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Kälvesten, J., Lui, L.-Y., Brismar, T. & Cummings, S. (2016). Digital X-ray radiogrammetry in the study of osteoporotic fractures: Comparison to dual energy X-ray absorptiometry and FRAX. Bone, 86, 30-35
Open this publication in new window or tab >>Digital X-ray radiogrammetry in the study of osteoporotic fractures: Comparison to dual energy X-ray absorptiometry and FRAX
2016 (English)In: Bone, ISSN 8756-3282, E-ISSN 1873-2763, Vol. 86, p. 30-35Article in journal (Refereed) Published
Abstract [en]

Osteoporosis is often underdiagnosed and undertreated. Screening of post -menopausal women for clinical risk factors and/or low bone mineral density (BMD) has been proposed to overcome this. Digital X-ray radiogrammetry (DXR) estimates hand BMD from standard hand X-ray images and have shown to predict fractures and osteoporosis. Recently, digital radiology and the internet have opened up the possibility of conducting automated opportunistic screening with DXR in post -fracture care or in combination with mammography. This study compared the performance of DXR with FRAX (R) and DXA in discriminating major osteoporotic fracture (MOF) (hip, clinical spine, forearm or shoulder), hip fracture and femoral neck osteoporosis. This prospective cohort study was conducted on 5278 women 65 years and older in the Study of Osteoporotic Fractures (SOF) cohort Baseline hand X-ray images were analyzed and fractures were ascertained during 10 years of follow up. Age -adjusted area under receiver operating characteristic curve (AUC) for MOF and hip fracture and for femoral neck osteoporosis (DXA FN BMD T -score <= -2.5) was used to compare the methods. Sensitivity to femoral neck osteoporosis at equal selection rates was tabulated for FRAX and DXR. DXR-BMD, FRAX (no BMD) and lumbar spine DXA BMD were all similar in fracture discriminative performance with an AUC around 0.65 for MOF and 0.70 for hip fractures for all three methods. As expected femoral neck DXA provided fracture discrimination superior both to other BMD measurements and to FRAX. AUC for selection of patients with femoral neck osteoporosis was higher with DXR-BMD, 0.76 (0.74-0.77), than with FRAX, 0.69 (0.67-0.71), (p < 0.0001). In conclusion, DXR-BMD discriminates incident fractures to a similar degree as FRAX and predicts femoral neck osteoporosis to a larger degree than FRAX. DXR shows promise as a method to automatically flag individuals who might benefit from an osteoporosis assessment (C) 2016 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

Place, publisher, year, edition, pages
ELSEVIER SCIENCE INC, 2016
Keywords
Bone mineral density; Osteoporosis; Digital X-ray radiogrammetry; FRAX; Dual-energy X-ray absorptiometry
National Category
Orthopaedics
Identifiers
urn:nbn:se:liu:diva-128941 (URN)10.1016/j.bone.2016.02.011 (DOI)000374512700004 ()26921822 (PubMedID)
Note

Funding Agencies|Sectra AB, Linkoping, Sweden; National Institutes of Health; National Institute on Aging (NIA) [R01 AG005407, R01 AR35582, R01 AR35583, R01 AR35584, R01 AG005394, R01 AG027574, R01 AG027576]

Available from: 2016-06-09 Created: 2016-06-07 Last updated: 2018-01-10
Kälvesten, J. (2015). Automatic image analysis for decision support in rheumatoid arthritis and osteoporosis. (Doctoral dissertation). Linköping: Linköping University Electronic Press
Open this publication in new window or tab >>Automatic image analysis for decision support in rheumatoid arthritis and osteoporosis
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Low-energy trauma and fragility fractures represent a major public health problem. The societal cost of the fragility fractures that occurred in Sweden 2010 has been estimated at €4 billion.

In rheumatoid arthritis (RA), patient outcomes have improved greatly in recent years. However, the therapeutic decision making is still hampered by a lack of effective validated biomarkers. The cost of RA in Sweden 2010 has been estimated at €600 million, of which biologic drugs was €180 million.

Digital X-ray radiogrammetry (DXR) is a method to measure bone mineral density (BMD) in the metacarpals of the hand. It can be applied opportunistically in several workflows where a person is already at an X-ray machine, including fracture repositioning follow up, mammography screening and hand imaging in RA. This thesis explored DXR-BMD as a marker to identify individuals who would benefit from anti-osteoporotic treatment, change rate of DXR-BMD as a biomarker in RA and under what conditions historical X-ray images can be used to estimate DXR-BMD. An automated method for measurement of joint space width in metacarpophalangeal and interphalangeal joints was also developed and evaluated as a biomarker in RA.

Low DXR-BMD was predictive for hip fractures and predicted fragility fractures to a comparable degree as other BMD measurement sites. Rapid decrease of DXR-BMD was a strong and independent predictor for progression of radiographic damage in RA when manual radiographic progression scores were not available. Change of metacarpal joint space width was a statistically significant but weak predictor of joint space narrowing score progression. Guidelines and considerations for use of historical X-ray radiographs for DXR-BMD measurements in clinical trials have been developed and published.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2015. p. 57
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1433
Keywords
Osteoporosis, rheumatoid arthritis, digital X-ray radiogrammetry, joint space width, bone densitometry
National Category
Medical Image Processing
Identifiers
urn:nbn:se:liu:diva-113680 (URN)10.3384/diss.diva-113680 (DOI)978-91-7519-170-6 (ISBN)
Public defence
2015-03-13, Wrannesalen, CMIV, Campus US, Linköpings universitet, Linköping, 13:00 (English)
Opponent
Supervisors
Available from: 2015-01-28 Created: 2015-01-28 Last updated: 2015-03-26Bibliographically approved
Wevers-de Boer, K. V., Heimans, L., Visser, K., Kälvesten, J., Goekoop, R. J., van Oosterhout, M., . . . Allaart, C. F. (2015). Four-month metacarpal bone mineral density loss predicts radiological joint damage progression after 1 year in patients with early rheumatoid arthritis: exploratory analyses from the IMPROVED study. Annals of the Rheumatic Diseases, 74(2), 341-346
Open this publication in new window or tab >>Four-month metacarpal bone mineral density loss predicts radiological joint damage progression after 1 year in patients with early rheumatoid arthritis: exploratory analyses from the IMPROVED study
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2015 (English)In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 74, no 2, p. 341-346Article in journal (Refereed) Published
Abstract [en]

Aim To assess whether in early (rheumatoid) arthritis (RA) patients, metacarpal bone mineral density (BMD) loss after 4 months predicts radiological progression after 1 year of antirheumatic treatment. Methods Metacarpal BMD was measured 4 monthly during the first year by digital X-ray radiogrammetry (DXR-BMD) in patients participating in the IMPROVED study, a clinical trial in 610 patients with recent onset RA (2010 criteria) or undifferentiated arthritis, treated according to a remission (disease activity scoreless than1.6) steered strategy. With Sharp/van der Heijde progression greater than= 0.5 points after 1 year (yes/no) as dependent variable, univariate and multivariate logistic regression analyses were performed. Results Of 428 patients with DXR-BMD results and progression scores available, 28 (7%) had radiological progression after 1 year. Independent predictors for radiological progression were presence of baseline erosions (OR (95% CI) 6.5 (1.7 to 25)) and early DXR-BMD loss (OR (95% CI) 1.5 (1.1 to 2.0)). In 366 (86%) patients without baseline erosions, early DXR-BMD loss was the only independent predictor of progression (OR (95% CI) 2.0 (1.4 to 2.9)). Conclusions In early RA patients, metacarpal BMD loss after 4 months of treatment is an independent predictor of radiological progression after 1 year. In patients without baseline erosions, early metacarpal BMD loss is the main predictor of radiological progression.

Place, publisher, year, edition, pages
BMJ Publishing Group, 2015
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-114227 (URN)10.1136/annrheumdis-2013-203749 (DOI)000347458300005 ()24285491 (PubMedID)
Note

Funding Agencies|Abbott

Available from: 2015-02-16 Created: 2015-02-16 Last updated: 2017-12-04
Wilczek, M. L., Nielsen, C., Kälvesten, J., Algulin, J. & Brismar, T. B. (2015). Mammography and Osteoporosis Screening-Clinical Risk Factors and Their Association With Digital X-Ray Radiogrammetry Bone Mineral Density. Journal of clinical densitometry, 18(1), 22-29
Open this publication in new window or tab >>Mammography and Osteoporosis Screening-Clinical Risk Factors and Their Association With Digital X-Ray Radiogrammetry Bone Mineral Density
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2015 (English)In: Journal of clinical densitometry, ISSN 1094-6950, E-ISSN 1559-0747, Vol. 18, no 1, p. 22-29Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to study the association between digital X-ray radiogrammetry (DXR) T-score and clinical risk factors for osteoporosis. Women were recruited 2 d per wk at a single mammography screening center between year 2010 and 2012. Included women answered a questionnaire about risk factors for osteoporosis, and a radiograph of the nondominant hand was obtained for DXR analysis. Univariate associations between DXR T-score and risk factors were examined. A generalized linear regression model was fitted to independent variables with univariate associations at p less than 0.05. The multivariable model was reduced through manual backward elimination, with p greater than 0.1 as the exclusion criterion. Seventy-six percent of the women chose to participate in the study (n = 8810). The difference in number of daily mammograms performed on study vs nonstudy days was not significant. All univariate associations between DXR T-score and potential risk factors were highly significant. The multivariable model included height, weight, age, right-handedness, menopause before age 45, alcohol consumption, cortisone treatment, rheumatic disease, and age x smoking status. The coefficient of determination of the model was 0.37. The association between risk factors for osteoporosis and DXR T-score is similar to previously reported associations with dual-energy X-ray absorptiometry.

Place, publisher, year, edition, pages
Elsevier, 2015
Keywords
Bone mineral density; digital X-ray radiogrammetry; mammography; osteoporosis; screening
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-115003 (URN)10.1016/j.jocd.2014.07.007 (DOI)000348970300006 ()25294740 (PubMedID)
Note

Funding Agencies|Stockholm County Council; Karolinska Institutet

Available from: 2015-03-09 Created: 2015-03-06 Last updated: 2017-12-04
Kälvesten, J., Brismar, T. B. & Persson, A. (2014). Potential sources of quantification error when retrospectively assessing metacarpal bone loss from historical radiographs by using digital X-ray radiogrammetry: an experimental study. Journal of clinical densitometry, 17(1), 104-108
Open this publication in new window or tab >>Potential sources of quantification error when retrospectively assessing metacarpal bone loss from historical radiographs by using digital X-ray radiogrammetry: an experimental study
2014 (English)In: Journal of clinical densitometry, ISSN 1094-6950, E-ISSN 1559-0747, Vol. 17, no 1, p. 104-108Article in journal (Refereed) Published
Abstract [en]

During the past 15 yr, digital X-ray radiogrammetry (DXR) has been used to measure metacarpal bone mineral density (BMD). BMD is often measured in existing cohorts where X-ray images were not acquired in accordance with the DXR imaging protocol (DIP). The purpose of the present study was to analyze how deviations from DIP in historical radiographs may affect the reproducibility of DXR-BMD measurements. Cadaver hand phantoms were used to conduct repeat measurements of deviations from DIP with respect to voltage, exposure, lateral displacement, supination, combination of lateral displacement and supination or rotation, extension of the wrist, and edge enhancement. Direct digital radiography (Aristos; Siemens Healthcare, Erlangen, Germany) was used for image acquisition and dxr-online (Sectra, Linkoping, Sweden) for DXR-BMD measurements. The influence of the tested deviations from DIP ranged from 0 to 32.5 mg/cm(2) (0-6.8%). On repetition with the same specimen, none of the deviations resulted in a within-specimen reproducibility error greater than 2 mg/cm(2) (0.4%, equivalent to a T-score of 0.042). Among the tested deviations, all except tube voltage had a magnitude greater than the normal measurement noise for the technique and must therefore be considered when planning a study based on historical images.

Place, publisher, year, edition, pages
Elsevier, 2014
Keywords
Bone mineral density; digital X-ray radiogrammetry; osteoporosis; rheumatoid arthritis
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:liu:diva-105587 (URN)10.1016/j.jocd.2013.04.002 (DOI)000331598300018 ()23664111 (PubMedID)
Available from: 2014-03-28 Created: 2014-03-27 Last updated: 2017-12-05Bibliographically approved
Wilczek, M. L., Kälvesten, J., Algulin, J., Beiki, O. & Brismar, T. B. (2013). Digital X-ray radiogrammetry of hand or wrist radiographs can predict hip fracture risk-a study in 5,420 women and 2,837 men. European Radiology, 23(5), 1383-1391
Open this publication in new window or tab >>Digital X-ray radiogrammetry of hand or wrist radiographs can predict hip fracture risk-a study in 5,420 women and 2,837 men
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2013 (English)In: European Radiology, ISSN 0938-7994, E-ISSN 1432-1084, Vol. 23, no 5, p. 1383-1391Article in journal (Refereed) Published
Abstract [en]

To assess whether digital X-ray radiogrammetry (DXR) analysis of standard clinical hand or wrist radiographs obtained at emergency hospitals can predict hip fracture risk. less thanbrgreater than less thanbrgreater thanA total of 45,538 radiographs depicting the left hand were gathered from three emergency hospitals in Stockholm, Sweden. Radiographs with insufficiently included metacarpal bone, fractures in measurement regions, foreign material or unacceptable positioning were manually excluded. A total of 18,824 radiographs from 15,072 patients were analysed with DXR, yielding a calculated BMD equivalent (DXR-BMD). Patients were matched with the national death and inpatient registers. Inclusion criteria were age a parts per thousand yen 40 years, no prior hip fracture and observation time andgt; 7 days. Hip fractures were identified via ICD-10 codes. Age-adjusted hazard ratio per standard deviation (HR/SD) was calculated using Cox regression. less thanbrgreater than less thanbrgreater than8,257 patients (65.6 % female, 34.4 % male) met the inclusion criteria. One hundred twenty-two patients suffered a hip fracture after their radiograph. The fracture group had a significantly lower DXR-BMD than the non-fracture group when adjusted for age. The HR/SD for hip fracture was 2.52 and 2.08 in women and men respectively. The area under the curve was 0.89 in women and 0.84 in men. less thanbrgreater than less thanbrgreater thanDXR analysis of wrist and hand radiographs obtained at emergency hospitals predicts hip fracture risk in women and men. less thanbrgreater than less thanbrgreater thanKey Points less thanbrgreater than less thanbrgreater thanDigital X-ray radiogrammetry of emergency hand/wrist radiographs predicts hip fracture risk. less thanbrgreater than less thanbrgreater thanDigital X-ray radiogrammetry (DXR) predicts hip fracture risk in both women and men. less thanbrgreater than less thanbrgreater thanOsteoporosis can potentially be identified in patients with suspected wrist fractures. less thanbrgreater than less thanbrgreater thanDXR can potentially be used for selective osteoporosis screening.

Place, publisher, year, edition, pages
Springer Verlag (Germany), 2013
Keywords
Osteoporosis, Hip fracture, Digital X-ray radiogrammetry, Cohort, BMD
National Category
Engineering and Technology
Identifiers
urn:nbn:se:liu:diva-103399 (URN)10.1007/s00330-012-2706-9 (DOI)000317427500029 ()
Note

Funding Agencies|Stockholm County Council||Karolinska Institutet||

Available from: 2014-01-20 Created: 2014-01-20 Last updated: 2017-12-06Bibliographically approved
Kälvesten, J., Haugeberg, G., Forslind, K., Rezaei, H. & Ronald F, v. V.Feasibility, precision and validity of a novel fully automated quantitative method developed for measurement of digital joint space width in inflammatory arthritis.
Open this publication in new window or tab >>Feasibility, precision and validity of a novel fully automated quantitative method developed for measurement of digital joint space width in inflammatory arthritis
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(English)Manuscript (preprint) (Other academic)
Abstract [en]

Objectives

In rheumatoid arthritis (RA) radiographic joint damage is a key long-term outcome and is often evaluated in clinical trials through the van der Heijde modified Sharp method which includes the joint space narrowing (JSN) score. The aim of this study was to investigate the feasibility, the precision and the validity of a novel fully automated method for quantifying joint space width (JSW) in metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints in order to develop a method for use in the clinic where manual scoring is usually not available.

Methods

Radiographs from the SWEFOT trial were examined and processed for automated quantification of 1 year change (1yCh) in average JSW in MCP joints 2, 3 and 4 and proximal PIP joints 2 and 3. The relationship between change in JSW and change in JSN was studied using linear regression.

Results

1yCh in MCP234 and PIP23 was successfully measured in 119/119 and 117/119 patients respectively. Reproducibility expressed as coefficient of variation was 1.4% for MCP234 JSW and 1.6% for PIP23 JSW. There was a significant relationship between 1yCh in MCP234 JSW and 1yCh in JSN (r= -0.19, p=0.036). In contrast, 1yCh in PIP23 JSW was not independently significantly associated with 1yCh in JSN.

Conclusion

Automated measurement of change in MCP234 JSW was technically feasible and it was related to the change in JSN. Adding PIP23 JSW did not strengthen the association to JSN. We are continuing to study the possible utility of JSW in clinical trials and clinical practice.

Keywords
Joint space width, rheumatoid arthritis, Computer-aided joint space analysis, Sharp van der Heijde score, Digital X-ray radiogrammetry
National Category
Medical Image Processing Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:liu:diva-114401 (URN)
Available from: 2015-02-20 Created: 2015-02-20 Last updated: 2015-02-20Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-3486-796X

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