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Osteoarthritis
Original article
Preliminary validation of the Knee Inflammation MRI Scoring System (KIMRISS) for grading bone marrow lesions in osteoarthritis of the knee: data from the Osteoarthritis Initiative
  1. Jacob L Jaremko1,
  2. Dean Jeffery1,
  3. M Buller1,
  4. Stephanie Wichuk2,
  5. Dave McDougall1,
  6. Robert GW Lambert1 and
  7. Walter P Maksymowych2
  1. 1Department of Radiology & Diagnostic Imaging, University of Alberta Hospital, Edmonton, Alberta, Canada
  2. 2Faculty of Medicine, Division of Rheumatology, University of Alberta Hospital, Edmonton, Alberta, Canada
  1. Correspondence to Dr Jacob L Jaremko; jjaremko{at}ualberta.ca

Abstract

Objective Bone marrow lesions (BML) are an MRI feature of osteoarthritis (OA) offering a potential target for therapy. We developed the Knee Inflammation MRI Scoring System (KIMRISS) to semiquantitatively score BML with high sensitivity to small changes, and compared feasibility, reliability and responsiveness versus the established MRI Osteoarthritis Knee Score (MOAKS).

Methods KIMRISS incorporates a web-based graphic overlay to facilitate detailed regional BML scoring. Observers scored BML by MOAKS and KIMRISS on sagittal fluid-sensitive sequences. Exercise 1 focused on interobserver reliability in Osteoarthritis Initiative observational data, with 4 readers (two experienced/two new to KIMRISS) scoring BML in 80 patients (baseline/1 year). Exercise 2 focused on responsiveness in an open-label trial of adalimumab, with 2 experienced readers scoring BML in 16 patients (baseline/12 weeks).

Results Scoring time was similar for KIMRISS and MOAKS. Interobserver reliability of KIMRISS was equivalent to MOAKS for BML status (ICC=0.84 vs 0.79), but consistently better than MOAKS for change in BML: Exercise 1 (ICC 0.82 vs 0.53), Exercise 2 (ICC 0.90 vs 0.32), and in new readers (0.87–0.92 vs 0.32–0.51). KIMRISS BML was more responsive than MOAKS BML: post-treatment BML improvement in Exercise 2 reached statistical significance for KIMRISS (SRM −0.69, p=0.015), but not MOAKS (SRM −0.12, p=0.625). KIMRISS BML also more strongly correlated to WOMAC scores than MOAKS BML (r=0.80 vs 0.58, p<0.05).

Conclusions KIMRISS BML scoring was highly feasible, and was more reliable for assessment of change and more responsive to change than MOAKS BML for expert and new readers.

  • Osteoarthritis
  • Magnetic Resonance Imaging
  • Knee Osteoarthritis

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/rmdopen-2016-000355

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    Footnotes

    • Contributors JLJ, RGWL and WPM were involved in design and conception of the study. DJ, MB, SW and DM contributed by acquiring and analysing the data. JLJ, DJ and MB contributed by drafting the manuscript. All authors made substantial contribution by reviewing the manuscript, approving the final version and agreeing to be accountable for the work.

    • Funding Costs of the portion of the study involving patients who received adalimumab were supported by an investigator-initiated study supported by AbbVie. AbbVie played no role in the design of data acquisition, analysis or interpretation of the data or the development of related manuscripts including this manuscript. JLJ has unrestricted support from the Capital Health Endowment in Diagnostic Imaging.

    • Competing interests None declared.

    • Ethics approval University of Alberta Health Research Ethics Board.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional data are available.