University of Manchester, Manchester, UK.
University of Manchester and Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK.
Arthritis Care Res (Hoboken). 2018 Mar;70(3):486-490. doi: 10.1002/acr.23300.
Digital ulcers are a major problem in patients with systemic sclerosis (SSc), causing severe pain and impairment of hand function. In addition, digital ulcers heal slowly and sometimes become infected, which can lead to gangrene and necessitate amputation if appropriate intervention is not taken. A reliable, objective method for assessing digital ulcer healing or progression is needed in both the clinical and research arenas. This study was undertaken to compare 2 computer-assisted planimetry methods of measurement of digital ulcer area on photographs (ellipse and freehand regions of interest [ROIs]), and to assess the reliability of photographic calibration and the 2 methods of area measurement.
Photographs were taken of 107 digital ulcers in 36 patients with SSc spectrum disease. Three raters assessed the photographs. Custom software allowed raters to calibrate photograph dimensions and draw ellipse or freehand ROIs. The shapes and dimensions of the ROIs were saved for further analysis.
Calibration (by a single rater performing 5 repeats per image) produced an intraclass correlation coefficient (intrarater reliability) of 0.99. The mean ± SD areas of digital ulcers assessed using ellipse and freehand ROIs were 18.7 ± 20.2 mm and 17.6 ± 19.3 mm , respectively. Intrarater and interrater reliability of the ellipse ROI were 0.97 and 0.77, respectively. For the freehand ROI, the intrarater and interrater reliability were 0.98 and 0.76, respectively.
Our findings indicate that computer-assisted planimetry methods applied to SSc-related digital ulcers can be extremely reliable. Further work is needed to move toward applying these methods as outcome measures for clinical trials and in clinical settings.
手指溃疡是系统性硬化症（SSc）患者的一个主要问题，会导致严重的疼痛和手部功能障碍。此外，手指溃疡愈合缓慢，有时会感染，若不采取适当的干预措施，可能导致坏疽和需要截肢。在临床和研究领域都需要一种可靠的、客观的方法来评估手指溃疡的愈合或进展。本研究旨在比较两种计算机辅助的手指溃疡面积测量方法（椭圆和徒手感兴趣区域[ROI]），并评估照片校准和两种面积测量方法的可靠性。
对 36 例 SSc 谱系疾病患者的 107 个手指溃疡进行了拍照。3 名评估者对照片进行了评估。定制软件允许评估者校准照片尺寸并绘制椭圆或徒手 ROI。ROI 的形状和尺寸被保存下来进行进一步分析。
通过一名评估者对每张图像重复 5 次进行校准（单盲），产生了 0.99 的组内相关系数（组内可靠性）。使用椭圆和徒手 ROI 评估的手指溃疡平均面积分别为 18.7±20.2mm 和 17.6±19.3mm。椭圆 ROI 的组内和组间可靠性分别为 0.97 和 0.77。对于徒手 ROI，组内和组间可靠性分别为 0.98 和 0.76。
我们的研究结果表明，应用于 SSc 相关手指溃疡的计算机辅助面积测量方法非常可靠。需要进一步的工作来推动将这些方法作为临床试验和临床实践中的结果测量方法。
