Haj-Mirzaian Arya, Kubassova Olga, Boesen Mikael, Carrino John, Bird Paul
Johns Hopkins Hospital, Baltimore, Maryland.
Image Analysis Group, London, United Kingdom.
ACR Open Rheumatol. 2022 Aug;4(8):721-734. doi: 10.1002/acr2.11450. Epub 2022 Jun 10.
To summarize the feasibility of computer-assisted quantification of joint pathologies on magnetic resonance imaging (MRI) in patients with inflammatory arthritis by evaluating the published data on reliability, validity, and feasibility.
A systematic literature search was performed for original articles published from January 1, 1985, to January 1, 2021. We selected studies in which patients with inflammatory arthritis were enrolled, and arthritis-related structural damage/synovitis in peripheral joints was assessed on non-contrast-enhanced, contrast-enhanced (CE), or dynamic CE (DCE)-MRI using (semi)automated methods. Data were pooled using random-effects model.
Twenty-eight studies consisting of 1342 MRIs were included (mean age, 54.8 years; 66.7% female; duration of arthritis, 3.6 years). Among clinical/laboratory factors, synovial membrane volume (SV) was moderately correlated with erthrocyte sedimentation rate (ESR) level (P < 0.01). Pooled analysis showed an overall excellent intra- and inter-reader reliability for computer-aided quantification of bone erosion volume (BEV; r = 0.97 [95% CI: 0.92-0.99], 0.93 [0.87-0.97]), SV (r = 0.98 [95% CI: 0.90-0.99], 0.86 [0.78-0.91]), and DCE-MRI perfusion parameters (r = 0.96-0.99). Meta-regression showed that computer-aided and manual methods provide comparable reliability (P > 0.05). Computer-aided measurement of BEV (r = 0.92), SV (r = 0.82), and DCE-MRI biomarkers (r = 0.72 N-total; r = 0.74 N-plateau; r = 0.64 N-washout) were significantly correlated with the Rheumatoid Arthritis Magnetic Resonance Imaging Score (RAMRIS; P < 0.01), allowing for earlier assessment of drug efficacy. On average, (semi)automated analysis of BEV/SV took 17 minutes (vs. 9 minutes for the RAMRIS) and DCE-MRI took 4 minutes (vs. 33 minutes for manual assessment).
Computer-aided image quantification technologies demonstrate excellent reliability and validity when used to quantify MRI pathologies of peripheral joints in patients with inflammatory arthritis. Computer-aided evaluation of inflammatory arthritis is an emerging field and should be considered as a viable complement to conventional observer-based scoring methods for clinical trials application.
通过评估已发表的关于可靠性、有效性和可行性的数据，总结计算机辅助定量分析炎症性关节炎患者磁共振成像（MRI）关节病变的可行性。
对1985年1月1日至2021年1月1日发表的原创文章进行系统文献检索。我们选择纳入炎症性关节炎患者的研究，并使用（半）自动化方法在非增强、增强（CE）或动态CE（DCE）-MRI上评估外周关节的关节炎相关结构损伤/滑膜炎。使用随机效应模型汇总数据。
纳入了28项研究，共1342例MRI（平均年龄54.8岁；66.7%为女性；关节炎病程3.6年）。在临床/实验室因素中，滑膜体积（SV）与红细胞沉降率（ESR）水平呈中度相关（P<0.01）。汇总分析显示，计算机辅助定量分析骨侵蚀体积（BEV；组内相关系数r=0.97[95%CI：0.92-0.99]，组间相关系数r=0.93[0.87-0.97]）、SV（组内相关系数r=0.98[95%CI：0.90-0.99]，组间相关系数r=0.86[0.78-0.91]）和DCE-MRI灌注参数（组内相关系数r=0.96-0.99）的读者内和读者间可靠性总体极佳。Meta回归显示，计算机辅助方法和手动方法具有相当的可靠性（P>0.05）。计算机辅助测量的BEV（r=0.92）、SV（r=0.82）和DCE-MRI生物标志物（r=0.72 N-总量；r=0.74 N-平台期；r=0.64 N-廓清期）与类风湿关节炎磁共振成像评分（RAMRIS；P<0.01）显著相关，有助于更早评估药物疗效。平均而言，BEV/SV的（半）自动化分析耗时17分钟（而RAMRIS为9分钟），DCE-MRI耗时4分钟（而手动评估为33分钟）。
计算机辅助图像定量技术在用于定量分析炎症性关节炎患者外周关节的MRI病变时显示出极佳的可靠性和有效性。炎症性关节炎的计算机辅助评估是一个新兴领域，应被视为传统基于观察者的评分方法在临床试验应用中的可行补充。
