ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 2584

Quantitative and Semi-Quantitative Bone Erosion Assessment On High-Resolution Peripheral Quantitative Computed Tomography in Rheumatoid Arthritis

Waraporn Srikhum1, Warapat Virayavanich1, Andrew J. Burghardt2, Andrew Yu1, Thomas M. Link1, John B. Imboden3 and Xiaojuan Li4, 1Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, 2Department of Radiology & Biomedical Imaging, Musculoskeletal Quantitative Imaging Research, UCSF, San Francisco, CA, 3Department of Medicine, Division of Rheumatology, UCSF, San Francisco, CA, 4Department of Radiology and Biomedical Imaging, Musculoskeletal Quantitative Imaging Research, UCSF, San Francisco, CA

Meeting: 2012 ACR/ARHP Annual Meeting

Keywords: , ,

Session Information

Title: Imaging of Rheumatic Diseases III: Computed Tomography

Session Type: Abstract Submissions (ACR)

Background/Purpose:

The goals of this project were (i) to develop novel quantitative and semiquantitative measures of bone erosions at the metacarpophalangeal (MCP) and wrist joints in patients with rheumatoid arthritis (RA) using high-resolution peripheral quantitative computed tomography (HR-pQCT), and (ii) to correlate these measurements with disease duration and bone marrow edema (BME) pattern from MRI.

Methods:

16 RA patients (54.1±12.7 years, 13 females) underwent hand and wrist HR-pQCT and 3 Tesla MRI. Bone erosions of the 2nd and 3rd MCPs and distal radius were evaluated by measuring maximal erosion dimension on axial slices by two radiologists. Measurements were performed twice. Intraclass correlation coefficient (ICC) values were calculated for the inter- and intra-reader reliability. Bone erosions in each MCP and distal radius were graded (grades 0-3) based on the maximal dimension and number of erosions (Figure1A). The volume of bone marrow edema (BME) pattern was quantified on coronal T2-weighted fast spin-echo (FSE) MRI images using in-house software. Spearman correlation coefficients were calculated between 1) sum maximal dimensions, highest grades and sum grades of bone erosions; 2) erosion measures and the clinical evaluation (duration of disease, DAS28, ESR, and CRP); 3) erosion measures and BME pattern volume in distal radius.

Results:

The mean maximal dimension of erosions at MCP2, MCP3 and distal radius were 0.39±0.21 cm, 0.32±0.21 cm and 0.46±0.31 cm, respectively. The inter- and intra-reader agreements of maximal erosion dimensions were excellent (ICC 0.89 and 0.99, respectively). Correlations between highest grades and sum grades, vs. sum maximal dimensions of all erosions were r=0.96 and 0.94 (p<0.01), respectively. Number of erosions, sum maximal erosion dimensions, highest grades and sum grades significantly correlated with duration of the disease (p<0.01), but not with DAS28, ESR and CRP, which reflected accumulation of the structural damage during the course of RA. Number of erosions, sum maximal dimensions and erosion grading of the distal radius also correlated significantly with BME volume (p<0.01) (Figure 1B and C).

Conclusion:

HR-pQCT provides sensitive and highly reproducible evaluation of structural bone damage in RA. The good correlation between erosion measures with duration of the disease as well as BME volume suggests that they could become feasible measures of erosions in RA, if very detailed disease course evaluation are required.

Text Box: Grade 0 Grade 1 Grade 2 Grade 3 Metacarpal head erosions Definition of erosion grading at MCPs No evidence of erosion 1 or more erosions with a maximal dimension ≤ 3.5 mm 1 or more erosions with maximal dimension > 3.5 and ≤ 10 mm 1 or more erosions with maximal dimension > 10 mm Distal radius erosions Definition of erosion grading at distal radius No evidence of erosion 1 or more erosions with a maximal dimension ≤5 mm 1 or more erosions with maximal dimension > 5 and ≤ 15 mm 1 or more erosions with maximal dimension > 15 mm A. B. Figure 1. A, Axial HR-pQCT images (82μm isotropic resolution) of the metacarpal heads and distal radius of rheumatoid arthritis patients with different stage of erosions and definitions of the semi-quantitative grades for evaluating bone erosions at each region. B and C, Comparative axial HR-pQCT (B) and axial T2-weighted fast-spin echo (FSE) MRI using iterative decomposition of water and fat with echo asymmetry and least-squares estimation (IDEAL) sequences (C) of the distal radius from a rheumatoid arthritis patient show extensive erosive change at medial aspect, which is seen as a clearly demarcated zone of hyperintense signal within normal hypointense marrow on MR image. Axial T2-weighted IDEAL FSE MR image (C) also demonstrates significant patchy hyperintense signal intensity of bone marrow edema. C. ” src=”https://acr.confex.comhttps://acrabstracts.org/wp-content/uploads/2014/10/Paper-29066-abstract-30254-0.png” height=”820″ class=”documentimage”> </div> <!--<h5>Disclosures</h5>--> <hr /> <div class=

Disclosure:

W. Srikhum,
None;

W. Virayavanich,
None;

A. J. Burghardt,
None;

A. Yu,
None;

T. M. Link,
None;

J. B. Imboden,
None;

X. Li,
None.

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