TY - JOUR
T1 - Towards Establishing a Standardized Magnetic Resonance Imaging Scoring System for Temporomandibular Joints in Juvenile Idiopathic Arthritis
AU - Tolend, Mirkamal A.
AU - Twilt, Marinka
AU - Cron, Randy Q.
AU - Tzaribachev, Nikolay
AU - Guleria, Saurabh
AU - von Kalle, Thekla
AU - Koos, Bernd
AU - Miller, Elka
AU - Stimec, Jennifer
AU - Vaid, Yoginder
AU - Larheim, Tore A.
AU - Herlin, Troels
AU - Spiegel, Lynn
AU - Inarejos, Emilio
AU - Moineddin, Rahim
AU - van Rossum, Marion A.
AU - Saurenmann, Rotraud K.
AU - Doria, Andrea S.
AU - Kellenberger, Christian J.
PY - 2018
Y1 - 2018
N2 - The temporomandibular joints (TMJs) are frequently affected in children with juvenile idiopathic arthritis (JIA). Early detection is challenging, as major variation is present in scoring TMJ pathology on Magnetic Resonance Imaging (MRI). Consensus-driven development and validation of a MRI scoring system for TMJs has important clinical utility in timely improvement of diagnosis, and serving as an outcome measure. We report on a multi-institutional collaboration towards developing a TMJ MRI scoring system for JIA. Seven readers independently assessed MRI scans from 21 patients (42 TMJs, age range 6-16y) using three existing MRI scoring systems from American, German, and Swiss institutions. Reliability scores, scoring system definitions and items were discussed among 10 JIA experts through two rounds of Delphi surveys, nominal group voting, and subsequent consensus meetings to create a novel TMJ MRI scoring system. Average-measure intraclass correlation coefficients (avICC) for the total scores of all three scoring systems were highly reliable at 0.96 each. Osteochondral items showed higher reliability than inflammatory items. An additive system was deemed preferable for assessing minor joint changes over time. Eight items were considered sufficiently reliable and/or important for integration into the consensus scoring system: bone marrow edema and enhancement (avICC=0.57-0.61; %SDD=±45-63% prior to re-defining), condylar flattening (0.95-0.96; ±23-28%), effusions (0.85-0.88; ±25-26%), erosions (0.94; ±20%), synovial enhancement and thickening (previously combined; 0.90-0.91; ±33%), and disk abnormalities (0.90; ±19%). A novel TMJ MRI scoring system was developed by consensus. Further iterative refinements and reliability testing are warranted in upcoming studies. This article is protected by copyright. All rights reserved
AB - The temporomandibular joints (TMJs) are frequently affected in children with juvenile idiopathic arthritis (JIA). Early detection is challenging, as major variation is present in scoring TMJ pathology on Magnetic Resonance Imaging (MRI). Consensus-driven development and validation of a MRI scoring system for TMJs has important clinical utility in timely improvement of diagnosis, and serving as an outcome measure. We report on a multi-institutional collaboration towards developing a TMJ MRI scoring system for JIA. Seven readers independently assessed MRI scans from 21 patients (42 TMJs, age range 6-16y) using three existing MRI scoring systems from American, German, and Swiss institutions. Reliability scores, scoring system definitions and items were discussed among 10 JIA experts through two rounds of Delphi surveys, nominal group voting, and subsequent consensus meetings to create a novel TMJ MRI scoring system. Average-measure intraclass correlation coefficients (avICC) for the total scores of all three scoring systems were highly reliable at 0.96 each. Osteochondral items showed higher reliability than inflammatory items. An additive system was deemed preferable for assessing minor joint changes over time. Eight items were considered sufficiently reliable and/or important for integration into the consensus scoring system: bone marrow edema and enhancement (avICC=0.57-0.61; %SDD=±45-63% prior to re-defining), condylar flattening (0.95-0.96; ±23-28%), effusions (0.85-0.88; ±25-26%), erosions (0.94; ±20%), synovial enhancement and thickening (previously combined; 0.90-0.91; ±33%), and disk abnormalities (0.90; ±19%). A novel TMJ MRI scoring system was developed by consensus. Further iterative refinements and reliability testing are warranted in upcoming studies. This article is protected by copyright. All rights reserved
U2 - https://doi.org/10.1002/acr.23340
DO - https://doi.org/10.1002/acr.23340
M3 - Article
C2 - 28805021
SN - 2151-464X
VL - 70
SP - 758
EP - 767
JO - Arthritis care & research
JF - Arthritis care & research
IS - 5
ER -