Imaging of Juvenile Idiopathic Arthritis

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Magnetic Resonance Imaging: 2.00
Procedures: 2.00
Musculoskeletal: 2.00

Radiography: 2.00
Procedures: 2.00
Extremity Procedures: 2.00

Registered Radiologist Assistant: 4.00
Procedures: 4.00
Musculoskeletal and Endocrine Sections: 4.00

Sonography: 2.00
Procedures: 2.00
Superficial Structures and Other Sonographic Procedures: 2.00

Outline

1. Introduction
2. JIA Classification
3. Imaging Evaluation
   1. Radiography
   2. MR Imaging
   3. Ultrasonography
4. Joint-specific Findings and Recommendations
   1. Peripheral Joints
   2. Cervical Spine
   3. Temporomandibular Joints
   4. Sacroiliac Joints
5. Conclusion

Objectives

Upon completion of this course, students will:

1. be familiar with the criteria that defines juvenile idiopathic arthritis (JIA)
2. identify which medical imaging modalities play a role in diagnosing JIA
3. know the various subtypes of JIA and which one is the most common
4. understand the clinical features of each type of JIA
5. understand the serologic lab findings that are part of testing for JIA
6. know which sub type of JIA can potentially be fatal
7. be able to define the term enthesitis
8. know which tendon is most commonly affected in patients with ERA
9. be familiar with the seven ILAR classifications of JIA
10. now what dactylitis is
11. understand the principles of ALARA
12. know the radiographic signs and findings of JIA in late stages of disease
13. understand the composition of the pediatric skeleton and the limitation of obtaining radiographic detection of early erosive changes in children
14. be able to explain radiographic signs and findings of JIA in early stages of disease
15. be able to define orthoroentgenography
16. understand which sub type of JIA has more of a prevalence of erosion and joint space loss
17. understand the role of weight-bearing radiography
18. understand which inflammatory states and conditions are common with JIA
19. be able to explain the radiographic views for performing cervical spine radiography on patients with JIA
20. be able to define the term pannus
21. know which joints are commonly affected by JIA
22. be able to explain the radiographic views for performing knee radiography on patients with JIA
23. be familiar with which medical imaging modality is the most sensitive for detecting synovitis in patients with JIA
24. know which medical imaging modality can detect bone marrow edema in patients with JIA
25. be able to describe the semi quantitative scoring system and imaging protocol for the assessment of synovitis, bone marrow edema, and bone erosions created by OMERACT
26. understand how MR is used to assess the bone marrow and erosions in patients with JIA
27. understand the use of T2 relaxation time cartilage mapping for evaluating patients with JIA
28. be able to describe the sonographic appearance of normal cartilage
29. know the frequencies of transducers used for musculoskeletal US on patients with JIA
30. know which medical imaging modality is more sensitive for detecting joint effusions and synovial thickening
31. be familiar with standard US nomenclature
32. understand the uses of color and power Doppler US
33. understand what benefits color and power Doppler US offer in imaging inflammation in patients with JIA
34. be able to describe common US artifacts such as anisotropy
35. know the MR imaging definitions of joint and soft tissue disease in patients with inflammatory arthritis
36. understand the term rice bodies
37. know which medical imaging modality can visualize bone marrow edema on patients with JIA
38. understand the characteristic radiographic findings in the cervical spine of patients with JIA
39. know the role of each medical imaging modality in evaluating the TMJs in patients with JIA
40. be familiar with the imaging protocols and radiographic positions used when evaluating the TMJs