The OMERACT MRI in Enthesitis Initiative: Definitions of Key Pathologies, Suggested MRI Sequences, and a Novel Heel Enthesitis Scoring System.

Ashish Jacob Mathew ,Violaine Foltz,Robert G Lambert,Walter P Maksymowych,Jacob L Jaremko,Mikkel Østergaard,Philippe Carron,Joel Paschke,Daniel Glinatsi,Simon Krabbe,Ida K Haugen,Iris Eshed,Paul Bird,Frédérique Gandjbakhch,Philip G Conaghan,René Panduro Poggenborg ,Jean-Denis Larédo ,Susanne Juhl Pedersen ,Kay-Geert A Hermann ,Maria Stoenoiu

doi:10.3899/jrheum.181093

Abstract

To develop and validate an enthesitis magnetic resonance imaging (MRI) scoring system for spondyloarthritis/psoriatic arthritis, using the heel as model. Consensus definitions of key pathologies and 3 heel enthesitis multireader scoring exercises were done, separated by discussion, training, and calibration. Definitions for bone and soft tissue pathologies were agreed. In the final exercise, median pairwise single-measures intraclass correlation coefficients (ICC; patient-level) for entheseal inflammation status/change scores were 0.83/0.82 for all readers. For radiologists and selected rheumatologists, ICC were 0.91/0.84 and quadratic-weighted κ (lesion-level) 0.57-0.91/0.45-0.81. The proposed definitions and Heel Enthesitis Scoring System (HEMRIS) are reliable among trained readers and promising for clinical trials.

Highlights

The work was informed by an SLR8, which clarified knowledge gaps and the need for development of a validated magnetic resonance imaging (MRI) enthesitis scoring system to be used as outcome measure in clinical trials
Enthesitis in SpA may show changes both in inflammation and damage[13,14]. Both inflammatory and structural MRI findings were considered relevant to include in the scoring system
A series of multireader scoring exercises focused on the heel region, using an intuitive Web-based data entry and image display platform

Summary

MATERIALS AND METHODS

The Outcome Measures in Rheumatology (OMERACT) MRI in Arthritis Working Group initially performed a systematic literature review (SLR) of studies with MRI being used for assessment of enthesitis[8]. In exercise 1, performed to identify challenges and pitfalls, sagittal T1-weighted (T1W) and sagittal and axial T2W fat–suppressed (T2wFS) MR images of 10 ankles [4 inflammatory enthesitis (peripheral SpA), 4 mechanical enthesitis, and 2 normal controls] were scored by 15 readers from 10 countries, with varying expertise in ankle MRI, for enthesitis at Achilles tendon and plantar fascia insertions. This was followed by a Web-based calibration exercise leading to minor score sheet modifications. In exercise 3, the standardized response mean (SRM) was calculated

RESULTS

Intra-tendon hypersignal on T1W

DISCUSSION