Detection of Fine Radiographic Progression in Finger Joint Space Narrowing Beyond Human Eyes: Phantom Experiment and Clinical Study with Rheumatoid Arthritis Patients

Abstract

The visual assessment of joint space narrowing (JSN) on radiographs of rheumatoid arthritis (RA) patients such as the Genant-modified Sharp score (GSS) is widely accepted but limited by its subjectivity and insufficient sensitivity. We developed a software application which can assess JSN quantitatively using a temporal subtraction technique for radiographs, in which the chronological change in JSN between two radiographs was defined as the joint space difference index (JSDI). The aim of this study is to prove the superiority of the software in terms of detecting fine radiographic progression in finger JSN over human observers. A micrometer measurement apparatus that can adjust arbitrary joint space width (JSW) in a phantom joint was developed to define true JSW. We compared the smallest detectable changes in JSW between the JSDI and visual assessment using phantom images. In a clinical study, 222 finger joints without interval score change on GSS in 15 RA patients were examined. We compared the JSDI between joints with and without synovial vascularity (SV) on power Doppler ultrasonography during the follow-up period. True JSW difference was correlated with JSDI for JSW differences ranging from 0.10 to 1.00 mm at increments of 0.10 mm (R 2 = 0.986 and P < 0.001). Rheumatologists were difficult to detect JSW difference of 0.30 mm or less. The JSDI of finger joints with SV was significantly higher than those without SV (P = 0.030). The software can detect fine differences in JSW that are visually unrecognizable.

Recent Developments in Clinical Applications of Mesenchymal Stem Cells in the Treatment of Rheumatoid Arthritis and Osteoarthritis

“…The second is that the resistance to apoptosis due to defects in tumor protein p53 triggers the hyperplastic synovium ( 53 , 134 ). Here, the shortage of chondrocytes caused by apoptosis would result in cartilage degeneration and joint-space narrowing via directed adhesion and invasion ( 53 , 135 , 136 ).…”

Quantification of Joint Space Width Difference on Radiography Via Phase-Only Correlation (POC) Analysis: a Phantom Study Comparing with Various Tomographical Modalities Using Conventional Margin-Contouring

“…During the early stages of RA, JSN progression is usually less than 1 mm in 3 months [19]. Previous research could effectively detect changes only after waiting for a period of at least 1 or 2 years as human's minimum detectable change for joint space is about 0.4 mm [40]. In this phantom study, the measurement of 0.1 mm intervals had strong correlation and the SDC was as small as 0.02 mm on radiography postprocessed with POC.…”

Evaluation of the Therapeutic Potential of Mesenchymal Stem Cells (MSCs) in Preclinical Models of Autoimmune Diseases

“…A few clinical studies are available in the public domain (http://www .clinicaltrials.gov.) that evaluate the safety and efficacy of MSC-based therapy in RA, and some are still ongoing [10,[58][59][60][61]. So far, these proof-of-concept clinical translation studies have demonstrated promising results in terms of pathology resolution, safety, and efficacy with no to limited adverse events in patients with long histories of RA and particularly in refractory RA patients [59,61].…”