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Arthritis Res Ther. 2012; 14(3): R131.
Published online May 30, 2012. doi:  10.1186/ar3861
PMCID: PMC3446512
Evaluating joint-space narrowing and cartilage loss in rheumatoid arthritis by using MRI
Charles G Peterfy,1 Julie C DiCarlo,corresponding author1 Ewa Olech,2 Maire-Agnes Bagnard,3 Annarita Gabriele,3 and Norman Gaylis4
1Spire Sciences, LLC, 72 Rock Road, San Francisco, CA 94904, USA
2Department of Rheumatology, University of Nevada School of Medicine, 1707 West Charleston Boulevard, Suite 220, Las Vegas, NV 89102, USA
3F. Hoffman-La Roche AG, Konzern-Hauptsitz, Grenzacherstrasse 124, CH-4070 Basel, Switzerland
4Arthritis & Rheumatic Disease Specialties, 21097 NE 27th Court, Aventura, FL 33180, USA
corresponding authorCorresponding author.
Charles G Peterfy: charles.peterfy/at/spiresciences.com; Julie C DiCarlo: julie.dicarlo/at/spiresciences.com; Ewa Olech: Ewa-Olech/at/omrf.org; Maire-Agnes Bagnard: marie-agnes.bagnard/at/roche.com; Annarita Gabriele: annarita.gabriele/at/roche.com; Norman Gaylis: NGaylis/at/aol.com
Received November 7, 2011; Revised March 19, 2012; Accepted May 30, 2012.
Abstract
Introduction
Magnetic resonance imaging (MRI) has been shown to be superior to radiography (XR) for assessing synovitis, osteitis, and bone erosion in rheumatoid arthritis (RA), particularly in clinical trials. However, relatively little has been reported on the ability of MRI to evaluate articular cartilage loss, or joint-space narrowing (JSN), in the hands and wrists. In a previous study, we adapted the nine-point Genant-modified Sharp XR-JSN score for use with MRI (MRI-JSN). In this study, we compare MRI-JSN with XR-JSN by using images from two multicenter clinical trials.
Methods
Baseline XR and 1.5-Tesla MR images of one hand and wrist from each of 47 subjects with RA enrolled in one of two multicenter clinical trials were evaluated by using the XR-JSN and MRI-JSN methods by a single radiologist experienced in the two methods. Radiographs and MR images were read independently on different occasions.
Results
In total, 575 of 611 joints were compared (one metacarpophalangeal joint of the thumb and 35 proximal interphalangeal joints were outside the MRI field of view and could not be assessed). The 22 (47%) subjects showed JSN with both XR and MRI, and 25 (53%) subjects showed no JSN with either method. No subject showed JSN with only one or the other method. MRI showed high agreement with XR (intraclass correlation coefficient = 0.83). Sensitivity of MRI for JSN, by using XR as the gold standard, was 0.94; specificity was 0.91; accuracy was 0.91; positive predictive value was 0.64; and negative predictive value was 0.99.
Conclusions
This validation exercise suggests that MRI JSN scoring may offer a viable alternative to XR JSN scoring in multicenter clinical trials of RA. However, the relative longitudinal sensitivity of MRI to change and the ability to discriminate therapeutic effect on JSN were not evaluated in this study.
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