Pfeil Alexander, Haugeberg Glenn, Renz Diane M, Reinhardt Lisa, Jung Christian, Franz Marcus, Wolf Gunter, Böttcher Joachim
Department of Internal Medicine III, Jena University Hospital, Friedrich-Schiller-University Jena, Erlanger Allee 101, 07747, Jena, Germany.
Norwegian University of Science and Technology, Trondheim, Norway.
J Bone Miner Metab. 2017 Mar;35(2):192-198. doi: 10.1007/s00774-016-0741-3. Epub 2016 Mar 15.
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.
数字X线摄影测量法（DXR）是一种计算机辅助诊断技术，用于通过X线片定量分析手部皮质骨矿物质密度（BMD）以及掌骨的掌骨指数（MCI）。目的是比较健康个体与类风湿关节炎（RA）患者之间的DXR-BMD和DXR-MCI，并验证该技术识别手部皮质骨丢失作为RA额外诊断方法的敏感性和特异性。招募了618名患者并分为两组：RA患者组（n = 309）和健康对照组（n = 309）作为参考数据库。使用手部X线片通过DXR测量DXR-BMD和DXR-MCI。通过改良Larsen评分评估RA的严重程度。与健康受试者相比，RA患者的DXR-BMD和DXR-MCI平均值显著降低（分别为-20.7%和-21.1%）。根据RA相关关节损伤的严重程度，比较改良Larsen评分的1分和5分，DXR-BMD显示显著降低28.1%，DXR-MCI降低28.2%。DXR-BMD和DXR-MCI在识别RA相关手部皮质骨丢失方面均具有高敏感性（DXR-BMD为91%，DXR-MCI为87%）和中等特异性（DXR-BMD为47%，DXR-MCI为49%）。DXR技术似乎能够将RA相关的关节周围骨质流失量化为RA病程中的一个特征性表现。因此，关节周围骨质疏松似乎是一种可靠的诊断方法，可与RA诊断中的侵蚀和关节间隙变窄相媲美，并且可作为RA骨质流失进展的替代标志物。
