172 Utility, feasibility and acceptability of quantitative MRI in children with juvenile idiopathic arthritis
Bibliographic record
Abstract
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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.008 | 0.028 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".