title: Definition for Rheumatoid Arthritis Erosions Imaged with High Resolution Peripheral Quantitative Computed Tomography and Interreader Reliability for Detection and Measurement.
abstract: High-resolution peripheral quantitative computed tomography (HR-pQCT) sensitively detects erosions in rheumatoid arthritis (RA); however, nonpathological cortical bone disruptions are potentially misclassified as erosive. Our objectives were to set and test a definition for pathologic cortical bone disruptions in RA and to standardize reference landmarks for measuring erosion size.
  
  
  
  HR-pQCT images of metacarpophalangeal joints of RA and control subjects were used in an iterative process to achieve consensus on the definition and reference landmarks. Independent readers (n = 11) applied the definition to score 58 joints and measure pathologic erosions in 2 perpendicular multiplanar reformations for their maximum width and depth. Interreader reliability for erosion detection and variability in measurements between readers [root mean square coefficient of variation (RMSCV), intraclass correlation (ICC)] were calculated.
  
  
  
  Pathologic erosions were defined as cortical breaks extending over a minimum of 2 consecutive slices in perpendicular planes, with underlying trabecular bone loss and a nonlinear shape. Interreader agreement for classifying pathologic erosions was 90.2%, whereas variability for width and depth erosion assessment was observed (RMSCV perpendicular width 12.3%, axial width 20.6%, perpendicular depth 24.0%, axial depth 22.2%; ICC perpendicular width 0.206, axial width 0.665, axial depth 0.871, perpendicular depth 0.783). Mean erosion width was 1.84 mm (range 0.16-8.90) and mean depth was 1.86 mm (range 0.30-8.00).
  
  
  
  We propose a new definition for erosions visualized with HR-pQCT imaging. Interreader reliability for erosion detection is good, but further refinement of selection of landmarks for erosion size measurement, or automated volumetric methods, will be pursued.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Barnabe
authors.forename: Dominique
authors.initials: D
authors.lastname: Toepfer
authors.forename: Hubert
authors.initials: H
authors.lastname: Marotte
authors.forename: Ellen-Margrethe
authors.initials: EM
authors.lastname: Hauge
authors.forename: Andrea
authors.initials: A
authors.lastname: Scharmga
authors.forename: Roland
authors.initials: R
authors.lastname: Kocijan
authors.forename: Sebastian
authors.initials: S
authors.lastname: Kraus
authors.forename: Stephanie
authors.initials: S
authors.lastname: Boutroy
authors.forename: Georg
authors.initials: G
authors.lastname: Schett
authors.forename: Kresten Krarup
authors.initials: KK
authors.lastname: Keller
authors.forename: Joost
authors.initials: J
authors.lastname: de Jong
authors.forename: Kathryn S
authors.initials: KS
authors.lastname: Stok
authors.forename: Stephanie
authors.initials: S
authors.lastname: Finzel
mesh_terms: D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging*; D018450:Disease Progression; D006801:Humans; D008662:Metacarpophalangeal Joint / Q000000981:diagnostic imaging*; D015203:Reproducibility of Results; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: EROSIONS; HR-PQCT; RHEUMATOID ARTHRITIS