scholarly journals POS0444 DIAGNOSTIC VALUE OF HIGH-RESOLUTION PERIPHERAL QUANTITATIVE COMPUTED TOMOGRAPHY COMPARED TO CONVENTIONAL RADIOGRAPHY FOR DETECTING EROSIVE DISEASE IN RHEUMATOID ARTHRITIS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 451-452
Author(s):  
R. Klose-Jensen ◽  
J. Therkildsen ◽  
A. B. Blavnsfeldt ◽  
B. Langdahl ◽  
K. K. Keller ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Computed Tomography ◽  
High Resolution ◽  
Sensitivity And Specificity ◽  
Quantitative Computed Tomography ◽  
Conventional Radiography ◽  
Peripheral Quantitative Computed Tomography ◽  
Field Of View ◽  
Research Support ◽  
Erosive Disease

Background:Conventional radiography (CR) of the hands, wrists and feet is currently the gold standard for assessing erosive damage in patients with rheumatoid arthritis (RA). However, CR is prone to relatively low resolution and projection superimposition due to 2-dimensional imaging. Therefore, CR might not detect erosive disease in RA patients. High-resolution peripheral quantitative computed tomography (HR-pQCT) is an imaging modality with superior resolution (82µm3) to all other imaging modalities in vivo. However, HR-pQCT imaging is limited by a smaller field of view. Therefore, it needs to be illuminated, whether the higher resolution of HR-pQCT imaging is sufficient for diagnosing erosive disease in patients with RA despite the limited field of view.Objectives:The objective was to investigate whether High-Resolution peripheral Quantitative Computed Tomography (HR-pQCT) of just two metacarpophalangeal (MCP) joints can diagnose more patients having erosive RA than conventional radiography (CR) of 44 joints in the hands, wrist and feet.Methods:In this single-centre cross-sectional study. Patients with established RA (disease duration ≥ 5 years) were investigated by HR-pQCT and CR. The second and third MCP joints of the dominant hand were assessed for erosions by HR-pQCT. CR in the hands, wrist and feet were scored according to the Sharp/van der Heijde (SHS) method.Results:Three hundred fifty-four patients were included. By CR, 67 (18.9%) patients were classified with non-erosive RA, and 287 (81.1%) with erosive RA. In the 67 patients with non-erosive RA, 47 patients (70.1%) had erosions in the second and third MCP joints by HR-pQCT (Figure 1). We found an agreement between CR and HR-pQCT for 274 (77.4%) of the patients. The sensitivity and specificity (95%CI) of HR-pQCT for diagnosing erosive RA when CR of hands, wrist and feet were used as the reference was 89% (84 – 92) % and 30% (19 – 42) %, respectively. Using HR-pQCT for two MCP joints as the reference, the sensitivity and specificity of CR of hands, wrist and feet for diagnosing erosive RA were 84% (80 – 88) % and 38% (25 – 52) %, respectively. The McNemar’s χ2 test for diagnosing patients having erosive RA between the two modalities was 2.45, p = 0.146.Conclusion:HR-pQCT imaging identifies erosions which are not seen by CR. Using HR-pQCT at of the second and third MCP joint reclassified a substantial number of patients as having erosive RA compared to their non-erosive state determined by CR. The sensitivity and specificity of diagnosing patients having erosive RA using HR-pQCT from only two fingers were not statistically different from CR of 44 joints, in the hands, wrist and feet.Acknowledgements:The authors, we want to acknowledge Aarhus University, The Danish Rheumatism Association, Novo Nordic Foundation and A.P. Møller Fonden who have financially supported the study. The funding sources did not have any role in the collection, analysis and interpretation of data. The authors are grateful for the excellent assistance in recruiting and scheduling the patients by Mia Marie Remmer, Lone Thomasen and Else Sloth Rousing.Disclosure of Interests:Rasmus Klose-Jensen: None declared, Josephine Therkildsen: None declared, Anne-Birgitte Blavnsfeldt: None declared, Bente Langdahl Speakers bureau: Eli Lilly, Amgen, UCB, Gilead, and Gideon-Richter, Grant/research support from: Novo Nordisk and Amgen, Kresten Krarup Keller: None declared, Ellen-Margrethe Hauge Speakers bureau: MSD, Pfizer, UCB, and Sobi., Grant/research support from: Roche, Novartis and Novo Nordic Foundation.

scholarly journals Reliability and Change in Erosion Measurements by High-Resolution peripheral Quantitative Computed Tomography in a Longitudinal Dataset of Rheumatoid Arthritis Patients

2020 ◽  
pp. jrheum.191391 ◽  
Author(s):  
Stephanie Finzel ◽  
Sarah L. Manske ◽  
Cheryl Barnabe ◽  
Andrew J. Burghardt ◽  
Hubert Marotte ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Computed Tomography ◽  
High Resolution ◽  
Intraclass Correlation ◽  
Quantitative Computed Tomography ◽  
Correlation Coefficients ◽  
Peripheral Quantitative Computed Tomography ◽  
Good Reliability ◽  
Change Over Time ◽  
Over Time

Objective The aim of this multi-reader exercise was to assess the reliability and change over time of erosion measurements in rheumatoid arthritis (RA) patients using high-resolution peripheral quantitative computed tomography (HR-pQCT). Methods HR-pQCT scans of 23 patients with RA were assessed at baseline and 12 months. Four experienced readers examined the dorsal, palmar, radial, and ulnar surfaces of the metacarpal head (MH) and phalangeal base (PB) of the 2nd and 3rd digits, blinded to time order. In total, 368 surfaces (23 patients x16 surfaces) were evaluated per time point to characterize cortical breaks as pathological (erosion) or physiological, and to quantify erosion width and depth. Reliability was evaluated by intraclass correlation coefficients (ICC), percentage agreement, and Light’s kappa; change over time was defined by means ± SD of erosion numbers and dimensions. Results ICCs for the mean measurements of width and depth of the pathological breaks ranged between 0.819 - 0.883, and 0.771 - 0.907 respectively. Most physiological cortical breaks were found at the palmar PB, whereas most pathological cortical breaks were located at the radial MH. There was a significant increase in both the numbers and the dimensions of erosions between baseline and follow-up (p=0.0001 for erosion numbers, width, and depth in axial plane, and p=0.001 for depth in perpendicular plane). Conclusion This exercise confirmed good reliability of HR-pQCT erosion measurements and their ability to detect change over time.

Heterogeneity of Cortical Breaks in Hand Joints of Patients with Rheumatoid Arthritis and Healthy Controls Imaged by High-resolution Peripheral Quantitative Computed Tomography

2016 ◽  
Vol 43 (10) ◽  
pp. 1914-1920 ◽  
Author(s):  
Andrea Scharmga ◽  
Michiel Peters ◽  
Astrid van Tubergen ◽  
Joop van den Bergh ◽  
Cheryl Barnabe ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Computed Tomography ◽  
High Resolution ◽  
Trabecular Bone ◽  
Quantitative Computed Tomography ◽  
Peripheral Quantitative Computed Tomography ◽  
Healthy Controls ◽  
Poor Prognostic Factor ◽  
Bone Erosions ◽  
Bone Changes

Objective.Conventional radiographs (CR) of the hands are the gold standard for imaging bone erosions. The presence of bone erosions, reflected by the presence of cortical breaks, is a poor prognostic factor in patients with rheumatoid arthritis (RA). The availability of high-resolution peripheral quantitative computed tomography (HR-pQCT) enables detailed investigation of cortical breaks in rheumatic diseases. The aim of this image review is to show HR-pQCT images of the spectrum of cortical breaks with and without underlying trabecular bone changes in metacarpophalangeal (MCP) joints of healthy controls (HC) and patients with RA, with corresponding images on CR and magnetic resonance imaging (MRI).Methods.Second and third MCP joints of 41 patients (of which 10 were early RA with ≤ 2 years and 24 longstanding RA with ≥ 10 years of disease duration) and 38 HC were imaged by CR, MRI, and HR-pQCT (XtremeCT1, Scanco Medical AG). Representative images of the spectrum of cortical breaks were selected.Results.Cortical breaks were found in early and longstanding RA, but also in HC. They were heterogeneous in size, location, and number per joint, with a variety of surrounding cortical and underlying trabecular bone characteristics.Conclusion.Using HR-pQCT images of MCP joints, heterogeneous cortical breaks with and without surrounding trabecular bone changes were found, not only in RA but also in HC. The underlying mechanisms and significance of this spectrum of cortical breaks as found with high 3-D resolution needs further investigation.

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

2013 ◽  
Vol 40 (4) ◽  
pp. 408-416 ◽  
Author(s):  
Waraporn Srikhum ◽  
Warapat Virayavanich ◽  
Andrew J. Burghardt ◽  
Andrew Yu ◽  
Thomas M. Link ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Computed Tomography ◽  
High Resolution ◽  
Distal Radius ◽  
Disease Duration ◽  
Bone Erosion ◽  
Quantitative Computed Tomography ◽  
Correlation Coefficients ◽  
Peripheral Quantitative Computed Tomography ◽  
Bone Erosions

Objective.To develop novel quantitative and semiquantitative bone erosion measures at metacarpophalangeal (MCP) and wrist joints in patients with rheumatoid arthritis (RA) using high-resolution peripheral quantitative computed tomography (HR-pQCT), and to correlate these measurements with disease duration and bone marrow edema (BME) patterns derived from magnetic resonance imaging (MRI).Methods.Sixteen patients with RA and 7 healthy subjects underwent hand and wrist HR-pQCT and 3-Tesla MRI. Bone erosions of the MCP2, MCP3, and distal radius were evaluated by measuring maximal erosion dimension on axial slices, which is a simple and fast measurement, and then were graded (grades 0–3) based on the maximal dimension. Correlation coefficients were calculated between (1) sum maximal dimensions, highest grades, and sum grades of bone erosions; (2) erosion measures and the clinical evaluation; (3) erosion measures and BME volume in distal radius.Results.The inter- and intrareader agreements of maximal erosion dimensions were excellent (intraclass correlation coefficients 0.89, 0.99, and root mean square error 9.4%, 4.7%, respectively). Highest grades and sum grades were significantly correlated to sum maximal dimensions of all erosions. Number of erosions, sum maximal erosion dimensions, highest grades, and sum grades correlated significantly with disease duration. Number of erosions, sum maximal dimensions, and erosion grading of the distal radius correlated significantly with BME volume.Conclusion.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.

scholarly journals POS0043 PERIPHERAL QUANTITATIVE COMPUTED TOMOGRAPHY IN THE ASSESSMENT OF BONE MINERAL DENSITY IN ANTI-TNF-TREATED RHEUMATOID ARTHRITIS AND ANKYLOSING SPONDYLITIS PATIENTS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 226.1-227
Author(s):  
B. Juhász ◽  
K. Gulyás ◽  
Á. Horváth ◽  
E. Végh ◽  
A. Pusztai ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Computed Tomography ◽  
Disease Activity ◽  
Quantitative Computed Tomography ◽  
Peripheral Quantitative Computed Tomography ◽  
The European Union ◽  
Bone Biomarkers ◽  
Mineral Density ◽  
Research Support ◽  
Full Cohort

Background:Rheumatoid arthritis (RA) and ankylosing spondylitis (AS) have been associated with osteoporosis. There have been very few data on the use of peripheral quantitative computed tomography (QCT) in anti-TNF-treated patients.Objectives:We wished to assess volumetric bone mineral density (BMD) by forearm QCT in conjunction with dual-energy X-ray absorptiometry (DXA) and bone biomarkers in RA and AS.Methods:Forty RA and AS patients treated with etanercept (ETN) or certolizumab pegol (CZP) were included in a 12-month follow-up study. Peripheral QCT and DXA BMD were determined. Bone biomarkers, such as PTH, osteocalcin, RANKL, 25-hydroxyvitamin D (VITD), P1NP, CTX, sclerostin, DKK-1 and cathepsin K (CATHK) were assessed by ELISA.Results:There was no further bone loss during anti-TNF treatment. Volumetric and areal BMD showed significant correlations with each other (p<0.05). Total QCT BMD after 12 months was inversely determined by disease activity at baseline in the full cohort (p=0.030). Cortical BMD was negatively determined by baseline disease activity (p=0.005) and CATHK (p=0.025). In RA, VITD-0 determined QTRABBMD-12 (p=0.005). In the full cohort, the one-year change in QTRABBMD was related to TNF inhibition together with higher VITD-0 (p=0.031). Therapy and lower CATHK determined QCORTBMD changes (p=0.006). In RA, treatment together with VITD-0 (p<0.01) or CATHK-0 (p=0.002), while in AS, treatment together with RANKL-0 (p<0.05) determined QCT BMD changes.Conclusion:QCT confirmed that biologics may attenuate bone loss. Disease activity, CATHK, RANKL and VITD may predict the effects of anti-TNF treatment on volumetric BMD changes. There may be differences between RA and AS in this respect.Acknowledgements:This research was supported by Hungarian National Scientific Research Fund (OTKA) grant No. K 105073 (H.P.B. and Z.S.); by the European Union and the State of Hungary and co-financed by the European Social Fund in the framework of TAMOP-4.2.4.A/2-11/1-2012-0001 ‘National Excellence Program ’(Z.S.); by the European Union grant GINOP-2.3.2-15-2016-00050 (Z.S.); and by the Pfizer Investigator Initiated Research Grants no. WS1695414 and WS1695450 (Z.S.).Disclosure of Interests:Balázs Juhász: None declared, Katalin Gulyás: None declared, Ágnes Horváth: None declared, Edit Végh: None declared, Anita Pusztai: None declared, Agnes Szentpetery: None declared, Zsófia Pethö: None declared, Nóra Bodnár: None declared, Attila Hamar: None declared, Levente Bodoki: None declared, Harjit Pal Bhattoa: None declared, Éva Szekanecz: None declared, Katalin Hodosi: None declared, Andrea Domjan: None declared, Szilvia Szamosi Speakers bureau: Roche, Csaba Horváth: None declared, Sándor Szántó Speakers bureau: Abbvie, MSD, Novartis, Consultant of: Abbvie, Novartis, Gabriella Szücs Speakers bureau: Roche, Boehringer, Actelion, Sager, Consultant of: Actelion, Boehringer, Hennie Raterman: None declared, WIllem Lems Speakers bureau: Pfizer, Amgen, Lilly, UCB, Galapagos, Consultant of: Pfizer, Amgen, Lilly, UCB, Galapagos, Oliver FitzGerald Speakers bureau: AbbVie, Janssen, Pfizer, Consultant of: BMS, Celgene, Eli Lilly, Janssen, Pfizer, Grant/research support from: AbbVie, BMS, Eli Lilly, Novartis, Pfizer, Zoltán Szekanecz Speakers bureau: Pfizer, Roche, Abbvie, Novartis, Lilly, Sanofi, Consultant of: Pfizer, Abbvie, Novartis, Grant/research support from: Pfizer, UCB.

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