Department of Rheumatology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Central Denmark Region, Denmark.
Department of Rheumatology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Central Denmark Region, Denmark; Department of Clinical Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Central Denmark Region, Denmark.
Joint Bone Spine. 2024 Jul;91(4):105699. doi: 10.1016/j.jbspin.2024.105699. Epub 2024 Feb 1.
To assist the development of future treatments in systemic sclerosis (SSc), the development of reliable outcome measures is pivotal. We aimed to evaluate the use of high-resolution peripheral quantitative CT (HR-pQCT) for visualization and gradation of acro-osteolysis (AO) and calcinosis compared to conventional hand radiographs (CR) in patients with SSc.
HR-pQCT scans of the 2nd to 4th fingers, CR, nail fold capillaroscopy, and a clinical examination were conducted. Images were reviewed for the presence and degree of AO and calcinosis according to semiquantitative grading scales.
Forty patients were included. Fourteen had AO according to CR, whereas HR-pQCT revealed AO in 18 patients. The sensitivity and specificity of classifying patients as having AO by HR-pQCT when CR was used as reference were 93% (95% CI: 66-99%) and 80% (95% CI: 59-93%), respectively. By CR and with HR-pQCT as reference, the sensitivity and specificity were 72% (95% CI: 47-90%) and 95% (95% CI: 76-99%). Patients with AO had more or larger calcifications than patients without AO according to the proposed HR-pQCT grading system, with a median grade of 2 (IQR: 1-3) versus 0 (IQR: 0-1) (P<0.01). Grade 3 changes were observed exclusively in patients with AO (n=6/14, 42.9%). Assessment of AO and calcinosis by HR-pQCT demonstrated moderate to excellent test-retest reliability.
HR-pQCT allowed precise and reliable classification and grading of acro-osteolysis and acral calcinosis. The modality could prove helpful for detecting and monitoring these lesions as well as facilitating early diagnosis and guide treatment of these patients.
为了协助系统性硬化症（SSc）的未来治疗发展，开发可靠的结局指标至关重要。我们旨在评估高分辨率外周定量 CT（HR-pQCT）在可视化和分级肢端骨质溶解（AO）和钙沉积方面的作用，与 SSc 患者的常规手部 X 线摄影（CR）相比。
对第 2 至第 4 指进行 HR-pQCT 扫描、CR、甲褶微血管镜检查和临床检查。根据半定量分级量表评估图像中 AO 和钙沉积的存在和程度。
共纳入 40 例患者。14 例根据 CR 存在 AO，而 HR-pQCT 显示 18 例患者存在 AO。当 CR 作为参考时，HR-pQCT 将患者分类为 AO 的敏感性和特异性分别为 93%（95%CI：66-99%）和 80%（95%CI：59-93%）。通过 CR 和以 HR-pQCT 作为参考，敏感性和特异性分别为 72%（95%CI：47-90%）和 95%（95%CI：76-99%）。根据提出的 HR-pQCT 分级系统，与无 AO 的患者相比，AO 患者的钙化数量更多或更大，中位数为 2 级（IQR：1-3）与 0 级（IQR：0-1）（P<0.01）。仅在 14 例患者中有 6 例（42.9%）观察到 3 级变化。HR-pQCT 对 AO 和钙沉积的评估显示出中等到极好的测试-重测可靠性。
HR-pQCT 允许精确和可靠地分类和分级肢端骨质溶解和肢端钙沉积。该方法可有助于检测和监测这些病变，并促进对这些患者的早期诊断和治疗指导。
