas, and then developed consensus MRI definitions for these pathologies, selected anatomical locations for assessment, agreed on a core set of MRI sequences and imaging planes for the different regions, and proposed a preliminary scoring system. It was decided to test and further develop the system by iterative multireader exercises. Conclusion: These first steps in developing an OMERACT WB-MRI scoring system for use in inflammatory arthritides offer a framework for further testing and refinement

Localizing Broca's area for transcranial magnetic stimulation: Comparison of surface distance measurements and stereotaxic positioning

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High Spatial Resolution and High Contrast Visualization of Brain Arteries and Veins: Impact of Blood Pool Contrast Agent and Water-Selective Excitation Imaging at 3T

Purpose To investigate a blood pool contrast agent and water-selective excitation imaging at 3T for high spatial and high contrast imaging of brain vessels including the veins Methods and Results 48 clinical patients (47 +/- 18years old) were included Based on clinical findings twenty-four patients received a single dose of standard extracellular Gadoterate-meglumine (Dotareme (R)) and 24 received the blood pool contrast agent Gadofosveset (Vasovist (R)) After finishing routine MR protocols, all patients were investigated with two high spatial resolution (0 15 mm(3) voxel size) gradient echo sequences in random order in the equilibrium phase (steadystate) as approved by the review board A standard RF-spoiled gradient-echo sequence (HR-SS TR/TE 5 1/2 3 msec, FA 30 degrees) and a fat-suppressed gradient-echo sequence with water-selective excitation (HR-FS 1331 binominal-pulse, TRITE 8 8/3 8 msec FA 30 degrees) The images were subjectively assessed (image quality with vessel contrast artifacts depiction of lesions) by two investigators and contrast-to-noise ratios (CNR) were compared using the Student's t-test The image quality and CNR in the HR-FS were significantly superior compared to the HR-SS for both contrast agents (p < 0 05) The CNR was also improved when using the blood pool agent but only to a minor extent while the subjective image quality was similar for both contrast agents Conclusion The utilized sequence with water-selective excitation improved image quality and CNR properties in high spatial resolution imaging of brain arteries and veins The used blood pool contrast agent improved the CNR only to a minor extent over the extracellular contrast agen

The OMERACT MRI in Enthesitis Initiative: Definitions of Key Pathologies, Suggested MRI Sequences and Novel Heel Enthesitis Scoring System (HEMRIS)

Objective: To develop and validate an enthesitis MRI-scoring system for spondyloarthritis/psoriatic arthritis, using the heel as model. Methods: Consensus definitions of key pathologies and three heel enthesitis multi-reader scoring exercises were done, separated by discussion, training and calibration. Results: Definitions for bone and soft tissue pathologies were agreed. In final exercise, median pairwise single-measures intra-class correlation coefficients(ICCs; patient-level) for entheseal inflammation status/change scores were 0.83/0.82 for all readers. For radiologists and selected rheumatologists ICCs were 0.91/0.84 and quadratic-weighted kappas(lesionlevel) 0.57-0.91/0.45-0.81. Conclusion: The proposed definitions and heel enthesitis scoring system (HEMRIS) are reliable among trained readers and promising for clinical trials

Psoriatic arthritis: Lessons from imaging studies and implications for therapy.

Introduction: Modern imaging may aid in the diagnosis, prognosis and monitoring of therapeutic response in psoriatic arthritis (PsA). Detection of osteitis and technical advances like whole body magnetic resonance imaging (MRI) exemplify the value of this technology. Areas covered: Ultrasound (US) provides a clinic-based tool for evaluating both joint pathologies and extra-articular structures (especially enthesitis) including skin and nail disease. Recent studies have demonstrated subclinical disease in psoriasis without arthritis, as well as in PsA, with implications for diagnosis and treatment classification. Modern imaging can also facilitate decisions on tapering of expensive biologics, though real-world clinical studies are still lacking. Expert commentary: The increase in novel PsA therapies should increase the utilization of modern imaging, providing both increased validation of imaging biomarkers as well as responsive outcome measures