Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany; Bone Metabolism Laboratory, Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany.
Semin Arthritis Rheum. 2018 Apr;47(5):611-618. doi: 10.1016/j.semarthrit.2017.09.011. Epub 2017 Sep 23.
The comparison between different techniques to quantify the 3-dimensional size of inflammatory bone erosions in rheumatoid arthritis(RA) patients.
Anti-cyclic citrullinated peptide antibody(ACPA) positive RA patients received high-resolution peripheral quantitative computed tomography (HR-pQCT) scans of the metacarpophalangeal joints (MCP). Erosions were measured by three different segmentation techniques: (1) manual method with calculation by half-ellipsoid formula, (2) semi-automated modified Evaluation Script for Erosions (mESE), and (3) semi-automated Medical Image Analysis Framework (MIAF) software. Bland & Altman plots were used to describe agreement between methods. Furthermore, shape of erosions was classified as regular or irregular and then compared to the sphericity obtained by MIAF.
A total of 76 erosions from 65 RA patients (46 females/19 males), median age 57 years, median disease duration 6.1 years and median disease activity score 28 of 2.8 units were analyzed. While mESE and MIAF showed good agreement in the measurement of erosion size, the manual method with calculation by half-ellipsoid formula underestimated erosions size, particularly with larger erosions. Accurate segmentation is particularly important in larger erosions, which are irregularly shaped. In all three segmentation techniques irregular erosions were larger in size than regular erosions (MIAF: 19.7 vs. 3.4mm; mESE: 15.5 vs. 2.3mm; manual = 7.2 vs. 1.52mm; all p < 0.001). In accordance, sphericity of erosions measured by MIAF significantly decreased with their size (p < 0.001).
MIAF and mESE allow segmentation of inflammatory bone erosions in RA patients with excellent inter reader reliability. They allow calculating erosion volume independent of erosion shape and therefore provide an attractive tool to quantify structural damage in individual joints of RA patients.
比较不同技术量化类风湿关节炎（RA）患者炎症性骨侵蚀三维大小的方法。
抗环瓜氨酸肽抗体（ACPA）阳性的 RA 患者接受掌指关节（MCP）的高分辨率外周定量计算机断层扫描（HR-pQCT）扫描。侵蚀通过三种不同的分割技术进行测量：（1）用半椭圆公式计算的手动方法，（2）半自动改良侵蚀评估脚本（mESE），和（3）半自动医学图像分析框架（MIAF）软件。Bland & Altman 图用于描述方法之间的一致性。此外，将侵蚀的形状分类为规则或不规则，并与 MIAF 获得的球体度进行比较。
共分析了 65 例 RA 患者的 76 个侵蚀（46 名女性/19 名男性），中位年龄 57 岁，中位病程 6.1 年，中位疾病活动评分 28 为 2.8 单位。虽然 mESE 和 MIAF 在侵蚀大小的测量上显示出良好的一致性，但用半椭圆公式计算的手动方法低估了侵蚀的大小，尤其是在较大的侵蚀中。在所有三种分割技术中，不规则侵蚀的大小都大于规则侵蚀（MIAF：19.7 比 3.4mm；mESE：15.5 比 2.3mm；手动 = 7.2 比 1.52mm；所有 p < 0.001）。相应地，MIAF 测量的侵蚀球体度随其大小显著降低（p < 0.001）。
MIAF 和 mESE 允许 RA 患者炎症性骨侵蚀的分割，具有出色的读者间可靠性。它们允许独立于侵蚀形状计算侵蚀体积，因此为量化 RA 患者单个关节的结构损伤提供了一种有吸引力的工具。
