Quantification of periarticular demineralization in rheumatoid arthritis by digital X-ray radiogrammetry (DXR) and peripheral quantitative computed tomography (pQCT)Keywords DXR Á Rheumatoid arthritis Á Peripheral quantitative computed tomography Á Bone mineral density Purpose Rheumatoid arthritis as a chronic and inflammatory disease of the hand is associated with a periarticular bone loss [1, 2]. Advances in established techniques and the implementation of new computer-aided diagnosis (CAD) methods in the field of osteodensitometry have widened the spectrum of diagnostic tools available for assessing bone mineral density (BMD) in different body regions. The most established techniques used for estimating BMD in the routine clinical setting include quantitative computed tomography, quantitative ultrasound, and dual-energy X-ray absorptiometry (DXA). Digital X-ray radiogrammetry (DXR) is a recently developed CAD tool for automatically assessing cortical mineralization. The aim of this study was to evaluate changes of bone mineral density using the radiogrammetrically based densitometric technology (DXR) in patients suffering from rheumatoid arthritis and to compare this technique with findings of peripheral quantitative computed tomography (pQCT). Methods Ninety patients with a verified RA, following the criteria of the American College of Rheumatology [3], underwent a prospective analysis of their BMD. Bone mineralization was assessed using DXR and pQCT. Digital X-ray radiogrammetry (DXR, Pronosco X-Posure System TM , Version 2.0; Sectra, Linköping, Sweden) was applied to quantify bone mineral density (BMD in g/cm 2 ) based on radiographs of the hand in an anterior-posterior projection. The radiographs were digitized by a scanner. CAD analysis was performed without user interaction. DXR-BMD was measured on the three middle metacarpals. To locate the diaphysis of the metacarpals in the radiographs, Pronosco X-posure used a well-established model-based algorithm known as the active shape model (ASM). After each diaphysis had been identified, the computer algorithm automatically defined regions of interest (ROIs) for measurements at the narrowest parts of the diaphysis of the index, middle, and ring finger metacarpals. PQCT-BMD (Version 3.3; Stratec Medizintechnik GmbH, Pforzheim, Germany) was calculated of the distal radius and differentiated in total, trabecular, and cortical BMD. The clinical severity of RA was assessed using the Larsen Score.
ResultsThe mean value of DXR-BMD decreased from 0.57 g/cm 2 ± 0.08 (Larsen Score 1) to 0.45 g/cm 2 ± 0.11 (Larsen Score 5). The relative decrease of BMD measured by DXR between the highest and the lowest score was 20% (p \ 0.05). The relative decrease of BMD (pQCT) from Larsen Score 1 to Score 5 also showed a significant result regarding pQCT-BMD (trabecular; as the most metabolic active bone tissue) with 16% (p \ 0.05). No significant changes in the demineralization were confirmed for pQCT-BMD (total) with 12% and for pQCT-BMD (cortical) with 2%. Conclusion