Prospective Follow-Up of Cortical Interruptions, Bone Density, and Micro-structure Detected on HR-pQCT: A Study in Patients with Rheumatoid Arthritis and Healthy Subjects

Peters, M.; Bergh, Joop van den; Geusens, Piet; Scharmga, A.; Loeffen, D.; Weijers, R.; Rietbergen, Bert van; Tubergen, Astrid van

doi:10.1007/s00223-019-00523-2

Cited by 21 publications

(22 citation statements)

References 31 publications

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“…Erosions are most abundant in patients with RA (3,4,16,33,52,54,55,57,64,65,69), especially ACPA and rheumatoid factor (RF) positive RA patients (26). The erosions exhibit a clear predilection for the radial and ulnar quadrant of the 2nd and 3rd MCP joints.…”

Section: Erosion Detection By Hr-pqctmentioning

confidence: 99%

“…However, manual scoring is laborious and requires substantial training and standardization. An automated detection algorithm has been developed, named the Cortical Interruption Detection Algorithm (39,40,52,53,64). The Cortical Interruption Detection Algorithm detects the presence of cortical interruptions, directing the reader to lesion locations to verify that they meet the erosion definition as opposed to those that merely represent physiological breaks in the cortical bone, i.e., vascular channels ( Figure 4A) or stack misalignment ( Figure 4B) and osteophyte formation ( Figure 4C).…”

Section: Erosion Detection By Hr-pqctmentioning

confidence: 99%

“…Fifteen studies have reported longitudinal changes in the number and/or size of erosions. Of these, three investigated PsA (14,49,66), 10 investigated patients with RA (6,10,15,29,42,46,58,59,64,65), and one study examined ACPA+ individuals without arthritis (62). Seven studies investigated intervention with different therapies either as an open-label study or secondary analysis in a randomized controlled trial.…”

Section: Longitudinal Changes Of the Pathological Measuresmentioning

confidence: 99%

“…Five of the seven studies were done on patients with RA (12,19,43,55,69), and two in PsA (21,60). In patients with established RA, two studies of patients with mean disease duration more than 5 years did not detect any change in erosions at 1-year follow-up (10,64). However, longitudinal changes are diverse.…”

Section: Longitudinal Changes Of the Pathological Measuresmentioning

confidence: 99%

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High-Resolution Peripheral Quantitative Computed Tomography for Bone Evaluation in Inflammatory Rheumatic Disease

et al. 2020

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High resolution peripheral quantitative computed tomography (HR-pQCT) is a 3-dimensional imaging modality with superior sensitivity for bone changes and abnormalities. Recent advances have led to increased use of HR-pQCT in inflammatory arthritis to report quantitative volumetric measures of bone density, microstructure, local anabolic (e.g., osteophytes, enthesiophytes) and catabolic (e.g., erosions) bone changes and joint space width. These features may be useful for monitoring disease progression, response to therapy, and are responsive to differentiating between those with inflammatory arthritis conditions and healthy controls. We reviewed 69 publications utilizing HR-pQCT imaging of the metacarpophalangeal (MCP) and/or wrist joints to investigate arthritis conditions. Erosions are a marker of early inflammatory arthritis progression, and recent work has focused on improvement and application of techniques to sensitively identify erosions, as well as quantifying erosion volume changes longitudinally using manual, semi-automated and automated methods. As a research tool, HR-pQCT may be used to detect treatment effects through changes in erosion volume in as little as 3 months. Studies with 1-year follow-up have demonstrated progression or repair of erosions depending on the treatment strategy applied. HR-pQCT presents several advantages. Combined with advances in image processing and image registration, individual changes can be monitored with high sensitivity and reliability. Thus, a major strength of HR-pQCT is its applicability in instances where subtle changes are anticipated, such as early erosive progression in the presence of subclinical inflammation. HR-pQCT imaging results could ultimately impact decision making to uptake aggressive treatment strategies and prevent progression of joint damage. There are several potential areas where HR-pQCT evaluation of inflammatory arthritis still requires development. As a highly sensitive imaging technique, one of the major challenges has been motion artifacts; Klose-Jensen et al. HR-pQCT for Inflammatory Rheumatic Disease motion compensation algorithms should be implemented for HR-pQCT. New research developments will improve the current disadvantages including, wider availability of scanners, the field of view, as well as the versatility for measuring tissues other than only bone. The challenge remains to disseminate these analysis approaches for broader clinical use and in research.

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Section: Erosion Detection By Hr-pqctmentioning

confidence: 99%

Section: Erosion Detection By Hr-pqctmentioning

confidence: 99%

Section: Longitudinal Changes Of the Pathological Measuresmentioning

confidence: 99%

Section: Longitudinal Changes Of the Pathological Measuresmentioning

confidence: 99%

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High-Resolution Peripheral Quantitative Computed Tomography for Bone Evaluation in Inflammatory Rheumatic Disease

et al. 2020

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“…These artifacts may increase the difficulty in analyzing bone erosions that span two stacks by causing a misalignment, thereby impacting determination of the erosion volume, and potentially impacting the assessment of the presence of an erosion. Prior studies have addressed this issue by only analyzing erosions contained within a single stack, or by discarding scans with stack shift artifacts [14][15][16]. In a study that proposes an automated method for quantifying longitudinal changes in erosions using 3D registration, 43% of HR-pQCT scans of the MCP joints had to be excluded due to severe motion artifact [6].…”

Section: Introductionmentioning

confidence: 99%

The utility of multi-stack alignment and 3D longitudinal image registration to assess bone remodeling in rheumatoid arthritis patients from second generation HR-pQCT scans

et al. 2020

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Background: Medical imaging plays an important role in determining the progression of joint damage in rheumatoid arthritis (RA). High resolution peripheral quantitative computed tomography (HR-pQCT) is a sensitive tool capable of evaluating bone microarchitecture and erosions, and 3D rigid image registration can be used to visualize and quantify bone remodeling over time. However, patient motion during image acquisition can cause a "stack shift" artifact resulting in loss of information and reducing the number of erosions that can be analyzed using HR-pQCT. The purpose of this study was to use image registration to improve the number of useable HR-pQCT scans and to apply image-based bone remodeling assessment to the metacarpophalangeal (MCP) joints of RA patients. Methods: Ten participants with RA completed HR-pQCT scans of the 2nd and 3rd MCP joints at enrolment to the study and at a 6-month follow-up interval. At 6-months, an additional repeat scan was acquired to evaluate reliability. HR-pQCT images were acquired in three individual 1 cm acquisitions (stacks) with a 25% overlap. We completed analysis first using standard evaluation methods, and second with multi-stack registration. We assessed whether additional erosions could be evaluated after multi-stack registration. Bone remodeling analysis was completed using registration and transformation of baseline and follow-up images. We calculated the bone formation and resorption volume fractions with 6-month follow-up, and same-day repositioning as a negative control.

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The clinical application of high-resolution peripheral computed tomography (HR-pQCT) in adults: state of the art and future directions

et al. 2021

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High-resolution peripheral computed tomography (HR-pQCT) was developed to image bone microarchitecture in vivo at peripheral skeletal sites. Since the introduction of HR-pQCT in 2005, clinical research to gain insight into pathophysiology of skeletal fragility and to improve prediction of fractures has grown. Meanwhile, the second-generation HR-pQCT device has been introduced, allowing novel applications such as hand joint imaging, assessment of subchondral bone and cartilage thickness in the knee, and distal radius fracture healing. This article provides an overview of the current clinical applications and guidance on interpretation of results, as well as future directions. Specifically, we provide an overview of (1) the differences and reference data for HR-pQCT variables by age, sex, and race/ethnicity;(2) fracture risk prediction using HR-pQCT; (3) the ability to monitor response of anti-osteoporosis therapy with HR-pQCT; (4) the use of HR-pQCT in patients with metabolic bone disorders and diseases leading to secondary osteoporosis; and (5) novel applications of HR-pQCT imaging. Finally, we summarize the status of the application of HR-pQCT in clinical practice and discuss future directions. From the clinical perspective, there are both challenges and opportunities for more widespread use of HR-pQCT. Assessment of bone microarchitecture by HR-pQCT improves fracture prediction in mostly normal or osteopenic elderly subjects beyond DXA of the hip, but the added value is marginal. The prospects of HR-pQCT in clinical practice need further study with respect to medication effects, metabolic bone disorders, rare bone diseases, and other applications such as hand joint imaging and fracture healing. The mostly unexplored potential may be the differentiation of patients with only moderately low BMD but severe microstructural deterioration, which would have important implications for the decision on therapeutical interventions.

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Prospective Follow-Up of Cortical Interruptions, Bone Density, and Micro-structure Detected on HR-pQCT: A Study in Patients with Rheumatoid Arthritis and Healthy Subjects

Cited by 21 publications

References 31 publications

High-Resolution Peripheral Quantitative Computed Tomography for Bone Evaluation in Inflammatory Rheumatic Disease

High-Resolution Peripheral Quantitative Computed Tomography for Bone Evaluation in Inflammatory Rheumatic Disease

The utility of multi-stack alignment and 3D longitudinal image registration to assess bone remodeling in rheumatoid arthritis patients from second generation HR-pQCT scans

The clinical application of high-resolution peripheral computed tomography (HR-pQCT) in adults: state of the art and future directions

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