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Quantitative In Vivo HR-pQCT Imaging of 3D Wrist and Metacarpophalangeal Joint Space Width in Rheumatoid Arthritis

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Abstract

In this technique development study, high-resolution peripheral quantitative computed tomography (HR-pQCT) was applied to non-invasively image and quantify 3D joint space morphology of the wrist and metacarpophalangeal (MCP) joints of patients with rheumatoid arthritis (RA). HR-pQCT imaging (82 μm voxel-size) of the dominant hand was performed in patients with diagnosed rheumatoid arthritis (RA, N = 16, age: 52.6 ± 12.8) and healthy controls (CTRL, N = 7, age: 50.1 ± 15.0). An automated computer algorithm was developed to segment wrist and MCP joint spaces. The 3D distance transformation method was applied to spatially map joint space width, and summarized by the mean joint space width (JSW), minimal and maximal JSW (JSW.MIN, JSW.MAX), asymmetry (JSW.AS), and distribution (JSW.SD)—a measure of joint space heterogeneity. In vivo precision was determined for each measure by calculating the smallest detectable difference (SDD) and root mean square coefficient of variation (RMSCV%) of repeat scans. Qualitatively, HR-pQCT images and pseudo-color JSW maps showed global joint space narrowing, as well as regional and focal abnormalities in RA patients. In patients with radiographic JSN at an MCP, JSW.SD was two-fold greater vs. CTRL (p < 0.01), and JSW.MIN was more than two-fold lower (p < 0.001). Similarly, JSW.SD was significantly greater in the wrist of RA patients vs. CTRL (p < 0.05). In vivo precision was highest for JSW (SDD: 100 μm, RMSCV: 2.1%) while the SDD for JSW.MIN and JSW.SD were 370 and 110 μm, respectively. This study suggests that in vivo quantification of 3D joint space morphology from HR-pQCT, could improve early detection of joint damage in rheumatological diseases.

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Abbreviations

HR-pQCT:

High-resolution peripheral quantitative computed tomography

RA:

Rheumatoid arthritis

CTRL:

Control

DMARD:

Disease-modifying antrirheumatic drug

MCP:

Metacarpophalangeal

RU:

Radioulnar

RS:

Radioscaphoid

RL:

Radiolunate

VOI:

Volume of interest

SDD:

Smallest detectable difference

JSN:

Joint space narrowing

JSV:

Joint space volume

JSW:

Joint space width

JSW.MIN:

JSW minimum

JSW.MAX:

JSW maximum

JSW.SD:

JSW standard deviation (heterogeneity)

JSW.AS:

JSW asymmetry

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Acknowledgments

The authors would like to thank Melissa Guan, Thelma Munoz, and Gus Del Puerto for coordinating subject recruitment, and translation assistance. Furthermore they thank Dr. Miki Sode, Ph.D. and Steve Rock for the design and construction of the forearm cast used for MCP imaging. This study was supported with funds from a UCSF Academic Senate Grant (XL), NIH R01 AG17762 (SM), and NIH R01 AR060700 (AJB).

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Authors and Affiliations

  1. Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco, QB3 Building, Suite 203, 1700 4th St, San Francisco, CA, 94158, USA

    Andrew J. Burghardt, Chan Hee Lee, Daniel Kuo, Sharmila Majumdar, Thomas M. Link & Xiaojuan Li

  2. Division of Rheumatology, Department of Internal Medicine, NHIC Ilsan Hospital, Goyang-si, Gyeonggi-do, South Korea

    Chan Hee Lee

  3. Department of Medicine, University of California, San Francisco, San Francisco, CA, USA

    John B. Imboden

  4. Division of Rheumatology, San Francisco General Hospital, San Francisco, CA, USA

    John B. Imboden

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  1. Andrew J. Burghardt
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Correspondence to Andrew J. Burghardt.

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Associate Editor Joel D. Stitzel oversaw the review of this article.

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Burghardt, A.J., Lee, C.H., Kuo, D. et al. Quantitative In Vivo HR-pQCT Imaging of 3D Wrist and Metacarpophalangeal Joint Space Width in Rheumatoid Arthritis. Ann Biomed Eng 41, 2553–2564 (2013). https://doi.org/10.1007/s10439-013-0871-x

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