title: Visual detection of cortical breaks in hand joints: reliability and validity of high-resolution peripheral quantitative CT compared to microCT.
abstract: To study the reliability and validity of high-resolution peripheral quantitative CT (HR-pQCT) with microCT (μCT) as gold standard in the visual detection of cortical breaks in metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints.
  
  
  
  Ten cadaveric fingers (10 MCP and 9 PIP joints) were imaged by HR-pQCT and μCT and visually analyzed by two independent readers. Intra- and interreader reliability were evaluated for the presence (yes/no, kappa statistics) and the total number (intraclass correlation coefficient, ICC) of cortical breaks. Sensitivity, specificity, positive and negative predictive value (PPV respectively NPV) of HR-pQCT in detecting cortical breaks were calculated.
  
  
  
  With HR-pQCT, mean 149 cortical breaks were identified and with μCT mean 129 (p < 0.05). Intrareader reliability for the presence of a cortical break per quadrant was 0.52 (95 % CI 0.48-0.56) and 0.71 (95 % CI 0.67-0.75) for HR-pQCT and μCT, respectively, and for the total number of cortical breaks 0.61 (95 % CI 0.49-0.70) and 0.75 (95 % CI 0.68-0.82). Interreader reliability for the presence of a cortical break per quadrant was 0.37 (95 % CI 0.33-0.41) and 0.45 (95 % CI 0.41-0.49) for HR-pQCT and μCT, respectively, and for the number of cortical breaks 0.55 (95 % CI 0.43-0.65) and 0.54 (95 % CI 0.35-0.67). Sensitivity, specificity, PPV and NPV of HR-pQCT were 81.6, 64.0, 81.6, and 64 % respectively.
  
  
  
  Cortical breaks were commonly visualized in MCP and PIP joints with HR-pQCT and μCT. Reliability of both HR-pQCT and μCT was fair to moderate. HR-pQCT was highly sensitive to detect cortical breaks with μCT as gold standard.
authors.affiliation: Department of Medicine, division of Rheumatology, Maastricht University Medical Centre, P.O. Box 5800, NL-6202 AZ, Maastricht, The Netherlands. a.scharmga@maastrichtuniversity.nl.|NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands. a.scharmga@maastrichtuniversity.nl.|CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands. a.scharmga@maastrichtuniversity.nl.
authors.forename: A
authors.identifier: 0000-0001-8940-8827
authors.initials: A
authors.lastname: Scharmga
authors.affiliation: Department of Medicine, division of Rheumatology, Maastricht University Medical Centre, P.O. Box 5800, NL-6202 AZ, Maastricht, The Netherlands.|NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.|CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Peters
authors.affiliation: Department of Medicine, division of Rheumatology, Maastricht University Medical Centre, P.O. Box 5800, NL-6202 AZ, Maastricht, The Netherlands.|CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: van Tubergen
authors.affiliation: Department of Medicine, division of Rheumatology, Maastricht University Medical Centre, P.O. Box 5800, NL-6202 AZ, Maastricht, The Netherlands.|NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.|Department of Internal Medicine, Viecuri Medical Center, Venlo, The Netherlands.|Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.
authors.forename: J
authors.initials: J
authors.lastname: van den Bergh
authors.affiliation: Department of Medicine, division of Rheumatology, Maastricht University Medical Centre, P.O. Box 5800, NL-6202 AZ, Maastricht, The Netherlands.|NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: de Jong
authors.affiliation: Department of Radiology, Maastricht University Medical Centre, Maastricht, The Netherlands.
authors.forename: D
authors.initials: D
authors.lastname: Loeffen
authors.affiliation: Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.
authors.forename: B
authors.initials: B
authors.lastname: van Rietbergen
authors.affiliation: Department of Radiology, Maastricht University Medical Centre, Maastricht, The Netherlands.
authors.forename: R
authors.initials: R
authors.lastname: Weijers
authors.affiliation: Department of Medicine, division of Rheumatology, Maastricht University Medical Centre, P.O. Box 5800, NL-6202 AZ, Maastricht, The Netherlands.|CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.|Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.
authors.forename: P
authors.initials: P
authors.lastname: Geusens
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging*; D005260:Female; D005384:Finger Joint / Q000000981:diagnostic imaging*; D006801:Humans; D008662:Metacarpophalangeal Joint / Q000000981:diagnostic imaging*; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: Bone; Computed tomography; Hand; Imaging; Rheumatoid arthritis