Preliminary validation of a web-based MRI scoring system for children with chronic nonbacterial osteomyelitis (ChRonic nonbacterial Osteomyelitis Magnetic Resonance Imaging Scoring: CROMRIS)

Farzana Nuruzzaman; T Shawn Sato; Jennifer Stimec; Ramesh S Iyer; Andrew Carbert; Joel Paschke; Lauren Potts; Meinrad Beer; Ming Huang; Johanna Monsalve; Anh-Vu Ngo; Mahesh Thapa; Xiaoyue Zhang; Walter P Maksymowych; Polly J Ferguson; Yongdong Zhao; CARRA CRMO Workgroup

doi:10.1186/s12969-025-01135-x

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Preliminary validation of a web-based MRI scoring system for children with chronic nonbacterial osteomyelitis (ChRonic nonbacterial Osteomyelitis Magnetic Resonance Imaging Scoring: CROMRIS)

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Preliminary validation of a web-based MRI scoring system for children with chronic nonbacterial osteomyelitis (ChRonic nonbacterial Osteomyelitis Magnetic Resonance Imaging Scoring: CROMRIS)

Farzana Nuruzzaman, T Shawn Sato, Jennifer Stimec, Ramesh S Iyer, Andrew Carbert, Joel Paschke, Lauren Potts, Meinrad Beer, Ming Huang, Johanna Monsalve, …

Pediatric rheumatology online journal, Vol.23(1), 85

08/01/2025

DOI: 10.1186/s12969-025-01135-x

PMCID: PMC12317626

PMID: 40750879

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Abstract

The ChRonic nonbacterial Osteomyelitis Magnetic Resonance Imaging Scoring (CROMRIS) tool was developed to assess specific characteristics of bone and soft tissue inflammation on MR images of patients with CNO; however, this tool was labor intensive to utilize. We aimed (1) to refine and adapt this scoring method, (2) to assess the usability of this web-based CROMRIS system among radiologists and (3) to evaluate the absolute agreement of the components and summary CROMRIS scores at each body site, and the interrater reliability. We used a qualitative, user-centered design approach involving software developers, rheumatologists, radiologists, and a patient artist to adapt the paper-based scoring system to a web-based prototype that was further refined by monthly meetings between the group members. A clickable-schematic-based CROMRIS system was developed to include all body regions: head (skull/mandible), spine, torso (clavicle, sternum, and ribs), pelvis, hands, feet, arms, and legs. Readers scored individual bone units to indicate the presence of bone marrow hyperintensity on STIR images (score 0-1), soft tissue/periosteal hyperintensity of surrounding tissue (score 0-1), and bony expansion (score 0-1), and quantified the signal size of the CNO lesion (scores 1-3 defined as < 25%, 25-50%, or > 50% of the estimated volume, respectively). The sum of these parameters for lesions detected on fluid-sensitive sequences was the CROMIS Activity Index (maximum score 720). Feedback for usability was reported with descriptive content analysis and continuous variables as means and categorical variables as percentages. Interrater reliability was assessed by free-marginal kappa (k) statistics and the intraclass correlation coefficient (ICC). The mean system usability score increased from 64.5 (below average) to 75 (above average) after user feedback. Interrater reliability for the CROMRIS Activity Index was excellent for clavicle, tibia, cervical and lumbar spines (> 0.9) and good to moderate for the remainder of the body regions. The mean kappa of each category of bones was > 0.6 demonstrating substantial interrater reliability among radiologists for the bone sites most affected by CNO, namely the long bones and clavicle. The web-based CROMRIS portal developed was usable and showed substantial-moderate agreement in the total CROMRIS Activity Index total scores among experienced radiologists after self-guided learning of the atlas and video. This tool can potentially be used in future clinical trials after calibration.

Adolescent

Child

Chronic Disease

Female

Humans

Internet

Magnetic Resonance Imaging - methods

Male

Osteomyelitis - diagnostic imaging

Reproducibility of Results

Severity of Illness Index

Details

Title: Subtitle: Preliminary validation of a web-based MRI scoring system for children with chronic nonbacterial osteomyelitis (ChRonic nonbacterial Osteomyelitis Magnetic Resonance Imaging Scoring: CROMRIS)
Creators: Farzana Nuruzzaman - Stony Brook University
T Shawn Sato - University of Iowa
Jennifer Stimec - Hospital for Sick Children
Ramesh S Iyer - University of Washington
Andrew Carbert - CARE Arthritis LTD, Edmonton, Alberta, Canada
Joel Paschke - CARE Arthritis LTD, Edmonton, Alberta, Canada
Lauren Potts - Illustrator/Patient Research Partner, Long Beach, California, USA
Meinrad Beer - University Hospital Ulm
Ming Huang - Mount Sinai Hospital, New York, New York, USA
Johanna Monsalve - Stony Brook School
Anh-Vu Ngo - University of Washington
Mahesh Thapa - University of Washington
Xiaoyue Zhang - Stony Brook University
Walter P Maksymowych - University of Alberta
Polly J Ferguson - University of Iowa
Yongdong Zhao - Seattle Children's Hospital
CARRA CRMO Workgroup
Resource Type: Journal article
Publication Details: Pediatric rheumatology online journal, Vol.23(1), 85
DOI: 10.1186/s12969-025-01135-x
PMID: 40750879
PMCID: PMC12317626
NLM abbreviation: Pediatr Rheumatol Online J
ISSN: 1546-0096
eISSN: 1546-0096
Publisher: BMC
Grant note: 92240 / CARRA-Arthritis Foundation
Language: English
Date published: 08/01/2025
Academic Unit: Radiology; Stead Family Department of Pediatrics; Rheumatology, Allergy, and Immunology
Record Identifier: 9984927217402771

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