Computerized Digital Imaging Techniques Provided by Digital X-ray Radiogrammetry as New Diagnostic Tool in Rheumatoid Arthritis

Böttcher, Joachim; Pfeil, Alexander; Rosholm, Anders; Schäfer, M.; Malich, Ansgar; Petrovitch, A.; Seidl, Bettina E.; Lehmann, G.; Mentzel, Hans‐Joachim; Hein, Gert; Wolf, Günter; Kaiser, Werner A.

doi:10.1007/s10278-006-0263-y

Cited by 33 publications

(21 citation statements)

References 29 publications

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“…Digital x-ray radiogrammetry (DXR) converts plain radiographs into high-resolution, digital images that are then analyzed for geometric dimensions by computer software. This method measures the total width of a bone and the medullary width at the midpoint of the metacarpal bone, and is typically used to calculate changes in the cortical bone (40). Various indices are then derived from this calculation, including the metacarpal index, the Garn index (defined as the cortical area), the Exton-Smith index (related to the cortical area and the surface area), and the Barnett and Nordin index (defined as the percentage of cortical thickness) (40 -42).…”

Section: Discussionmentioning

confidence: 99%

“…In more recent years, computer-based methods have been used to define cortical thickness on each side of the metacarpal shaft, after which cortical thickness was related to the width of the metacarpal shaft as a ratio. Most studies appear to have measured 3 metacarpal bones (6,38,40). DXR, which has been extensively employed in studies of osteoporosis and in RA, may combine a measure of cortical thickness with a measure of …”

Section: Discussionmentioning

confidence: 99%

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Denosumab prevents metacarpal shaft cortical bone loss in patients with erosive rheumatoid arthritis

Sharp¹,

Tsuji²,

Ory³

et al. 2010

Arthritis Care & Research

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Objective. Osteoclast-mediated bone loss in the hand predicts future bone erosions in patients with rheumatoid arthritis (RA). Osteoclast activity depends on RANKL, which is inhibited by denosumab, an investigational fully human monoclonal antibody against RANKL. We measured metacarpal shaft cortical bone thickness using a novel computer-based technique, digital x-ray radiogrammetry (DXR), to evaluate the effects of denosumab on cortical bone in RA. Methods. Patients (n ‫؍‬ 227) with active, erosive RA were randomized to receive subcutaneous denosumab 60 mg or 180 mg or placebo every 6 months. All patients received stable doses of methotrexate and daily calcium and vitamin D. For this blinded post hoc analysis (n ‫؍‬ 218), cortical bone loss was determined by DXR using computer-assisted measurement of cortical thickness and shaft width at 21 midshaft levels of the second through fourth metacarpal bones of both hands. Results. At 12 months, patients receiving denosumab had significantly less metacarpal bone loss versus placebo (denosumab 60 mg: ؊0.0034, denosumab 180 mg: 0.0001 gain, placebo: ؊0.0108; P < 0.01 for both denosumab doses). Twelve-month decreases from baseline greater than the smallest detectable change occurred in 2 patients in the denosumab 180 mg group, 9 patients in the denosumab 60 mg group, and 12 patients in the placebo group. Negative correlation was significant between static cortical thickness ratios and static erosion scores (6 and 12 months), and for placebo, between changes in erosion scores and changes in cortical thickness ratio. Conclusion. Twice-yearly injections of denosumab with ongoing methotrexate treatment significantly reduced cortical bone loss in RA patients for up to 12 months. These results add to the growing evidence supporting the clinical utility of DXR.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Denosumab prevents metacarpal shaft cortical bone loss in patients with erosive rheumatoid arthritis

Sharp¹,

Tsuji²,

Ory³

et al. 2010

Arthritis Care & Research

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“…Recently, normative data for the finger articulations were published, and a strong relationship between age and joint space narrowing was revealed [18][19][20] . Studies have consistently shown evidence of decreased joint space widths dependent on the severity of RA, and have demonstrated the excellent reproducibility of the MCP articulation by the CAJSA technique 15,16 .…”

mentioning

confidence: 98%

“…In particular, CAD techniques have been developed for estimating periarticular demineralization based on digital X-ray radiogrammetry [7][8][9] ; some studies have also reported a measurement of erosion size 6,10,11 and joint space width 5,[10][11][12][13][14][15][16][17] .…”

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confidence: 99%

Implementation of Z-Scores as an Age- and Sex-independent Parameter for Estimating Joint Space Widths in Rheumatoid Arthritis

Pfeil

Schäfer²,

Lehmann³

et al. 2009

J Rheumatol

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The CAJSA technique seems to distinguish age-related JSD changes in healthy volunteers from RA-induced alterations. In addition the Z-score was also able to differentiate RA-dependent narrowing of JSD. Calculation of the Z-scores based on sex- and age-specific reference data may facilitate earlier identification of patients with RA, allowing initiation of a more optimal, individually adapted therapeutic strategy.

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“…In comparison to established scoring methods, CAJSA has the advantage of quantitative parameters that supplement the established scoring methods diagnosing rheumatoid arthritis by precise, observer-independent and reproducible data. Such a reliable and cost-eVective diagnostic CAD-tool may optimize a more precise/eVective monitoring of RA before erosions and advanced joint destruction can occur [21,30].…”

Section: Reproducibility Of Computer-aided Joint Space Analysismentioning

confidence: 99%

Feasibility study of semi-automated measurements of finger joint space widths

et al. 2010

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The purpose of this study is to evaluate technical feasibility based on image capturing conditions (film-focus distance (FFD), film sensitivity, film brand, exposure level and tube voltage) that potentially alter radiographs and consequently may influence the semi-automated measurement of joint space distance (JSD) by computer-aided joint space analysis (CAJSA) in rheumatoid arthritis and osteoarthritis. The radiographs of a left hand (deceased man) were acquired under systematically changing image capturing conditions (exposure level: 4-8 mAs; FFD: 90-130 cm; film sensitivity: 200/400 and tube voltage: 40-52 kV with different image modalities: conventional radiographs, original digital radiographs, digital print-outs). All JSD-measurements were performed with the CAJSA-technology (Radiogrammetry Kit, Version 1.3.6; Sectra; Sweden) at the metacarpal-phalangeal articulation. JSD-analysis was not influenced by changes of FFD, exposure level, film sensitivity or film brand. JSD showed significant variation caused by tube voltage (conventional: CV = 1.913% for Agfa and CV = 2.448% for Kodak; digital: CV = 0.741% for Philips print-outs and CV = 0.620% with original digital images versus CV = 2.185% for Siemens print-outs and 0.951% with original digital images). Computer-aided joint space analysis for JSD-measurements is unaffected by the following image capturing parameters: film-focus distance, film sensitivity, film brand and exposure level. An influence of tube voltage was detected in a lesser extent for original digital images compared to the printed digital as well as conventional versions. Consequently, a standardized tube voltage is essential for accurate reproductions of CAJSA-measurements in rheumatoid arthritis and osteoarthritis.

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Computerized Digital Imaging Techniques Provided by Digital X-ray Radiogrammetry as New Diagnostic Tool in Rheumatoid Arthritis

Cited by 33 publications

References 29 publications

Denosumab prevents metacarpal shaft cortical bone loss in patients with erosive rheumatoid arthritis

Denosumab prevents metacarpal shaft cortical bone loss in patients with erosive rheumatoid arthritis

Implementation of Z-Scores as an Age- and Sex-independent Parameter for Estimating Joint Space Widths in Rheumatoid Arthritis

Feasibility study of semi-automated measurements of finger joint space widths

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