Development of a scoring method to visually score cortical interruptions on high-resolution peripheral quantitative computed tomography in rheumatoid arthritis and healthy controls

Andrea Scharmga; Michiel Peters; Joop P van den Bergh; Piet Geusens; Daan Loeffen; Bert van Rietbergen; Thea Schoonbrood; Debby Vosse; René Weijers; Astrid van Tubergen

doi:10.1371/journal.pone.0200331

Development of a scoring method to visually score cortical interruptions on high-resolution peripheral quantitative computed tomography in rheumatoid arthritis and healthy controls

PLoS One. 2018 Jul 9;13(7):e0200331. doi: 10.1371/journal.pone.0200331. eCollection 2018.

Authors

Andrea Scharmga^{1

2

3}, Michiel Peters^{1

2

3}, Joop P van den Bergh^{1

2

4

5}, Piet Geusens^{1

3

5}, Daan Loeffen⁶, Bert van Rietbergen^{7

8}, Thea Schoonbrood¹, Debby Vosse¹, René Weijers⁶, Astrid van Tubergen^{1

3}

Affiliations

¹ Department of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands.
² NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.
³ CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.
⁴ Department of Internal Medicine, Viecuri Medical Center, Venlo, The Netherlands.
⁵ Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.
⁶ Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands.
⁷ Department of Medical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.
⁸ Department of Orthopaedic surgery, Maastricht University Medical Center, Maastricht, The Netherlands.

Abstract

Objectives: To develop a scoring method to visually score cortical interruptions in finger joints on High-Resolution peripheral Quantitative Computed Tomography (HR-pQCT), determine its intra- and inter-reader reliability and test its feasibility.

Methods: The scoring method was developed by integrating results from in-depth discussions with experts, consensus meetings, multiple reading experiments and the literature. Cortical interruptions were scored by two independent readers in an imaging dataset with finger joints from patients with rheumatoid arthritis (RA) and healthy controls and assessed for adjacent trabecular distortion. Reliability for the total number of cortical interruptions per joint and per quadrant was calculated using intraclass correlation coefficient (ICC). Feasibility was tested by recording the time to analyze one joint.

Results: In 98 joints we identified 252 cortical interruptions, 17% had trabecular distortion. Mean diameter of the interruptions was significantly larger in patients with RA compared with healthy controls (0.88 vs 0.47 mm, p = 0.03). Intra-reader reliability was ICC 0.88 (95% CI 0.83;0.92) per joint and ICC 0.69 (95% CI 0.65;0.73) per quadrant. Inter-reader reliability was ICC 0.48 (95% CI 0.20;0.67) per joint and ICC 0.56 (95% CI 0.49;0.62) per quadrant. The time to score one joint was mean 9.2 (SD 4.9) min.

Conclusions: This scoring method allows detection of small cortical interruptions on HR-pQCT imaging of finger joints, which is promising for use in clinical studies.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Arthritis, Rheumatoid / diagnostic imaging*
Cortical Bone / diagnostic imaging*
Female
Finger Joint / diagnostic imaging*
Humans
Middle Aged
Reproducibility of Results
Tomography, X-Ray Computed / methods

Grants and funding

This work was supported by: the Weijerhorst foundation (JvdB) http://www.deweijerhorst.nl/weijerhorst/home. Funding that was used to purchase the HR-pQCT scanner and pay half of the PhD student salaries of MP and AS. It was also supported by Pfizer (PG), grant number: WS2056904, http://www.pfizer.nl/. This funding was used to perform the study (NL42300.068.12 / METC 12-2-037) of HR-pQCT imaging in patients with RA compared to conventional imaging techniques.