Publications by authors named "Robert Hemke"

47 Publications

The added value of SPECT/CT in the painful foot and ankle: A review of the literature.

Foot Ankle Surg 2020 Sep 30. Epub 2020 Sep 30.

Amsterdam University Medical Centers, Location AMC, University of Amsterdam, Trauma Unit, Department of Surgery, Amsterdam, The Netherlands. Electronic address:

Introduction: Foot and ankle injuries are common. Radiographic assessment is difficult because of the complex anatomy. In the past decade SPECT/CT made its introduction in assessing bone pathology, it combines both morphologic and pathologic imaging in one image aiming to increase sensitivity and specificity when compared with MRI or CT alone. The purpose of this review was to provide a literature overview on the diagnostic value of SPECT/CT in foot and ankle pathology.

Methods: A literature search was conducted in the databases of PubMed and EMBASE between January 2004 and September 2019 for articles describing the diagnostic value of SPECT/CT in foot and ankle pathology. For assessment of methodological quality of each study included in the analysis, QUADAS-2 checklist was used. Main outcomes were change of management, improved diagnosis and symptomatic improvement.

Results: A total of eight studies were identified describing the diagnostic value of SPECT/CT in foot and ankle pathology based on patient data. The combined analysis shows that change of management and improved diagnosis occurred in 48-62% and 40-79% of the patients when compared with other imaging modalities and/or clinical assessment. Symptomatic improvement due to treatment based on SPECT/CT findings occurred in 92% of the patients.

Conclusion: SPECT/CT is useful when diagnosis based on other imaging modalities is inconclusive or when treatment based on these modalities does not lead to the desired symptomatic improvement.
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http://dx.doi.org/10.1016/j.fas.2020.09.009DOI Listing
September 2020

Quantitative Imaging of Body Composition.

Semin Musculoskelet Radiol 2020 Aug 29;24(4):375-385. Epub 2020 Sep 29.

Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.

Body composition refers to the amount and distribution of lean tissue, adipose tissue, and bone in the human body. Lean tissue primarily consists of skeletal muscle; adipose tissue comprises mostly abdominal visceral adipose tissue and abdominal and nonabdominal subcutaneous adipose tissue. Hepatocellular and myocellular lipids are also fat pools with important metabolic implications. Importantly, body composition reflects generalized processes such as increased adiposity in obesity and age-related loss of muscle mass known as sarcopenia.In recent years, body composition has been extensively studied quantitatively to predict overall health. Multiple imaging methods have allowed precise estimates of tissue types and provided insights showing the relationship of body composition to varied pathologic conditions. In this review article, we discuss different imaging methods used to quantify body composition and describe important anatomical locations where target tissues can be measured.
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http://dx.doi.org/10.1055/s-0040-1708824DOI Listing
August 2020

Novel Body Composition Predictors of Outcome in Patients With Angiosarcoma of the Breast: A Preliminary Study.

J Comput Assist Tomogr 2020 Jul/Aug;44(4):605-609

From the Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.

Objective: The aim of the study was to determine abdominal and breast adipose tissue parameters on 18-fluorodeoxyglucose positron emission tomography/computed tomography (CT) that may serve as outcome predictors in breast angiosarcoma patients.

Materials: Women with breast angiosarcoma (n = 13) who underwent 18-fluorodeoxyglucose positron emission tomography/CT were identified. A control group was selected (n = 25). Abdominal subcutaneous (SAT) and visceral adipose tissue (VAT) were assessed on unenhanced computed tomographies. Breast adipose tissue (BAT) volumes of the uninvolved breast were quantified. Metabolic activity of VAT, SAT, and BAT was calculated (standardized uptake value [SUV]).

Results: Breast angiosarcoma patients had higher metabolic activity of VAT compared with controls (SUV 0.93 ± 0.39 vs 0.64 ± 0.11, P = 0.044). Within the patient group, there were 6 deaths (46.2%). Patients who died had higher SAT activity (SUV 0.52 ± 0.24 vs 0.29 ± 0.06, P = 0.027) and higher BAT metabolic activity (SUV 0.48 ± 0.20 vs 0.27 ± 0.11, P = 0.045) compared with nondeceased patients.

Conclusions: Patients with breast angiosarcoma have higher metabolic activity of VAT. Higher abdominal SAT and higher BAT metabolic activity of the uninvolved breast might predict mortality.
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http://dx.doi.org/10.1097/RCT.0000000000001066DOI Listing
July 2020

Exploring contrast-enhanced MRI findings of the clinically non-inflamed symptomatic pediatric wrist.

Pediatr Radiol 2020 09 13;50(10):1387-1396. Epub 2020 Jul 13.

Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Academic Medical Center Amsterdam Movement Sciences, University of Amsterdam, Amsterdam, The Netherlands.

Background: Knowledge of the synovial and tenosynovial appearance of the clinically non-arthritic symptomatic juvenile wrist using contrast-enhanced magnetic resonance imaging (MRI) is sparse.

Objectives: To analyze contrast-enhanced MRI findings of the clinically non-inflamed symptomatic pediatric wrist, focusing on the enhancing synovial and tenosynovial membrane. To evaluate the coexistent presence of (teno)synovial enhancement, joint fluid, bony depressions and medullary changes suggestive of bone marrow edema.

Materials And Methods: We included 20 children (15 girls; age range: 7.5-17.6 years) who underwent contrast-enhanced MRI of the wrist, based on initial clinical indication, and eventually turned out to be unaffected by arthritic or orthopedic disorders. Various imaging characteristics of the synovium, tenosynovium, joint fluid, bone tissue and bone marrow were evaluated using existing MRI scoring systems.

Results: In 3/20 (15%) children, mild or moderate-severe synovial enhancement was observed and 2/20 (10%) children showed mild tenosynovial enhancement/thickening. Joint fluid (11/20 children; 55%), bony depressions (20/20 children; 100%) and medullary changes suggestive of bone marrow edema (6/20; 30%) were found in a substantial percentage of children. The most frequently observed combination of coexisting imaging characteristics was bony depressions with ≥2 mm joint fluid, which was found in 7/20 (35%) children. Simultaneous presence of synovial and tenosynovial enhancement/thickening, bony depressions and medullary changes suggestive of bone marrow edema was observed in one child.

Conclusion: Several juvenile idiopathic arthritis-relevant MRI characteristics can be observed in the clinically non-inflamed symptomatic pediatric wrist.
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http://dx.doi.org/10.1007/s00247-020-04739-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7445206PMC
September 2020

Imaging assessment of children presenting with suspected or known juvenile idiopathic arthritis: ESSR-ESPR points to consider.

Eur Radiol 2020 Oct 12;30(10):5237-5249. Epub 2020 May 12.

Department of Radiology, University Hospital of North Norway, Tromsø, Norway.

Juvenile idiopathic arthritis (JIA) is the most common paediatric rheumatic disease. It represents a group of heterogenous inflammatory disorders with unknown origin and is a diagnosis of exclusion in which imaging plays an important role. JIA is defined as arthritis of one or more joints that begins before the age of 16 years, persists for more than 6 weeks and is of unknown aetiology and pathophysiology. The clinical goal is early suppression of inflammation to prevent irreversible joint damage which has shifted the emphasis from detecting established joint damage to proactively detecting inflammatory change. This drives the need for imaging techniques that are more sensitive than conventional radiography in the evaluation of inflammatory processes as well as early osteochondral change. Physical examination has limited reliability, even if performed by an experienced clinician, emphasising the importance of imaging to aid in clinical decision-making. On behalf of the European Society of Musculoskeletal Radiology (ESSR) arthritis subcommittee and the European Society of Paediatric Radiology (ESPR) musculoskeletal imaging taskforce, based on literature review and/or expert opinion, we discuss paediatric-specific imaging characteristics of the most commonly involved, in literature best documented and clinically important joints in JIA, namely the temporomandibular joints (TMJs), spine, sacroiliac (SI) joints, wrists, hips and knees, followed by a clinically applicable point to consider for each joint. We will also touch upon controversies in the current literature that remain to be resolved with ongoing research. KEY POINTS: • Juvenile idiopathic arthritis (JIA) is the most common chronic paediatric rheumatic disease and, in JIA imaging, is increasingly important to aid in clinical decision-making. • Conventional radiographs have a lower sensitivity and specificity for detection of disease activity and early destructive change, as compared to MRI or ultrasound. Nonetheless, radiography remains important, particularly in narrowing the differential diagnosis and evaluating growth disturbances. • Mainly in peripheral joints, ultrasound can be helpful for assessment of inflammation and guiding joint injections. In JIA, MRI is the most validated technique. MRI should be considered as the modality of choice to assess the axial skeleton or where the clinical presentation overlaps with JIA.
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http://dx.doi.org/10.1007/s00330-020-06807-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7476913PMC
October 2020

Juvenile Idiopathic Arthritis: Diffusion-weighted MRI in the Assessment of Arthritis in the Knee.

Radiology 2020 05 10;295(2):373-380. Epub 2020 Mar 10.

From the Department of Radiology and Nuclear Medicine (A.M.B., E.C.v.G., A.J.N., M.M., R.H.), Department of Pediatric Immunology, Rheumatology and Infectious Disease (A.M.B., E.C.v.G., D.S.M., A.N.S.a.R., J.M.v.d.B., T.W.K.), and Department of Pediatrics (C.M.N.), Amsterdam University Medical Centers, location AMC, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; Department of Radiology, Lucas Center for Imaging, Stanford University, Stanford, Calif (V.M.); Department of Pediatric Rheumatology, Reade, Amsterdam, the Netherlands (K.M.D.); and Department of Pediatrics, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands (K.M.D.).

Background Diffusion-weighted imaging (DWI) can depict the inflamed synovial membrane in arthritis. Purpose To study the diagnostic accuracy of DWI for the detection of arthritis compared with the clinical reference standard and to compare DWI to contrast material-enhanced MRI for the detection of synovial inflammation. Materials and Methods In this institutional review board-approved prospective study, 45 participants with juvenile idiopathic arthritis (JIA) or suspected of having JIA (seven boys, 38 girls; median age, 14 years [interquartile range, 12-16 years]) were included between December 2015 and December 2018. Study participants underwent pre- and postcontrast 3.0-T MRI of the knee with an additional DWI sequence. For the clinical reference standard, a multidisciplinary team determined the presence or absence of arthritis on the basis of clinical, laboratory, and imaging findings (excluding DWI). Two data sets were scored by two radiologists blinded to all clinical data; data set 1 contained pre- and postcontrast sequences (contrast-enhanced MRI), and data set 2 contained precontrast and DWI sequences (DWI). Diagnostic accuracy was determined by comparing the scores of the DWI data set to those of the clinical reference standard. Second, DWI was compared with contrast-enhanced MRI regarding detection of synovial inflammation. Results Sensitivity for detection of arthritis for DWI was 93% (13 of the 14 participants with arthritis were correctly classified with DWI; 95% confidence interval [CI]: 64%, 100%) and specificity was 81% (25 of 31 participants without arthritis were correctly classified with DWI; 95% CI: 62%, 92%). Scores for synovial inflammation at DWI and contrast-enhanced MRI agreed in 37 of 45 participants (82%), resulting in a sensitivity of 92% (12 of 13 participants; 95% CI: 62%, 100%) and specificity of 78% (25 of 32 participants; 95% CI: 60%, 90%) with DWI when contrast-enhanced MRI was considered the reference standard. Conclusion Diffusion-weighted imaging (DWI) was accurate in detecting arthritis in pediatric participants with juvenile idiopathic arthritis (JIA) or suspected of having JIA and showed agreement with contrast-enhanced MRI. The results indicate that DWI could replace contrast-enhanced MRI for imaging of synovial inflammation in this patient group. © RSNA, 2020
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http://dx.doi.org/10.1148/radiol.2020191685DOI Listing
May 2020

Quantitative MRI Reveals Microstructural Changes in the Upper Leg Muscles After Running a Marathon.

J Magn Reson Imaging 2020 08 7;52(2):407-417. Epub 2020 Mar 7.

Amsterdam University Medical Centers, University of Amsterdam, Department of Biomedical Engineering and Physics, Amsterdam Movement Sciences, Amsterdam, Netherlands.

Background: The majority of sports-related injuries involve skeletal muscle. Unlike acute trauma, which is often caused by a single traumatic event leading to acute symptoms, exercise-induced microtrauma may remain subclinical and difficult to detect. Therefore, novel methods to detect and localize subclinical exercise-induced muscle microtrauma are desirable.

Purpose: To assess acute and delayed microstructural changes in upper leg muscles with multiparametric quantitative MRI after running a marathon.

Study Type: Longitudinal; 1-week prior, 24-48 hours postmarathon and 2-week follow-up POPULATION: Eleven men participants (age: 47-68 years).

Field Strength/sequence: Spin-echo echo planar imaging (SE-EPI) with diffusion weighting, multispin echo, Dixon, and fat-suppressed turbo spin-echo (TSE) sequences at 3T. MR datasets and creatine kinase (CK) concentrations were obtained at three timepoints.

Assessment: Diffusion parameters, perfusion fractions, and quantitative (q)T values were determined for hamstring and quadriceps muscles, TSE images were scored for acute injury. The vastus medialis and biceps femoris long head muscles were divided and analyzed in five segments to assess local damage.

Statistical Tests: Differences between timepoints in MR parameters were assessed with a multilevel linear mixed model and in CK concentrations with a Friedman test. Mean diffusivity (MD) and qT for whole muscle and muscle segments were compared using a multivariate analysis of covariance (MANCOVA).

Results: CK concentrations were elevated (1194 U/L [166-3906], P < 0.001) at 24-48 hours postmarathon and returned to premarathon values (323 U/L [56-2216]) at 2-week follow-up. Most of the MRI diffusion indices in muscles without acute injury changed at 24-48 hours postmarathon and returned to premarathon values at follow-up (MD, RD, and λ3; P < 0.006). qT values (P = 0.003) and perfusion fractions (P = 0.003) were higher at baseline compared to follow-up. Local assessments of MD and qT revealed more pronounced changes than whole muscle assessment (2-3-fold; P < 0.01).

Data Conclusion: Marathon running-induced microtrauma was detected with MRI in individual whole upper leg muscles and even more pronounced on local segments.

Level Of Evidence: 2 TECHNICAL EFFICACY STAGE: 3 J. Magn. Reson. Imaging 2020;52:407-417.
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http://dx.doi.org/10.1002/jmri.27106DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7496541PMC
August 2020

Does MR arthrography cause intracranial gadolinium deposition?

Skeletal Radiol 2020 Jul 25;49(7):1051-1056. Epub 2020 Jan 25.

Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Yawkey 6E, 55 Fruit Street, Boston, MA, 02114, USA.

Purpose: To determine (i) whether intra-articular gadolinium from MR arthrography (MRA) results in gadolinium deposition in the brain and (ii) whether there is a correlation between intra-articular gadolinium dose and intracranial gadolinium deposition.

Materials And Methods: This retrospective study was institutional review board (IRB) approved and HIPAA compliant. The study group included consecutive adult patients who had undergone MRA of the hip or shoulder and subsequent MRI of the brain. None of the patients had a history of intravenous gadolinium exposure. A control group of patients of similar age and sex who were never exposed to gadolinium and had brain MRIs available was included. Signal intensities (SI) of four brain regions: pons, dentate nuclei (DN), globus pallidi (GP), and thalamus (Thal) normalized to cerebrospinal fluid (CSF) and expressed in SI ratios were measured on T1-weighted non-contrast MR images. Groups were compared using the student's t test. Linear correlation analysis of gadolinium dose and brain SI ratios was performed, and Pearson correlation coefficients (r) are reported.

Results: We identified 109 patients (mean age 44 ± 14 years, 54% men) who had undergone MRA and 149 controls of similar age and sex distribution. There was no significant difference in mean SI ratios of the brain regions between patients and controls: pons/CSF (p = 0.7), DN/CSF (p = 0.4), GP/CSF (p > 0.99), Thal/CSF (p = 0.3). Within the MRA group, gadolinium dose was not associated with SI ratios (p > 0.2).

Conclusion: Our study found no MR evidence of intracranial gadolinium deposition following MRA. In addition, there was no association between intra-articular gadolinium dose and SI ratios in commonly affected regions of the brain.
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http://dx.doi.org/10.1007/s00256-020-03380-5DOI Listing
July 2020

MRP8/14 and neutrophil elastase for predicting treatment response and occurrence of flare in patients with juvenile idiopathic arthritis.

Rheumatology (Oxford) 2020 09;59(9):2392-2401

Department of Paediatric Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam.

Objective: To study two neutrophil activation markers, myeloid-related protein (MRP) 8/14 and neutrophil elastase (NE), for their ability to predict treatment response and flare in patients with JIA.

Methods: Using samples from two cohorts (I and II), we determined MRP8/14 and NE levels of 32 (I) and 81 (II) patients with new-onset, DMARD-naïve arthritis and compared patients who responded to treatment (defined as fulfilling ≥ adjusted ACRpedi50 response and/or inactive disease) with non-responders (defined as fulfilling < adjusted ACRpedi50 response and/or active disease) at 6 and 12 months. Secondly, we compared biomarker levels of 54 (I) and 34 (II) patients with clinically inactive disease who did or did not suffer from a flare of arthritis after 6 or 12 months. Receiver operating characteristic analyses were carried out to study the predictive value of MRP8/14 and NE for treatment response and flare.

Results: For both cohorts, baseline MRP8/14 and NE levels for patients who did or did not respond to treatment were not different. Also, MRP8/14 and NE levels were not different in patients who did or did not flare. Receiver operating characteristic analysis of MRP8/14 and NE demonstrated areas under the curve <0.7 in both cohorts.

Conclusion: In our cohorts, MRP8/14 and NE could not predict treatment response. Also, when patients had inactive disease, neither marker could predict flares.
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http://dx.doi.org/10.1093/rheumatology/kez590DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7449815PMC
September 2020

Effects of intra-articular corticosteroid injections on lumbar trabecular density.

Skeletal Radiol 2020 May 13;49(5):787-793. Epub 2019 Dec 13.

Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Yawkey 6E, 55 Fruit Street, Boston, MA, 02114, USA.

Purpose: To determine the effect of intra-articular corticosteroid injections on lumbar spine trabecular density.

Materials And Methods: This retrospective study was IRB-approved and HIPAA-compliant. We identified 50 patients (26 F, 24 M, mean age 69 ± 14 years) who had undergone at least three medium or large joint corticosteroid injections using insoluble corticosteroids and a subsequent non-contrast abdominal CT within 5 years of the first injection. About 126 age- and sex-matched controls without history of prior corticosteroid use who had undergone non-contrast abdominal CT were identified. Cumulative corticosteroid dose was calculated. Density measurements (HU) of trabecular bone of L1 to L4 were performed, and measurements of L1 were compared to established normative data. Groups were compared using a two-sided paired t-test or a chi-squared test. Linear regression analysis between cumulative corticosteroid dose and trabecular density was performed.

Results: Patients underwent a mean of 4 corticosteroid injections (range 3 to 11) with a mean cumulative corticosteroid dose of 232 ± 100 mg triamcinolone equivalent (range 120 mg to 480 mg). There was no significant difference in trabecular density of L1 to L4 between cases and controls, and there was no significant difference in trabecular density at L1 compared to normative data (p > 0.2). There was no association between cumulative intra-articular corticosteroid dose and mean lumbar trabecular density (p > 0.3).

Conclusion: Patients who underwent repetitive intra-articular insoluble corticosteroid injections showed no increased risk of bone loss compared to controls. Cumulative intra-articular corticosteroid dose was not associated with lumbar trabecular density.
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http://dx.doi.org/10.1007/s00256-019-03362-2DOI Listing
May 2020

CT-guided discitis-osteomyelitis biopsies with negative microbiology: how many days should we wait before repeating the biopsy?

Skeletal Radiol 2020 Apr 23;49(4):619-623. Epub 2019 Nov 23.

Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street Yawkey 6E, Boston, MA, 02114, USA.

Purpose: To determine the number of days to positive CT-guided biopsy sample culture in patients with discitis-osteomyelitis.

Methods: Our study was IRB approved and HIPAA compliant. All CT-guided biopsies performed for acute discitis-osteomyelitis with positive microbiology between 2002 and 2018 were reviewed. Microbiological organism and days to positive biopsy were documented. Mean, median, skew, and standard deviation were calculated. The proportion of positive cultures that become positive after each day has elapsed was also calculated.

Results: There were 96 true positive cultures, with 64 (67%) male and 32 (33%) female, ages 57 ± 18 (range 19-87) years. Overall, including all culture results, the mean number of days to positive culture was 2.9 ± 3.5 days. The median number of days was 2, with a positive skew of 2.9. At days 1, 2, 3, 4, and 5, 48%, 68%, 78%, 85%, and 89%, respectively, of biopsy samples had a positive microbiology culture.

Conclusion: Approximately three-quarters of discitis-osteomyelitis pathogens will be identified by biopsy sample culture by 3 days after CT-guided biopsy. This finding should be considered if planning for a repeat biopsy in the setting of a negative microbiology culture.
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http://dx.doi.org/10.1007/s00256-019-03344-4DOI Listing
April 2020

T-mapping for assessing knee joint cartilage in children with juvenile idiopathic arthritis - feasibility and repeatability.

Pediatr Radiol 2020 03 9;50(3):371-379. Epub 2019 Nov 9.

Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, location AMC, Meibergdreef 9, Room G1-226, 1105 AZ, Amsterdam, The Netherlands.

Background: Ongoing arthritis in children with juvenile idiopathic arthritis (JIA) can result in cartilage damage.

Objective: To study the feasibility and repeatability of T for assessing knee cartilage in JIA and also to describe T values and study correlation between T and conventional MRI scores for disease activity.

Materials And Methods: Thirteen children with JIA or suspected JIA underwent 3-tesla (T) knee MRI that included conventional sequences and a T sequence. Segmentation of knee cartilage was carried out on T images. We used intraclass correlation coefficient to study the repeatability of segmentation in a subset of five children. We used the juvenile arthritis MRI scoring system to discriminate inflamed from non-inflamed knees. The Mann-Whitney U and Spearman correlation compared T between children with and without arthritis on MRI and correlated T with the juvenile arthritis MRI score.

Results: All children successfully completed the MRI examination. No images were excluded because of poor quality. Repeatability of T measurement had an intraclass correlation coefficient (ICC) of 0.99 (P<0.001). We observed no structural cartilage damage and found no differences in T between children with (n=7) and without (n=6) inflamed knees (37.8 ms vs. 31.7 ms, P=0.20). However, we observed a moderate correlation between T values and the juvenile arthritis MRI synovitis score (r=0.59, P=0.04).

Conclusion: This pilot study suggests that T is a feasible and repeatable quantitative imaging technique in children. T values were associated with the juvenile arthritis MRI synovitis score.
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http://dx.doi.org/10.1007/s00247-019-04557-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7026305PMC
March 2020

Organ dose and total effective dose of whole-body CT in multiple myeloma patients.

Skeletal Radiol 2020 Apr 15;49(4):549-554. Epub 2019 Oct 15.

Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA.

Objective: To evaluate organ dose and total effective dose of whole-body low-dose CT (WBLDCT) performed on different CT-scanner models in patients with multiple myeloma (MM) and to compare it to the effective dose of radiographic skeletal survey and representative diagnostic CTs.

Material And Methods: We retrospectively analyzed data from 228 patients (47.4% females, mean age 67.9 ± 10.4 years, mean weight 81.8 ± 22.4 kg) who underwent WBLDCT for the work-up or surveillance of MM. Patients were scanned using one of six multi-detector CT-scanners. Organ doses and total effective doses per scan were calculated using a commercially available dose-management platform (Radimetrics, Bayer Healthcare, Leverkusen, Germany). The median effective dose was compared to radiographic skeletal survey and representative diagnostic CTs.

Results: The mean effective dose of our WBLDCT-protocol was 4.82 mSv. A significantly higher effective dose was observed in females compared to males (4.95 vs. 4.70 mSv, P = 0.002). Mean organ dose ranged from 3.72 mSv (esophagus) to 13.09 mSv (skeleton). Mean effective dose varied amongst different CT-scanners (range 4.34-8.37 mSv). The median effective dose of WBLDCT was more than twice the dose of a skeletal survey (4.82 vs. 2.04 mSv), 23% higher than a diagnostic contrast-enhanced chest CT (3.9 mSv), 46% lower than a diagnostic contrast-enhanced abdomen/pelvis CT (9.0 mSv), and 45% lower than a lumbar spine CT (8.7 mSv).

Conclusions: WBLDCT in MM has a higher effective dose than a radiographic skeletal survey, but a lower effective dose than diagnostic CTs of lumbar spine, abdomen and pelvis. This underlines the broad applicability of WBLDCT in the management of MM patients.
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http://dx.doi.org/10.1007/s00256-019-03292-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7021660PMC
April 2020

Deep learning for automated segmentation of pelvic muscles, fat, and bone from CT studies for body composition assessment.

Skeletal Radiol 2020 Mar 8;49(3):387-395. Epub 2019 Aug 8.

Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, YAW 6048, Boston, MA, 02114, USA.

Objective: To develop a deep convolutional neural network (CNN) to automatically segment an axial CT image of the pelvis for body composition measures. We hypothesized that a deep CNN approach would achieve high accuracy when compared to manual segmentations as the reference standard.

Materials And Methods: We manually segmented 200 axial CT images at the supra-acetabular level in 200 subjects, labeling background, subcutaneous adipose tissue (SAT), muscle, inter-muscular adipose tissue (IMAT), bone, and miscellaneous intra-pelvic content. The dataset was randomly divided into training (180/200) and test (20/200) datasets. Data augmentation was utilized to enlarge the training dataset and all images underwent preprocessing with histogram equalization. Our model was trained for 50 epochs using the U-Net architecture with batch size of 8, learning rate of 0.0001, Adadelta optimizer and a dropout of 0.20. The Dice (F1) score was used to assess similarity between the manual segmentations and the CNN predicted segmentations.

Results: The CNN model with data augmentation of N = 3000 achieved accurate segmentation of body composition for all classes. The Dice scores were as follows: background (1.00), miscellaneous intra-pelvic content (0.98), SAT (0.97), muscle (0.95), IMAT (0.91), and bone (0.92). Mean time to automatically segment one CT image was 0.07 s (GPU) and 2.51 s (CPU).

Conclusions: Our CNN-based model enables accurate automated segmentation of multiple tissues on pelvic CT images, with promising implications for body composition studies.
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http://dx.doi.org/10.1007/s00256-019-03289-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6980503PMC
March 2020

Prolonged time between intravenous contrast administration and image acquisition results in increased synovial thickness at magnetic resonance imaging in patients with juvenile idiopathic arthritis.

Pediatr Radiol 2019 05 1;49(5):638-645. Epub 2019 Feb 1.

Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands.

Background: Post-contrast synovial thickness measurement is necessary for scoring disease activity in juvenile idiopathic arthritis (JIA). However, the timing of post-contrast sequences varies widely among institutions. This variation in timing could influence thickness measurements.

Objective: To measure thickness of the synovial membrane on early and late post-contrast knee magnetic resonance (MR) images of patients with JIA.

Materials And Methods: Dynamic contrast-enhanced T1-weighted knee MR images of 53 children with JIA with current or past knee arthritis were used to study synovial thickness at time point 1 (about 1 min) and time point 2 (about 5 min after contrast administration). Two experienced readers, who were blinded for the time point, independently measured synovial thickness at a predefined, marked location in the patellofemoral compartment on randomized images. Synovial thickness at the two time points was compared using the Wilcoxon signed rank test. Repeatibility of the synovial thickness measurements was studied using intraclass correlation coefficients and Bland-Altman plots.

Results: Median synovial thickness of the 53 patients (median age: 13.5 years, 59% female) increased with prolonged post-contrast interval with a synovial thickness of 1.4 mm at time point 1 and a synovial thickness of 1.5 mm at time point 2 (P<0.001). Repeated synovial thickness measurements showed an intraclass correlation coefficient (ICC) of 0.75, P<0.05 for time point 1 and an ICC of 0.91, P<0.05 for time point 2.

Conclusion: Post-contrast synovial membrane thickness measurements are time-dependent. Therefore, standardization of post-contrast image acquisition timing is important to achieve consistent grading of synovial inflammation.
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http://dx.doi.org/10.1007/s00247-018-04332-xDOI Listing
May 2019

Risk of chronic ankle instability: A reliability study on radiographic assessment of the ankle joint geometry.

Foot (Edinb) 2019 Mar 6;38:12-18. Epub 2018 Nov 6.

Academic Center for Evidence based Sports medicine (ACES), The Netherlands; Amsterdam Collaboration for Health and Safety in Sports (ACHSS), VUmc / AMC IOC Research Centre for Prevention of Injury and Protection of Athlete Health, The Netherlands; Amsterdam UMC, University of Amsterdam, Department of Musculoskeletal Radiology, The Netherlands; Musculoskeletal Imaging Quantification Center (MIQC), The Netherlands.

Background: Chronic ankle instability (CAI) is a multifactorial disabling condition. Ideally all factors contributing to CAI are identified and implemented in a risk assessment model. However, they need to meet strict reliability requirements. To assess usability of radiographic factors for this risk assessment model and future clinical practice, the objective of the current study was to assess the intra and inter observer reliability of three radiographic measurements.

Methods And Methods: The radiographs of 39 consecutive patients, at least 16years, who visited the Emergency Department after sustaining a lateral ankle sprain (LAS), were assessed by four observers. The radiographic measurements included absolute and relative ankle alignment, sagittal fibular position and ankle joint congruency (talar radius and height, and tibiotalar sector), performed twice by all observers independently. Reliability was assessed by calculating the Intraclass Correlation Coefficient (ICC) which was considered good when ICC>0.70.

Results: The intra observer reliability of the absolute and relative fibular position, and talar height were good to excellent, (ICC 0.84-0.98, 0.85-0.98, and 0.79-0.93, respectively). The talar radius (ICC 0.69-0.89) was moderate to good. The overall inter observer reliability was good for the absolute and relative fibular position, and talar radius (ICC 0.84, 0.86, and 0.79, respectively). Other measurements had ICC values of <0.70.

Conclusions: In an effort to identify the multifactorial nature of CAI, both the fibular position and the talar radius measurements showed good observer reliability, and will be implemented in a future risk assessment models. The other measurements are too prone for measurement errors, for future reference.

Level Of Evidence: IV Case Series.
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http://dx.doi.org/10.1016/j.foot.2018.11.001DOI Listing
March 2019

Correction to: Diffusion-weighted imaging for assessment of synovial inflammation in juvenile idiopathic arthritis: a promising imaging biomarker as an alternative to gadolinium-based contrast agents.

Eur Radiol 2019 Jun;29(6):3319-3320

Department of Radiology, Academic Medical Center/University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.

The original version of this article, published on 12 June 2017, unfortunately contained a mistake.
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http://dx.doi.org/10.1007/s00330-018-5881-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6828305PMC
June 2019

MR Imaging of Joint Infection and Inflammation with Emphasis on Dynamic Contrast-Enhanced MR Imaging.

PET Clin 2018 Oct 17;13(4):523-550. Epub 2018 Aug 17.

Department of Radiology, Boston University School of Medicine, Boston, MA, USA.

Contrast-enhanced MR imaging (CE-MR imaging) is recommended for diagnosis and monitoring of infectious and most inflammatory joint diseases. CE-MR imaging clearly differentiates soft and bony tissue from fluid collections and infectious debris. To improve imaging information, a dynamic CE-MR imaging sequence (DCE-MR imaging) sequence can be applied using fast T1-weighted sequential image acquisition during contrast injection. Use of DCE-MR imaging allows robust extraction of quantitative information regarding blood flow and capillary permeability, especially when dedicated analysis methods and software are used to analyze contrast kinetics. This article describes principles of DCE-MR imaging for the assessment of infectious and inflammatory joint diseases.
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http://dx.doi.org/10.1016/j.cpet.2018.05.007DOI Listing
October 2018

Imaging Features of the Juvenile Inflammatory Arthropathies.

Semin Musculoskelet Radiol 2018 09 22;22(4):506-508. Epub 2018 Aug 22.

Department of Paediatric Imaging, Hospital Jeanne de Flandre, CHU Lille, France.

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http://dx.doi.org/10.1055/s-0038-1667059DOI Listing
September 2018

A risk assessment model for chronic ankle instability: indications for early surgical treatment? An observational prospective cohort - study protocol.

BMC Musculoskelet Disord 2018 Jul 18;19(1):225. Epub 2018 Jul 18.

Orthopaedic Research Center Amsterdam, Department of Orthopedic Surgery, Amsterdam Movement Sciences, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands.

Background: Chronic ankle instability (CAI) is a common result of an ankle sprain. Even though early surgical treatment yields the best results, overall only professional athletes are eligible for acute surgical stabilization. Treating all patients with early surgical stabilization leads to a high amount of unnecessary invasive interventions, as not all patients progress to CAI. If patients at risk of developing CAI can be identified, treatment policies may be applied more effectively and efficiently. The purpose of this study is to develop a risk assessment model to identify patients at risk for CAI that should receive early surgical treatment.

Methods: In this observational prospective cohort, all patients aged sixteen years and older, reporting at the emergency department of one of the participating hospitals after sustaining a lateral ankle sprain, and filled out 1 out of 3 follow-up questionnaires and the 1 year follow-up are included. A lateral and anteroposterior radiograph is made. Patients are excluded if a fracture or other pathology is present. The included patients receive four questionnaires, including questions focusing on the sprain, treatment and complaints, the Foot and Ankle Outcome Score and the Cumberland Ankle Instability Tool. A total of eleven radiographic variables are assessed for inter- and intra-observer reliability. Additionally, four factors extracted from the questionnaires, will be evaluated for correlation with CAI. Significantly correlating factors (e.a. risk factors) will be implemented in a risk assessment model. For the final model, based on sixteen variables with a minimum of 20 events per variable and a prevalence of 30-40% after an initial sprain, a sample size of 2370 patients is needed to perform both internal and external model validation.

Discussion: This study will develop the first large scale model for the risk at CAI after an ankle sprain combining radiographic and patient characteristics. With this risk assessment model, patients at risk for CAI may be identified and properly informed on the treatment options. Patients identified as being at risk, may receive more adequate follow-up and become eligible for early surgical stabilization. This prevents patients from experiencing unnecessary long-lasting complaints, increasing the success rate of conservative and surgical treatment.

Trial Registration: Retrospectively registered: NCT02955485 [Registration date: 3-11-2016]. NTR6139 [Registration date: 3-1-2017].
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http://dx.doi.org/10.1186/s12891-018-2124-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6052530PMC
July 2018

Imaging of the knee in juvenile idiopathic arthritis.

Pediatr Radiol 2018 06 8;48(6):818-827. Epub 2018 May 8.

Department of Radiology and Nuclear Medicine, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands.

In juvenile idiopathic arthritis (JIA), imaging is increasingly used in clinical practice. In this paper we discuss imaging of the knee, the clinically most commonly affected joint in JIA. In the last decade, a number of important steps have been made in the development of imaging outcome measures in children with JIA knee involvement. Ultrasound is undergoing a fast validation process, which should be accomplished within the next few years. The validation processes of MRI as an imaging biomarker for clinical trials in the JIA knee are at an advanced stage, with important data available on the feasibility, reliability and validity of the Juvenile Arthritis MRI Scoring system. Moreover, both US and MRI data are emerging on the normal appearance of the growing knee joint.
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http://dx.doi.org/10.1007/s00247-017-4015-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5954001PMC
June 2018

Normal MRI findings of the knee in patients with clinically active juvenile idiopathic arthritis.

Eur J Radiol 2018 May 6;102:36-40. Epub 2018 Mar 6.

Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Diseases, Emma Children's Hospital AMC, University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands. Electronic address:

Objective: In a number of patients with clinically active juvenile idiopathic arthritis (JIA), contrast-enhanced MRI shows no signs of synovitis. The objective of this study was to assess the frequency and the patient characteristics in clinically active JIA patients in which MRI showed no signs of synovitis.

Methods: From our cohort of 313 patients in which contrast-enhanced MRI of the knee had been performed, we selected 72 JIA patients with clinically active disease involving the target joint. The validated Juvenile Arthritis MRI Scoring (JAMRIS) system was used to evaluate synovial thickening. Patients were divided into two groups based on MRI outcome: Group 1: thickened synovium on MRI (JAMRIS score ≥1) or Group 2: normal synovium on MRI (JAMRIS score 0). Patient characteristics and disease activity parameters were then compared.

Results: In 35% (25/72) of these patients, MRI results contrasted with the clinical assessment (Group 2). In comparison to Group 1, the patients with discrepant findings were significantly older at the date of examination and JIA had been diagnosed at later age (median age of 13.2 vs. 10.9 and median age 10.0 vs. 8.0 respectively). In Group 2 there were significantly more patients with RF-negative polyarticular disease.

Conclusion: Patients with RF-negative polyarticular JIA who had been diagnosed at a later age and were older at the time of MRI were most likely to be considered clinically active while MRI showed no signs of synovitis. These particular JIA patients may benefit from monitoring of disease activity by MRI to prevent overtreatment.
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http://dx.doi.org/10.1016/j.ejrad.2018.02.027DOI Listing
May 2018

Systematic assessment of the growth plates of the wrist in young gymnasts: development and validation of the Amsterdam MRI assessment of the Physis (AMPHYS) protocol.

BMJ Open Sport Exerc Med 2018 9;4(1):e000352. Epub 2018 Apr 9.

Department of Radiology and Nuclear Medicine, Academic Medical Center Amsterdam, The Netherlands.

Objectives: To develop and validate a protocol for MRI assessment of the distal radial and ulnar periphyseal area in gymnasts and non-gymnasts.

Methods: Twenty-four gymnasts with wrist pain, 18 asymptomatic gymnasts and 24 non-gymnastic controls (33 girls) underwent MRI of the wrist on a 3T scanner. Sequences included coronal proton density-weighted images with and without fat saturation, and three-dimensional water-selective cartilage scan and T2 Dixon series. Skeletal age was determined using hand radiographs. Three experienced musculoskeletal radiologists established a checklist of possible (peri)physeal abnormalities based on literature and clinical experience. Five other musculoskeletal radiologists and residents evaluated 30 MRI scans (10 from each group) using this checklist and reliability was determined using the intraclass correlation coefficient (ICC) and Fleiss' kappa. A final evaluation protocol was established containing only items with fair to excellent reliability.

Results: Twenty-seven items were assessed for reliability. Intra-rater and inter-rater agreement was good to excellent (respective ICCs 0.60-0.91 and 0.60-0.78) for four epiphyseal bone marrow oedema-related items, physeal signal intensity, metaphyseal junction and depth of metaphyseal intrusions. For physeal thickness, thickness compared with proximal physis of first metacarpal, metaphyseal intrusions, physeal connection of intrusions and metaphyseal bone marrow signal intensity, intra-rater agreement was fair to excellent (ICC/kappa 0.55-0.85) and inter-rater agreement was fair (ICC/kappa 0.41-0.59). Twelve items were included in the final protocol.

Conclusion: The Amsterdam MRI assessment of the Physis protocol facilitates patient-friendly and reliable assessment of the (peri)physeal area in the radius and ulna.
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http://dx.doi.org/10.1136/bmjsem-2018-000352DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5905740PMC
April 2018

Novel Imaging Techniques in Rheumatic Diseases.

Semin Musculoskelet Radiol 2018 Apr 19;22(2):237-244. Epub 2018 Apr 19.

Department of Radiology and Nuclear Medicine, Academic Medical Center, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands.

Since the introduction of new MR imaging techniques within the past two decades, the imaging assessment of joints in rheumatic diseases has changed considerably. MRI enables to evaluate both the inflamed synovial membrane as well as early structural damage. In the last few years, several new functional/metabolic MR imaging techniques have applied in rheumatic diseases, making it possible to evaluate the pathophysiology of the disease in greater detail. Moreover, they permit a more quantitative approach for the evaluation of disease activity and damage. Several functional imaging techniques in rheumatic diseases have been proposed for the evaluation and monitoring of disease status.
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http://dx.doi.org/10.1055/s-0038-1641160DOI Listing
April 2018

Imaging Features of the Juvenile Inflammatory Arthropathies.

Semin Musculoskelet Radiol 2018 Apr 19;22(2):147-165. Epub 2018 Apr 19.

Department of Paediatric Imaging, Hospital Jeanne de Flandre, CHU Lille, France.

We discuss the imaging of several juvenile inflammatory arthropathies including juvenile idiopathic arthritis, juvenile systemic lupus erythematosus, juvenile scleroderma, juvenile dermatomyositis, and chronic recurrent multifocal osteomyelitis. Juvenile idiopathic arthritis is the most common autoimmune chronic systemic disease of connective tissue in children. The remaining systemic juvenile connective tissue diseases are rare. However, they require early diagnosis and initiation of treatment to prevent injury, not only to the musculoskeletal system but also to the internal organs, and even death. Imaging of juvenile inflammatory arthropathies has relied for years on radiography. Recent advances in disease-modifying drugs have led to a greater emphasis on the detection of early inflammation not evident on plain radiography. Ultrasound examination allows for the early recognition of the disease process in the soft tissues. Magnetic resonance imaging detects early inflammatory changes involving the soft tissues, the subcortical bone of peripheral joints, the spine, and entheses.
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http://dx.doi.org/10.1055/s-0038-1639468DOI Listing
April 2018

Imaging in juvenile idiopathic arthritis - international initiatives and ongoing work.

Pediatr Radiol 2018 06 13;48(6):828-834. Epub 2018 Jan 13.

Department of Radiology, Haukeland University Hospital, Bergen, Norway.

Imaging is increasingly being integrated into clinical practice to improve diagnosis, disease control and outcome in children with juvenile idiopathic arthritis. Over the last decades several international groups have been launched to standardize and validate different imaging techniques. To enhance transparency and facilitate collaboration, we present an overview of ongoing initiatives.
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http://dx.doi.org/10.1007/s00247-017-4054-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5953998PMC
June 2018

Juvenile idiopathic arthritis: magnetic resonance imaging of the clinically unaffected knee.

Pediatr Radiol 2018 03 6;48(3):333-340. Epub 2018 Jan 6.

Department of Radiology and Nuclear Medicine, Academic Medical Center, University of Amsterdam, Department of Radiology (G1-213), Meibergdreef 9, 1105AZ, Amsterdam, the Netherlands.

Background: Synovial thickening detected on magnetic resonance imaging (MRI) is present in a significant number of children with clinically inactive juvenile idiopathic arthritis (JIA).

Objective: To evaluate patient characteristics and disease activity parameters in a cohort of children with clinically inactive JIA, both with and without synovial thickening, in order to clarify the observed discrepancy between clinical and MRI assessments.

Materials And Methods: We prospectively enrolled 52 clinically inactive JIA patients (median age 13.3 years, 63.5% girls) who underwent MRI of the knee as major target joint in JIA. Children were divided into two groups based on MRI outcome: group 1, with synovial thickening on MRI; and group 2, with no synovial thickening on MRI. We used the Juvenile Arthritis MRI Scoring system to evaluate synovial thickness. We compared patient characteristics and disease activity parameters between the groups.

Results: Synovial thickening on MRI was present in 18 clinically inactive patients (group 1, 34.6%). The age was significantly lower for the patients in group 1 (median 10.7 versus 14.4, P=0.008). No significant differences were observed in any of the other patient characteristics nor the disease activity parameters tested.

Conclusion: Synovial thickening on MRI was present in nearly 35% of the children with clinically inactive JIA. Children with synovial thickening on MRI were significantly younger than those without. This might indicate that younger patients are at risk of subclinical disease activity and under-treatment, although the exact clinical relevance of synovial thickening on MRI has not been determined.
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http://dx.doi.org/10.1007/s00247-017-4059-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5823947PMC
March 2018

Contrast-enhanced MRI findings of the knee in healthy children; establishing normal values.

Eur Radiol 2018 Mar 6;28(3):1167-1174. Epub 2017 Oct 6.

Department of Radiology and Nuclear Medicine, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands.

Objectives: To define normative standards for the knee in healthy children using contrast-enhanced MRI, focusing on normal synovial membrane thickness. Secondly, presence of joint fluid and bone marrow oedema was evaluated.

Methods: For this study, children without disorders potentially resulting in (accompanying) arthritis were included. Patients underwent clinical assessments, followed by contrast-enhanced MRI. MRI features were evaluated in consensus using the Juvenile Arthritis MRI Scoring (JAMRIS) system. Additionally, the presence of joint fluid was evaluated. No cartilage lesions or bone abnormalities were observed.

Results: We included 57 healthy children. The overall mean thickness of the normal synovial membrane was 0.4 mm (min-max; 0.0-1.8mm). The synovium was thickest around the cruciate ligaments and retropatellar and suprapatellar regions. The mean overall diameter of the largest pocket of joint fluid was 2.8 mm (min-max; 0.9-8.0mm). Bone marrow changes were observed in three children (all in the apex patellae).

Conclusions: The normal synovial membrane was maximally 1.8 mm thick, indicating that the JAMRIS cut-off value of 2 mm can be considered a valid measure for evaluating synovial hypertrophy. Some joint fluid and bone marrow changes suggestive of bone marrow oedema in the apex patellae can be seen in healthy children.

Key Points: • Knowledge on the normal synovial appearance using contrast-enhanced MR is lacking. • In healthy children, normal synovial membrane is maximally 1.8 mm thick. • Normal synovium is thickest around the cruciate ligaments, retropatellar and suprapatellar. • Bone marrow oedema in the apex patellae is seen in healthy children.
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http://dx.doi.org/10.1007/s00330-017-5067-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5811591PMC
March 2018

Construct validity of pixel-by-pixel DCE-MRI: Correlation with conventional MRI scores in juvenile idiopathic arthritis.

Eur J Radiol 2017 Sep 14;94:1-5. Epub 2017 Jul 14.

Department of Radiology and Nuclear Medicine,Academic Medical Center, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.

Objectives: To assess the capability of the pixel-by-pixel DCE-MRI time intensity curve (TIC)-shape analysis method in the evaluation of juvenile idiopathic arthritis (JIA) disease activity by correlating DCE-MRI parameters with semi-quantitative conventional-MRI scores of synovitis.

Methods: Clinical, laboratory, and (DCE)-MRI datasets of 85 JIA patients were prospectively obtained. TIC-shapes of each voxel were classified into one of seven predefined color-coded TIC shape categories. Spatial information on the relative amount of TIC-shapes, maximal enhancement (ME), maximal initial slope (MIS), initial area under the curve (iAUC), time-to-peak (TTP), enhancing volume (EV) was calculated of the synovial membrane. The grade of synovitis was scored on conventional MR images by two readers using the validated JAMRIS system. The Bonferroni method was used to correct for multiple testing, therefore, a P value of <0.0056 is considered significant (0.05/9=0.0056).

Results: The semi-quantitative JAMRIS synovitis score correlated substantially with the ME, EV, and iAUC (Rs=0.658, P<0.001; Rs=0.618, P<0.001; Rs=0.639, P<0.001), and moderately with MIS (Rs=0.453, P<0.001). A poor correlation was observed between the relative number of TIC-shapes 2-5 and the JAMRIS synovitis score (Rs=0.209, P=0.054; Rs=0.328, P=0.002; Rs=0.241, P=0.023; Rs=-0.241, P=0.026).

Conclusion: In this explorative study, both TIC shape and semi-quantitative DCE-MRI analysis methods showed moderate to substantial correlations with conventional MRI scores of disease activity, indicating that this methods are feasible. Further research is warranted whether DCE-MRI holds potential to become an objective and quantitative method for the evaluation of disease activity in JIA.
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http://dx.doi.org/10.1016/j.ejrad.2017.07.003DOI Listing
September 2017

Diffusion-weighted imaging for assessment of synovial inflammation in juvenile idiopathic arthritis: a promising imaging biomarker as an alternative to gadolinium-based contrast agents.

Eur Radiol 2017 Nov 12;27(11):4889-4899. Epub 2017 Jun 12.

Department of Radiology, Academic Medical Center/University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.

Objectives: To compare dynamic-contrast-enhanced MRI (DCE) and diffusion-weighted imaging (DWI) in quantifying synovial inflammation in juvenile idiopathic arthritis (JIA).

Methods: Regions of interest (ROI) were drawn in the synovium of JIA patients on T1 DCE and T2 DWI, followed by extraction of the maximum enhancement (ME), maximum initial slope (MIS), time to peak (TTP), % of different time intensity curve shapes (TIC) and apparent diffusion coefficient (ADC) of the ROIs. Mann-Whitney-U test was used for comparing parameters between MRI-active and -inactive patients (defined by the juvenile arthritis MRI scoring system). Spearman's rank was used to analyse the correlation between DCE and DWI.

Results: Thirty-five JIA patients (18 MRI active and 17 MRI inactive) were included. Median age was 13.1 years and 71% were female. ME, MIS, TTP, % TIC 5 and ADC were significantly different in MRI-active versus MRI-inactive JIA with median ADC 1.49 × 10mm/s in MRI-active and 1.25 × 10mm/s in MRI-inactive JIA, p = 0.001, 95% confidence interval of difference in medians =0.11-0.53 × 10mm/s. ADC correlated to ME, MIS and TIC 5 shapes (r = 0.62, r = 0.45, r = -0.51, respectively, all p < 0.05).

Conclusions: Similar to DCE parameters, DWI-derived ADC is significantly different in MRI-active JIA as compared to MRI-inactive JIA. The non-invasiveness of DWI combined with its possibility to detect synovial inflammation shows the potential of DWI.

Key Points: • MRI can quantify: dynamic contrast-enhanced and diffusion-weighted MRI can quantify synovitis • Both DWI and DCE can differentiate active from inactive JIA • The DWI-derived apparent diffusion coefficient (ADC) is higher in active JIA • DWI is non-invasive and thus safer and more patient-friendly • DWI is a potentially powerful and non-invasive imaging biomarker for JIA.
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http://dx.doi.org/10.1007/s00330-017-4876-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5635098PMC
November 2017