Session Title: Imaging of Rheumatic Diseases III: Computed Tomography
Session Type: Abstract Submissions (ACR)
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.
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.
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).
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.
A. J. Burghardt,
T. M. Link,
J. B. Imboden,
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/quantitative-and-semi-quantitative-bone-erosion-assessment-on-high-resolution-peripheral-quantitative-computed-tomography-in-rheumatoid-arthritis/