Abstract
ObjectivesTo develop a scoring method to visually score cortical interruptions in finger joints on High-Resolution peripheral Quantitative Computed Tomography (HR-pQCT), determine its intra- and inter-reader reliability and test its feasibility.MethodsThe scoring method was developed by integrating results from in-depth discussions with experts, consensus meetings, multiple reading experiments and the literature. Cortical interruptions were scored by two independent readers in an imaging dataset with finger joints from patients with rheumatoid arthritis (RA) and healthy controls and assessed for adjacent trabecular distortion. Reliability for the total number of cortical interruptions per joint and per quadrant was calculated using intraclass correlation coefficient (ICC). Feasibility was tested by recording the time to analyze one joint.ResultsIn 98 joints we identified 252 cortical interruptions, 17% had trabecular distortion. Mean diameter of the interruptions was significantly larger in patients with RA compared with healthy controls (0.88 vs 0.47 mm, p = 0.03). Intra-reader reliability was ICC 0.88 (95% CI 0.83;0.92) per joint and ICC 0.69 (95% CI 0.65;0.73) per quadrant. Inter-reader reliability was ICC 0.48 (95% CI 0.20;0.67) per joint and ICC 0.56 (95% CI 0.49;0.62) per quadrant. The time to score one joint was mean 9.2 (SD 4.9) min.ConclusionsThis scoring method allows detection of small cortical interruptions on HR-pQCT imaging of finger joints, which is promising for use in clinical studies.
Highlights
High-Resolution peripheral Quantitative Computed Tomography (HR-pQCT) is a non-invasive imaging technique enabling three dimensional analysis of bone microarchitecture at an isotropic voxel size of 82 microns and a spatial resolution of 130 microns
In 98 joints we identified 252 cortical interruptions, 17% had trabecular distortion
Development of a scoring method to visually score cortical interruptions funding was used to perform the study (NL42300.068.12 / METC 12-2-037) of HR-pQCT imaging in patients with rheumatoid arthritis (RA) compared to conventional imaging techniques
Summary
High-Resolution peripheral Quantitative Computed Tomography (HR-pQCT) is a non-invasive imaging technique enabling three dimensional analysis of bone microarchitecture at an isotropic voxel size of 82 microns and a spatial resolution of 130 microns. With HR-pQCT, very small cortical interruptions of less than 0.5 mm can be detected [1,2]. These cortical interruptions can be physiological, e.g. vascular channels or pathological, e.g. erosions in rheumatic diseases [3]. A validated visual scoring method for HR-pQCT images that incorporates all cortical interruptions, including vascular channels and erosions, is lacking. Such a scoring system could aid in making a distinction between (small) physiological vascular channels and pathological erosions, which may be accompanied by adjacent trabecular distortion [3]
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