Definition for Rheumatoid Arthritis Erosions Imaged with High Resolution Peripheral Quantitative Computed Tomography and Interreader Reliability for Detection and Measurement

Barnabé, Cheryl; Toepfer, D.; Marotte, Hubert; Hauge, Ellen‐Margrethe; Scharmga, A.; Kocijan, Roland; Kraus, Sebastian; Boutroy, Stéphanie; Schett, Georg; Keller, Kresten Krarup; Jong, J. de; Stok, Kathryn S.; Finzel, Stephanie

doi:10.3899/jrheum.160648

Cited by 65 publications

(91 citation statements)

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“…Previous studies that compared patients with RA with healthy subjects using HR‐pQCT primarily focused on the visual detection of pathological interruptions . In a prior study, we demonstrated that with HR‐pQCT a variety of cortical interruptions can be seen in the finger joints of both patients with RA and healthy subjects.…”

Section: Introductionmentioning

confidence: 84%

“…(14) Previous studies that compared patients with RA with healthy subjects using HR-pQCT primarily focused on the visual detection of pathological interruptions. (14)(15)(16)(17)(18)(19)(20) In a prior study, we demonstrated that with HR-pQCT a variety of cortical interruptions can be seen in the finger joints of both patients with RA and healthy subjects. Some (larger) cortical interruptions had underlying trabecular bone voids and were suggestive of an erosion, whereas other cortical interruptions were smaller and may represent physiological interruptions (ie, vascular channels).…”

Section: Introductionmentioning

confidence: 94%

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Assessment of Cortical Interruptions in the Finger Joints of Patients With Rheumatoid Arthritis Using HR-pQCT, Radiography, and MRI

Peters

Tubergen

Scharmga

et al. 2018

Journal of Bone and Mineral Research

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Small cortical interruptions may be the first sign of an erosion, and more interruptions can be found in patients with rheumatoid arthritis (RA) compared with healthy subjects. First, we compared the number and size of interruptions in patients with RA with healthy subjects using high-resolution peripheral quantitative CT (HR-pQCT). Second, we investigated the association between structural damage and inflammatory markers on conventional radiography (CR) and MRI with interruptions on HR-pQCT. Third, the added value of HR-pQCT over CR and MRI was investigated. The finger joints of 39 patients with RA and 38 healthy subjects were examined through CR, MRI, and HR-pQCT. CRs were scored using the Sharp/Van der Heijde method. MRI images were analyzed for the presence of erosions, bone marrow edema, and synovitis. HR-pQCT images were analyzed for the number, surface area, and volume of interruptions using a semiautomated algorithm. Descriptives were calculated and associations were tested using generalized estimating equations. Significantly more interruptions and both a larger surface area and the volume of interruptions were detected in the metacarpophalangeal joints of patients with RA compared with healthy subjects (median, 2.0, 1.42 mm , and 0.48 mm versus 1.0, 0.69 mm , and 0.23 mm , respectively; all p < 0.01). Findings on CR and MRI were significantly associated with more and larger interruptions on HR-pQCT (prevalence ratios [PRs] ranging from 1.03 to 7.74; all p < 0.01) in all subjects, and were consistent in patients with RA alone. Having RA was significantly associated with more and larger interruptions on HR-pQCT (PRs, 2.33 to 5.39; all p < 0.01), also after adjustment for findings on CR or MRI. More and larger cortical interruptions were found in the finger joints of patients with RA versus healthy subjects, also after adjustment for findings on CR or MRI, implying that HR-pQCT imaging may be of value in addition to CR and MRI for the evaluation of structural damage in patients with RA. © 2018 The Authors. Journal of Bone and Mineral Research Published by Wiley Periodicals Inc.

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Section: Introductionmentioning

confidence: 84%

Section: Introductionmentioning

confidence: 94%

Assessment of Cortical Interruptions in the Finger Joints of Patients With Rheumatoid Arthritis Using HR-pQCT, Radiography, and MRI

Peters

Tubergen

Scharmga

et al. 2018

Journal of Bone and Mineral Research

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“…A cortical interruption was defined as a clear interruption of the cortex, seen on two consecutive slices on two orthogonal planes (on transverse, and on sagittal or coronal plane) [29,30]. …”

Section: Methodsmentioning

confidence: 99%

An automated algorithm for the detection of cortical interruptions on high resolution peripheral quantitative computed tomography images of finger joints

et al. 2017

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ObjectivesTo introduce a fully-automated algorithm for the detection of small cortical interruptions (≥0.246mm in diameter) on high resolution peripheral quantitative computed tomography (HR-pQCT) images, and to investigate the additional value of manual correction of the automatically obtained contours (semi-automated procedure).MethodsTen metacarpophalangeal joints from seven patients with rheumatoid arthritis (RA) and three healthy controls were imaged with HR-pQCT. The images were evaluated by an algorithm according to the fully- and semi-automated procedure for the number and surface of interruptions per joint. Reliability between the fully- and semi-automated procedure and between two independent operators was tested using intra-class correlation coefficient (ICC) and the proportion of matching interruptions. Validity of single interruptions detected was tested by comparing it to visual scoring, as gold standard. The positive predictive value (PPV) and sensitivity were calculated.ResultsThe median number of interruptions per joint was 14 (range 2 to 59) and did not significantly differ between the fully- and semi-automated procedure (p = 0.37). The median interruption surface per joint was significantly higher with the fully- vs. semi-automated procedure (respectively, 8.6mm2 vs. 5.8mm2 and 6.1mm2, p = 0.01). Reliability was almost perfect between the fully- and semi-automated procedure for both the number and surface of interruptions (ICC≥0.95) and the proportion of matching interruptions was high (≥76%). Also the inter-operator reliability was almost perfect (ICC≥0.97, proportion of matching interruptions 92%). The PPV ranged from 27.6% to 29.9%, and sensitivity from 69.7% to 76.3%. Most interruptions detected with the algorithm, did show an interruption on a 2D grayscale image. However, this interruption did not meet the criteria of an interruption with visual scoring.ConclusionThe algorithm for HR-pQCT images detects cortical interruptions, and its interruption surface. Reliability and validity was comparable for the fully- and semi-automated procedures. However, we advise the use of the semi-automated procedure to assure quality. The algorithm is a promising tool for a sensitive and objective assessment of cortical interruptions in finger joints assessed by HR-pQCT.

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“…Anatomic pseudoerosions, i.e., normal concavities of a bone with a potential for misinterpreting them as arthritis-related erosions, were described in twelve original papers and reviews and may be classified into four types according to their anatomic form and configuration (Table 1): (1) a groove or notch or its incomplete form, i.e., a jutty, (2) a sulcus as part of an osteofibrous channel, (3) a subcapital neck on long bones, or (4) a nutritional channel or a zonal roughness [3,11,41,[51][52][53][54][55][56][57]. According to their shape, they may be grouped into (1) shallow or broad concavities and (2) subchondral cysts, if en-face displayed on an image and occasionally with a small opening to the joint space, or (3) channel-like structures (Figure 2a,c) [3,54,55].…”

Section: Anatomic Pseudoerosionsmentioning

confidence: 99%

“…The diagnosis of erosions and their quantification as part of radiographic scoring systems is an accepted surrogate biomarker of structural progression of arthritis [4,5]. Erosions in RA have been defined in consensus statements and in studies with high-resolution peripheral quantitative computed tomography (HRpqCT) as cortical defects, breaks, or other discontinuities with underlying trabecular bone loss and characteristic locations that can be identified with imaging [6][7][8][9][10][11][12]. diseases, clinical studies comparing therapeutic measurements in RA, studies comparing the sensitivity of imaging modalities without report of false positive diagnosed erosions or erosion-like lesions, surgical procedures or longitudinal studies without direct reference to this topic, case reports and conference papers.…”

Section: Introductionmentioning

confidence: 99%

Pseudoerosions of Hands and Feet in Rheumatoid Arthritis: Anatomic Concepts and Redefinition

Hirtler

Rath

Platzgummer

et al. 2019

JCM

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Rheumatoid arthritis is a chronic inflammatory disease characterized by the development of osseous and cartilaginous damage. The correct differentiation between a true erosion and other entities—then often called “pseudoerosions”—is essential to avoid misdiagnosing rheumatoid arthritis and to correctly interpret the progress of the disease. The aims of this systematic review were as follows: to create a definition and delineation of the term “pseudoerosion”, to point out morphological pitfalls in the interpretation of images, and to report on difficulties arising from choosing different imaging modalities. A systematic review on bone erosions in rheumatoid arthritis was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The following search terms were applied in PubMed and Scopus: “rheumatoid arthritis”, “bone erosion”, “ultrasonography”, “radiography”, “computed tomography” and “magnetic resonance imaging”. Appropriate exclusion criteria were defined. The systematic review registration number is 138826. The search resulted ultimately in a final number of 25 papers. All indications for morphological pitfalls and difficulties utilizing imaging modalities were recorded and summarized. A pseudoerosion is more than just a negative definition of an erosion; it can be anatomic (e.g., a normal osseous concavity) or artefact-related (i.e., an artificial interruption of the calcified zones). It can be classified according to their configuration, shape, content, and can be described specifically with an anatomical term. “Calcified zone” is a term to describe the deep components of the subchondral, subligamentous and subtendinous bone, and may be applied for all non-cancellous borders of a bone, thus representing a third type of the bone matrix beside the cortical and the trabecular bone.

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Definition for Rheumatoid Arthritis Erosions Imaged with High Resolution Peripheral Quantitative Computed Tomography and Interreader Reliability for Detection and Measurement

Abstract: We propose a new definition for erosions visualized with HR-pQCT imaging. Interreader reliability for erosion detection is good, but further refinement of selection of landmarks for erosion size measurement, or automated volumetric methods, will be pursued.

Cited by 65 publications

References 19 publications

Assessment of Cortical Interruptions in the Finger Joints of Patients With Rheumatoid Arthritis Using HR-pQCT, Radiography, and MRI

Assessment of Cortical Interruptions in the Finger Joints of Patients With Rheumatoid Arthritis Using HR-pQCT, Radiography, and MRI

An automated algorithm for the detection of cortical interruptions on high resolution peripheral quantitative computed tomography images of finger joints

Pseudoerosions of Hands and Feet in Rheumatoid Arthritis: Anatomic Concepts and Redefinition

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