OMERACT Rheumatoid Arthritis Magnetic Resonance Imaging Studies. Exercise 3: an international multicenter reliability study using the RA-MRI Score.

We examined inter-reader agreement of the revised OMERACT 5 Rheumatoid Arthritis MRI Score (RAMRIS v3). Magnetic resonance (MR) images of 10 sets of metacarpophalangeal (MCP) joints 2-5 and 8 sets of rheumatoid arthritis (RA) wrists [1.5 T, coronal and axial T1 and T2 spin-echo, +/- fat saturation (FS), +/- intravenous gadolinium (Gd)] were scored for (1) synovitis using a global score (0-3) and a direct measurement of synovial thickness (mm) and (2) three bone lesions: erosions, defects and edema, (score 0-10 by the volume of the lesion as a proportion of the "assessed bone volume" by 10% increments). Six readers from 5 multinational centers performed all scoring. Three statistical methods were used to analyze the data: (1) single-measure fixed effects intraclass correlations (sICC) and average-measure fixed effects ICC (avICC), (2) percentage exact and close agreement, and (3) the smallest detectable difference (SDD). The sICC were moderate to good (between 0.60 and 0.91) for half of the joint sites for the 2 synovitis scoring methods, and for bone erosions and bone edema. After adjusting for 6 readers, the avICC was very good to excellent (0.80-0.98) for two-thirds of the joint sites by lesion, excluding bone defects that performed relatively poorly, primarily because few readers scored these lesions. The aggregated scores with the best reliability were those with a wide range of scores, high ICC, low SDD, and low percentage SDD (< 33%). The metacarpophalangeal (MCP) bone erosion (sICC 0.58, avICC 0.89, %SDD +/- 27), wrist bone erosion scores (0.72, 0.94, +/- 31%), the wrist synovitis global (0.74, 0.94, +/- 32%), and synovial maximal thickness (0.6, 0.94, +/- 32%) met these conditions. MCP joint synovitis global (0.76, 0.95, +/-35%), MCP joint bone edema (0.63, 0.91, +/- 34%), and wrist bone edema (0.78, 0.95, +/- 38%) performed marginally less well. Bone defects performed poorly (MCP joint 0.18, 0.46, +/- 56%; wrist 0.06, 0.24, +/- 55%). The revised OMERACT 5 RAMRIS has acceptable inter-reader reliability for measures of disease activity (synovitis global and bone edema scores) and damage (bone erosion score). Whether the score is sensitive to change will be determined by its performance in longitudinal and intervention studies.

[1]  M. Boers,et al.  Reliability of measures of disease activity and disease damage in rheumatoid arthritis: implications for smallest detectable difference, minimal clinically important difference, and analysis of treatment effects in randomized controlled trials. , 2001, The Journal of rheumatology.

[2]  P. Gideon,et al.  Wrist and Finger Joint MR Imaging in Rheumatoid Arthritis , 1999, Acta radiologica.

[3]  M. Boers,et al.  Smallest detectable difference in radiological progression. , 1999, The Journal of rheumatology.

[4]  S. Chinn,et al.  The assessment of methods of measurement. , 1990, Statistics in medicine.

[5]  J M Bland,et al.  Statistical methods for assessing agreement between two methods of clinical measurement , 1986 .

[6]  M J Healy,et al.  Measuring measuring errors. , 1989, Statistics in medicine.

[7]  J. Fleiss,et al.  Intraclass correlations: uses in assessing rater reliability. , 1979, Psychological bulletin.

[8]  H. Genant,et al.  Magnetic resonance imaging in rheumatoid arthritis: summary of OMERACT activities, current status, and plans. , 2001, The Journal of rheumatology.

[9]  H K Genant,et al.  Reproducibility of multiple-observer scoring of radiologic abnormalities in the hands and wrists of patients with rheumatoid arthritis. , 1985, Arthritis and rheumatism.

[10]  M. Lassere,et al.  Measurements of rheumatoid arthritis disease activity and damage using magnetic resonance imaging. Truth and discrimination: does MRI make the grade? , 2001, The Journal of rheumatology.

[11]  Neal Stewart,et al.  OMERACT Rheumatoid Arthritis Magnetic Resonance Imaging Studies. Summary of OMERACT 6 MR Imaging Module. , 2003, The Journal of rheumatology.

[12]  Douglas G. Altman,et al.  Practical statistics for medical research , 1990 .

[13]  M F James,et al.  Reliability and sensitivity of joint space measurements in hand radiographs using computerized image analysis. , 2001, The Journal of rheumatology.

[14]  N Stewart,et al.  Magnetic resonance imaging of the wrist in early rheumatoid arthritis reveals a high prevalence of erosions at four months after symptom onset , 1998, Annals of the rheumatic diseases.

[15]  J C Gardner,et al.  Computer-based methods for measuring joint space and estimating erosion volume in the finger and wrist joints of patients with rheumatoid arthritis. , 2000, Arthritis and rheumatism.

[16]  H. Genant,et al.  Assessment of radiologic progression in rheumatoid arthritis. A randomized, controlled trial. , 1986, Arthritis and rheumatism.

[17]  E. Jeong,et al.  Role of the inflamed synovial volume of the wrist in defining remission of rheumatoid arthritis with gadolinium‐enhanced 3D‐SPGR MR imaging , 1999, Journal of magnetic resonance imaging : JMRI.

[18]  Paul Bird,et al.  Computerized measurement of magnetic resonance imaging erosion volumes in patients with rheumatoid arthritis: a comparison with existing magnetic resonance imaging scoring systems and standard clinical outcome measures. , 2003, Arthritis and rheumatism.

[19]  H K Genant,et al.  How many joints in the hands and wrists should be included in a score of radiologic abnormalities used to assess rheumatoid arthritis? , 1985, Arthritis and rheumatism.

[20]  P. Tugwell,et al.  The OMERACT filter for Outcome Measures in Rheumatology. , 1998, The Journal of rheumatology.

[21]  H. Genant,et al.  Interreader agreement in the assessment of magnetic resonance images of rheumatoid arthritis wrist and finger joints--an international multicenter study. , 2001, The Journal of rheumatology.