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Feasibility, precision and validity of a novel fully automated quantitative method developed for measurement of digital joint space width in inflammatory arthritis
Linköping University, Center for Medical Image Science and Visualization (CMIV). Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Faculty of Health Sciences. Sectra AB, Linköping, Sweden.ORCID iD: 0000-0002-3486-796X
Department of Neurosciences, Norwegian University of Science and Technology, Trondheim / Department of Rheumatology, Hospital of Southern Norway Trust, Kristiansand, Norway.
Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund / Section of Rheumatology, Department of Medicine, Helsingborg’s Lasarett, Helsingborg, Sweden.
Unit of Clinical Therapy Research, Inflammatory Diseases (ClinTRID), The Karolinska Institute, Stockholm / Rheumatology Clinic, Karolinska University Hospital, Stockholm, Sweden.
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(English)Manuscript (preprint) (Other academic)
Abstract [en]


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.


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.


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.


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.

Keyword [en]
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
URN: urn:nbn:se:liu:diva-114401OAI: diva2:789781
Available from: 2015-02-20 Created: 2015-02-20 Last updated: 2015-02-20Bibliographically approved
In thesis
1. Automatic image analysis for decision support in rheumatoid arthritis and osteoporosis
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. 57 p.
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1433
Osteoporosis, rheumatoid arthritis, digital X-ray radiogrammetry, joint space width, bone densitometry
National Category
Medical Image Processing
urn:nbn:se:liu:diva-113680 (URN)10.3384/diss.diva-113680 (DOI)978-91-7519-170-6 (print) (ISBN)
Public defence
2015-03-13, Wrannesalen, CMIV, Campus US, Linköpings universitet, Linköping, 13:00 (English)
Available from: 2015-01-28 Created: 2015-01-28 Last updated: 2015-03-26Bibliographically approved

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Kälvesten, Johan
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