Development of semiquantitative ultrasound scoring system to assess cartilage in rheumatoid arthritis

Mandl, Péter; Studenic, Paul; Filippucci, Emilio; Bachta, Artur; Backhaus, Marina; Bong, David; Bruyn, George A W; Collado, Paz; Damjanov, Nemanja; Dejaco, Christian; Sedie, Andrea Delle; Miguel, Eugenio de; Duftner, Christina; Gessl, Irina; Gutiérrez, Marwin; Hammer, Hilde Berner; Hernández‐Díaz, Cristina; Iagnocco, A.; Ikeda, Kei; Kane, David; Keen, Helen; Kelly, Stephen; Kővári, Eszter; Möller, Ingrid; Møller-Dohn, Uffe; Naredo, Esperanza; Nieto, Juan Carlos; Pineda, Carlos; Platzer, Alexander; Rodrı́guez, Ana; Schmidt, Wolfgang A.; Supp, Gabriela; Szkudlarek, Marcin; Terslev, Lene; Thiele, Ralf; Wakefield, Richard J.; Windschall, Daniel; D'Agostino, Maria Antonietta; Bálint, Péter

doi:10.1093/rheumatology/kez153

Cited by 22 publications

(32 citation statements)

References 27 publications

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“…For semiquantitative evaluation of RA finger joint cartilage, the 5‐grade evaluation (grades 0–4) reported by Filippucci et al (4) and the 3‐grade evaluation (grades 0–2) reported by the EULAR‐Outcome Measures in Rheumatology (OMERACT) group (5) are currently available. In the current study, we used the 3‐grade evaluation advocated by the EULAR‐OMERACT group because of its favorable feasibility.…”

Section: Discussionmentioning

confidence: 99%

“…Since the evaluation was of a semiquantitative method, the cartilage measurement was not corrected for the increased speed of sound within it. Furthermore, one US examiner (TO) who was blinded to other medical information performed the semiquantitative scoring of the recorded cartilage images using a scale of 0–2 (0 = normal, 1 = minimal, and 2 = severe) (5) (see Supplementary Figure , available on the Arthritis Care & Research website at http://onlinelibrary.wiley.com/doi/10.1002/acr.24101/abstract).…”

Section: Methodsmentioning

confidence: 99%

“…Semiquantitative methods such as those that measure bone erosion and JSN in radiograph examinations and gray-scale and power Doppler US evaluations have been widely accepted in clinical trials and practice because their findings are known to correlate with quantitative evaluation of structural damage (radiograph and US gray scale) or severity of synovitis (US, especially power Doppler). Although the use of a semiquantitative method for US cartilage evaluation in RA has been proposed, its correlation with cartilage thickness and its clinical significance have not been clarified (4,5). Therefore, we examined the validity of US cartilage evaluation by performing a cross-sectional study of the use of a semiquantitative method in evaluating RA patients in remission or with low disease activity.…”

Section: Introductionmentioning

confidence: 99%

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Finger Joint Cartilage Evaluated by Semiquantitative Ultrasound Score in Patients With Rheumatoid Arthritis

Ogura

Hirata

Hayashi

et al. 2021

Arthritis Care & Research

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Objective Joint destruction in rheumatoid arthritis (RA) includes both bone and cartilage lesions. Since joint space narrowing (JSN) is not a direct evaluation of cartilage using radiography, we aimed to examine the validity of ultrasound (US) cartilage evaluation using a semiquantitative method in patients with RA. Methods We enrolled 103 patients with RA who were in remission or showing low disease activity and 42 healthy subjects. The cartilage thickness of the bilateral metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints of the second to fifth fingers was measured by US, and the recorded images were scored semiquantitatively using a scale of 0–2. In addition, the JSN of the corresponding joints was scored using a hand radiograph. The relationships between total cartilage thickness, its semiquantitative score, and JSN score were assessed using Spearman’s rank correlation coefficients. Results Total cartilage thickness was significantly thinner in patients with RA compared to healthy subjects for both the MCP and PIP joints (both P < 0.001). The semiquantitative sum of 16 joints ranged from 2 to 26 (median 8) in patients with RA, which was significantly greater than the 0–11 (median 4) in healthy subjects (P < 0.001). In patients with RA, the semiquantitative score showed a significant negative correlation with cartilage thickness (ρ = −0.64, P < 0.001) and a significant positive correlation with JSN score (ρ = 0.66, P < 0.001). Furthermore, these scores showed a significant correlation with RA disease duration. Conclusion A simplified and direct evaluation of finger joint cartilage damage by semiquantitative US score is valid and useful for patients with RA.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Finger Joint Cartilage Evaluated by Semiquantitative Ultrasound Score in Patients With Rheumatoid Arthritis

Ogura

Hirata

Hayashi

et al. 2021

Arthritis Care & Research

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“…The hands were placed on the table, with the metacarpophalangeal joints in maximal flexion (>60 • ) (14,36,37). The metacarpal head from the 2nd to the 5th digit of both hands was scanned on the dorsal aspect from radial to ulnar and from proximal to distal sides to ensure the maximal exploration of the hyaline cartilage using the EULAR standard scans (38).…”

Section: Us Image Acquisition and Interpretationmentioning

confidence: 99%

“…The main aim of this study was to develop an automatic DL algorithm for US informative-image selection of hyaline cartilage at metacarpal head level. An image was defined informative when it shows enough information to fulfill the Outcome Measure in Rheumatology US definition of healthy hyaline cartilage (36). The algorithm performance and that of three beginner sonographers were compared with an expert assessment, which was considered the gold standard.…”

Section: Introductionmentioning

confidence: 99%

Artificial Intelligence for Ultrasound Informative Image Selection of Metacarpal Head Cartilage. A Pilot Study

et al. 2021

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Objectives: This study aims to develop an automatic deep-learning algorithm, which is based on Convolutional Neural Networks (CNNs), for ultrasound informative-image selection of hyaline cartilage at metacarpal head level. The algorithm performance and that of three beginner sonographers were compared with an expert assessment, which was considered the gold standard.Methods: The study was divided into two steps. In the first one, an automatic deep-learning algorithm for image selection was developed using 1,600 ultrasound (US) images of the metacarpal head cartilage (MHC) acquired in 40 healthy subjects using a very high-frequency probe (up to 22 MHz). The algorithm task was to identify US images defined informative as they show enough information to fulfill the Outcome Measure in Rheumatology US definition of healthy hyaline cartilage. The algorithm relied on VGG16 CNN, which was fine-tuned to classify US images in informative and non-informative ones. A repeated leave-four-subject out cross-validation was performed using the expert sonographer assessment as gold-standard. In the second step, the expert assessed the algorithm and the beginner sonographers' ability to obtain US informative images of the MHC.Results: The VGG16 CNN showed excellent performance in the first step, with a mean area (AUC) under the receiver operating characteristic curve, computed among the 10 models obtained from cross-validation, of 0.99 ± 0.01. The model that reached the best AUC on the testing set, which we named “MHC identifier 1,” was then evaluated by the expert sonographer. The agreement between the algorithm, and the expert sonographer was almost perfect [Cohen's kappa: 0.84 (95% confidence interval: 0.71–0.98)], whereas the agreement between the expert and the beginner sonographers using conventional assessment was moderate [Cohen's kappa: 0.63 (95% confidence interval: 0.49–0.76)]. The conventional obtainment of US images by beginner sonographers required 6.0 ± 1.0 min, whereas US videoclip acquisition by a beginner sonographer lasted only 2.0 ± 0.8 min.Conclusion: This study paves the way for the automatic identification of informative US images for assessing MHC. This may redefine the US reliability in the evaluation of MHC integrity, especially in terms of intrareader reliability and may support beginner sonographers during US training.

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Ultrasonography of Inflammatory and Structural Lesions in Hand Osteoarthritis: An Outcome Measures in Rheumatology Agreement and Reliability Study

Mathiessen

Hammer

Terslev

et al. 2022

Arthritis Care & Research

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Objective: To standardize and assess the reliability of ultrasonographic assessment of inflammatory and structural lesions in patients with hand osteoarthritis (OA). Methods:The Outcome Measures in Rheumatology (OMERACT) Ultrasound Working Group selected synovial hypertrophy (SH), joint effusion (JE), and power Doppler (PD) signals as the main inflammatory lesions in hand OA, and suggested osteophytes in the scapho-trapezio-trapezoid (STT) and cartilage defects in the proximal interphalangeal (PIP) joints as novel additions to previous structural scoring systems. A complementary imaging atlas provided detailed examples of the scores.A reliability exercise of static images was performed for the inflammatory features, followed by a patient-based exercise with six sonographers testing inflammatory and structural features in twelve hand OA patients. We used Cohen's kappa (κ) for intra-reader and Light's κ for inter-reader reliability for all features except PD, in which Prevalence-Adjusted Bias-Adjusted Kappa (PABAK) was applied. Percentage agreement was also assessed. Results:The web-based reliability exercise demonstrated substantial intra-and inter-reader reliability for all inflammatory features (κ>0.64). In the patient-based exercise, intra-and inter-reader reliability varied: SH κ=0.73 and 0.45; JE κ=0.70 and 0.55; PD PABAK=0.90 and 0.88; PIP cartilage κ=0.56 and 0.45; STT osteophytes κ=0.62 and 0.36. Percentage close agreement was high for all features (>85%). Conclusion:With ultrasound, substantial to excellent intra-reader reliability was found for inflammatory features of hand OA. Inter-reader reliability was moderate, but overall high close agreement between readers suggest that better reliability is achievable after further training.Assessment of osteophytes in the STT joint and cartilage in the PIP joints achieved less good reliability and the latter is not endorsed.

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Development of semiquantitative ultrasound scoring system to assess cartilage in rheumatoid arthritis

Cited by 22 publications

References 27 publications

Finger Joint Cartilage Evaluated by Semiquantitative Ultrasound Score in Patients With Rheumatoid Arthritis

Finger Joint Cartilage Evaluated by Semiquantitative Ultrasound Score in Patients With Rheumatoid Arthritis

Artificial Intelligence for Ultrasound Informative Image Selection of Metacarpal Head Cartilage. A Pilot Study

Ultrasonography of Inflammatory and Structural Lesions in Hand Osteoarthritis: An Outcome Measures in Rheumatology Agreement and Reliability Study

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