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Tse JJ, Brunet SC, Salat P, Hazlewood GS, Barnabe C, Manske SL. Multi-Modal Imaging to Assess the Interaction Between Inflammation and Bone Damage Progression in Inflammatory Arthritis. Front Med (Lausanne) 2020; 7:545097. [PMID: 33102498 PMCID: PMC7544988 DOI: 10.3389/fmed.2020.545097] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 08/26/2020] [Indexed: 12/12/2022] Open
Abstract
Combining results from multiple imaging techniques (i.e., multi-modal imaging) through image registration can result in the better characterization of joint tissue characteristics. In the context of inflammatory arthritis conditions, high-resolution peripheral quantitative computed tomography (HR-pQCT) provides excellent bone contrast while magnetic resonance imaging (MRI) provides superior contrast and resolution of soft tissue and inflammatory characteristics. Superimposing these imaging results upon each other provides a robust characterization of the joint. In a preliminary study of nine rheumatoid arthritis (RA) participants in clinical remission, we acquired HR-pQCT and MR images of their 2nd and 3rd metacarpophalangeal (MCP) joints at two timepoints 6 months apart. We present the benefits of a multi-modal imaging approach, in which we demonstrate the ability to localize regions of inflammation with subtle changes in bone erosion volume. Using HR-pQCT and MRI to visualize bone damage and inflammation, respectively, will improve our understanding of the impact that subclinical inflammation has on bone damage progression, and demonstrating if bone repair occurs where inflammation is resolved. The presented multi-modal imaging technique has the potential to study the progression of bone damage in relation to inflammation that otherwise would not be possible with either imaging technique alone. The multi-modal image registration technique will be helpful to understanding the development and pathogenesis of RA-associated bone erosions. Additionally, multi-modal imaging may provide a technique to probe the tissue-level changes that occur as a result of treatment regimes.
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Affiliation(s)
- Justin J Tse
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Cumming School of Medicine, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada
| | - Scott C Brunet
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Cumming School of Medicine, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada.,Biomedical Engineering Graduate Program, Schulich School of Engineering, University of Calgary, Calgary, AB, Canada
| | - Peter Salat
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Cumming School of Medicine, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada
| | - Glen S Hazlewood
- Cumming School of Medicine, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada.,Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Cheryl Barnabe
- Cumming School of Medicine, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada.,Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Sarah L Manske
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Cumming School of Medicine, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada.,Biomedical Engineering Graduate Program, Schulich School of Engineering, University of Calgary, Calgary, AB, Canada
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Klose-Jensen R, Tse JJ, Keller KK, Barnabe C, Burghardt AJ, Finzel S, Tam LS, Hauge EM, Stok KS, Manske SL. High-Resolution Peripheral Quantitative Computed Tomography for Bone Evaluation in Inflammatory Rheumatic Disease. Front Med (Lausanne) 2020; 7:337. [PMID: 32766262 PMCID: PMC7381125 DOI: 10.3389/fmed.2020.00337] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 06/05/2020] [Indexed: 12/25/2022] Open
Abstract
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; 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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Affiliation(s)
- Rasmus Klose-Jensen
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Justin J Tse
- Cumming School of Medicine, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada.,Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Cheryl Barnabe
- Cumming School of Medicine, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada.,Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Andrew J Burghardt
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
| | - Stephanie Finzel
- Department of Rheumatology and Clinical Immunology, Medical Centre - University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Lai-Shan Tam
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Ellen-Margrethe Hauge
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Kathryn S Stok
- Department of Biomedical Engineering, The University of Melbourne, Parkville, VIC, Australia
| | - Sarah L Manske
- Cumming School of Medicine, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada.,Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Manske SL, Brunet SC, Finzel S, Stok KS, Conaghan PG, Boyd SK, Barnabe C. The SPECTRA Collaboration OMERACT Working Group: Construct Validity of Joint Space Outcomes with High-resolution Peripheral Quantitative Computed Tomography. J Rheumatol 2019; 46:1369-1373. [PMID: 30647172 DOI: 10.3899/jrheum.180870] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2018] [Indexed: 01/19/2023]
Abstract
OBJECTIVE We assessed construct validity of high-resolution peripheral quantitative computed tomography (HR-pQCT) joint space outcomes by comparison with radiographs in patients with rheumatoid arthritis. METHODS In 43 patients, quantitative, volumetric, HR-pQCT measurements were compared with ordinal Sharp/van der Heijde scoring (SvdH) in the 2nd and 3rd metacarpophalangeal joints. RESULTS Generalized estimating equations showed that joint space minimum, SD, and asymmetry by HR-pQCT were associated with SvdH scores (p < 0.05). There was a considerable range in HR-pQCT measurements at SvdH equal to 0. CONCLUSION HR-pQCT demonstrated construct validity outcomes and provides improved 3-D visualization of joint space.
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Affiliation(s)
- Sarah L Manske
- From the Department of Radiology, and Department of Medicine, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary; Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Rheumatology and Clinical Immunology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Department of Biomedical Engineering, The University of Melbourne, Parkville, Australia; Leeds Institute for Rheumatic and Musculoskeletal Medicine, University of Leeds and UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK. .,S.L. Manske, PhD, Department of Radiology, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, and Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary; S.C. Brunet, BSc, Department of Radiology, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, and Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary; S. Finzel, MD, Department of Rheumatology and Clinical Immunology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg; K.S. Stok, PhD, Department of Biomedical Engineering, The University of Melbourne; P.G. Conaghan, MD, PhD, Leeds Institute for Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; S.K. Boyd, PhD, Department of Radiology, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, and Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary; C. Barnabe, MSc, MD, Department of Medicine, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary.
| | - Scott C Brunet
- From the Department of Radiology, and Department of Medicine, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary; Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Rheumatology and Clinical Immunology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Department of Biomedical Engineering, The University of Melbourne, Parkville, Australia; Leeds Institute for Rheumatic and Musculoskeletal Medicine, University of Leeds and UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK.,S.L. Manske, PhD, Department of Radiology, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, and Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary; S.C. Brunet, BSc, Department of Radiology, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, and Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary; S. Finzel, MD, Department of Rheumatology and Clinical Immunology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg; K.S. Stok, PhD, Department of Biomedical Engineering, The University of Melbourne; P.G. Conaghan, MD, PhD, Leeds Institute for Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; S.K. Boyd, PhD, Department of Radiology, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, and Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary; C. Barnabe, MSc, MD, Department of Medicine, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary
| | - Stephanie Finzel
- From the Department of Radiology, and Department of Medicine, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary; Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Rheumatology and Clinical Immunology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Department of Biomedical Engineering, The University of Melbourne, Parkville, Australia; Leeds Institute for Rheumatic and Musculoskeletal Medicine, University of Leeds and UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK.,S.L. Manske, PhD, Department of Radiology, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, and Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary; S.C. Brunet, BSc, Department of Radiology, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, and Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary; S. Finzel, MD, Department of Rheumatology and Clinical Immunology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg; K.S. Stok, PhD, Department of Biomedical Engineering, The University of Melbourne; P.G. Conaghan, MD, PhD, Leeds Institute for Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; S.K. Boyd, PhD, Department of Radiology, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, and Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary; C. Barnabe, MSc, MD, Department of Medicine, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary
| | - Kathryn S Stok
- From the Department of Radiology, and Department of Medicine, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary; Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Rheumatology and Clinical Immunology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Department of Biomedical Engineering, The University of Melbourne, Parkville, Australia; Leeds Institute for Rheumatic and Musculoskeletal Medicine, University of Leeds and UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK.,S.L. Manske, PhD, Department of Radiology, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, and Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary; S.C. Brunet, BSc, Department of Radiology, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, and Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary; S. Finzel, MD, Department of Rheumatology and Clinical Immunology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg; K.S. Stok, PhD, Department of Biomedical Engineering, The University of Melbourne; P.G. Conaghan, MD, PhD, Leeds Institute for Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; S.K. Boyd, PhD, Department of Radiology, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, and Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary; C. Barnabe, MSc, MD, Department of Medicine, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary
| | - Philip G Conaghan
- From the Department of Radiology, and Department of Medicine, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary; Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Rheumatology and Clinical Immunology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Department of Biomedical Engineering, The University of Melbourne, Parkville, Australia; Leeds Institute for Rheumatic and Musculoskeletal Medicine, University of Leeds and UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK.,S.L. Manske, PhD, Department of Radiology, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, and Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary; S.C. Brunet, BSc, Department of Radiology, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, and Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary; S. Finzel, MD, Department of Rheumatology and Clinical Immunology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg; K.S. Stok, PhD, Department of Biomedical Engineering, The University of Melbourne; P.G. Conaghan, MD, PhD, Leeds Institute for Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; S.K. Boyd, PhD, Department of Radiology, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, and Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary; C. Barnabe, MSc, MD, Department of Medicine, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary
| | - Steven K Boyd
- From the Department of Radiology, and Department of Medicine, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary; Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Rheumatology and Clinical Immunology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Department of Biomedical Engineering, The University of Melbourne, Parkville, Australia; Leeds Institute for Rheumatic and Musculoskeletal Medicine, University of Leeds and UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK.,S.L. Manske, PhD, Department of Radiology, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, and Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary; S.C. Brunet, BSc, Department of Radiology, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, and Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary; S. Finzel, MD, Department of Rheumatology and Clinical Immunology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg; K.S. Stok, PhD, Department of Biomedical Engineering, The University of Melbourne; P.G. Conaghan, MD, PhD, Leeds Institute for Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; S.K. Boyd, PhD, Department of Radiology, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, and Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary; C. Barnabe, MSc, MD, Department of Medicine, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary
| | - Cheryl Barnabe
- From the Department of Radiology, and Department of Medicine, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary; Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Rheumatology and Clinical Immunology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Department of Biomedical Engineering, The University of Melbourne, Parkville, Australia; Leeds Institute for Rheumatic and Musculoskeletal Medicine, University of Leeds and UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK.,S.L. Manske, PhD, Department of Radiology, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, and Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary; S.C. Brunet, BSc, Department of Radiology, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, and Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary; S. Finzel, MD, Department of Rheumatology and Clinical Immunology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg; K.S. Stok, PhD, Department of Biomedical Engineering, The University of Melbourne; P.G. Conaghan, MD, PhD, Leeds Institute for Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; S.K. Boyd, PhD, Department of Radiology, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, and Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary; C. Barnabe, MSc, MD, Department of Medicine, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary
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