Radiographic quantifications of joint space narrowing progression by computer-based approach using temporal subtraction in rheumatoid wrist

Fully automatic software for detecting radiographic joint space narrowing progression in rheumatoid arthritis: phantom study and comparison with visual assessment

PURPOSE

We have developed an in-house software equipped with partial image phase-only correlation (PIPOC) which can automatically quantify radiographic joint space narrowing (JSN) progression. The purpose of this study was to evaluate the software in phantom and clinical assessments.

MATERIALS AND METHODS

In the phantom assessment, the software's performance on radiographic images was compared to the joint space width (JSW) difference using a micrometer as ground truth. A phantom simulating a finger joint was scanned underwater. In the clinical assessment, 15 RA patients were included. The software measured the radiological progression of the finger joints between baseline and the 52nd week. The cases were also evaluated with the Genant-modified Sharp score (GSS), a conventional visual scoring method. We also quantitatively assessed these joints' synovial vascularity (SV) on power Doppler ultrasonography (0, 8, 20 and 52 weeks).

RESULTS

In the phantom assessment, the PIPOC software could detect changes in JSN with a smallest detectable difference of 0.044 mm at 0.1 mm intervals. In the clinical assessment, the JSW change of the joints with GSS progression detected by the software was significantly greater than those without GSS progression (p = 0.004). The JSW change of joints with positive SV at baseline was significantly higher than those with negative SV (p = 0.024).

CONCLUSION

Our in-house software equipped with PIPOC can automatically and quantitatively detect slight radiographic changes of JSW in clinically inactive RA patients.

Radiographic changes in the temporomandibular joint related to medication in rheumatic diseases

OBJECTIVES

The purpose of this study was to assess radiographical changes on temporomandibular joint (TMJ) in relation the autoimmune rheumatic diseases and the medicines that treat this diseases with cone beam computed tomography(CBCT).

METHODS

65 people with rheumatoid diseases were included in the study and divided into five subgroups according to drugs they used. Condyle height (CH), anteroposterior dimension (APD), mesiolateral dimension (MLD) and superior joint space (SJS) were measured in order to evaluate mandibular condyle dimensions. Further, were evaluated in terms of osteoarthritic changes such as erosion, flattening, osteophyte and subchondral cyst in the mandibular condyle. TMJ measurements were compared between study-control groups and subgroups by using Student's t-test, Mann-Whitney-U test, one-way analysis of variance (ANOVA) and Kruskal-Wallis test. The association between osteoarthritic features, rheumatoid status was tested by using χ2 test. Observers were blinded to all groups. Cohen κ values (0853-0945) and Spearman's correlation coefficient (0.959-0.997) indicated high interexaminer reliability.

RESULTS

Condylar dimentions were significantly lower in CH and SJS in rheumatic diseases group (p < 0.001), however APD (p = 0,681) and MLD (p = 0,757) was not different significantly. Osteoarthritic changes such as erosion (p < 0.001), flattening (p = 0.005), osteophyte (p = 0.001) and subchondral cyst (p = 0.001) were significantly higher in the patient group. None of the parameters were different significantly according to subgroups determined according to drugs used(p > 0.05).

CONCLUSIONS

Degenerative changes may cause decrease in condyle size and changes in condyle position. It is a process that can continue despite the use of antirheumatic or immunosuppressive drugs. All of these can become the source of possible TMJ problems.

Application of ImageJ software for quantification of Hand Joint Space Narrowing in Patients with Rheumatoid Arthritis

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.

Validation of Fully Automatic Quantitative Software for Finger Joint Space Narrowing Progression for Rheumatoid Arthritis Patients

In rheumatoid arthritis (RA), the radiographic progression of joint space narrowing (JSN) is evaluated using visual assessments. However, those methods are complicated and time-consuming. We developed an automatic system that can detect joint locations and compute the joint space difference index (JSDI), which was defined as the chronological change in JSN between two radiographs. The purpose of this study was to establish the validity of the software that automatically evaluates the temporal change of JSN. This study consisted of 39 patients with RA. All patients were treated with tocilizumab and underwent hand radiography (left and right hand separately) at 0, 6, and 12 months. The JSN was evaluated using mTSS (modified Total Sharp Score) by one musculoskeletal radiologist as well as our automatic system. Software measurement showed that JSDI between 0 and 12 months was significantly higher than that between 0 and 6 months (p < 0.01). While, there was no significant difference in mTSS between 0, 6, and 12 months. The group with higher disease activity at 0 months had significantly higher JSDI between 0 and 6 months than that with lower disease activity (p = 0.02). The automatic software can evaluate JSN progression of RA patients in the finger joint on X-ray.

Fully automatic quantitative software for assessment of minute finger joint space narrowing progression on radiographs: evaluation in rheumatoid arthritis patients with long-term sustained clinical low disease activity

PURPOSE

Rheumatoid arthritis (RA) causes joint space narrowing (JSN) as a form of joint destruction. We developed an automatic system that can detect joint locations and compute the joint space difference index (JSDI), which was defined as the chronological change in JSN between two radiographs. This study aims to evaluate the application of "machine vision" for radiographic image of the finger joints.

MATERIALS AND METHODS

Fifteen RA patients with long-term sustained clinical low disease activity were recruited. All patients underwent hand radiography and power Doppler ultrasonography (PDUS). The JSN was evaluated using the Genant-modified Sharp scoring (GSS) method and the automatic system. Synovial vascularity (SV) was assessed quantitatively using ultrasonography.

RESULTS

There were no significant differences in the JSDI between the joints with JSN and those without JSN on GSS (p = 0.052). The JSDI of the joints with SV was significantly higher than those without SV (p = 0.043). The JSDI of the no therapeutic response group was significantly higher than those of the response group (p < 0.001).

CONCLUSION

Our software can automatically evaluate temporal changes of JSN, which might free rheumatologists / radiologists from the burden of scoring hand radiography.

Relation Between Anti-CCP Antibodies and Sharp Score in Rheumatoid Arthritis

Introduction

Rheumatoid arthritis (RA) is a chronic, inflammatory, systemic rheumatic disease, very complex, with many different forms, progressive course, with pronounced changes in the joints, still unknown etiology and poorly understood pathology. Assessing of structural change can be done with proposed scores which observe changes on wrist and wrist joints, as a Sharp score.

Aim

To examine the correlation between Anti-Citrullinated Protein Antibodies (Anti-CCP) values and Sharp score, and to determine the importance of Sharp score in the progression of RA.

Methods

The study had prospective character and followed patients in the period from January 1, 2017 to December 31, 2017. The study included 40 patients with RA. At the beginning of the follow-up of patients, X-ray of hands and feet were performed.

Results

Out of total of 40 patients, 34 or 85% had a follow-up examination after one year. Of these, 14 patients (41.2%) were reported to have complications. The subjects were divided into two groups according to Anti-CCP values. First group included patients with Anti-CCP values <4 and second those who had Anti-CCP> 4. Statistical analysis of the number of patients with complications at first and repeated examination indicated that there were no significant differences and that the sample was consistent between the first and repeated results (p> 0.05). Patients with higher Anti-CCP values also had a higher Sharp score with statistically significant differences during repeated examination (p <0.05). Correlation analysis shows that there was statistically significant (p <0.05) positive correlation with Anti-CCP values, and that an increase in values leads to an increase in the Sharp score (first measurement rho = 0.193, p> 0.05; repeated measurement rho = 0.645, p <0.0001). No statistically significant differences in Sharp score values at the first examination were compared with the repeated examination, but there was a statistically significant difference after one year in patients with complications (X2 = 13,388; p = 0.001), indicating that the Sharp score reflects disease progression.

Conclusion

Anti-CCP values are also directly correlated with the Sharp score, which should be routine in both initial and repeated examination of a patient with RA. Sharp's score represents a marker of progression as well as of therapeutic modality of RA.

Detection of Fine Radiographic Progression in Finger Joint Space Narrowing Beyond Human Eyes: Phantom Experiment and Clinical Study with Rheumatoid Arthritis Patients

The visual assessment of joint space narrowing (JSN) on radiographs of rheumatoid arthritis (RA) patients such as the Genant-modified Sharp score (GSS) is widely accepted but limited by its subjectivity and insufficient sensitivity. We developed a software application which can assess JSN quantitatively using a temporal subtraction technique for radiographs, in which the chronological change in JSN between two radiographs was defined as the joint space difference index (JSDI). The aim of this study is to prove the superiority of the software in terms of detecting fine radiographic progression in finger JSN over human observers. A micrometer measurement apparatus that can adjust arbitrary joint space width (JSW) in a phantom joint was developed to define true JSW. We compared the smallest detectable changes in JSW between the JSDI and visual assessment using phantom images. In a clinical study, 222 finger joints without interval score change on GSS in 15 RA patients were examined. We compared the JSDI between joints with and without synovial vascularity (SV) on power Doppler ultrasonography during the follow-up period. True JSW difference was correlated with JSDI for JSW differences ranging from 0.10 to 1.00 mm at increments of 0.10 mm (R² = 0.986 and P < 0.001). Rheumatologists were difficult to detect JSW difference of 0.30 mm or less. The JSDI of finger joints with SV was significantly higher than those without SV (P = 0.030). The software can detect fine differences in JSW that are visually unrecognizable.

Computer-Based Radiographic Quantification of Joint Space Narrowing Progression Using Sequential Hand Radiographs: Validation Study in Rheumatoid Arthritis Patients from Multiple Institutions

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.

Radiographic temporal subtraction analysis can detect finger joint space narrowing progression in rheumatoid arthritis with clinical low disease activity

Background Recent papers suggest that finger joints with positive synovial vascularity (SV) assessed by ultrasonography under clinical low disease activity (CLDA) in rheumatoid arthritis (RA) patients may cause joint space narrowing (JSN) progression. Purpose To investigate the performance of a computer-based method by directly comparing with the conventional scoring method in terms of the detectability of JSN progression in hand radiography of RA patients with CLDA. Material and Methods Fifteen RA patients (13 women, 2 men) with long-term sustained CLDA of >2 years were included. Radiological progression of finger joints was measured or scored using the computer-based method which can detect JSN progression between two radiographic images as the joint space difference index (JSDI), as well as the Genant-modified Sharp score (GSS). We also quantitatively assessed SV of these joints using ultrasonography. Results Out of 270 joints, we targeted 259 finger joints after excluding nine damaged joints (four ankylosis, three complete luxation, and two subluxation) and two improved joints according to the GSS results. The JSDI of finger joints with JSN progression was significantly higher than those without JSN progression ( P = 0.018). The JSDI of finger joints with ultrasonographic SV was significantly higher than those without ultrasonographic SV ( P = 0.004). Progression in JSDI showed stronger associations with ultrasonographic SV than progression in GSS (odds ratio [95% confidence interval]: 7.19 [3.37-15.36] versus 5.84 [2.76-12.33]). Conclusion The computer-based method was comparable to the conventional scoring method regarding the detectability of JSN progression in RA patients with CLDA.

A reliability study using computer-based analysis of finger joint space narrowing in rheumatoid arthritis patients

The joint space difference index (JSDI) is a newly developed radiographic index which can quantitatively assess joint space narrowing progression of rheumatoid arthritis (RA) patients by using an image subtraction method on a computer. The aim of this study was to investigate the reliability of this method by non-experts utilizing RA image evaluation. Four non-experts assessed JSDI for radiographic images of 510 metacarpophalangeal joints from 51 RA patients twice with an interval of more than 2 weeks. Two rheumatologists and one radiologist as well as the four non-experts examined the joints by using the Sharp-van der Heijde Scoring (SHS) method. The radiologist and four non-experts repeated the scoring with an interval of more than 2 weeks. We calculated intra-/inter-observer reliability using the intra-class correlation coefficients (ICC) for JSDI and SHS scoring, respectively. The intra-/inter-observer reliabilities for the computer-based method were almost perfect (inter-observer ICC, 0.966-0.983; intra-observer ICC, 0.954-0.996). Contrary to this, intra-/inter-observer reliability for SHS by experts was moderate to almost perfect (inter-observer ICC, 0.556-0.849; intra-observer ICC, 0.589-0.839). The results suggest that our computer-based method has high reliability to detect finger joint space narrowing progression in RA patients.