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

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

doi:10.3899/jrheum.181093

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

J Rheumatol. 2019 Sep;46(9):1232-1238. doi: 10.3899/jrheum.181093. Epub 2019 Feb 1.

Authors

Ashish J Mathew^{1

2}, Simon Krabbe^{1

2}, Iris Eshed^{1

2}, Frédérique Gandjbakhch^{1

2}, Paul Bird^{1

2}, Susanne J Pedersen^{1

2}, Maria S Stoenoiu^{1

2}, Violaine Foltz^{1

2}, Daniel Glinatsi^{1

2}, Robert G Lambert^{1

2}, Kay Geert A Hermann^{1

2}, Walter P Maksymowych^{1

2}, Ida K Haugen^{1

2}, Jacob L Jaremko^{1

2}, René P Poggenborg^{1

2}, Joel Paschke^{1

2}, Jean-Denis Laredo^{1

2}, Philippe Carron^{1

2}, Philip G Conaghan^{1

2}, Mikkel Østergaard^{3

4}

Affiliations

¹ From the Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark; Department of Diagnostic Imaging, Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Hôpitaux Universitaires Pitié Salpêtrière; Paris 6 University, GRC-UPMC 08, Pierre Louis Institute of Epidemiology and Public Health; Service de Radiologie, Hôpital Lariboisière, AP-HP and Université Paris-Diderot, Paris, France; Division of Medicine, University of New South Wales, Sydney, Australia; Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain, Brussels; Department of Rheumatology, Ghent University Hospital, Ghent, Belgium; Department of Radiology and Diagnostic Imaging, and CaRE (Canadian Research Education) Arthritis and Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; Department of Radiology, Arthritis Imaging Research Group, University Hospital Charité, Berlin, Germany; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Faculty of Medicine and Health, University of Leeds, Leeds, UK.
² A.J. Mathew, MBBS, DNB, DM, Associate Professor, Department of Clinical Immunology and Rheumatology, Christian Medical College, and PhD Fellow, Department of Clinical Medicine, Faculty of Health and Medical Sciences, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet Glostrup, University of Copenhagen; S. Krabbe, MD, PhD Fellow, Department of Clinical Medicine, Faculty of Health and Medical Sciences, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet Glostrup, University of Copenhagen; I. Eshed, MD, Professor, Department of Diagnostic Imaging, Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University; F. Gandjbakhch, MD, Practicing Rheumatologist, Hôpitaux Universitaires Pitié Salpêtrière, Paris 6 University, GRC-UPMC 08, Pierre Louis Institute of Epidemiology and Public Health; P. Bird, B Med (Hons), FRACP, PhD, Grad Dip MRI, Associate Professor, University of New South Wales; S.J. Pedersen, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.S. Stoenoiu, MD, PhD, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain; V. Foltz, MD, Practising Rheumatologist, Hôpitaux Universitaires Pitié Salpêtrière; D. Glinatsi, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; R.G. Lambert, MB.BCh, FRCR, FRCPC, Professor, Department of Radiology and Diagnostic Imaging, University of Alberta; K.G. Hermann, MD, PhD, Senior Consultant, Department of Radiology, Arthritis Imaging Research Group, University Hospital Charité; W.P. Maksymowych MD, FRCP(C), Professor, Division of Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; I.K. Haugen, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; J.L. Jaremko, MD, PhD, FRCPC, Associate Professor, Department of Radiology, University of Alberta; R.P. Poggenborg, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; J. Paschke, BSc, CaRE (Canadian Research Education) Arthritis; J.D. Laredo, MD, Professor, Service de Radiologie, Hôpital Lariboisière, AP-HP and Université Paris-Diderot; P. Carron, MD, PhD, Department of Rheumatology, Ghent University Hospital; P.G. Conaghan, MB, BS, PhD, FRACP, FRCP, Professor of Musculoskeletal Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals National Health Service Trust; M. Østergaard, MD, PhD, DMSc, Professor, Department of Clinical Medicine, Faculty of Health and Medical Sciences, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet Glostrup, University of Copenhagen.
³ From the Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark; Department of Diagnostic Imaging, Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Hôpitaux Universitaires Pitié Salpêtrière; Paris 6 University, GRC-UPMC 08, Pierre Louis Institute of Epidemiology and Public Health; Service de Radiologie, Hôpital Lariboisière, AP-HP and Université Paris-Diderot, Paris, France; Division of Medicine, University of New South Wales, Sydney, Australia; Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain, Brussels; Department of Rheumatology, Ghent University Hospital, Ghent, Belgium; Department of Radiology and Diagnostic Imaging, and CaRE (Canadian Research Education) Arthritis and Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; Department of Radiology, Arthritis Imaging Research Group, University Hospital Charité, Berlin, Germany; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Faculty of Medicine and Health, University of Leeds, Leeds, UK. [email protected].
⁴ A.J. Mathew, MBBS, DNB, DM, Associate Professor, Department of Clinical Immunology and Rheumatology, Christian Medical College, and PhD Fellow, Department of Clinical Medicine, Faculty of Health and Medical Sciences, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet Glostrup, University of Copenhagen; S. Krabbe, MD, PhD Fellow, Department of Clinical Medicine, Faculty of Health and Medical Sciences, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet Glostrup, University of Copenhagen; I. Eshed, MD, Professor, Department of Diagnostic Imaging, Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University; F. Gandjbakhch, MD, Practicing Rheumatologist, Hôpitaux Universitaires Pitié Salpêtrière, Paris 6 University, GRC-UPMC 08, Pierre Louis Institute of Epidemiology and Public Health; P. Bird, B Med (Hons), FRACP, PhD, Grad Dip MRI, Associate Professor, University of New South Wales; S.J. Pedersen, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.S. Stoenoiu, MD, PhD, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain; V. Foltz, MD, Practising Rheumatologist, Hôpitaux Universitaires Pitié Salpêtrière; D. Glinatsi, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; R.G. Lambert, MB.BCh, FRCR, FRCPC, Professor, Department of Radiology and Diagnostic Imaging, University of Alberta; K.G. Hermann, MD, PhD, Senior Consultant, Department of Radiology, Arthritis Imaging Research Group, University Hospital Charité; W.P. Maksymowych MD, FRCP(C), Professor, Division of Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; I.K. Haugen, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; J.L. Jaremko, MD, PhD, FRCPC, Associate Professor, Department of Radiology, University of Alberta; R.P. Poggenborg, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; J. Paschke, BSc, CaRE (Canadian Research Education) Arthritis; J.D. Laredo, MD, Professor, Service de Radiologie, Hôpital Lariboisière, AP-HP and Université Paris-Diderot; P. Carron, MD, PhD, Department of Rheumatology, Ghent University Hospital; P.G. Conaghan, MB, BS, PhD, FRACP, FRCP, Professor of Musculoskeletal Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals National Health Service Trust; M. Østergaard, MD, PhD, DMSc, Professor, Department of Clinical Medicine, Faculty of Health and Medical Sciences, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet Glostrup, University of Copenhagen. [email protected].

PMID: 30709961
DOI: 10.3899/jrheum.181093

Abstract

Objective: To develop and validate an enthesitis magnetic resonance imaging (MRI) scoring system for spondyloarthritis/psoriatic arthritis, using the heel as model.

Methods: Consensus definitions of key pathologies and 3 heel enthesitis multireader scoring exercises were done, separated by discussion, training, and calibration.

Results: 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.

Conclusion: The proposed definitions and Heel Enthesitis Scoring System (HEMRIS) are reliable among trained readers and promising for clinical trials.

Keywords: ENTHESOPATHY; MAGNETIC RESONANCE IMAGING; OMERACT; PSORIATIC ARTHRITIS; SPONDYLOARTHROPATHY.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Arthritis, Psoriatic / diagnostic imaging*
Enthesopathy / diagnostic imaging*
Heel / diagnostic imaging*
Humans
Magnetic Resonance Imaging
Reproducibility of Results
Severity of Illness Index
Spondylarthritis / diagnostic imaging*