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Tse JJ, Contreras D, Salat P, Barber CEH, Hazlewood GS, Barnabe C, Penney C, Ibrahem A, Mosher D, Manske SL. Evaluating high-resolution computed tomography derived 3-D joint space metrics of the metacarpophalangeal joints between rheumatoid arthritis and age- and sex-matched control participants. Front Med (Lausanne) 2024; 11:1387532. [PMID: 38784224 PMCID: PMC11112086 DOI: 10.3389/fmed.2024.1387532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 04/16/2024] [Indexed: 05/25/2024] Open
Abstract
Introduction Rheumatoid arthritis (RA) is commonly characterized by joint space narrowing. High-resolution peripheral quantitative computed tomography (HR-pQCT) provides unparalleled in vivo visualization and quantification of joint space in extremity joints commonly affected by RA, such as the 2nd and 3rd metacarpophalangeal joints. However, age, sex, and obesity can also influence joint space narrowing. Thus, this study aimed to determine whether HR-pQCT joint space metrics could distinguish between RA patients and controls, and determine the effects of age, sex and body mass index (BMI) on these joint space metrics. Methods HR-pQCT joint space metrics (volume, width, standard deviation of width, maximum/minimum width, and asymmetry) were acquired from RA patients and age-and sex-matched healthy control participants 2nd and 3rd MCP joints. Joint health and functionality were assessed with ultrasound (i.e., effusion and inflammation), hand function tests, and questionnaires. Results HR-pQCT-derived 3D joint space metrics were not significantly different between RA and control groups (p > 0.05), despite significant differences in inflammation and joint function (p < 0.05). Joint space volume, mean joint space width (JSW), maximum JSW, minimum JSW were larger in males than females (p < 0.05), while maximum JSW decreased with age. No significant association between joint space metrics and BMI were found. Conclusion HR-pQCT did not detect group level differences between RA and age-and sex-matched controls. Further research is necessary to determine whether this is due to a true lack of group level differences due to well-controlled RA, or the inability of HR-pQCT to detect a difference.
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Affiliation(s)
- Justin J. Tse
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Dani Contreras
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Peter Salat
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Claire E. H. Barber
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Glen S. Hazlewood
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Cheryl Barnabe
- Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Chris Penney
- Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Ahmed Ibrahem
- Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Dianne Mosher
- Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Sarah L. Manske
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Mathiessen A, Onuoha I, Luh R, Driban JB, Roberts MB, Eaton CB, McAlindon TE, Duryea J. Radiographic joint space width in individuals with hand osteoarthritis: Are their "healthy" joints really healthy? Osteoarthritis Cartilage 2023:S1063-4584(23)00947-0. [PMID: 37865135 DOI: 10.1016/j.joca.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 10/08/2023] [Accepted: 10/09/2023] [Indexed: 10/23/2023]
Abstract
OBJECTIVES We aimed to investigate the systemic nature of hand osteoarthritis (OA). We hypothesized that people who suffer from hand OA would display narrower radiographic joint space width (JSW) - not only in joints with apparent radiographic OA but also in their unaffected "healthy" joints. METHOD We examined 3394 participants from the Osteoarthritis Initiative with available dominant hand radiographs at baseline. Cases were defined as having interphalangeal OA (IPOA) based on a Kellgren and Lawrence (KL) score of ≥2 in two or more finger joints, whereas controls did not have IPOA. We used custom software to make JSW measurements of the metacarpophalangeal, proximal interphalangeal, and distal interphalangeal joints in fingers 2-5 per hand. In joint-level analyses, we included only KL score=0, allowing us to compare all joints without IPOA in cases and controls. We used generalized estimating equation models to compare JSW between both groups, adjusted for age, gender, metacarpal length, and joint type. RESULTS Finger joints without radiographic OA had significantly narrower JSW in the IPOA group compared to finger joints in the control group (p < 0.001). The differences were significant across all joint types and for both total JSW measurements as well as for central and lateral sub-regions within each joint group (p < 0.001). CONCLUSION Unaffected finger joints in people with IPOA had narrower joint space than joints of healthy controls. This implies a systemic nature of hand OA, in which people may have a predisposition for general cartilage deterioration.
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Affiliation(s)
- Alexander Mathiessen
- Brigham and Women's Hospital, Boston, MA, USA; Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | | | - Rebecca Luh
- Brigham and Women's Hospital, Boston, MA, USA
| | | | - Mary B Roberts
- Center for Primary Care and Prevention, Kent Hospital, Warwick, RI, USA
| | - Charles B Eaton
- Department of Family Medicine Warren Alpert Medical School of Brown University, Providence, RI, USA; Department of Epidemiology, School of Public Health of Brown University, Providence, RI, USA
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The relationship between structural analysis of the hand and clinical characteristics in psoriatic arthritis. Sci Rep 2022; 12:18913. [PMID: 36344592 PMCID: PMC9640661 DOI: 10.1038/s41598-022-23555-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 11/02/2022] [Indexed: 11/09/2022] Open
Abstract
Up to now, there is only limited information available on a possible relationship between clinical characteristics and the mineralization of metacarpal bones and finger joint space distance (JSD) in patients with psoriatic arthritis (PsA). Computerized digital imaging techniques like digital X-ray radiogrammetry (DXR) and computer-aided joint space analysis (CAJSA) have significantly improved the structural analysis of hand radiographs and facilitate the recognition of radiographic damage. The objective of this study was to evaluate clinical features which potentially influence periarticular mineralization of the metacarpal bones and finger JSD in PsA-patients. 201 patients with PsA underwent computerized measurements of the metacarpal bone mineral density (BMD) with DXR and JSD of all finger joints by CAJSA. DXR-BMD and JSD were compared with clinical features such as age and sex, disease duration, C-reactive protein (CRP) as well as treatment with prednisone and disease-modifying antirheumatic drugs (DMARDs). A longer disease duration and an elevated CRP value were associated with a significant reduction of DXR-BMD, whereas JSD-parameters were not affected by both parameters. DXR-BMD was significantly reduced in the prednisone group (-0.0383 g/cm²), but prednisone showed no impact on finger JSD. Patients under the treatment with bDMARDs presented significant lower DXR-BMD (-0.380 g/cm²), JSDMCP (-0.0179 cm), and JSDPIP (-0.0121 cm) values. Metacarpal BMD was influenced by inflammatory activity, prednisone use, and DMARDs. In contrast, finger JSD showed only a change compared to baseline therapy. Therefore, metacarpal BMD as well as finger JSD represent radiographic destruction under different aspects.
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Minh NN, Nguyen NPT, Ngoc CN, Duy TT, Huy TN, Do BN, Viet TT. Application of ImageJ software for quantification of Hand Joint Space Narrowing in Patients with Rheumatoid Arthritis. Curr Rheumatol Rev 2021; 18:136-143. [PMID: 34080966 DOI: 10.2174/1573397117666210602113848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 02/01/2021] [Accepted: 03/16/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND ImageJ software is used to quantify the joint space width (JSW) of hand and wrist in patients with rheumatoid arthritis (RA) as well as in the healthy control group. METHOD Forty-one RA patients and 31 healthy controls are included in this study. All of 72 participants underwent digital radiography of the bilateral hand and wrist, then all the images were opened by ImageJ software to measure the width of wrist and hand joint space (total 2160 joints). Joint space narrowing (JSN) was defined if the width was less than the mean - 2SD of the control group. RESULT The mean JSW of all sites of wrist and hand joints of RA patients was significantly reduced as compared to those in the control group (p<0.001). There were 37/41 (90.24%) RA patients who had JSN in at least one joint in hand or wrist. In total, 70.89% of joints on the right and 68.46% of joints on the left wrist and hand had JSN. CONCLUSION ImageJ software was simple and convenient , which helps rheumatologists quantify the width of joint space for diagnosis and follow-up in RA patients.
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Affiliation(s)
- Nui Nguyen Minh
- Department of Rheumatology, Military Hospital 103, Hanoi, Vietnam
| | | | - Chau Nguyen Ngoc
- Department of Rheumatology, Military Hospital 103, Hanoi, Vietnam
| | - Tien Tran Duy
- Department of Rheumatology, Military Hospital 103, Hanoi, Vietnam
| | - Thong Nguyen Huy
- Department of Rheumatology, Military Hospital 103, Hanoi, Vietnam
| | - Binh Nhu Do
- Division of Military Science, Military Hospital 103, Hanoi, Vietnam
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Pfeil A, Oelzner P, Hoffmann T, Renz DM, Wolf G, Böttcher J. Sind röntgenologische Scoring-Methoden als Parameter zur
Verlaufsbeurteilung der rheumatoiden Arthritis noch
zeitgemäß? AKTUEL RHEUMATOL 2021. [DOI: 10.1055/a-1394-0299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
ZusammenfassungDie radiologische Progression beschreibt das Ausmaß der
Gelenkzerstörung im Verlauf einer rheumatoiden Arthritis. Zur
Quantifizierung der radiologischen Progression werden Scoring-Methoden
(z. B. van der Heijde Modifikation des Sharp-Score) eingesetzt. In
verschiedenen Studien zu biologischen- bzw. target-synthetischen Disease
Modifying Anti-Rheumatic Drugs gelang nur unzureichend eine Differenzierung
der radiologischen Progression. Zudem finden die Scores oft keinen
routinemäßigen Einsatz in der klinischen
Entscheidungsfindung. Durch die computerbasierte Analyse von
Handröntgenaufnahmen ist eine valide Quantifizierung der
radiologischen Progression und die zuverlässige Bewertung von
Therapieeffekten möglich. Somit stellen die computerbasierten
Methoden eine vielversprechende Alternative in der Quantifizierung der
radiologischen Progression dar.
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Affiliation(s)
- Alexander Pfeil
- Klinik für Innere Medizin III, Universitätsklinikum
Jena, Jena, Deutschland
| | - Peter Oelzner
- Klinik für Innere Medizin III, Universitätsklinikum
Jena, Jena, Deutschland
| | - Tobias Hoffmann
- Klinik für Innere Medizin III, Universitätsklinikum
Jena, Jena, Deutschland
| | - Diane M. Renz
- Institut für Diagnostische und Interventionelle Radiologie,
Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Gunter Wolf
- Klinik für Innere Medizin III, Universitätsklinikum
Jena, Jena, Deutschland
| | - Joachim Böttcher
- Medizinische Fakultät, Friedrich-Schiller-Universität
Jena, Jena, Deutschland
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Haghnegahdar A, Pakshir H, Ghanbari I. Correlation between Skeletal Age and Metacarpal Bones and Metacarpophalangeal Joints Dimensions. JOURNAL OF DENTISTRY (SHIRAZ, IRAN) 2019; 20:159-164. [PMID: 31579689 PMCID: PMC6732183 DOI: 10.30476/dentjods.2019.44904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Statement of the Problem: Currently, two major methods have been introduced for bone age assessment using left hand radiography. The first approach is Greulich and Pyle, which is very subjective. The second method is Tanner and Whitehouse, which is very time consuming and its morphological criteria are not quantitative, therefore it is hardly used.
Purpose: The purpose of this study is to evaluate the relationship between skeletal age and bone size and joint space measurements among Asian children using hand radiographs and using this correlation as an aid in determining bone age.
Materials and Method: In this analytic research, 304 hand radiographs from Asian children with normal development have been included in this study (155 female, 149 male). Two radiologists using Greulich and Pyle method assessed their bone ages. The 2nd-5th metacarpal bones length and width and 2nd-5th metacarpophalangeal joints width and length were manually measured by Adobe Photoshop and compared with subjects’ skeletal age. Pearson correlation was used to determine the relationship.
Results: Pearson correlation between bone age and metacarpal bones length was 0.902-0.938; metacarpal bones width was 0.452-0.850; metacarpophalangeal joints width was 0.656 - 0.811, and metacarpophalangeal joints length was 0.920 - 0.947.
Conclusion: Regarding Pearson correlation, metacarpophalangeal joints length, metacarpal bones length, metacarpophalangeal joints width, and metacarpal bones width showed significant relationship with bone age, respectively. These measurements can be used as accessory criteria for bone age assessment using left hand radiography, to reduce inter-observer reading differences.
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Affiliation(s)
- Abdolaziz Haghnegahdar
- Dept. of Maxillofacial Radiology, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamidreza Pakshir
- Dept. of Maxillofacial Orthodontics School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ilnaz Ghanbari
- Postgraduate Student Dept. of Oral and Maxillofacial Surgery, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
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Computer-Based Radiographic Quantification of Joint Space Narrowing Progression Using Sequential Hand Radiographs: Validation Study in Rheumatoid Arthritis Patients from Multiple Institutions. J Digit Imaging 2018; 30:648-656. [PMID: 28378032 DOI: 10.1007/s10278-017-9970-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
We have developed a refined computer-based method to detect joint space narrowing (JSN) progression with the joint space narrowing progression index (JSNPI) by superimposing sequential hand radiographs. The purpose of this study is to assess the validity of a computer-based method using images obtained from multiple institutions in rheumatoid arthritis (RA) patients. Sequential hand radiographs of 42 patients (37 females and 5 males) with RA from two institutions were analyzed by a computer-based method and visual scoring systems as a standard of reference. The JSNPI above the smallest detectable difference (SDD) defined JSN progression on the joint level. The sensitivity and specificity of the computer-based method for JSN progression was calculated using the SDD and a receiver operating characteristic (ROC) curve. Out of 314 metacarpophalangeal joints, 34 joints progressed based on the SDD, while 11 joints widened. Twenty-one joints progressed in the computer-based method, 11 joints in the scoring systems, and 13 joints in both methods. Based on the SDD, we found lower sensitivity and higher specificity with 54.2 and 92.8%, respectively. At the most discriminant cutoff point according to the ROC curve, the sensitivity and specificity was 70.8 and 81.7%, respectively. The proposed computer-based method provides quantitative measurement of JSN progression using sequential hand radiographs and may be a useful tool in follow-up assessment of joint damage in RA patients.
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Huo Y, Vincken KL, van der Heijde D, de Hair MJH, Lafeber FP, Viergever MA. Automatic Quantification of Radiographic Wrist Joint Space Width of Patients With Rheumatoid Arthritis. IEEE Trans Biomed Eng 2018; 64:2695-2703. [PMID: 28141515 DOI: 10.1109/tbme.2017.2659223] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Objective: Wrist joint space narrowing is a main radiographic outcome of rheumatoid arthritis (RA). Yet, automatic radiographic wrist joint space width (JSW) quantification for RA patients has not been widely investigated. The aim of this paper is to present an automatic method to quantify the JSW of three wrist joints that are least affected by bone overlapping and are frequently involved in RA. These joints are located around the scaphoid bone, viz. the multangular-navicular, capitate-navicular-lunate, and radiocarpal joints. Methods: The joint space around the scaphoid bone is detected by using consecutive searches of separate path segments, where each segment location aids in constraining the subsequent one. For joint margin delineation, first the boundary not affected by X-ray projection is extracted, followed by a backtrace process to obtain the actual joint margin. The accuracy of the quantified JSW is evaluated by comparison with the manually obtained ground truth. Results: Two of the 50 radiographs used for evaluation of the method did not yield a correct path through all three wrist joints. The delineated joint margins of the remaining 48 radiographs were used for JSW quantification. It was found that 90% of the joints had a JSW deviating less than 20% from the mean JSW of manual indications, with the mean JSW error less than 10%. Conclusion: The proposed method is able to automatically quantify the JSW of radiographic wrist joints reliably. SIGNIFICANCE The proposed method may aid clinical researchers to study the progression of wrist joint damage in RA studies.Objective: Wrist joint space narrowing is a main radiographic outcome of rheumatoid arthritis (RA). Yet, automatic radiographic wrist joint space width (JSW) quantification for RA patients has not been widely investigated. The aim of this paper is to present an automatic method to quantify the JSW of three wrist joints that are least affected by bone overlapping and are frequently involved in RA. These joints are located around the scaphoid bone, viz. the multangular-navicular, capitate-navicular-lunate, and radiocarpal joints. Methods: The joint space around the scaphoid bone is detected by using consecutive searches of separate path segments, where each segment location aids in constraining the subsequent one. For joint margin delineation, first the boundary not affected by X-ray projection is extracted, followed by a backtrace process to obtain the actual joint margin. The accuracy of the quantified JSW is evaluated by comparison with the manually obtained ground truth. Results: Two of the 50 radiographs used for evaluation of the method did not yield a correct path through all three wrist joints. The delineated joint margins of the remaining 48 radiographs were used for JSW quantification. It was found that 90% of the joints had a JSW deviating less than 20% from the mean JSW of manual indications, with the mean JSW error less than 10%. Conclusion: The proposed method is able to automatically quantify the JSW of radiographic wrist joints reliably. SIGNIFICANCE The proposed method may aid clinical researchers to study the progression of wrist joint damage in RA studies.
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Affiliation(s)
- Yinghe Huo
- Image Sciences Institute, University Medical Center Utrecht, Utrecht 3584, CX, The Netherlands
| | - Koen L Vincken
- Image Sciences InstituteUniversity Medical Center Utrecht
| | | | - Maria J H de Hair
- Department of Rheumatology and Clinical ImmunologyUniversity Medical Center Utrecht
| | - Floris P Lafeber
- Department of Rheumatology and Clinical ImmunologyUniversity Medical Center Utrecht
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Ichikawa S, Kamishima T, Sutherland K, Kasahara H, Shimizu Y, Fujimori M, Yasojima N, Ono Y, Kaneda T, Koike T. Semi-Automated Quantification of Finger Joint Space Narrowing Using Tomosynthesis in Patients with Rheumatoid Arthritis. J Digit Imaging 2017; 30:369-375. [PMID: 28105533 DOI: 10.1007/s10278-017-9949-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
The purpose of the study is to validate the semi-automated method using tomosynthesis images for the assessment of finger joint space narrowing (JSN) in patients with rheumatoid arthritis (RA), by using the semi-quantitative scoring method as the reference standard. Twenty patients (14 females and 6 males) with RA were included in this retrospective study. All patients underwent radiography and tomosynthesis of the bilateral hand and wrist. Two rheumatologists and a radiologist independently scored JSN with two modalities according to the Sharp/van der Heijde score. Two observers independently measured joint space width on tomosynthesis images using an in-house semi-automated method. More joints with JSN were revealed with tomosynthesis score (243 joints) and the semi-automated method (215 joints) than with radiography (120 joints), and the associations between tomosynthesis scores and radiography scores were demonstrated (P < 0.001). There was significant, negative correlation between measured joint space width and tomosynthesis scores with r = -0.606 (P < 0.001) in metacarpophalangeal joints and r = -0.518 (P < 0.001) in proximal interphalangeal joints. Inter-observer and intra-observer agreement of the semi-automated method using tomosynthesis images was in almost perfect agreement with intra-class correlation coefficient (ICC) values of 0.964 and 0.963, respectively. The semi-automated method using tomosynthesis images provided sensitive, quantitative, and reproducible measurement of finger joint space in patients with RA.
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Affiliation(s)
- Shota Ichikawa
- Graduate School of Health Sciences, Hokkaido University, North-12 West-5, Kita-ku, Sapporo, 060-0812, Japan
| | - Tamotsu Kamishima
- Faculty of Health Sciences, Hokkaido University, North-12 West-5, Kita-ku, Sapporo, 060-0812, Japan.
| | - Kenneth Sutherland
- Graduate School of Medicine, Hokkaido University, North-15 West-7, Kita-ku, Sapporo, 060-8638, Japan
| | - Hideki Kasahara
- Department of Rheumatology, Sapporo Medical Center NTT EC, South-1 West-15, Chuo-ku, Sapporo, 060-0061, Japan
| | - Yuka Shimizu
- Division of Rheumatology, Endocrinology and Nephrology, Graduate School of Medicine, Hokkaido University, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan
| | - Motoshi Fujimori
- Department of Health Sciences, Hokkaido University, North-12 West-5, Kita-ku, Sapporo, 060-0812, Japan
| | - Nobutoshi Yasojima
- Department of Radiology, Sapporo Medical Center NTT EC, South-1 West-15, Chuo-ku, Sapporo, 060-0061, Japan
| | - Yohei Ono
- Department of Radiology, Sapporo Medical Center NTT EC, South-1 West-15, Chuo-ku, Sapporo, 060-0061, Japan
| | - Takahiko Kaneda
- Graduate School of Health Sciences, Hokkaido University, North-12 West-5, Kita-ku, Sapporo, 060-0812, Japan
| | - Takao Koike
- Sapporo Medical Center NTT EC, South-1 West-15, Chuo-ku, Sapporo, 060-0061, Japan
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Huo Y, Vincken KL, van der Heijde D, De Hair MJH, Lafeber FP, Viergever MA. Automatic Quantification of Radiographic Finger Joint Space Width of Patients With Early Rheumatoid Arthritis. IEEE Trans Biomed Eng 2016; 63:2177-86. [DOI: 10.1109/tbme.2015.2512941] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Damman W, Kortekaas MC, Stoel BC, van 't Klooster R, Wolterbeek R, Rosendaal FR, Kloppenburg M. Sensitivity-to-change and validity of semi-automatic joint space width measurements in hand osteoarthritis: a follow-up study. Osteoarthritis Cartilage 2016; 24:1172-9. [PMID: 26876778 DOI: 10.1016/j.joca.2016.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 01/11/2016] [Accepted: 02/07/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess sensitivity-to-change and validity of longitudinal quantitative semi-automatic joint space width (JSW) measurements and to compare this method with semi-quantitative joint space narrowing (JSN) scoring in hand osteoarthritis (OA) patients. DESIGN Baseline and 2-year follow-up radiographs of 56 hand OA patients (mean age 62 years, 86% women) were used. JSN was scored 0-3 using the Osteoarthritis Research Society International atlas and JSW was quantified in millimetres (mm) in the second to fifth distal, proximal interphalangeal and metacarpal joints (DIPJs, PIPJs, MCPJs). Sensitivity-to-change was evaluated by calculating Standardized Response Means (SRMs). Change in JSW or JSN above the Smallest Detectable Difference (SDD) defined progression on joint level. To assess construct validity, progressed joints were compared by cross-tabulation and by associating baseline ultrasound variables with progression (using generalized estimating equations, adjusting for age and sex). RESULTS The JSW method detected statistically significant mean changes over 2.6 years (-0.027 mm (95%CI -0.01; -0.04), -0.024 mm (-0.01; -0.03), -0.021 mm (-0.01; -0.03) for DIPJs, PIPJs, MCPJs, respectively). Sensitivity-to-change was low (SRMs: 0.174, 0.168, 0.211, respectively). 9.1% (121/1336) of joints progressed in JSW, but 3.6% (48/1336) widened. 83 (6.2%) joints progressed in JSW only, 36 (2.7%) in JSN only and 37 (2.8%) in both methods. Progression in JSW showed weaker associations with baseline inflammatory ultrasound features than progression in JSN. CONCLUSIONS Assessment of progression in hand OA defined by JSW measurements is possible, but performs less well than progression defined by JSN scoring. Therefore, the value of JSW measurements in hand OA clinical trials remains questionable.
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Affiliation(s)
- W Damman
- Department of Rheumatology, Leiden University Medical Center (LUMC), Leiden, The Netherlands.
| | - M C Kortekaas
- Department of Rheumatology, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - B C Stoel
- Division of Image Processing, Department of Radiology, LUMC, Leiden, The Netherlands
| | - R van 't Klooster
- Division of Image Processing, Department of Radiology, LUMC, Leiden, The Netherlands
| | - R Wolterbeek
- Department of Medical Statistics, LUMC, Leiden, The Netherlands
| | - F R Rosendaal
- Department of Clinical Epidemiology, LUMC, Leiden, The Netherlands
| | - M Kloppenburg
- Department of Rheumatology, Leiden University Medical Center (LUMC), Leiden, The Netherlands
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Pfeil A, Oelzner P, Bornholdt K, Hansch A, Lehmann G, Renz DM, Wolf G, Böttcher J. Joint damage in rheumatoid arthritis: assessment of a new scoring method. Arthritis Res Ther 2013; 15:R27. [PMID: 23406946 PMCID: PMC3672701 DOI: 10.1186/ar4163] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2012] [Revised: 01/10/2013] [Accepted: 02/06/2013] [Indexed: 01/24/2023] Open
Abstract
INTRODUCTION The aim of this study was to assess a novel approach for the quantification of finger joint space narrowing and joint destruction in patients with rheumatoid arthritis (RA) focusing on the peripheral hand articulations. METHODS A total of 280 patients with verified RA underwent computerized semi-automated measurements of joint space distance at the finger articulations based on radiographs. The Z-Score, which can differentiate between joint space alterations caused by RA versus age/gender-related changes, was calculated as a comparative parameter. The severity of joint space narrowing was also quantified by the Sharp Score. Sensitivity and specificity of the Z-Score (based on joint space widths differentiated for each peripheral finger joint) were evaluated to reveal the potential for the occurrence of erosions. Additionally, the potential of the Z-Score regarding the differentiation of therapeutic effects on joint space widths in patients under a therapy of methotrexate versus leflunomide was performed. RESULTS The Z-Scores of finger articulations in patients with RA were generally decreased. Metacarpal-phalangeal (MCP) joint articulations showed a continuous significant decline of -1.65±0.30 standard deviations dependent on the Sharp Score. The proximal-interphalangeal joints also revealed a significant reduction of the Z-Score (-0.96±0.31 standard deviations). The sensitivity and specificity of MCP joint space distance for the detection of erosions were 85.4% versus 55.2%. The Sharp Score for joint space narrowing was not able to detect different treatments, whereas an accentuated stabilization of joint space narrowing could be identified for the Z-Score of the MCP joints in patients treated with leflunomide and methotrexate. CONCLUSION The Z-Scoring method based on computer-aided analysis of joint space widths was able to reliably quantify severity-dependent joint space narrowing in RA patients. In the future, calculation of a Z-Score based on gender-specific and age-specific reference data shows the potential for a surrogate marker of RA progression that comprehends the early identification of patients with RA, and in particular those with erosive course of the disease, enabling a timely therapeutic strategy for cartilage protection.
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Affiliation(s)
- Alexander Pfeil
- Department of Internal Medicine III, Jena University Hospital - Friedrich Schiller University Jena, Erlanger Allee 101, 07747 Jena, Germany
| | - Peter Oelzner
- Department of Internal Medicine III, Jena University Hospital - Friedrich Schiller University Jena, Erlanger Allee 101, 07747 Jena, Germany
| | - Klaus Bornholdt
- Sanofi-Aventis Deutschland GmbH, Potsdamer Straße 8, 10785 Berlin, Germany
| | - Andreas Hansch
- Institute of Diagnostic and Interventional Radiology, Jena University Hospital - Friedrich Schiller University Jena, Erlanger Allee 101, 07747 Jena, Germany
| | - Gabriele Lehmann
- Department of Internal Medicine III, Jena University Hospital - Friedrich Schiller University Jena, Erlanger Allee 101, 07747 Jena, Germany
| | - Diane M Renz
- Department of Diagnostic Radiology, Charité University Medicine Berlin, Campus Virchow Clinic, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Gunter Wolf
- Department of Internal Medicine III, Jena University Hospital - Friedrich Schiller University Jena, Erlanger Allee 101, 07747 Jena, Germany
| | - Joachim Böttcher
- Institute of Diagnostic and Interventional Radiology, SRH Wald-Klinikum Gera, Straße des Friedens 122, 07548 Gera, Germany
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Pfeil A, Renz DM, Hansch A, Kainberger F, Lehmann G, Malich A, Wolf G, Böttcher J. The usefulness of computer-aided joint space analysis in the assessment of rheumatoid arthritis. Joint Bone Spine 2012; 80:380-5. [PMID: 23245655 DOI: 10.1016/j.jbspin.2012.10.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Accepted: 10/26/2012] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Computer-aided joint space analysis (CAJSA) is a newly developed technique for the measurement of radiogeometrically detectable joint space widths of the metacarpal-phalangeal (JSD-MCP) and proximal-interphalangeal articulations (JSD-PIP). The aim of this study was to verify the sensitivity and specificity of these CAJSA measurements in the assessment of established RA. METHODS Four hundred and fifty-eight participants (248 healthy subjects, 210 RA patients) underwent computerized semi-automated measurements of the JSD-MCP and JSD-PIP articulations (CAJSA, Radiogrammetry Kit, Version 1.3.6) based on digitally performed radiographs. The Sharp joint space narrowing score was also performed to determine RA-related joint space narrowing. RESULTS The significant severity-dependent reduction for JSD-MCP was -44.0% and for JSD-PIP, -25.94% between Sharp scores 0 and 3. The sensitivity and specificity of JSD-MCP (total) was 88.1% versus 77.8%, respectively (AUC = 0.920; P < 0.001). Furthermore, JSD-PIP (total) revealed a lower sensitivity and specificity with 61.4% and 88.7% (AUC = 0.878; P < 0.001). CONCLUSION The CAJSA method presented a reliable assessment of disease-related joint space narrowing in patients suffering from RA with excellent sensitivity and specificity. By providing quantitative data, other scoring methods could be significantly improved, and thereby the accuracy of the diagnosis and a better therapeutic evaluation could be achieved.
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Affiliation(s)
- Alexander Pfeil
- Department of Internal Medicine III, Jena University Hospital, Friedrich Schiller University Jena, Erlanger Allee 101, 07747 Jena, Germany.
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Improved Fuzzy Entropy Algorithm for X-Ray Pictures Preprocessing. ARTIFICIAL INTELLIGENCE AND SOFT COMPUTING 2012. [DOI: 10.1007/978-3-642-29350-4_32] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
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Huétink K, van 't Klooster R, Kaptein BL, Watt I, Kloppenburg M, Nelissen RGHH, Reiber JHC, Stoel BC. Automatic radiographic quantification of hand osteoarthritis; accuracy and sensitivity to change in joint space width in a phantom and cadaver study. Skeletal Radiol 2012; 41:41-9. [PMID: 21311883 PMCID: PMC3223586 DOI: 10.1007/s00256-011-1110-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2010] [Revised: 01/06/2011] [Accepted: 01/18/2011] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To validate a newly developed quantification method that automatically detects and quantifies the joint space width (JSW) in hand radiographs. Repeatability, accuracy and sensitivity to changes in JSW were determined. The influence of joint location and joint shape on the measurements was tested. METHODS A mechanical micrometer set-up was developed to define and adjust the true JSW in an acrylic phantom joint and in human cadaver-derived phalangeal joints. Radiographic measurements of the JSW were compared to the true JSW. Repeatability, systematic error (accuracy) and sensitivity (defined as the smallest detectable difference (SDD)) were determined. The influence of joint position on the JSW measurement was assessed by varying the location of the acrylic phantom on the X-ray detector with respect to the X-ray beam and the influence of joint shape was determined by using morphologically different human cadaver joints. RESULTS The mean systematic error was 0.052 mm in the phantom joint and 0.210 mm in the cadaver experiment. In the phantom experiments, the repeatability was high (SDD = 0.028 mm), but differed slightly between joint locations (p = 0.046), and a change in JSW of 0.037 mm could be detected. Dependent of the joint shape in the cadaver hand, a change in JSW between 0.018 and 0.047 mm could be detected. CONCLUSIONS The automatic quantification method is sensitive to small changes in JSW. Considering the published data of JSW decline in the normal and osteoarthritic population, the first signs of OA progression with this method can be detected within 1 or 2 years.
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Affiliation(s)
- Kasper Huétink
- Department of Radiology, Leiden University Medical Center, 9600, 2300, RC Leiden, The Netherlands.
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Kwok WY, Bijsterbosch J, Malm SH, Biermasz NR, Huetink K, Nelissen RG, Meulenbelt I, Huizinga TWJ, van 't Klooster R, Stoel BC, Kloppenburg M. Validity of joint space width measurements in hand osteoarthritis. Osteoarthritis Cartilage 2011; 19:1349-55. [PMID: 21924370 DOI: 10.1016/j.joca.2011.08.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2011] [Revised: 08/24/2011] [Accepted: 08/29/2011] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate the validity of joint space width (JSW) measurements in millimeters (mm) in hand osteoarthritis (OA) patients by comparison to controls, grading of joint space narrowing (JSN), and clinical features. METHODS Hand radiographs of 235 hand OA patients (mean age 65 years, 83% women) and 471 controls were used. JSW was measured with semi-automated image analysis software in the distal, proximal interphalangeal and metacarpal joints (DIPJs, PIPJs and MCPJs). JSN (grade 0-3) was assessed using the osteoarthritis research society international (OARSI) atlas. Associations between the two methods and clinical determinants (presence of pain, nodes and/or erosions, decreased mobility) were assessed using Generalized Estimating Equations with adjustments for age, sex, body mass index (BMI) and mean width of proximal phalanx. RESULTS JSW was measured in 5631 joints with a mean JSW of 0.98 mm (standard deviation (SD) 0.21), being the smallest for DIPJs (0.70 (SD 0.25)) and largest for MCPJs (1.40 (SD 0.25)). The JSN=0 group had a mean JSW of 1.28 mm (SD 0.34), the JSN=3 group 0.17 mm (SD 0.23). Controls had larger JSW than hand OA patients (P-value<0.001). In hand OA, females had smaller JSW than men (β -0.08, (95% confidence interval (95% CI) -0.15 to -0.01)) and lower JSW was associated with the presence of pain, nodes, erosions and decreased mobility (adjusted β -0.21 (95% CI -0.27, -0.16), -0.37 (-0.40, -0.34), -0.61 (-0.68, -0.54) and -0.46 (-0.68, -0.24) respectively). These associations were similar for JSN in grades. CONCLUSION In hand OA the quantitative JSW measurement is a valid method to measure joint space and shows a good relation with clinical features.
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Affiliation(s)
- W Y Kwok
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
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Pfeil A, Hansch A, Sommerfeld J, Fröber R, Renz DM, Lehmann G, Malich A, Wolf G, Böttcher J. Reproducibility and influence of hand rotation on computer-aided joint space analysis. Joint Bone Spine 2011; 79:384-8. [PMID: 21963809 DOI: 10.1016/j.jbspin.2011.07.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Accepted: 07/25/2011] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Computer-aided joint space analysis (CAJSA) is a recently developed, semi-automated tool to aid in the measurement of joint space margins based on hand radiographs. The objective of this study is to verify the potential effect of hand rotation during X-ray imaging on the measurement of joint space width using CAJSA and to evaluate the reproducibility of the CAJSA technique in healthy subjects and in patients with rheumatoid arthritis. METHODS All joint space distance (JSD) measurements were performed using CAJSA-technology at the metacarpophalangeal articulation based on conventional and digital hand radiographs. RESULTS I. Hand rotation showed an effect on the reproducibility with CV ranging between 0.39% (angulation 1°) and 1.66% (angulation 19°). II. Regarding the overall reproducibility of the CAJSA method, the intra-radiograph reproducibility of JSD was calculated with CV=0.54% for conventional images and CV=0.38% for digital images. The inter-radiograph reproducibility error was observed with CV=0.66% (conventional images) and CV=0.63% (digital images). III. The study revealed a reproducibility for CAJSA measurements in RA ranging between 0.37% (JSD-MCP ring finger; van der Heijde-modification of the Sharp method score 1) to 1.37% (JSD-MCP index finger; van der Heijde-modification of the Sharp method score 3). CONCLUSION CAJSA measures JSD at the metacarpophalangeal articulation with high reproducibility in healthy subjects and in patients with differing stages of rheumatoid arthritis. Additional findings show that hand rotation during X-ray imaging has an impact on the CAJSA measurements; thus avoiding acquisition of hand radiographs with a rotation error of more than 15 degrees can be recommended.
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Abstract
Osteoarthritis occurs with the highest prevalence in the distal interphalangeal joint of the hand and has been divided into an erosive and a nonerosive form. The pathogenesis of the early stages of osteoarthritis is poorly understood, but considerable emphasis has been placed on the role of cartilage and subchondral bone as well as soft tissue structures such as collateral ligaments and tendons. Radiographic evaluation represents the most standardized method to quantify disease progression, with different systems having been developed for defining and grading radiographic features. This current concepts article examines the recent knowledge base regarding the etiology, pathogenesis, and evaluation of osteoarthritis of the distal interphalangeal joint.
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Pfeil A, Sommerfeld J, Fröber R, Lehmann G, Malich A, Hansch A, Wolf G, Böttcher J. Feasibility study of semi-automated measurements of finger joint space widths. Rheumatol Int 2010; 31:1349-54. [PMID: 20401484 DOI: 10.1007/s00296-010-1468-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2010] [Accepted: 03/12/2010] [Indexed: 11/26/2022]
Abstract
The purpose of this study is to evaluate technical feasibility based on image capturing conditions (film-focus distance (FFD), film sensitivity, film brand, exposure level and tube voltage) that potentially alter radiographs and consequently may influence the semi-automated measurement of joint space distance (JSD) by computer-aided joint space analysis (CAJSA) in rheumatoid arthritis and osteoarthritis. The radiographs of a left hand (deceased man) were acquired under systematically changing image capturing conditions (exposure level: 4-8 mAs; FFD: 90-130 cm; film sensitivity: 200/400 and tube voltage: 40-52 kV with different image modalities: conventional radiographs, original digital radiographs, digital print-outs). All JSD-measurements were performed with the CAJSA-technology (Radiogrammetry Kit, Version 1.3.6; Sectra; Sweden) at the metacarpal-phalangeal articulation. JSD-analysis was not influenced by changes of FFD, exposure level, film sensitivity or film brand. JSD showed significant variation caused by tube voltage (conventional: CV = 1.913% for Agfa and CV = 2.448% for Kodak; digital: CV = 0.741% for Philips print-outs and CV = 0.620% with original digital images versus CV = 2.185% for Siemens print-outs and 0.951% with original digital images). Computer-aided joint space analysis for JSD-measurements is unaffected by the following image capturing parameters: film-focus distance, film sensitivity, film brand and exposure level. An influence of tube voltage was detected in a lesser extent for original digital images compared to the printed digital as well as conventional versions. Consequently, a standardized tube voltage is essential for accurate reproductions of CAJSA-measurements in rheumatoid arthritis and osteoarthritis.
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Affiliation(s)
- Alexander Pfeil
- Department of Internal Medicine III, Friedrich-Schiller-University Jena, Erlanger Allee 101, 07747, Jena, Germany.
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Hand Radiograph Analysis and Joint Space Location Improvement for Image Interpretation. ACTA ACUST UNITED AC 2010. [DOI: 10.2478/v10149-010-0003-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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PFEIL ALEXANDER, SCHÄFER MAXL, LEHMANN GABRIELE, SEIDL BETTINAE, EIDNER THORSTEN, MALICH ANSGAR, RENZ DIANEM, OELZNER PETER, HANSCH ANDREAS, WOLF GUNTER, HEIN GERT, KAISER WERNERA, BÖTTCHER JOACHIM. Implementation of Z-Scores as an Age- and Sex-independent Parameter for Estimating Joint Space Widths in Rheumatoid Arthritis. J Rheumatol 2009; 36:717-23. [DOI: 10.3899/jrheum.080651] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Objective.To compare normative data of joint space distances (JSD) with the JSD of patients with rheumatoid arthritis (RA) as measured by computer-aided joint space analysis (CAJSA) at the metacarpophalangeal (MCP) articulations, and to differentiate age- and sex-related alterations from the disease-related joint space narrowing.Methods.In total, 256 healthy subjects and 248 patients with verified RA (following revised ACR criteria) underwent computerized semiautomated measurements of JSD (CAJSA, version 1.3.6) at the MCP articulation (JSD-MCP) based on digital radiographs. The Z-score, a comparative parameter that differentiates joint space alterations caused by RA-related cartilage destruction from age- and sex-related changes, was calculated.Results.Our data showed a relationship between measured joint space widths (MCP total and MCP thumb to little finger) and age for healthy subjects and also the RA group. The RA group revealed an age-related joint space narrowing that was surpassed by the RA-related narrowing of joint space widths classified by Sharp joint space narrowing score and resulting in smaller Z-scores for RA patients.Conclusion.The CAJSA technique seems to distinguish age-related JSD changes in healthy volunteers from RA-induced alterations. In addition the Z-score was also able to differentiate RA-dependent narrowing of JSD. Calculation of the Z-scores based on sex- and age-specific reference data may facilitate earlier identification of patients with RA, allowing initiation of a more optimal, individually adapted therapeutic strategy.
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Pfeil A, Hansch A, Lehmann G, Eidner T, Schäfer ML, Oelzner P, Renz DM, Wolf G, Hein G, Kaiser WA, Böttcher J. Impact of sex, age, body mass index and handedness on finger joint space width in patients with prolonged rheumatoid arthritis using computer-aided joint space analysis. Rheumatol Int 2008; 29:517-24. [DOI: 10.1007/s00296-008-0728-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2008] [Accepted: 09/12/2008] [Indexed: 11/24/2022]
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