Abstract
BackgroundTo study the reliability and validity of high-resolution peripheral quantitative CT (HR-pQCT) with microCT (μCT) as gold standard in the visual detection of cortical breaks in metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints.MethodsTen cadaveric fingers (10 MCP and 9 PIP joints) were imaged by HR-pQCT and μCT and visually analyzed by two independent readers. Intra- and interreader reliability were evaluated for the presence (yes/no, kappa statistics) and the total number (intraclass correlation coefficient, ICC) of cortical breaks. Sensitivity, specificity, positive and negative predictive value (PPV respectively NPV) of HR-pQCT in detecting cortical breaks were calculated.ResultsWith HR-pQCT, mean 149 cortical breaks were identified and with μCT mean 129 (p < 0.05). Intrareader reliability for the presence of a cortical break per quadrant was 0.52 (95 % CI 0.48–0.56) and 0.71 (95 % CI 0.67–0.75) for HR-pQCT and μCT, respectively, and for the total number of cortical breaks 0.61 (95 % CI 0.49–0.70) and 0.75 (95 % CI 0.68–0.82). Interreader reliability for the presence of a cortical break per quadrant was 0.37 (95 % CI 0.33–0.41) and 0.45 (95 % CI 0.41–0.49) for HR-pQCT and μCT, respectively, and for the number of cortical breaks 0.55 (95 % CI 0.43–0.65) and 0.54 (95 % CI 0.35–0.67). Sensitivity, specificity, PPV and NPV of HR-pQCT were 81.6, 64.0, 81.6, and 64 % respectively.ConclusionCortical breaks were commonly visualized in MCP and PIP joints with HR-pQCT and μCT. Reliability of both HR-pQCT and μCT was fair to moderate. HR-pQCT was highly sensitive to detect cortical breaks with μCT as gold standard.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-016-1148-y) contains supplementary material, which is available to authorized users.
Highlights
To study the reliability and validity of high-resolution peripheral quantitative computed tomography (CT) (HR-pQCT) with microCT as gold standard in the visual detection of cortical breaks in metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints
A study by Stach et al has demonstrated that high-resolution peripheral quantitative CT (HR-pQCT) is more sensitive than conventional radiographs (CR) in detecting cortical breaks in the hand joints in rheumatoid arthritis (RA) and in healthy controls [8]
We investigated the sensitivity of HR-pQCT in detecting cortical breaks with μCT as the gold standard and found a high sensitivity (81.6 %)
Summary
To study the reliability and validity of high-resolution peripheral quantitative CT (HR-pQCT) with microCT (μCT) as gold standard in the visual detection of cortical breaks in metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints. Peri-articular cortical breaks are one of the characteristic features of bone involvement in rheumatoid arthritis (RA) and predictors of further radiographic progression [1, 2]. Detection of cortical breaks is an important indicator for intensifying treatment in order to modify the disease course [3]. A study by Stach et al has demonstrated that HR-pQCT is more sensitive than CR in detecting cortical breaks in the hand joints in RA and in healthy controls [8]. The resolution of the HR-pQCT images can be of the same order as the thickness of the cortical bone in finger joints. In particular with thin cortices, the reliability, sensitivity and specificity of the measurements might be impaired and depend on the reader’s perception
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