Article Figures & Data
Figures
- Figure 1.
Computed tomography (CT; A), magnetic resonance imaging (MRI; B), and radiography (C) of the wrist of a patient with rheumatoid arthritis. A coronal CT slice, the corresponding coronal T1-weighted slice, and the conventional radiograph in posterior–anterior projection are shown (note that not all joint spaces are visible in this slice). CMC: carpometacarpal; Tm: trapezium; Td: trapezoid; C: capitate; H: hamate; S: scaphoid; L: lunate; Tr: triquetrum; R: radius. Joint space narrowing scores on CT/MRI were CMC1 = 3/3; CMC2 = 3/1; CMC3 = 2/0; CMC4 = 2/0; CMC5 = 1/0; Tm-Td = 3/1; Td-C = 3/1; C-H = 0/1; Tm-S = 2/3; Td-S = 0/1; C-S = 1/1; C-L = 2/0; H-T = 0/0; S-L = 0/0; L-T = 1/1; R-S = 1/1; R-L = 1/1. Sharp/van der Heijde joint space narrowing scores were CMC3 = 2; CMC4 = 2; CMC5 = 0; Tm/Td-S = 2; C-S = 3; R-S = 2.
- Figure 2.
Computed tomography (CT; A), magnetic resonance imaging (MRI; B), and radiography (C) of the metacarpophalangeal (MCP 2–4) joints (left to right) of a patient with rheumatoid arthritis. A coronal CT slice, the corresponding coronal T1-weighted slice and the conventional radiograph in posterior-anterior projection are shown. Joint space narrowing scores on CT/MRI/radiography were MCP2 = 1/2/3, MCP3 = 2/3/3, MCP4 = 0/0/0.
Tables
Age, yrs 60 (31–78) Female 71% Disease duration, yrs 4.5 (1–20) IgM rheumatoid factor-positive 71% Swollen joint count, 0–28 6 (1–20) Tender joint count, 0–28 5 (1–26) CRP, mg/l 9 (3–117) DAS28-CRP3 4.2 (3.5–7.1) HAQ score 1.13 (0–1.88) No. previous DMARD 2.5 (1–5) Methotrexate dose, mg/week 18.8 (7.5–25) -
The healthy control was a 37-year-old male. CRP: Serum C-reactive protein; DAS: Disease Activity Score; HAQ: Health Assessment Questionnaire; DMARD: disease-modifying antirheumatic drugs.
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- Table 2.
Magnetic resonance imaging and computed tomography joint space narrowing scores in patients with rheumatoid arthritis and healthy controls. Intrareader and interreader agreement.
Score
CharacteristicsMRI Observed Scores, median (range) MRI Intrareader Agreement (single measure ICC) MRI Interreader Agreement MRI Agreement with Radiograph SvdH JSN Score (single measure ICC)* CT Observed Scores, median (range) CT Intrareader Agreement (single measure ICC) CT Interreader Agreement CT Agreement with Radiograph SvdH JSN score (single measure ICC)* MRI Agreement with CT Radiograph Observed Scores, Median (range) JSN score** No. Assessed Areas Possible Range Radiologist Radiologist Rheumatologist 1 Rheumatologist 2 ICC (average measure) Unilateral MCP2–5 Unilateral Wrist Unilateral MCP2–5 and Wrist Bilateral Hands and Feet Radiologist Radiologist Rheumatologist 1 Rheumatologist 2 ICC (average measure) Unilatral MCP2–5 Unilateral Wrist Unilateral MCP2–5 and Wrist Bilatral Hands and Feet ICC (single measure) Rheumatologist Wrist + MCP2–5 21 0–84 13 (0–57) 0.98 0.97 0.98 0.94 −0.01 0.53 0.57 0.46 23 (0–58) 0.98 0.96 0.95 0.96 0.03 0.40 0.50 0.67 0.92 — MCP2–5 4 0–16 0 (0–5) 0.91 0.99 0.93 0.82 0.49 0.02 0.09 0.03 1 (0–6) 0.90 0.81 0.75 0.66 0.56 −0.01 0.09 0.03 0.94 2 (0–16) Wrist 17 0–68 12 (0–57) 0.98 0.97 0.98 0.95 −0.04 0.55 0.55 0.40 17 (0–58) 0.98 0.97 0.96 0.97 0.01 0.43 0.50 0.61 0.92 — SvdH-Wrist + 11 0–40 5 (0–19) 0.96 0.96 0.95 0.91 0.10 0.85 0.63 0.14 11 (0–20) 0.97 0.92 0.90 0.92 0.23 0.89 0.89 0.24 0.81 14 (0–24) MCP2–5 SvdH-wrist 7 0–24 3 (0–19) 0.97 0.96 0.96 0.95 −0.16 0.80 0.47 0.10 7 (0–20) 0.98 0.95 0.95 0.97 0.07 0.95 0.75 0.19 0.81 8 (0–22) Genant-wrist + 11 0–28 4 (0–11) 0.93 0.94 0.97 0.90 0.32 0.54 0.39 0.09 6 (0–11) 0.95 0.91 0.88 0.89 0.46 0.62 0.51 0.12 0.89 — MCP2–5 Genant-wrist 7 0–12 1 (0–9) 0.96 0.93 0.99 0.97 −0.14 0.47 0.24 0.05 5 (0–15) 0.99 0.96 0.96 0.96 0.06 0.83 0.56 0.13 0.69 — OM14 14 0–56 9 (0–49) 0.98 0.97 0.98 0.95 −0.05 0.64 0.62 0.35 16 (0–50) 0.99 0.97 0.96 0.97 0.01 0.52 0.60 0.54 0.92 — OM7 7 0–28 4 (0–24) 0.96 0.97 0.97 0.94 −0.08 0.91 0.66 0.16 8 (0–24) 0.99 0.98 0.95 0.97 0.06 0.90 0.84 0.25 0.91 — -
↵* For comparison with radiography, JSN scores of unilateral second to fifth MCP joints, unilateral wrist by the SvdH and the total SvdH JSN score (bilateral PIP2–5, MCP1–5, wrist, MTP1–5 and IP1) are used.
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↵** Simplified MRI and CT JSN scores in which only some joint spaces are evaluated: SvdH-wrist, SvdH-wrist + MCP2–5, Genant-wrist and Genant-wrist + MCP2–5 include all joint spaces included in the SvdH and Genant radiograph methods, respectively (for wrist and wrist + MCP2–5). OM7 includes the CMC2–3, trapezoid-scaphoid, capitate-lunate, hamate-triquetrum, radius-scaphoid, and the radius-lunate joint spaces and OM14 the same plus CMC4–5, trapezoid-capitate, capitate-hamate, trapezium-scaphoid, capitate-scaphoid, and the lunate-triquetrum joint spaces. For a detailed description of which joint areas are included in the different scoring approaches, see Table 1 in Østergaard, et al8. Observed MRI and CT scores, correlations with radiographic scores, and agreement between MRI and CT are given for the experienced musculoskeletal radiologist. Interreader ICC (average measure ICC provided) are for all 3 readers. MRI: magnetic resonance imaging; CT: computed tomography; JSN: joint space narrowing; MCP: metacarpophalangeal; OM7: OMERACT JSN assessment of 7 joint spaces; OM14: OMERACT JSN assessment of 14 joint spaces; SvdH: Sharp/van der Heijde; ICC: intraclass correlation coefficient.
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MRI Intraobserver SDD† (SDD/maximum observed value) CT Intraobserver SDD† (SDD/maximum observed value) Reader Radiologist Rheumatologist 1 Rheumatologist 2 Mean SDD Radiologist Rheumatologist 1 Rheumatologist 2 Mean SDD MCP2–5 1.7 (0.28) 1.0 (0.12) 1.0 (0.20) 1.2 1.8 (0.29) 3.3 (0.37) 3.1 (0.34) 2.7 Wrist 6.4 (0.11) 7.1 (0.12) 4.9 (0.08) 6.1 7.1 (0.12) 9.4 (0.16) 8.3 (0.14) 8.3 Total 6.6 (0.12) 7.3 (0.13) 5.2 (0.09) 6.4 8.1 (0.14) 11.2 (0.17) 10.4 (0.16) 9.9 -
↵† SDD = ± 1.96•SD[ReadA–ReadB]. SDD: smallest detectable difference; MCP2-5: second to fifth metacarpophalangeal joints; MRI: magnetic resonance imaging; CT: computed tomography; JSN: joint space narrowing.
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