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Visual detection of cortical breaks in hand joints: reliability and validity of high-resolution peripheral quantitative CT compared to microCT.

Scharmga A, Peters M, van Tubergen A, van den Bergh J, de Jong J, Loeffen D, van Rietbergen B, Weijers R, Geusens P - BMC Musculoskelet Disord (2016)

Bottom Line: Cortical breaks were commonly visualized in MCP and PIP joints with HR-pQCT and μCT.Reliability of both HR-pQCT and μCT was fair to moderate.HR-pQCT was highly sensitive to detect cortical breaks with μCT as gold standard.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, division of Rheumatology, Maastricht University Medical Centre, P.O. Box 5800, NL-6202 AZ, Maastricht, The Netherlands. a.scharmga@maastrichtuniversity.nl.

ABSTRACT

Background: To study the reliability and validity of high-resolution peripheral quantitative CT (HR-pQCT) with microCT (μCT) as gold standard in the visual detection of cortical breaks in metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints.

Methods: Ten cadaveric fingers (10 MCP and 9 PIP joints) were imaged by HR-pQCT and μCT and visually analyzed by two independent readers. Intra- and interreader reliability were evaluated for the presence (yes/no, kappa statistics) and the total number (intraclass correlation coefficient, ICC) of cortical breaks. Sensitivity, specificity, positive and negative predictive value (PPV respectively NPV) of HR-pQCT in detecting cortical breaks were calculated.

Results: With HR-pQCT, mean 149 cortical breaks were identified and with μCT mean 129 (p < 0.05). Intrareader reliability for the presence of a cortical break per quadrant was 0.52 (95 % CI 0.48-0.56) and 0.71 (95 % CI 0.67-0.75) for HR-pQCT and μCT, respectively, and for the total number of cortical breaks 0.61 (95 % CI 0.49-0.70) and 0.75 (95 % CI 0.68-0.82). Interreader reliability for the presence of a cortical break per quadrant was 0.37 (95 % CI 0.33-0.41) and 0.45 (95 % CI 0.41-0.49) for HR-pQCT and μCT, respectively, and for the number of cortical breaks 0.55 (95 % CI 0.43-0.65) and 0.54 (95 % CI 0.35-0.67). Sensitivity, specificity, PPV and NPV of HR-pQCT were 81.6, 64.0, 81.6, and 64 % respectively.

Conclusion: Cortical breaks were commonly visualized in MCP and PIP joints with HR-pQCT and μCT. Reliability of both HR-pQCT and μCT was fair to moderate. HR-pQCT was highly sensitive to detect cortical breaks with μCT as gold standard.

No MeSH data available.


Corresponding images of cortical breaks on HR-pQCT and μCT. Panel a A discontinuity of the cortex (arrow) meeting the definition of a cortical break was seen on both HR-pQCT and μCT. Panel b A discontinuity of the cortex (arrow) meeting the definition of a cortical break was seen on both HR-pQCT and μCT. Panel c A discontinuity of the cortex (arrow) is seen on one slice only on HR- pQCT, thereby not fulfilling the definition for a break on HR-pQCT. A clear cortical break (arrow) is seen on μCT, which was also seen on nine subsequent slices, thereby fulfilling the definition of a break. Panel d A discontinuity of the cortex (arrow) meeting the definition of a cortical break is seen on HR-pQCT. On μCT, the cortical lining is intact (arrow). Abbreviations: MCP; metacarpophalangeal, HR-pQCT; high-resolution peripheral quantitative computed tomography, μCT; microCT
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Fig1: Corresponding images of cortical breaks on HR-pQCT and μCT. Panel a A discontinuity of the cortex (arrow) meeting the definition of a cortical break was seen on both HR-pQCT and μCT. Panel b A discontinuity of the cortex (arrow) meeting the definition of a cortical break was seen on both HR-pQCT and μCT. Panel c A discontinuity of the cortex (arrow) is seen on one slice only on HR- pQCT, thereby not fulfilling the definition for a break on HR-pQCT. A clear cortical break (arrow) is seen on μCT, which was also seen on nine subsequent slices, thereby fulfilling the definition of a break. Panel d A discontinuity of the cortex (arrow) meeting the definition of a cortical break is seen on HR-pQCT. On μCT, the cortical lining is intact (arrow). Abbreviations: MCP; metacarpophalangeal, HR-pQCT; high-resolution peripheral quantitative computed tomography, μCT; microCT

Mentions: In Fig. 1, several examples of cortical breaks on corresponding HR-pQCT and μCT images are presented. Panel A and B show a cortical break on both HR-pQCT and μCT. In panel C, a discontinuity of the cortex is found on HR-pQCT. However, it did not meet the definition of a cortical break applied in this study, because it was visible on one slice only, leading to discrepancy with the results from μCT. In panel D, a cortical break was detected on HR-pQCT, but not on μCT, where a thin cortical lining was seen.Fig. 1


Visual detection of cortical breaks in hand joints: reliability and validity of high-resolution peripheral quantitative CT compared to microCT.

Scharmga A, Peters M, van Tubergen A, van den Bergh J, de Jong J, Loeffen D, van Rietbergen B, Weijers R, Geusens P - BMC Musculoskelet Disord (2016)

Corresponding images of cortical breaks on HR-pQCT and μCT. Panel a A discontinuity of the cortex (arrow) meeting the definition of a cortical break was seen on both HR-pQCT and μCT. Panel b A discontinuity of the cortex (arrow) meeting the definition of a cortical break was seen on both HR-pQCT and μCT. Panel c A discontinuity of the cortex (arrow) is seen on one slice only on HR- pQCT, thereby not fulfilling the definition for a break on HR-pQCT. A clear cortical break (arrow) is seen on μCT, which was also seen on nine subsequent slices, thereby fulfilling the definition of a break. Panel d A discontinuity of the cortex (arrow) meeting the definition of a cortical break is seen on HR-pQCT. On μCT, the cortical lining is intact (arrow). Abbreviations: MCP; metacarpophalangeal, HR-pQCT; high-resolution peripheral quantitative computed tomography, μCT; microCT
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4940720&req=5

Fig1: Corresponding images of cortical breaks on HR-pQCT and μCT. Panel a A discontinuity of the cortex (arrow) meeting the definition of a cortical break was seen on both HR-pQCT and μCT. Panel b A discontinuity of the cortex (arrow) meeting the definition of a cortical break was seen on both HR-pQCT and μCT. Panel c A discontinuity of the cortex (arrow) is seen on one slice only on HR- pQCT, thereby not fulfilling the definition for a break on HR-pQCT. A clear cortical break (arrow) is seen on μCT, which was also seen on nine subsequent slices, thereby fulfilling the definition of a break. Panel d A discontinuity of the cortex (arrow) meeting the definition of a cortical break is seen on HR-pQCT. On μCT, the cortical lining is intact (arrow). Abbreviations: MCP; metacarpophalangeal, HR-pQCT; high-resolution peripheral quantitative computed tomography, μCT; microCT
Mentions: In Fig. 1, several examples of cortical breaks on corresponding HR-pQCT and μCT images are presented. Panel A and B show a cortical break on both HR-pQCT and μCT. In panel C, a discontinuity of the cortex is found on HR-pQCT. However, it did not meet the definition of a cortical break applied in this study, because it was visible on one slice only, leading to discrepancy with the results from μCT. In panel D, a cortical break was detected on HR-pQCT, but not on μCT, where a thin cortical lining was seen.Fig. 1

Bottom Line: Cortical breaks were commonly visualized in MCP and PIP joints with HR-pQCT and μCT.Reliability of both HR-pQCT and μCT was fair to moderate.HR-pQCT was highly sensitive to detect cortical breaks with μCT as gold standard.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, division of Rheumatology, Maastricht University Medical Centre, P.O. Box 5800, NL-6202 AZ, Maastricht, The Netherlands. a.scharmga@maastrichtuniversity.nl.

ABSTRACT

Background: To study the reliability and validity of high-resolution peripheral quantitative CT (HR-pQCT) with microCT (μCT) as gold standard in the visual detection of cortical breaks in metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints.

Methods: Ten cadaveric fingers (10 MCP and 9 PIP joints) were imaged by HR-pQCT and μCT and visually analyzed by two independent readers. Intra- and interreader reliability were evaluated for the presence (yes/no, kappa statistics) and the total number (intraclass correlation coefficient, ICC) of cortical breaks. Sensitivity, specificity, positive and negative predictive value (PPV respectively NPV) of HR-pQCT in detecting cortical breaks were calculated.

Results: With HR-pQCT, mean 149 cortical breaks were identified and with μCT mean 129 (p < 0.05). Intrareader reliability for the presence of a cortical break per quadrant was 0.52 (95 % CI 0.48-0.56) and 0.71 (95 % CI 0.67-0.75) for HR-pQCT and μCT, respectively, and for the total number of cortical breaks 0.61 (95 % CI 0.49-0.70) and 0.75 (95 % CI 0.68-0.82). Interreader reliability for the presence of a cortical break per quadrant was 0.37 (95 % CI 0.33-0.41) and 0.45 (95 % CI 0.41-0.49) for HR-pQCT and μCT, respectively, and for the number of cortical breaks 0.55 (95 % CI 0.43-0.65) and 0.54 (95 % CI 0.35-0.67). Sensitivity, specificity, PPV and NPV of HR-pQCT were 81.6, 64.0, 81.6, and 64 % respectively.

Conclusion: Cortical breaks were commonly visualized in MCP and PIP joints with HR-pQCT and μCT. Reliability of both HR-pQCT and μCT was fair to moderate. HR-pQCT was highly sensitive to detect cortical breaks with μCT as gold standard.

No MeSH data available.