Quantitative and Semiquantitative Bone Erosion Assessment on High-resolution Peripheral Quantitative Computed Tomography in Rheumatoid Arthritis

Srikhum, Waraporn; Virayavanich, Warapat; Burghardt, Andrew J.; Yu, Aihong; Link, Thomas M.; Imboden, John B.; Li, Xiaojuan

doi:10.3899/jrheum.120780

Cited by 40 publications

(44 citation statements)

References 36 publications

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“…The number of cortical interruptions per joint detected in our study (median 14, ranging from 2 to 59) is substantially higher than observed in other studies using HR-pQCT, ranging from 0.5 to 2.9 interruptions per MCP joint [10,11,15,16,18,19,21]. This can mainly be explained by the fact that our algorithm detects smaller cortical interruptions (mean interruption surface < 1mm 2 , equivalent to a width of <1.13mm when assuming a circle) compared with a visual scoring of the number of interruptions (mean width >2mm [15,21]).…”

Section: Discussioncontrasting

confidence: 79%

“…High intra- and inter-rater reliability for the visual scoring of the number of erosions was found, with intra-class correlation coefficients (ICC) and kappa values ranging from 0.6 to 1.0 [10–12,18]. However, in all studies only established erosions and thus relatively large cortical interruptions were scored (mean width >2mm [15,21], mean depth >2mm [15,21], mean maximal dimension >3mm [11] and mean volume >4mm 3 [14,19]). Studies that systematically investigate the visual detection of smaller cortical interruptions on HR-pQCT images are currently lacking, but it is known that this is a laborious, complex and difficult process [22].…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussioncontrasting

confidence: 79%

Section: Introductionmentioning

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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“…To evaluate the feasibility of applying the image processing techniques and quantitative measures described in the previous sections, a pilot study was performed in a cohort of patients with established RA and healthy controls 38 . Sixteen patients (RA, age: 52.6±12.8 yrs, 81% female) who fulfilled the 1987 American College of Rheumatology (ACR) classification criteria for RA were recruited for the study.…”

Section: Methodsmentioning

confidence: 99%

“…With an isotropic voxel size of 82 μm (130 μm spatial resolution), this technology permits quantification of bone density and microstructure in the appendicular skeleton 7,25,27,28 . Although the primary application of this technology has been for the purposes of understanding skeletal development 11,20 , aging 4,9,12,19,26 , and fracture risk 5,37,40,43 in the context of bone metabolic disorders, recently HR-pQCT has been utilized to image bone affected by inflammatory diseases 16,17,38,39,44 . To date these studies have provided qualitative and semi-quantitative grading of the 3D appearance of the juxta-articular bone surfaces of the metacarpophalangeal (MCP) joint, including the prevalence and scale of erosions and osteophytes.…”

Section: Introductionmentioning

confidence: 99%

Quantitative In Vivo HR-pQCT Imaging of 3D Wrist and Metacarpophalangeal Joint Space Width in Rheumatoid Arthritis

et al. 2013

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In this technique development study, high-resolution peripheral quantitative computed tomography (HR-pQCT) was applied to non-invasively image and quantify 3D joint space morphology of the wrist and metacarpophalangeal (MCP) joints of patients with rheumatoid arthritis (RA). HR-pQCT imaging (82μm voxel-size) of the dominant hand was performed in patients with diagnosed rheumatoid arthritis (RA, N=16, age:52.6±12.8) and healthy controls (CTRL, N=7, age:50.1±15.0). An automated computer algorithm was developed to segment wrist and MCP joint spaces. The 3D distance transformation method was applied to spatially map joint space width, and summarized by the mean joint space width (JSW), minimal and maximal JSW (JSW.MIN, JSW.MAX), asymmetry (JSW.AS), and distribution (JSW.SD) – a measure of joint space heterogeneity. In vivo precision was determined for each measure by calculating the smallest detectable difference (SDD) and root mean square coefficient of variation (RMSCV%) of repeat scans. Qualitatively, HR-pQCT images and pseudo-color JSW maps showed global joint space narrowing, as well as regional and focal abnormalities in RA patients. In patients with radiographic JSN at an MCP, JSW.SD was two-fold greater versus CTRL (p<0.01), and JSW.MIN was more than two-fold lower (p<0.001). Similarly, JSW.SD was significantly greater in the wrist of RA patients versus CTRL (p<0.05). In vivo precision was highest for JSW (SDD: 100μm, RMSCV: 2.1%) while the SDD for JSW.MIN and JSW.SD were 370 and 110μm, respectively. This study suggests that in vivo quantification of 3D joint space morphology from HR-pQCT, could improve early detection of joint damage in rheumatological diseases.

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“…6 Thirdly, a 3D assessment of joint space is described using quantitative analysis algorithms. 12,13 Fourthly, 3D measurement of bone microarchitecture in rheumatoid arthritis patients showed altered results with disease…”

Section: Correspondencementioning

confidence: 99%

High-resolution peripheral quantitative CT in rheumatology

et al. 2015

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CORRESPONDENCEWe read with interest the Perspectives article by Filippucci et al. (Progress in imaging in rheumatology. Nat. Rev. Rheumatol. 10, 628-634;. 1 This article is a very informative concise paper on MRI and musculoskeletal ultrasono graphy. However, we were surprised that no mention was made of high-resolution peripheral quantitative CT (HR-pQCT), previously highlighted in a Review in this journal, 2 and we would like to call attention to its emerging potential in the field of advanced diagnostic imaging.HR-pQCT was initially developed to study bone diseases such as osteoporosis, and has contributed to a better understanding of the separate behavior of trabecular and cortical bone structures and the different cortical envelopes during ageing, in metabolic bone diseases and during fracture healing; 2 moreover, it allows for calculation of bone strength in vivo using finite-element analysis. 3 Due to its ability to evaluate bone in 3D at a high resolution (82 μm) and with minimal irradiation (5 μSv to image a 0.9 cm region of interest), HR-pQCT is being intensely investigated in the evaluation of bone architecture in the small joints of the hands in rheumatoid arthritis, 4-6 psori atic arthritis, 7 and hand osteoarthritis. 8 To what degree can this method now be rated as "progress in imaging" in rheumatology?Firstly, an increased number of, and earlier stages of, erosions are visible with HR-pQCT than on plain radiography, as evidenced by the work of Stach et al. 4 Secondly, quantification of erosions in terms of size (width, depth and volume) together with changes in trabecular bone is possible, and has been studied in crosssectional and longitudinal studies 5,9-11 and in comparison with MRI. 6 Thirdly, a 3D assessment of joint space is described using quantitative analysis algorithms. 12,13 Fourthly, 3D measurement of bone microarchitecture in rheumatoid arthritis patients showed altered results with disease High-resolution peripheral quantitative CT in rheumatologyCheryl Barnabe, Stephanie Finzel, Kathryn S. Stok and Piet Geusens activity. 14 None of these 3D parameters can currently be evaluated by other imaging techniques at such high resolution.In conclusion, HR-pQCT is, besides MRI and musculoskeletal ultrasonography, also promising "progress in imaging" for clinical research in rheumatic disease of the hand joints. SPECTRA (Study Group for X-treme CT in Rheumatoid Arthritis) 15 is an inter national collaboration between rheumatologists, radiologists, biomedical engineers, physicists and clinical researchers in bone metabolism and osteoimmunology that has provided fertile ground for crossdisciplinary research, united by the desire to certify the validity of the research findings from the application of this technology to the assessment of inflammatory arthritis.

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Quantitative and Semiquantitative Bone Erosion Assessment on High-resolution Peripheral Quantitative Computed Tomography in Rheumatoid Arthritis

Abstract: HR-pQCT provides a sensitive method with high reader agreement in assessment of structural bone damage in RA. The good correlation of erosion measures with disease duration as well as BME volume suggests that they could become feasible measures of erosions in RA.

Cited by 40 publications

References 36 publications

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

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

Quantitative In Vivo HR-pQCT Imaging of 3D Wrist and Metacarpophalangeal Joint Space Width in Rheumatoid Arthritis

High-resolution peripheral quantitative CT in rheumatology

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