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

2016 ◽  
Vol 43 (10) ◽  
pp. 1935-1940 ◽  
Author(s):  
Cheryl Barnabe ◽  
Dominique Toepfer ◽  
Hubert Marotte ◽  
Ellen-Margrethe Hauge ◽  
Andrea Scharmga ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Computed Tomography ◽  
High Resolution ◽  
Cortical Bone ◽  
Intraclass Correlation ◽  
Quantitative Computed Tomography ◽  
Peripheral Quantitative Computed Tomography ◽  
Maximum Width ◽  
Trabecular Bone Loss ◽  
Axial Depth

Objective.High-resolution peripheral quantitative computed tomography (HR-pQCT) sensitively detects erosions in rheumatoid arthritis (RA); however, nonpathological cortical bone disruptions are potentially misclassified as erosive. Our objectives were to set and test a definition for pathologic cortical bone disruptions in RA and to standardize reference landmarks for measuring erosion size.Methods.HR-pQCT images of metacarpophalangeal joints of RA and control subjects were used in an iterative process to achieve consensus on the definition and reference landmarks. Independent readers (n = 11) applied the definition to score 58 joints and measure pathologic erosions in 2 perpendicular multiplanar reformations for their maximum width and depth. Interreader reliability for erosion detection and variability in measurements between readers [root mean square coefficient of variation (RMSCV), intraclass correlation (ICC)] were calculated.Results.Pathologic erosions were defined as cortical breaks extending over a minimum of 2 consecutive slices in perpendicular planes, with underlying trabecular bone loss and a nonlinear shape. Interreader agreement for classifying pathologic erosions was 90.2%, whereas variability for width and depth erosion assessment was observed (RMSCV perpendicular width 12.3%, axial width 20.6%, perpendicular depth 24.0%, axial depth 22.2%; ICC perpendicular width 0.206, axial width 0.665, axial depth 0.871, perpendicular depth 0.783). Mean erosion width was 1.84 mm (range 0.16–8.90) and mean depth was 1.86 mm (range 0.30–8.00).Conclusion.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.

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.

Identification, localization and differentiation of erosions and physiological bone channels by ultrasound in rheumatoid arthritis patients

Rheumatology ◽  
2020 ◽  
Vol 59 (12) ◽  
pp. 3784-3792
Author(s):  
Stephanie Finzel ◽  
Philippe Aegerter ◽  
Georg Schett ◽  
Maria-Antonietta D’Agostino
Keyword(s):  
Rheumatoid Arthritis ◽  
Computed Tomography ◽  
Cortical Bone ◽  
Quantitative Computed Tomography ◽  
Peripheral Quantitative Computed Tomography ◽  
Bone Lesions ◽  
Lateral Part ◽  
Healthy Controls ◽  
Dorsal Part

Abstract Objectives Ultrasound (US) can detect cortical bone lesions in RA. However, not all cortical bone lesions are erosions. Herein, we aimed to define whether US can differentiate between physiological bone channels and pathological erosions in RA and to provide topographic description of their differential localization. Methods RA patients and healthy controls (HC) received US examination of the metacarpophalangeal (MCPJ) and proximal inter-phalangeal (PIPJ) joints adjudicating cortical bone lesions as physiological bone channels or pathological erosions. In a subset of RA patients and HC, high-resolution peripheral quantitative computed tomography (HR-pQCT) of the hand was performed to validate the classification of lesions. Results A total of 40 RA patients and 43 HC were enrolled and totally 771 MCPJ and 638 PIPJ were examined by US, and 94 and 51, respectively, by HR-pQCT. US-defined cortical bone lesions clustered in the lateral part of the MCP (50%) and the dorsal part of the PIPJ (66.7%) in RA. US-defined physiological bone channels clustered in the palmar parts of the MCPJ and PIPJ in both RA (78.8% and 100%, respectively) and HC (51.8% and 80%, respectively). HR-pQCT data confirmed US data with respect to adjudication of physiological bone channels and pathological erosions. Erosions were significantly (all P <0.000001) larger than physiological channels and preferentially localized at radial and ulnar sites, while physiological channels were clustered at palmar sites. Specificity of US was excellent for erosions in RA and for physiological bone channels in HC and RA. Conclusion US allows differentiation between physiological channels and bone erosions in RA.

Sign in / Sign up

Export Citation Format

Share Document