A customized protocol to assess bone quality in the metacarpal head, metacarpal shaft and distal radius: a high resolution peripheral quantitative computed tomography precision study

BMC Musculoskeletal Disorders

Heather McKay³  Linda Li¹  Helen Buie²  Lynne Feehan³ 

[1] Arthritis Research Centre of Canada, Richmond, BC, Canada;The Bone Imaging Laboratory, University of Calgary, Calgary, AB, Canada;Centre for Hip Health and Mobility, Faculty of Medicine, UBC, Vancouver, BC, Canada

关键词: Early rheumatoid arthritis;    Ultra-ultra-distal radius;    Metacarpal shaft;    Metacarpal head;    Precision;    Volumetric bone mineral density;    Bone microstructure;    HR-pQCT;   

Others  :  1128991
DOI  :  10.1186/1471-2474-14-367

 received in 2013-08-21, accepted in 2013-12-18,  发布年份 2013

【 摘 要 】

Background

High Resolution-Peripheral Quantitative Computed Tomography (HR-pQCT) is an emerging technology for evaluation of bone quality in Rheumatoid Arthritis (RA). However, there are limitations with standard HR-pQCT imaging protocols for examination of regions of bone commonly affected in RA. We developed a customized protocol for evaluation of volumetric bone mineral density (vBMD) and microstructure at the metacarpal head (MH), metacarpal shaft (MS) and ultra-ultra-distal (UUD) radius; three sites commonly affected in RA. The purpose was to evaluate short-term measurement precision for bone density and microstructure at these sites.

Methods

12 non-RA participants, individuals likely to have no pre-existing bone damage, consented to participate [8 females, aged 23 to 71 y [median (IQR): 44 (28) y]. The custom protocol includes more comfortable/stable positioning and adapted cortical segmentation and direct transformation analysis methods. Dominant arm MH, MS and UUD radius scans were completed on day one; repeated twice (with repositioning) three to seven days later. Short-term precision for repeated measures was explored using intraclass correlational coefficient (ICC), mean coefficient of variation (CV%), root mean square coefficient of variation (RMSCV%) and least significant change (LSC%₉₅).

Results

Bone density and microstructure precision was excellent: ICCs varied from 0.88 (MH₂ trabecular number) to .99 (MS₃ polar moment of inertia); CV% varied from < 1 (MS₂ vBMD) to 6 (MS₃ marrow space diameter); RMSCV% varied from < 1 (MH₂ full bone vBMD) to 7 (MS₃ marrow space diameter); and LSC% ₉₅varied from 2 (MS₂ full bone vBMD to 21 (MS₃ marrow space diameter). Cortical porosity measures were the exception; RMSCV% varying from 19 (MS₃) to 42 (UUD). No scans were stopped for discomfort. 5% (5/104) were repeated due to motion during imaging. 8% (8/104) of final images had motion artifact graded > 3 on 5 point scale.

Conclusion

In our facility, this custom protocol extends the potential for in vivo HR-pQCT imaging to assess, with high precision, regional differences in bone quality at three sites commonly affected in RA. Our methods are easy to adopt and we recommend other users of HR-pQCT consider this protocol for further evaluations of its precision and feasibility in their imaging facilities.

【 授权许可】

   
2013 Feehan et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

【 参考文献 】

• [1]Brown AK, Conaghan PG, Karim Z, Quinn MA, Ikeda K, Peterfy CG, Hensor E, Wakefield RJ, O’Connor PJ, Emery P: An explanation for the apparent dissociation between clinical remission and continued structural deterioration in rheumatoid arthritis. Arthritis Rheum 2008, 58:2958-2967.
• [2]Rezaei H, Saevarsdottir S, Forslind K, Albertsson K, Wallin H, Bratt J, Ernestam S, Geborek P, Pettersson IF, van Vollenhoven RF: In early rheumatoid arthritis, patients with a good initial response to methotrexate have excellent 2-year clinical outcomes, but radiological progression is not fully prevented: data from the methotrexate responders population in the SWEFOT trial. Ann Rheum Dis 2012, 71:186-191.
• [3]Rezaei H, Saevarsdottir S, Geborek P, Petersson IF, van Vollenhoven RF, Forslind K: Evaluation of hand bone loss by digital X-ray radiogrammetry as a complement to clinical and radiographic assessment in early rheumatoid arthritis: results from the SWEFOT trial. BMC Musculoskelet Disord 2013, 14:79. BioMed Central Full Text
• [4]Naumann L, Hermann K-GA, Huscher D, Lenz K, Burmester G-R, Backhaus M, Buttgereit F: Quantification of periarticular demineralization and synovialitis of the hand in rheumatoid arthritis patients. Osteoporos Int 2012, 23:2671-2679.
• [5]Vis M, Güler-Yüksel M, Lems WF: Can bone loss in rheumatoid arthritis be prevented? Osteoporos Int 2013, 24(10):2541-2553.
• [6]Johnsson PM, Eberhardt K: Hand deformities are important signs of disease severity in patients with early rheumatoid arthritis. Rheumatology 2009, 48:1398-1401.
• [7]Toyama S, Tokunaga D, Fujiwara H, Oda R, Kobashi H, Okumura H, Nakamura S, Taniguchi D, Kubo T: Rheumatoid arthritis of the hand: a five-year longitudinal analysis of clinical and radiographic findings. Mod Rheumatol 2013. In press
• [8]Staa TPV, Geusens P, Bijlsma JWJ, Leufkens HGM, Cooper C: Clinical assessment of the long-term risk of fracture in patients with rheumatoid arthritis. Arthritis Rheum 2006, 54:3104-3112.
• [9]Kanis JA, McCloskey EV, Johansson H, Oden A, Ström O, Borgström F: Development and use of FRAX® in osteoporosis. Osteoporos Int 2010, 21:407-413.
• [10]Nampei A, Hashimoto J, Koyanagi J, Ono T, Hashimoto H, Tsumaki N, Tomita T, Sugamoto K, Nishimoto N, Ochi T, Yoshikawa H: Characteristics of fracture and related factors in patients with rheumatoid arthritis. Mod Rheumatol 2008, 18:170-176.
• [11]Ochi K, Furuya T, Ikari K, Taniguchi A, Yamanaka H, Momohara S: Sites, frequencies, and causes of self-reported fractures in 9,720 rheumatoid arthritis patients: a large prospective observational cohort study in Japan. Arch Osteoporos 2013, 8:1-8.
• [12]Ejbjerg BJ, Vestergaard A, Jacobsen S, Thomsen HS, ØStergaard M: The smallest detectable difference and sensitivity to change of magnetic resonance imaging and radiographic scoring of structural joint damage in rheumatoid arthritis finger, wrist, and toe joints: a comparison of the omeract rheumatoid arthritis magnetic resonance imaging score applied to different joint combinations and the sharp/van der heijde radiographic score. Arthritis Rheum 2005, 52:2300-2306.
• [13]Døhn UM, Ejbjerg BJ, Hasselquist M, Narvestad E, Moller J, Thomsen HS, Ostergaard M: Detection of bone erosions in rheumatoid arthritis wrist joints with magnetic resonance imaging, computed tomography and radiography. Arthritis Res Ther 2008, 10:R25. BioMed Central Full Text
• [14]Østergaard M, Pedersen SJ, Døhn UM: Imaging in rheumatoid arthritis – status and recent advances for magnetic resonance imaging, ultrasonography, computed tomography and conventional radiography. Best Pract Res Clin Rheumatol 2008, 22:1019-1044.
• [15]Alves C, Colin EM, van Oort WJ, Sluimer JP, Hazes JMW, Luime JJ: Periarticular osteoporosis: a useful feature in the diagnosis of early rheumatoid arthritis? Reliability and validity in a cross-sectional diagnostic study using dual-energy X-ray absorptiometry. Rheumatology 2011, 50:2257-2263.
• [16]Da Mota LMH, Laurindo IMM, dos Santos Neto LL, Lima FAC, Viana SL, Mendlovitz PS, Fernandes JL: Imaging diagnosis of early rheumatoid arthritis. Rev Bras Reumatol 2012, 52:757-766.
• [17]Døhn UM, Terslev L, Szkudlarek M, Hansen MS, Hetland ML, Hansen A, Madsen OR, Hasselquist M, Møller J, Østergaard M: Detection, scoring and volume assessment of bone erosions by ultrasonography in rheumatoid arthritis: comparison with CT. Ann Rheum Dis 2013, 72:530-534.
• [18]Atkinson SC, Cormia FE, Unrau SA: The diameter and growth phase of hair in relation to age. Br J Dermatol 1959, 71:309-311.
• [19]Møller Døhn U, Boonen A, Hetland ML, Hansen MS, Knudsen LS, Hansen A, Madsen OR, Hasselquist M, Møller JM, Østergaard M: Erosive progression is minimal, but erosion healing rare, in patients with rheumatoid arthritis treated with adalimumab. A 1 year investigator-initiated follow-up study using high-resolution computed tomography as the primary outcome measure. Ann Rheum Dis 2009, 68:1585-1590.
• [20]Stach CM, Bäuerle M, Englbrecht M, Kronke G, Engelke K, Manger B, Schett G: Periarticular bone structure in rheumatoid arthritis patients and healthy individuals assessed by high-resolution computed tomography. Arthritis Rheum 2010, 62:330-339.
• [21]Fouque-Aubert A, Boutroy S, Marotte H, Vilayphiou N, Bacchetta J, Miossec P, Delmas PD, Chapurlat RD: Assessment of hand bone loss in rheumatoid arthritis by high-resolution peripheral quantitative CT. Ann Rheum Dis 2010, 69:1671-1676.
• [22]Finzel S, Englbrecht M, Engelke K, Stach C, Schett G: A comparative study of periarticular bone lesions in rheumatoid arthritis and psoriatic arthritis. Ann Rheum Dis 2011, 70:122-127.
• [23]Finzel S, Ohrndorf S, Englbrecht M, Stach C, Messerschmidt J, Schett G, Backhaus M: A detailed comparative study of high-resolution ultrasound and micro-computed tomography for detection of arthritic bone erosions. Arthritis Rheum 2011, 63:1231-1236.
• [24]Schett G, Coates LC, Ash ZR, Finzel S, Conaghan PG: Structural damage in rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis: traditional views, novel insights gained from TNF blockade, and concepts for the future. Arthritis Res Ther 2011, 13(Suppl 1):S4.
• [25]Finzel S, Rech J, Schmidt S, Engelke K, Englbrecht M, Stach C, Schett G: Repair of bone erosions in rheumatoid arthritis treated with tumour necrosis factor inhibitors is based on bone apposition at the base of the erosion. Ann Rheum Dis 2011, 70:1587-1593.
• [26]Zhu TY, Griffith JF, Qin L, Hung VWY, Fong T-N, Kwok AW, Leung P-C, Li EK, Tam L-S: Bone density and microarchitecture: relationship between hand, peripheral, and axial skeletal sites assessed by HR-pQCT and DXA in rheumatoid arthritis. Calcif Tissue Int 2012, 91:343-355.
• [27]Srikhum W, Virayavanich W, Burghardt AJ, Yu A, Link TM, Imboden JB, Li X: Quantitative and semiquantitative bone erosion assessment on high-resolution peripheral quantitative computed tomography in rheumatoid arthritis. J Rheumatol 2013, 40:408-416.
• [28]Barnabe C, Szabo E, Martin L, Boyd SK, Barr SG: Quantification of small joint space width, periarticular bone microstructure and erosions using high-resolution peripheral quantitative computed tomography in rheumatoid arthritis. Clin Exp Rheumatol 2013, 31:243-250.
• [29]Zhu TY, Griffith JF, Qin L, Hung VWY, Fong T-N, Au S-K, Tang XL, Kwok AW, Leung P-C, Li EK, Tam L-S: Structure and strength of the distal radius in female patients with rheumatoid arthritis: a case–control study. J Bone Miner Res Off J Am Soc Bone Miner Res 2013, 28:794-806.
• [30]Kleyer A, Finzel S, Rech J, Manger B, Krieter M, Faustini F, Araujo E, Hueber AJ, Harre U, Engelke K, Schett G: Bone loss before the clinical onset of rheumatoid arthritis in subjects with anticitrullinated protein antibodies. Ann Rheum Dis 2013. In press
• [31]Barnabe C, Buie H, Kan M, Szabo E, Barr SG, Martin L, Boyd SK: Reproducible metacarpal joint space width measurements using 3D analysis of images acquired with high-resolution peripheral quantitative computed tomography. Med Eng Phys 2013. In press
• [32]Aschenberg S, Finzel S, Schmidt S, Kraus S, Engelke K, Englbrecht M, Rech J, Schett G: Catabolic and anabolic periarticular bone changes in patients with rheumatoid arthritis: a computed tomography study on the role of age, disease duration and bone markers. Arthritis Res Ther 2013, 15:R62. BioMed Central Full Text
• [33]Barnabe C, Feehan L: High-resolution peripheral quantitative computed tomography imaging protocol for metacarpophalangeal joints in inflammatory arthritis: the SPECTRA collaboration. J Rheumatol 2012, 39:1494-1495.
• [34]Ostergaard M, Møller Døhn U, Duer-Jensen A, Hetland ML, Hørslev-Petersen K, Stengaard-Pedersen K, Junker P, Pødenphant J, Ejbjerg B: Patterns of magnetic resonance imaging bone erosion in rheumatoid arthritis--which bones are most frequently involved and show the most change? J Rheumatol 2011, 38:2014-2017.
• [35]De Rooy DPC, Kälvesten J, Huizinga TWJ, van der Helm-van Mil AHM: Loss of metacarpal bone density predicts RA development in recent-onset arthritis. Rheumatol Oxf Engl 2012, 51:1037-1041.
• [36]Moon S-J, Ahn IE, Kwok S-K, Park K-S, Min J-K, Park S-H, Kim H-Y, Ju JH: Periarticular osteoporosis is a prominent feature in early rheumatoid arthritis: estimation using shaft to periarticular bone mineral density ratio. J Korean Med Sci 2013, 28:287-294.
• [37]Buie HR, Campbell GM, Klinck RJ, MacNeil JA, Boyd SK: Automatic segmentation of cortical and trabecular compartments based on a dual threshold technique for in vivo micro-CT bone analysis. Bone 2007, 41:505-515.
• [38]Burghardt AJ, Buie HR, Laib A, Majumdar S, Boyd SK: Reproducibility of direct quantitative measures of cortical bone microarchitecture of the distal radius and tibia by HR-pQCT. Bone 2010, 47:519-528.
• [39]Burghardt AJ, Kazakia GJ, Ramachandran S, Link TM, Majumdar S: Age- and gender-related differences in the geometric properties and biomechanical significance of intracortical porosity in the distal radius and tibia. J Bone Miner Res Off J Am Soc Bone Miner Res 2010, 25:983-993.
• [40]Nishiyama KK, Macdonald HM, Buie HR, Hanley DA, Boyd SK: Postmenopausal women with osteopenia have higher cortical porosity and thinner cortices at the distal radius and tibia than women with normal aBMD: an in vivo HR-pQCT study. J Bone Miner Res Off J Am Soc Bone Miner Res 2010, 25:882-890.
• [41]Liu XS, Zhang XH, Sekhon KK, Adams MF, McMahon DJ, Bilezikian JP, Shane E, Guo XE: High-resolution peripheral quantitative computed tomography can assess microstructural and mechanical properties of human distal tibial bone. J Bone Miner Res Off J Am Soc Bone Miner Res 2010, 25:746-756.
• [42]Engelke K, Stampa B, Timm W, Dardzinski B, de Papp AE, Genant HK, Fuerst T: Short-term in vivo precision of BMD and parameters of trabecular architecture at the distal forearm and tibia. Osteoporos Int J Establ Result Coop Eur Found Osteoporos Natl Osteoporos Found USA 2012, 23:2151-2158.
• [43]Pauchard Y, Liphardt A-M, Macdonald HM, Hanley DA, Boyd SK: Quality control for bone quality parameters affected by subject motion in high-resolution peripheral quantitative computed tomography. Bone 2012, 50:1304-1310.
• [44]Flegal KM, Carroll MD, Kit BK, Ogden CL: Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999–2010. JAMA J Am Med Assoc 2012, 307:491-497.
• [45]AAPM task group 23: AAPM report number 96: The measurement, reporting and management of radiation dose in CT. 2008. http://www.aapm.org/pubs/reports/rpt_96.pdf webcite. Accessed December 26, 2013
• [46]Bonnick SL, Johnston CC Jr, Kleerekoper M, Lindsay R, Miller P, Sherwood L, Siris E: Importance of precision in bone density measurements. J Clin Densitom Off J Int Soc Clin Densitom 2001, 4:105-110.
• [47]Pialat JB, Burghardt AJ, Sode M, Link TM, Majumdar S: Visual grading of motion induced image degradation in high resolution peripheral computed tomography: impact of image quality on measures of bone density and micro-architecture. Bone 2012, 50:111-118.
• [48]Laib A, Häuselmann HJ, Rüegsegger P: In vivo high resolution 3D-QCT of the human forearm. Technol Health Care Off J Eur Soc Eng Med 1998, 6:329-337.
• [49]Van Rietbergen B, Majumdar S, Pistoia W, Newitt DC, Kothari M, Laib A, Rüegsegger P: Assessment of cancellous bone mechanical properties from micro-FE models based on micro-CT, pQCT and MR images. Technol Health Care Off J Eur Soc Eng Med 1998, 6:413-420.
• [50]Laib A, Rüegsegger P: Calibration of trabecular bone structure measurements of in vivo three-dimensional peripheral quantitative computed tomography with 28-microm-resolution microcomputed tomography. Bone 1999, 24:35-39.
• [51]Bonnick SL: Monitoring changes in bone density. Womens Health (Lond Engl) 2008, 4:89-97.
• [52]Sode M, Burghardt AJ, Pialat J-B, Link TM, Majumdar S: Quantitative characterization of subject motion in HR-pQCT images of the distal radius and tibia. Bone 2011, 48:1291-1297.
• [53]Cheung AM, Adachi JD, Hanley DA, Kendler DL, Davison KS, Josse R, Brown JP, Ste-Marie L-G, Kremer R, Erlandson MC, Dian L, Burghardt AJ, Boyd SK: High-resolution peripheral quantitative computed tomography for the assessment of bone strength and structure: a review by the Canadian bone strength working group. Curr Osteoporos Rep 2013, 11:136-146.
• [54]MacNeil JA, Boyd SK: Improved reproducibility of high-resolution peripheral quantitative computed tomography for measurement of bone quality. Med Eng Phys 2008, 30:792-799.
• [55]Landis JR, Koch GG: The measurement of observer agreement for categorical data. Biometrics 1977, 33:159-174.
• [56]Ito M, Nishida A, Koga A, Ikeda S, Shiraishi A, Uetani M, Hayashi K, Nakamura T: Contribution of trabecular and cortical components to the mechanical properties of bone and their regulating parameters. Bone 2002, 31:351-358.
• [57]Chevalley T, Bonjour JP, van Rietbergen B, Ferrari S, Rizzoli R: Fracture history of healthy premenopausal women is associated with a reduction of cortical microstructural components at the distal radius. Bone 2013, 55:377-383.
• [58]Bjørnerem Å, Bui QM, Ghasem-Zadeh A, Hopper JL, Zebaze R, Seeman E: Fracture risk and height: an association partly accounted for by cortical porosity of relatively thinner cortices. J Bone Miner Res 2013, 28(9):2017-2026.
• [59]Macdonald HM, Nishiyama KK, Kang J, Hanley DA, Boyd SK: Age-related patterns of trabecular and cortical bone loss differ between sexes and skeletal sites: a population-based HR-pQCT study. J Bone Miner Res Off J Am Soc Bone Miner Res 2011, 26:50-62.
• [60]Boutroy S, Bouxsein ML, Munoz F, Delmas PD: In vivo assessment of trabecular bone microarchitecture by high-resolution peripheral quantitative computed tomography. J Clin Endocrinol Metab 2005, 90:6508-6515.
• [61]Mueller TL, Stauber M, Kohler T, Eckstein F, Müller R, van Lenthe GH: Non-invasive bone competence analysis by high-resolution pQCT: an in vitro reproducibility study on structural and mechanical properties at the human radius. Bone 2009, 44:364-371.
• [62]Bui M, Bjørnerem A, Ghasem-Zadeh A, Dite GS, Hopper JL, Seeman E: Architecture of cortical bone determines in part its remodelling and structural decay. Bone 2013, 55:353-358.
• [63]Buenzli PR, Thomas CDL, Clement JG, Pivonka P: Endocortical bone loss in osteoporosis: the role of bone surface availability. Biomed Eng: Int J Numer Methods; 2013.
• [64]Chen H, Zhou X, Fujita H, Onozuka M, Kubo K-Y: Age-related changes in trabecular and cortical bone microstructure. Int J Endocrinol 2013, 2013:213234.
• [65]Trombetti A, Stoermann C, Chevalley T, Van Rietbergen B, Herrmann FR, Martin P-Y, Rizzoli R: Alterations of bone microstructure and strength in end-stage renal failure. Osteoporos Int J Establ Result Coop Eur Found Osteoporos Natl Osteoporos Found USA 2013, 24:1721-1732.
• [66]Davis KA, Burghardt AJ, Link TM, Majumdar S: The effects of geometric and threshold definitions on cortical bone metrics assessed by in vivo high-resolution peripheral quantitative computed tomography. Calcif Tissue Int 2007, 81:364-371.
• [67]Tjong W, Kazakia GJ, Burghardt AJ, Majumdar S: The effect of voxel size on high-resolution peripheral computed tomography measurements of trabecular and cortical bone microstructure. Med Phys 2012, 39:1893-1903.
• [68]Kazakia GJ, Nirody JA, Bernstein G, Sode M, Burghardt AJ, Majumdar S: Age- and gender-related differences in cortical geometry and microstructure: improved sensitivity by regional analysis. Bone 2013, 52:623-631.
• [69]Zebaze R, Ghasem-Zadeh A, Mbala A, Seeman E: A new method of segmentation of compact-appearing, transitional and trabecular compartments and quantification of cortical porosity from high resolution peripheral quantitative computed tomographic images. Bone 2013, 54:8-20.