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      Visual detection of cortical breaks in hand joints: reliability and validity of high-resolution peripheral quantitative CT compared to microCT

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          Abstract

          Background

          To study the reliability and validity of high-resolution peripheral quantitative CT (HR-pQCT) with microCT (μCT) as gold standard in the visual detection of cortical breaks in metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints.

          Methods

          Ten cadaveric fingers (10 MCP and 9 PIP joints) were imaged by HR-pQCT and μCT and visually analyzed by two independent readers. Intra- and interreader reliability were evaluated for the presence (yes/no, kappa statistics) and the total number (intraclass correlation coefficient, ICC) of cortical breaks. Sensitivity, specificity, positive and negative predictive value (PPV respectively NPV) of HR-pQCT in detecting cortical breaks were calculated.

          Results

          With HR-pQCT, mean 149 cortical breaks were identified and with μCT mean 129 ( p < 0.05). Intrareader reliability for the presence of a cortical break per quadrant was 0.52 (95 % CI 0.48–0.56) and 0.71 (95 % CI 0.67–0.75) for HR-pQCT and μCT, respectively, and for the total number of cortical breaks 0.61 (95 % CI 0.49–0.70) and 0.75 (95 % CI 0.68–0.82). Interreader reliability for the presence of a cortical break per quadrant was 0.37 (95 % CI 0.33–0.41) and 0.45 (95 % CI 0.41–0.49) for HR-pQCT and μCT, respectively, and for the number of cortical breaks 0.55 (95 % CI 0.43–0.65) and 0.54 (95 % CI 0.35–0.67). Sensitivity, specificity, PPV and NPV of HR-pQCT were 81.6, 64.0, 81.6, and 64 % respectively.

          Conclusion

          Cortical breaks were commonly visualized in MCP and PIP joints with HR-pQCT and μCT. Reliability of both HR-pQCT and μCT was fair to moderate. HR-pQCT was highly sensitive to detect cortical breaks with μCT as gold standard.

          Electronic supplementary material

          The online version of this article (doi:10.1186/s12891-016-1148-y) contains supplementary material, which is available to authorized users.

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          Most cited references12

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          Periarticular bone structure in rheumatoid arthritis patients and healthy individuals assessed by high-resolution computed tomography.

          To define the nature of structural bone changes in patients with rheumatoid arthritis (RA) compared with those in healthy individuals by using the novel technique of high-resolution microfocal computed tomography (micro-CT). Fifty-eight RA patients and 30 healthy individuals underwent a micro-CT scan of the proximal wrist and metacarpophalangeal joints. Bone lesions such as cortical breaks, osteophytes, and surface changes were quantified on 2-dimensional (2-D) slices as well as by using 3-D reconstruction images, and exact localization of lesions was recorded. Micro-CT scans could detect bone lesions 1.9 mm in diameter were highly specific for RA. Cortical breaks were mostly found along the radial sites of the metacarpal heads. No significant difference in the presence of osteophytes between healthy individuals and RA patients was found. Cortical surface changes, presumably cortical thinning and fenestration, became evident from 3-D reconstructions and were more pronounced in RA patients. Micro-CT allows exact detection of morphologic changes of juxtaarticular bone in healthy individuals and RA patients. Even healthy individuals occasionally show bone changes, but the severity of these lesions, with the exception of osteophytes, is greater in RA patients. Thus, micro-CT allows accurate differentiation among physiologic bone changes in joints and among types of pathologic bone damage resulting from RA.
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            High-resolution in vivo imaging of bone and joints: a window to microarchitecture.

            Imaging is essential to the evaluation of bone and joint diseases, and the digital era has contributed to an exponential increase in the number of publications on noninvasive analytical techniques for the quantification of changes to bone and joints that occur in health and in disease. One such technique is high-resolution peripheral quantitative CT (HR-pQCT), which has introduced a new dimension in the imaging of bone and joints by providing images that are both 3D and at high resolution (82 μm isotropic voxel size), with a low level of radiation exposure (3-5 μSv). HR-pQCT enables the analysis of cortical and trabecular properties separately and to apply micro-finite element analysis for calculating bone biomechanical competence in vivo at the distal sites of the skeleton (distal radius and distal tibia). Moreover, HR-pQCT makes possible the in vivo assessment of the spatial distribution, dimensions and delineation of cortical bone erosions, osteophytes, periarticular cortical and trabecular microarchitecture, and 3D joint-space volume of the finger joints and wrists. HR-pQCT is, therefore, a technique with a high potential for improving our understanding of bone and joint diseases at the microarchitectural level.
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              Comparison of the efficacy of sonography, magnetic resonance imaging and conventional radiography for the detection of bone erosions in rheumatoid arthritis patients: a systematic review and meta-analysis.

              To evaluate the reproducibility of US and to compare its efficacy with that of MRI and conventional radiography (CR) for the detection of bone erosion in RA patients. A systematic literature search was performed in the Medline, Embase and Cochrane databases up to August 2009. Trials evaluating the reproducibility of US for bone erosion detection or comparing the number of erosions detected by the three imaging methods at patient and/or joint level were included. This last parameter was assessed using the odds ratio (OR) and 95% CI with the Mantel-Haenszel method (OR < 1 favours US). We explored the heterogeneity between the studies by subgroup analysis. Twenty-one studies including 913 patients were included in this meta-analysis. Intraobserver and interobserver reproducibility of US for erosion detection was good. US and MRI efficacies were comparable at both joint (OR = 1.19, P = 0.45; seven studies, 869 joints) and patient (OR = 1.76, P = 0.22; nine studies, 338 patients) levels. US detected significantly more erosion than CR at both joint (OR = 0.30, P < 0.00001; 4047 joints studied) and patient (OR = 0.31, P < 0.00001; 592 studied patients) levels. The number of patients to screen in order to detect an additional patient with an erosion in comparison with CR was 4, 95% CI (2.4, 5.9). US is more effective for erosion detection than CR and has a comparable efficacy to MRI with good reproducibility.
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                Author and article information

                Contributors
                +31433884230 , a.scharmga@maastrichtuniversity.nl
                michiel.peters@maastrichtuniversity.nl
                a.van.tubergen@mumc.nl
                j@vdbergh.org
                joost.dejong@maastrichtuniversity.nl
                d.loeffen@mumc.nl
                b.v.Rietbergen@tue.nl
                r.weijers@mumc.nl
                piet.geusens@scarlet.be
                Journal
                BMC Musculoskelet Disord
                BMC Musculoskelet Disord
                BMC Musculoskeletal Disorders
                BioMed Central (London )
                1471-2474
                11 July 2016
                11 July 2016
                2016
                : 17
                : 271
                Affiliations
                [ ]Department of Medicine, division of Rheumatology, Maastricht University Medical Centre, P.O. Box 5800, NL-6202 AZ Maastricht, The Netherlands
                [ ]NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
                [ ]CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
                [ ]Department of Internal Medicine, Viecuri Medical Center, Venlo, The Netherlands
                [ ]Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
                [ ]Department of Radiology, Maastricht University Medical Centre, Maastricht, The Netherlands
                [ ]Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
                Author information
                http://orcid.org/0000-0001-8940-8827
                Article
                1148
                10.1186/s12891-016-1148-y
                4940720
                27401097
                5a249635-853d-424b-b40e-467965985d6c
                © The Author(s). 2016

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 7 April 2016
                : 29 June 2016
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2016

                Orthopedics
                imaging,computed tomography,hand,bone,rheumatoid arthritis
                Orthopedics
                imaging, computed tomography, hand, bone, rheumatoid arthritis

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