Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


The Intra- and Inter-Reader Reliability of the Oslo Hand Osteoarthritis (HOA) Magnetic Resonance Imaging (MRI) Score.

Haugen2,  Ida Kristin, Lillegraven2,  Siri, Slatkowsky-Christensen2,  Barbara, Haavardsholm2,  Espen, Sesseng2,  Sølve, Kvien1,  Tore K., Van Der Heijde3,  Desiree M.

Diakonhjemmet Hospital, Oslo, Norway
Diakonhjemmet Hospital
Leiden University Medical Center, Meerssen, The Netherlands

Background:

HOA is increasingly recognized to involve the whole joint, incl. articular cartilage, subchondral bone, synovium, capsule and ligaments. MRI has a unique advantage to depict all joint components, and may be useful in evaluation of emerging treatments.

Objectives:

To examine if pathological HOA features can be reliably assessed by testing the intra- and inter-reader reliability of the proposed Oslo HOA MRI score [1].

Methods:

The exercise was performed using MRI scans from 10 patients (9 women) with mean (SD) age of 69.5 (6.1) years from the Oslo HOA cohort [2]. The patients were selected from quintiles of radiographic severity. The dominant hand was anchored in a cylindrical coil (diameter 100 mm), and the distal (DIP) and proximal interphalangeal (PIP) joints of the 2nd-5th fingers were examined using a high-field extremity MRI unit (1.0 T). Coronal, sagittal and axial T1w fat-suppressed pre-and postgadolinium images were reproduced from a 3D dual echo Dixon technique (TR 20 ms, TE 5 ms, 1 mm slice thickness), in addition to coronal and axial Short T1 Inversion Recovery (STIR) images (TR 2850/3150 ms, TE 16.3/21 ms, 2/3 mm slice thickness). A training session and two exercises were arranged prior to this study. The images were read by three assessors (IKH, SL, PB) in accordance to the proposed MRI score of the DIP and PIP joints in HOA: Synovitis (grade 0–3), flexor tenosynovitis (grade 0–3), erosions (grade 0–3), cysts (grade 0–1), osteophytes (OP) (grade 0–3), joint space narrowing (JSN) (grade 0–3), malalignment (grade 0–1 in frontal and sagittal plane), bone marrow lesions (BML) (grade 0–3) and collateral ligament (CL) presence (grade 0–1), and BML at CL insertion sites (grade 0–1). The readers were blinded for patient characteristics. The images were read twice with one week interval, and were anonymised and rearranged prior to the last scoring session. Mean scores for all features across the three readers were calculated. The intra- and inter-reader reliability of the individual subscales was assessed by intra-class correlation coefficients (ICCs) (two way mixed effect model, single and average measure).

Results:

Table shows mean (min, max) scores and ICCs for intra- and inter-reader reliability. The range of each feature is reported in brackets. Inter-reader reliability was good to excellent for synovitis, tenosynovitis, erosions, OP, JSN, malalignment, BML and CL presence. The median intra-reader reliability was good to excellent for most features except synovitis, tenosynovitis and cysts.

Table

DIP and PIP jointsMean (min, max)Inter-reader AvmICCIntra-reader SmICC median (min, max)
Synovitis [0–24]11.6 (6.3–15.0)0.840.48 (0.09–0.70)
Flexor tenosynovitis [0–24]5.9 (1.7–10.3)0.640.51 (0.49–0.65)
Erosions [0–48]13.1 (2.3–29.0)0.940.92 (0.91–0.96)
Cysts [0–16]0.4 (0.0–2.0)0.590.21 (0.00–0.57)
Osteophytes [0–48]22.7 (7.3–34.0)0.910.88 (0.86–0.89)
Joint space narrowing [0–24]10.8 (0.7–15.30.990.97 (0.93–0.99)
Malalignment frontal [0–8]0.9 (0.0–2.3)0.950.79 (0.77–1.00)
Malalignment sagittal [0–8]0.0 (0.0–0.3)0.00*
BMLs [0–48]4.2 (0.3–9.7)0.830.89 (0.65–0.89)
CL presence [0–16]10.0 (3.0–14.3)0.790.81 (0.61, 0.81)
BML at CL insertion sites [0–32]2.4 (0.0–5.0)0.420.81 (-0.07, 0.82)
AvmICC=Average measure ICC, SmICC=single measure ICC, BMLs=bone marrow lesions, CL=collateral ligaments,*=no variance

Conclusion:

The proposed Oslo HOA MRI score could reliably assess key features of HOA. Further validation of the system to clinical and radiological findings should be performed.

Reference:

1.Haugen, IK. Abstract EULAR 2010

2.Slatkowsky-Christensen, B. A&R 2007

To cite this abstract, please use the following information:
Haugen, Ida Kristin, Lillegraven, Siri, Slatkowsky-Christensen, Barbara, Haavardsholm, Espen, Sesseng, Sølve, Kvien, Tore K., et al; The Intra- and Inter-Reader Reliability of the Oslo Hand Osteoarthritis (HOA) Magnetic Resonance Imaging (MRI) Score. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :142
DOI: 10.1002/art.27911

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