Quantitative In Vivo HR-pQCT Imaging of 3D Wrist and Metacarpophalangeal Joint Space Width in Rheumatoid Arthritis

Burghardt, Andrew J.; Lee, Chan Hee; Kuo, Daniel; Majumdar, Sharmila; Imboden, John B.; Link, Thomas M.; Li, Xiaojuan

doi:10.1007/s10439-013-0871-x

Cited by 61 publications

(53 citation statements)

References 39 publications

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“…This table illustrates that there is an overall agreement with measurements in other studies. 3,10,[19][20][21] The JSW of MCP joints with an SHS of one or more in our study matches the measurements by van 't Klooster in osteoarthritis (OA). 3 As a result of the short interval between consecutive images in early RA, the majority of joints had an unchanged SHS JSN (ΔSHS JSN ¼ 0) (Table 3).…”

Section: Resultssupporting

confidence: 77%

Validation of automatic joint space width measurements in hand radiographs in rheumatoid arthritis

et al. 2016

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Abstract. Computerized methods promise quick, objective, and sensitive tools to quantify progression of radiological damage in rheumatoid arthritis (RA). Measurement of joint space width (JSW) in finger and wrist joints with these systems performed comparable to the Sharp-van der Heijde score (SHS). A next step toward clinical use, validation of precision and accuracy in hand joints with minimal damage, is described with a close scrutiny of sources of error. A recently developed system to measure metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints was validated in consecutive hand images of RA patients. To assess the impact of image acquisition, measurements on radiographs from a multicenter trial and from a recent prospective cohort in a single hospital were compared. Precision of the system was tested by comparing the joint space in mm in pairs of subsequent images with a short interval without progression of SHS. In case of incorrect measurements, the source of error was analyzed with a review by human experts. Accuracy was assessed by comparison with reported measurements with other systems. In the two series of radiographs, the system could automatically locate and measure 1003/1088 (92.2%) and 1143/1200 (95.3%) individual joints, respectively. In joints with a normal SHS, the average (SD) size of MCP joints was 1.7 AE 0.2 and 1.6 AE 0.3 mm in the two series of radiographs, and of PIP joints 1.0 AE 0.2 and 0.9 AE 0.2 mm. The difference in JSW between two serial radiographs with an interval of 6 to 12 months and unchanged SHS was 0.0 AE 0.1 mm, indicating very good precision. Errors occurred more often in radiographs from the multicenter cohort than in a more recent series from a single hospital. Detailed analysis of the 55/1125 (4.9%) measurements that had a discrepant paired measurement revealed that variation in the process of image acquisition (exposure in 15% and repositioning in 57%) was a more frequent source of error than incorrect delineation by the software (25%). Various steps in the validation of an automated measurement system for JSW of MCP and PIP joints are described. The use of serial radiographs from different sources, with a short interval and limited damage, is helpful to detect sources of error. Image acquisition, in particular repositioning, is a dominant source of error. © The Authors. Published by SPIE under a Creative Commons Attribution 3.0 Unported License. Distribution or reproduction of this work in whole or in part requires full attribution of the original publication, including its DOI.

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Section: Resultssupporting

confidence: 77%

Validation of automatic joint space width measurements in hand radiographs in rheumatoid arthritis

et al. 2016

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“…6 Thirdly, a 3D assessment of joint space is described using quantitative analysis algorithms. 12,13 Fourthly, 3D measurement of bone microarchitecture in rheumatoid arthritis patients showed altered results with disease …”

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confidence: 99%

High-resolution peripheral quantitative CT in rheumatology

et al. 2015

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CORRESPONDENCEWe read with interest the Perspectives article by Filippucci et al. (Progress in imaging in rheumatology. Nat. Rev. Rheumatol. 10, 628-634;. 1 This article is a very informative concise paper on MRI and musculoskeletal ultrasono graphy. However, we were surprised that no mention was made of high-resolution peripheral quantitative CT (HR-pQCT), previously highlighted in a Review in this journal, 2 and we would like to call attention to its emerging potential in the field of advanced diagnostic imaging.HR-pQCT was initially developed to study bone diseases such as osteoporosis, and has contributed to a better understanding of the separate behavior of trabecular and cortical bone structures and the different cortical envelopes during ageing, in metabolic bone diseases and during fracture healing; 2 moreover, it allows for calculation of bone strength in vivo using finite-element analysis. 3 Due to its ability to evaluate bone in 3D at a high resolution (82 μm) and with minimal irradiation (5 μSv to image a 0.9 cm region of interest), HR-pQCT is being intensely investigated in the evaluation of bone architecture in the small joints of the hands in rheumatoid arthritis, 4-6 psori atic arthritis, 7 and hand osteoarthritis. 8 To what degree can this method now be rated as "progress in imaging" in rheumatology?Firstly, an increased number of, and earlier stages of, erosions are visible with HR-pQCT than on plain radiography, as evidenced by the work of Stach et al. 4 Secondly, quantification of erosions in terms of size (width, depth and volume) together with changes in trabecular bone is possible, and has been studied in crosssectional and longitudinal studies 5,9-11 and in comparison with MRI. 6 Thirdly, a 3D assessment of joint space is described using quantitative analysis algorithms. 12,13 Fourthly, 3D measurement of bone microarchitecture in rheumatoid arthritis patients showed altered results with disease High-resolution peripheral quantitative CT in rheumatologyCheryl Barnabe, Stephanie Finzel, Kathryn S. Stok and Piet Geusens activity. 14 None of these 3D parameters can currently be evaluated by other imaging techniques at such high resolution.In conclusion, HR-pQCT is, besides MRI and musculoskeletal ultrasonography, also promising "progress in imaging" for clinical research in rheumatic disease of the hand joints. SPECTRA (Study Group for X-treme CT in Rheumatoid Arthritis) 15 is an inter national collaboration between rheumatologists, radiologists, biomedical engineers, physicists and clinical researchers in bone metabolism and osteoimmunology that has provided fertile ground for crossdisciplinary research, united by the desire to certify the validity of the research findings from the application of this technology to the assessment of inflammatory arthritis.

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“…From a 3D quantitative analysis based on a semi-automatic segmentation method at the wrist and metacarpal joints, JS_min and JS_asym have already been considered as the most interesting biomarkers in rheumatoid arthritis. 29 The quantitative analysis based on CT images allowed us to have a real distribution of the JSW compared to an approach based on radiographs. 8,9,35 The semi-quantitative scoring of cartilage lesions based on CT arthrography has limitation with a low inter-observer agreement.…”

Section: Discussionmentioning

confidence: 99%

“…The complete process has been described in detail elsewhere and briefly described in the present paper. 29 In order to standardize the knee position, the specimen was reoriented by the user so that the tangent to the bicondylar femoral posterior line was positioned to be parallel to the X-axis. For smoothing the image and enhancing edges, an average filter was applied to the original CT DICOM grayscale images with a disk of eight pixels; thus, it was a possible to find a stable value of gray levels for separating bone from soft tissue for the whole stack of images.…”

Section: Joint Space Segmentationmentioning

confidence: 99%

Three‐dimensional mapping of the joint space for the diagnosis of knee osteoarthritis based on high resolution computed tomography: Comparison with radiographic, outerbridge, and meniscal classifications

Mezlini-Gharsallah

Youssef

et al. 2018

Journal Orthopaedic Research

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One of the most important characteristic of knee osteoarthritis (OA) is the joint space (JS) width narrowing. Measurements are usually performed on two dimensional (2D) X‐rays. We propose and validate a new method to assess the 3D joint space at the medial knee compartment using high resolution peripheral computed tomography images. A semi‐automated method was developed to obtain a distance 3D map between femur an tibia with the following parameters: volume, minimum, maximum, mean, standard deviation, median, asymmetry, and entropy. We analyzed 71 knee specimens (mean age: 85 years), radiographs were performed for the Kellgren Lawrence (KL) score grading. In a subgroup of 41 specimens, the histopathological Outerbridge and meniscal classifications were performed and then cores were harvested from the tibial plateau in three different positions (posterior, central, and peripheral) and imaged at 10 µm of resolution to measure the cartilage thickness. Minimum, maximum, mean, and median were statistically lower and entropy higher between knee specimens classified as KL = 0 and KL = 3–4. Gr1 and 2 were statistically different from Gr3‐4 for minimum, asymmetry, entropy using the Outerbridge classification and Gr1 was statistically different from Gr3–4 using the meniscal classification. Asymmetry, minimum, mean, median and entropy were significantly correlated with cartilage thickness. Parameters extracted from a 3D map of the medial joint space indicate local variations of JS and are related to local measurements of tibial cartilage thickness, and could be consequently useful to identify early OA. © 2018 The Authors. Journal of Orthopaedic Research® Published by Wiley Periodicals, Inc. on behalf of Orthopaedic Research Society. J Orthop Res 36:2380–2391, 2018.

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Quantitative In Vivo HR-pQCT Imaging of 3D Wrist and Metacarpophalangeal Joint Space Width in Rheumatoid Arthritis

Cited by 61 publications

References 39 publications

Validation of automatic joint space width measurements in hand radiographs in rheumatoid arthritis

Validation of automatic joint space width measurements in hand radiographs in rheumatoid arthritis

High-resolution peripheral quantitative CT in rheumatology

Three‐dimensional mapping of the joint space for the diagnosis of knee osteoarthritis based on high resolution computed tomography: Comparison with radiographic, outerbridge, and meniscal classifications

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