We read with interest the Perspectives article by Filippucci et al. (Progress in imaging in rheumatology. Nat. Rev. Rheumatol. 10, 628–634; 2014).1 This article is a very informative concise paper on MRI and musculoskeletal ultrasonography. However, we were surprised that no mention was made of high-resolution peripheral quantitative CT (HR-pQCT), previously highlighted in a Review in this journal,2 and we would like to call attention to its emerging potential in the field of advanced diagnostic imaging.
HR-pQCT was initially developed to study bone diseases such as osteoporosis, and has contributed to a better understanding of the separate behavior of trabecular and cortical bone structures and the different cortical envelopes during ageing, in metabolic bone diseases and during fracture healing;2 moreover, it allows for calculation of bone strength in vivo using finite-element analysis.3 Due to its ability to evaluate bone in 3D at a high resolution (82 μm) and with minimal irradiation (5 μSv to image a 0.9 cm region of interest), HR-pQCT is being intensely investigated in the evaluation of bone architecture in the small joints of the hands in rheumatoid arthritis,4,5,6 psoriatic arthritis,7 and hand osteoarthritis.8 To what degree can this method now be rated as “progress in imaging” in rheumatology?
Firstly, an increased number of, and earlier stages of, erosions are visible with HR-pQCT than on plain radiography, as evidenced by the work of Stach et al.4 Secondly, quantification of erosions in terms of size (width, depth and volume) together with changes in trabecular bone is possible, and has been studied in cross-sectional and longitudinal studies5,9,10,11 and in comparison with MRI.6 Thirdly, a 3D assessment of joint space is described using quantitative analysis algorithms.12,13 Fourthly, 3D measurement of bone microarchitecture in rheumatoid arthritis patients showed altered results with disease activity.14 None of these 3D parameters can currently be evaluated by other imaging techniques at such high resolution.
In conclusion, HR-pQCT is, besides MRI and musculoskeletal ultrasonography, also promising “progress in imaging” for clinical research in rheumatic disease of the hand joints. SPECTRA (Study Group for X-treme CT in Rheumatoid Arthritis)15 is an international collaboration between rheumatologists, radiologists, biomedical engineers, physicists and clinical researchers in bone metabolism and osteoimmunology that has provided fertile ground for cross-disciplinary research, united by the desire to certify the validity of the research findings from the application of this technology to the assessment of inflammatory arthritis.
References
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This correspondence was written by the authors on behalf of the Study Group for X-treme Computed Tomography in Rheumatoid Arthritis (SPECTRA).
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Barnabe, C., Finzel, S., Stok, K. et al. High-resolution peripheral quantitative CT in rheumatology. Nat Rev Rheumatol 11, 123 (2015). https://doi.org/10.1038/nrrheum.2014.145-c1
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DOI: https://doi.org/10.1038/nrrheum.2014.145-c1
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