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

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.

The relationship between basal joint arthritis and carpal tunnel syndrome: an MRI pilot study.

PURPOSE: This investigation explored 2 questions. First, does basal joint arthritis lead to morphologic alterations that significantly narrow the carpal tunnel? Second, does trapezial excision alter the morphology of the carpal tunnel and decompress the median nerve? METHOD: Four patients with basal joint arthritis alone were treated with ligament reconstruction and tendon interposition (LRTI) arthroplasty. Three patients with basal joint arthritis and carpal tunnel syndrome were treated with LRTI and carpal tunnel release. Preoperative and postoperative magnetic resonance imaging (MRI) scans were obtained to assess differences in carpal tunnel volume and morphology between the groups before and after surgery. RESULTS: The difference in preoperative carpal tunnel volume between groups was not significantly different. Carpal tunnel volume increased by 7% with LRTI and by 24% after LRTI and carpal tunnel release. The anteroposterior diameter of the carpal canal increased in both groups to allow a volar migration of the median nerve. CONCLUSION: LRTI increases the anteroposterior diameter and volume of the carpal tunnel. A larger comparative study would be necessary to determine whether LRTI is sufficient to decompress the carpal tunnel.

Discrimination of benign from malignant hepatic lesions based on their T2-relaxation times calculated from moderately T2-weighted turbo SE sequence.

The differentiation of hemangioma from other hepatic neoplasms using MRI usually relies on the evaluation of heavily T2-weighted images. The aim of this study was to assess the value of T2-relaxation times calculated from moderately T2-weighted turbo spin-echo (TSE) sequence in characterization of focal hepatic lesions, including hepatic malignancies, focal nodular hyperplasia (FNH), hemangioma, and cyst. Fifty-two patients with 114 proven lesions (61 malignant masses, 6 focal nodular hyperplasias, 28 hemangiomas, 19 cystic lesions) were examined on 1.5-T system using a double-echo TSE sequence (TR=1800 ms; TE(eff) 1=40 ms; TE(eff) 2=120 ms). Signal intensities (SI) of the liver as well as SI of all lesions were measured, and then the T2-relaxation times were calculated. The mean T2 time for the liver was 54 ms (+/-8 ms), for FNH 66 ms (+/-7 ms), for malignant hepatic lesions 85 ms (+/-17 ms), for hemangiomas 155 ms (+/-35 ms), and for cystic lesions 583 ms (+/-369) ms. Most malignant hepatic lesions were best differentiated between the thresholds of 67 and 116 ms, generating a sensitivity of 90% and a specificity of 94%. There were six false-negative diagnoses of malignant tumor and three false-positive cases (two hemangiomas and one FNH). Calculation of the T2-relaxation times obtained from the double-echo TSE sequence with moderate T2-weighting allowed differentiation between malignant and benign hepatic lesions with high sensitivity and specificity.