Fully automated joint space width measurement and digital X-ray radiogrammetry in early RA

Abstract

ObjectivesTo study fully automated digital joint space width (JSW) and bone mineral density (BMD) in relation to a conventional radiographic scoring method in early rheumatoid arthritis (eRA).MethodsRadiographs scored by the modified Sharp van der Heijde score (SHS) in patients with eRA were acquired from the SWEdish FarmacOTherapy study. Fully automated JSW measurements of bilateral metacarpals 2, 3 and 4 were compared with the joint space narrowing (JSN) score in SHS. Multilevel mixed model statistics were applied to calculate the significance of the association between ΔJSW and ΔBMD over 1 year, and the JSW differences between damaged and undamaged joints as evaluated by the JSN.ResultsBased on 576 joints of 96 patients with eRA, a significant reduction from baseline to 1 year was observed in the JSW from 1.69 (±0.19) mm to 1.66 (±0.19) mm (p<0.01), and BMD from 0.583 (±0.068) g/cm2 to 0.566 (±0.074) g/cm2 (p<0.01). A significant positive association was observed between ΔJSW and ΔBMD over 1 year (p<0.0001). On an individual joint level, JSWs of undamaged (JSN=0) joints were wider than damaged (JSN>0) joints: 1.68 mm (95% CI 1.70 to 1.67) vs 1.54 mm (95% CI 1.63 to 1.46). Similarly the unadjusted multilevel model showed significant differences in JSW between undamaged (1.68 mm (95% CI 1.72 to 1.64)) and damaged joints (1.63 mm (95% CI 1.68 to 1.58)) (p=0.0048). This difference remained significant in the adjusted model: 1.66 mm (95% CI 1.70 to 1.61) vs 1.62 mm (95% CI 1.68 to 1.56) (p=0.042).ConclusionsTo measure the JSW with this fully automated digital tool may be useful as a quick and observer-independent application for evaluating cartilage damage in eRA.Trial registration numberNCT00764725.

Sind röntgenologische Scoring-Methoden als Parameter zur Verlaufsbeurteilung der rheumatoiden Arthritis noch zeitgemäß?

“…Durch die Einführung von Computer-assistierten Detektionstechniken (CAD) in der Radiologie besteht die Möglichkeit einer Computer-basierten Analyse von Handröntgenaufnahmen [29][30][31][32]. Hierbei kann eine objektive Quantifizierung der röntgenologischen Veränderungen in Bezug auf die periartikuläre Demineralisation, die Gelenkspaltweite und zudem eine Quantifizierung von Erosionen vorgenommen werden [29][30][31][33][34][35].…”

“…Durch die DXR kann eine Abnahme der Knochenmineraldichte früher als im Larsen-Score und durch die CASJA-Technik eine Reduktion der Fingergelenkspaltweite früher als im Larsen-und Sharp-Score verifiziert werden [29,38,[43][44][45][46]. Platten et al wiesen in einer Arbeit zur frühen RA mit einem erosiven Verlauf eine erniedrigte Gelenkspaltweite der MCP-Gelenke im Vergleich zu Patienten mit einem nicht erosiven Verlauf nach [34]. Hierbei ist das Ausmaß des Knochenmineraldichteverlustes gemessen mittels DXR ein unabhängiger Prädiktor hinsichtlich des Auftretens einer Gelenkzerstörung nach einem Erkrankungsjahr [47] und somit ein prognostischer Marker für das Ausmaß der Gelenkzerstörung [48].…”

A measurement method of knee joint space width by ultrasound: a large multicenter study

“…Despite technological advances and the availability of magnetic resonance imaging (MRI) and ultrasound (US) modalities, plain radiography is still the primary method for assessing knee joint structural damage. The measurement of radiographic joint space width (JSW) is the most commonly proposed and widely used method of assessing JSN (1,3). Once the diagnosis of arthritis is made, it is necessary to assess the changes of JSW while the patients are followed up or undergo medication.…”

“…Once the diagnosis of arthritis is made, it is necessary to assess the changes of JSW while the patients are followed up or undergo medication. However, due to the slight changes of JSW in these periods (1,3,4), the reduced responsiveness to change over time is a limitation in determining longitudinal progression (5,6). Hence, the patients may not only receive insufficient diagnostic benefits from plain radiography but also be subjected to radiation exposure.…”

Radiographic remission in rheumatoid arthritis quantified by computer-aided joint space analysis (CASJA): a post hoc analysis of the RAPID 1 trial

“…In the last years, different computer-based techniques were developed to assess finger JSW using hand radiographs [ 4 – 6 ]. One of these methods is the new computer-aided joint space analysis (CAJSA, Version 1.3.6; Sectra; Sweden), which conducts semi-automated measurements of joint space distances (JSD) at the metacarpal-phalangeal joints (MCP) by using digitized hand radiographs.…”