title: Digital X-ray radiogrammetry and its sensitivity and specificity for the identification of rheumatoid arthritis-related cortical hand bone loss.
abstract: Digital X-ray radiogrammetry (DXR) is a computer-assisted diagnosis technique for quantifying cortical hand bone mineral density (BMD) as well as the metacarpal index (MCI) in the metacarpal bones from radiographs. The objective was to compare DXR-BMD and DXR-MCI between healthy individuals and patients with rheumatoid arthritis (RA) and verify the sensitivity and specificity of this technique for the identification of cortical hand bone loss as an additional diagnostic approach in RA. 618 patients were enrolled and divided into two groups: those with RA (n = 309) and a healthy control group (n = 309) as a reference database. DXR-BMD and the DXR-MCI were measured by DXR using hand radiographs. The severity of RA was evaluated by the modified Larsen score. Mean values for DXR-BMD and DXR-MCI in RA patients were significantly lower compared to healthy subjects (-20.7 and -21.1 %, respectively). Depending on the severity of RA-related joint damage, DXR-BMD revealed a significant reduction of -28.1 % and DXR-MCI -28.2 %, comparing score 1 and score 5 of the modified Larsen score. Both DXR-BMD and DXR-MCI had a high sensitivity (DXR-BMD 91 %, DXR-MCI 87 %) and a moderate specificity (DXR-BMD 47 %, DXR-MCI 49 %) to identify RA-related cortical hand bone loss. The DXR technique seems to be able to quantify RA-related periarticular bone loss as a characteristic feature in the course of RA. Consequently, periarticular osteoporosis seems to function as a reliable diagnostic approach comparable to erosions and joint space narrowing in the diagnosis of RA and as a surrogate marker for the progression of bone loss in RA.
authors.affiliation: Department of Internal Medicine III, Jena University Hospital, Friedrich-Schiller-University Jena, Erlanger Allee 101, 07747, Jena, Germany. alexander.pfeil@med.uni-jena.de.
authors.forename: Alexander
authors.initials: A
authors.lastname: Pfeil
authors.affiliation: Norwegian University of Science and Technology, Trondheim, Norway.
authors.forename: Glenn
authors.initials: G
authors.lastname: Haugeberg
authors.affiliation: Institute of Diagnostic and Interventional Radiology, Jena University Hospital, Friedrich-Schiller-University Jena, Erlanger Allee 101, 07747, Jena, Germany.
authors.forename: Diane M
authors.initials: DM
authors.lastname: Renz
authors.affiliation: Department of Internal Medicine III, Jena University Hospital, Friedrich-Schiller-University Jena, Erlanger Allee 101, 07747, Jena, Germany.
authors.forename: Lisa
authors.initials: L
authors.lastname: Reinhardt
authors.affiliation: Department of Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, University Hospital Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Jung
authors.affiliation: Department of Internal Medicine I, Jena University Hospital, Friedrich-Schiller-University Jena, Erlanger Allee 101, 07747, Jena, Germany.
authors.forename: Marcus
authors.initials: M
authors.lastname: Franz
authors.affiliation: Department of Internal Medicine III, Jena University Hospital, Friedrich-Schiller-University Jena, Erlanger Allee 101, 07747, Jena, Germany.
authors.forename: Gunter
authors.initials: G
authors.lastname: Wolf
authors.affiliation: Institute of Diagnostic and Interventional Radiology, SRH Wald-Klinikum Gera, Straße des Friedens 122, 07548, Gera, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Böttcher
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001172:Arthritis, Rheumatoid / Q000473:pathology*; D015519:Bone Density; D016022:Case-Control Studies; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D050279:Metacarpal Bones / Q000000981:diagnostic imaging / Q000473:pathology*; D008875:Middle Aged; D010024:Osteoporosis / Q000000981:diagnostic imaging* / Q000473:pathology; D011856:Radiographic Image Enhancement; D011859:Radiography; D012680:Sensitivity and Specificity; D055815:Young Adult
keywords: Bone mineral density; Digital X-ray radiogrammetry; Osteoporosis; Rheumatoid arthritis; Sensitivity