MRI of the wrist in juvenile idiopathic arthritis: Proposal of a paediatric synovitis score by a consensus of an international working group. Results of a multicentre reliability study

Background: MRI is a sensitive tool for the evaluation of synovitis in juvenile idiopathic arthritis (JIA). Objective: The purpose of this study was to introduce a novel MRI-based score for synovitis in children and to examine its inter- and intraobserver variability in a multicentre study. Materials and methods: Wrist MRI was performed in 76 children with JIA. On postcontrast 3-D spoiled gradientecho and fat-suppressed T2-weighted spin-echo images, joint recesses were scored for the degree of synovial enhancement, effusion and overall inflammation independently by two paediatric radiologists. Totalenhancement and inflammation-synovitis scores were calculated. Results: Interobserver agreement was poor to moderate for enhancement and inflammation in all recesses, except in the radioulnar and radiocarpal joints. Intraobserver agreement was good to excellent. For enhancement and inflammation scores, mean differences (95 % CI) between observers were -1.18 (-4.79 to 2.42) and -2.11 (-6.06 to 1.83). Intraobserver variability (reader 1) was 0 (-1.65 to 1.65) and 0.02 (-1.39 to 1.44). Conclusion Intraobserver agreement was good. Except for the radioulnar and radiocarpal joints, interobserver agreement was not acceptable. Therefore, the proposed scoring system requires further refinement.