全身MRI综合评估幼年特发性关节炎：前瞻性横断面分析

OBJECTIVES: To evaluate the role of whole-body magnetic resonance imaging (WBMRI) using a noninvasive, non-contrast protocol in detecting clinical and subclinical inflammation in pediatric patients with juvenile idiopathic arthritis (JIA) and to assess its impact on treatment decisions.

METHODS: This prospective cross-sectional study included pediatric patients diagnosed with JIA according to ILAR criteria. All participants underwent WBMRI using STIR sequences to assess peripheral and axial joints and entheses. Clinical and laboratory data, including ESR, CRP, ANA, RF, and HLA-B27, were collected for correlation with imaging findings. Two experienced musculoskeletal radiologists independently reviewed the images. Sensitivity, specificity, predictive values, and diagnostic accuracy were calculated.

RESULTS: Forty patients (27 females, 13 males; mean age 11.7 ± 2.6 years) were enrolled. Clinically active disease was present in 72.5%. Subclinical inflammation was identified in 81.8% of clinically inactive patients. Overall, radiological activity was detected in 77.5%, predominantly in peripheral joints (83.7%), with joint effusion being the most frequent finding (34.2%). Sacroiliitis and enthesitis were detected in 12.5% and 10%, respectively. WBMRI demonstrated a sensitivity of 75.9%, and imaging findings led to treatment modification in 50% of cases.

CONCLUSIONS: Non-contrast WBMRI is a sensitive tool for detecting clinical and subclinical inflammation in JIA. Although specificity is relatively low, its comprehensive whole-body assessment supports its value in evaluating disease activity and guiding therapeutic decisions while avoiding contrast-related risks.