172 Utility, feasibility and acceptability of quantitative MRI in children with juvenile idiopathic arthritis
Notice bibliographique
Résumé
Background: Optimal assessment of disease activity in children and young people (CYP) with juvenile idiopathic arthritis (JIA) is central to high quality clinical care. Validated clinical measures include the juvenile arthritis disease activity score (JADAS). Yet clinical examination alone is less sensitive than imaging-based diagnosis of synovitis, with MRI established as the gold standard. Quantitative MRI methods describing synovitis and response to treatment may provide a useful adjunct to clinical measures of disease activity. Methods: We assessed the response of CYP with JIA to routine intra-articular corticosteroid (IACI) by measuring clinical and MRI metrics at baseline and 3-months after IACI. Patients aged 4-16 years presenting with knee synovitis requiring IACI were eligible. Exclusion criteria included concurrent oral/intravenous steroid use, recent knee trauma, or IACI within past 6 months. The 3-variable JADAS (cJADAS) was measured at both time points. The MR protocol included pre- and post-contrast images to calculate the total volume of synovium and dynamic imaging to measure rate of contrast uptake. Standard imaging was reported by a radiologist. Feedback from CYP and their families was obtained from a subsequent telephone interview. Results: 11 children (5 male) were recruited with median age 13 years (range 7-16) and median disease duration 1.2 years (0-11). Disease categories were as follows: oligoarticular (n = 8), polyarticular (n = 2), psoriatic (n = 1). One patient required a second IACI between assessments. Following IACI, the median cJADAS improved from 7.8 (2.0-15.6) to 1.6 (0-8.9), whilst the median synovial volume improved from 25.6cm3 (0.05-101.6cm3) to 0cm3 (0-1.9cm3). Of the patients completing both baseline and follow-up assessments (n = 10), 6 patients had frank synovitis outside normal limits with a median synovial volume of 79.6cm3 (25.7-101.6cm3) that reduced to 0.1cm3 at follow-up (0-1.9cm3). The second group (n = 3) had visible synovial enhancement, were called within normal limits and had a median synovial volume of 1.2cm3 (1.1-1.2cm3) that reduced to 0cm3 (0-0.2cm3) post-treatment. The remaining subject had a negligible volume that was unchanged (0.05cm3 vs. 0cm3). Rate of contrast uptake decreased post-IACI for all subjects. Families all reported a positive experience of the study, highlighting the importance of careful preparation with sufficient pre-procedural information, a relaxing study environment and a child-centred approach to discussing the study. Conclusion: IACI led to a marked reduction in synovial volume on MRI scanning, whilst improvements in cJADAS were more variable. It was notable that the patient/parent global assessment component contributed the most to the cJADAS scores. Quantitative MRI identified more patients with a demonstrable synovial volume that improved with IACI in comparison to routine qualitative clinical reporting. Further work exploring the utility of quantitative MRI in a larger cohort and with different treatment modalities is indicated. Disclosures: J.L. Bennett: None. A. Wood: None. N. Smith: None. R. Mistry: None. K. Allen: None. S. Jandial: None. J.M. Tuckett: None. C. Gowdy: None. H.E. Foster: None. F. McErlane: None. K.G. Hollingsworth: Consultancies; KGH reports consultancy for Summit pharmaceuticals and trial support from Imaging DMD outside the submitted work. All reimbursements were received by Newcastle University. Grants/research support; KGH reports grants from the United Kingdom Medical Research Council, Diabetes UK, the European Union (H2020, 667078) and the Newcastle Healthcare Charity.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,008 | 0,028 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».