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1.
Curr Rheumatol Rep ; 25(7): 119-127, 2023 07.
Artigo em Inglês | MEDLINE | ID: mdl-37126093

RESUMO

PURPOSE OF REVIEW: This study aims to review recent studies on risk factors for syndesmophyte growth in ankylosing spondylitis (AS) and on treatment effects. RECENT FINDINGS: New genetic studies, including a genome-wide association study, provided only limited evidence of specific genetic associations with radiographic severity. Measures of inflammation, including vertebral osteitis and C-reactive protein level, were strongly associated with radiographic progression, while studies of adipokines had mixed results. Mesenchymal stem cells from HLA-B27 positive AS patients were found to promote vertebral ossification via a pathway of B27 misfolding, retinoic acid receptor-ß activation, and increased bone alkaline phosphatase. Low vertebral trabecular bone density is associated with syndesmophyte growth, with reciprocal effects when bridged. Several observational studies suggested radiographic severity was reduced by treatment with tumor necrosis factor inhibitors, particularly when longer than 2 years. Syndesmophyte development in AS is the result of a complex, incompletely understood, interplay of inflammatory and mechanical factors.


Assuntos
Doenças Musculoesqueléticas , Espondilite Anquilosante , Humanos , Espondilite Anquilosante/diagnóstico por imagem , Espondilite Anquilosante/genética , Espondilite Anquilosante/complicações , Estudo de Associação Genômica Ampla , Coluna Vertebral , Inflamação/patologia , Osteogênese/fisiologia
2.
Arthritis Rheumatol ; 74(8): 1352-1362, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35315248

RESUMO

OBJECTIVE: To examine the relationship between vertebral trabecular bone mineral density (tBMD), vertebral strength, and syndesmophytes in patients with ankylosing spondylitis (AS) using quantitative computed tomography (QCT). METHODS: We performed QCT of the spine to measure syndesmophytes and tBMD in 5 vertebrae (T11-L3) in 61 patients with AS. Finite element analysis was performed to measure vertebral strength in compressive overload, including in trabecular and cortical compartments. In cross-sectional analyses, we examined associations of syndesmophyte height with tBMD and vertebral strength in each vertebra. In 33 patients followed up for 2 years, we investigated whether baseline tBMD and vertebral strength predicted syndesmophyte growth in the same vertebra, and vice versa. RESULTS: In the cross-sectional analyses, 126 vertebrae had bridging, 77 vertebrae had nonbridging syndesmophytes, and 83 vertebrae had no syndesmophytes. There were strong inverse associations between syndesmophyte height and tBMD, total strength, and trabecular strength only among bridged vertebrae. In the longitudinal analysis, nonbridged vertebrae with low tBMD (adjusted ß = -0.01 [95% confidence interval (95% CI) -0.019, -0.0012]) and low strength (adjusted ß = -0.0003 [95% CI -0.0004, -0.0002]) had more syndesmophyte growth over time. Similar associations were absent among bridged vertebrae. Conversely, vertebrae with bridging at baseline had a significant loss in percent tBMD over time (adjusted ß = -0.001 [95% CI -0.0017, -0.0004]). CONCLUSION: Associations between syndesmophytes and vertebral density and strength in AS differ between bridged and nonbridged vertebrae. Among nonbridged vertebrae, low tBMD and strength are associated with syndesmophyte growth. Bridging is associated with large subsequent losses in tBMD, possibly due to mechanical offloading.


Assuntos
Espondilite Anquilosante , Densidade Óssea , Estudos Transversais , Humanos , Vértebras Lombares/diagnóstico por imagem , Coluna Vertebral/diagnóstico por imagem , Espondilite Anquilosante/complicações , Espondilite Anquilosante/diagnóstico por imagem , Tomografia Computadorizada por Raios X
3.
Ann Rheum Dis ; 78(7): 922-928, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30954970

RESUMO

OBJECTIVES: The aorta inhibits paravertebral ossification in diffuse idiopathic skeletal hyperostosis. We investigated if syndesmophytes in ankylosing spondylitis (AS) occurred less often at the vertebral rim near the aorta. METHODS: We performed thoracolumbar CT scans in 60 subjects in this cross-sectional study. The mid-thoracic spine was also scanned in 22 subjects. We divided the rim of each intervertebral disc space (IDS) into 72 angular sectors, each of 5°. We computed syndesmophyte height in each sector, and the distance from the sector to the aorta. We evaluated if syndesmophyte size or frequency in a sector was associated with its distance from the aorta. RESULTS: In the 180° region of the vertebral rim centered on the sector closest to the aorta, syndesmophyte height and/or frequency varied with the distance of the sector to the aorta, with the lowest frequency and smallest mean syndesmophyte height at the sector along the rim nearest the aorta. Additionally, syndesmophytes were less common in subjects and at IDSs where the aorta was anatomically closer to the vertebra. No syndesmophytes were present in the sector closest to the aorta in subjects whose aorta-vertebral distance was less than 2 mm, but syndesmophytes were progressively more common among subjects whose aortas lay further from the rim. CONCLUSIONS: Syndesmophytes occurred less commonly and were smaller at the thoracolumbar vertebral rim near the aorta. These findings suggest that mechanical factors extrinsic to the spine and not solely vertebral inflammation, influence syndesmophyte development in AS.


Assuntos
Aorta/patologia , Pesos e Medidas Corporais/métodos , Disco Intervertebral/patologia , Espondilite Anquilosante/patologia , Vértebras Torácicas/patologia , Adulto , Idoso , Aorta/diagnóstico por imagem , Estudos Transversais , Feminino , Humanos , Disco Intervertebral/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Espondilite Anquilosante/diagnóstico por imagem , Vértebras Torácicas/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto Jovem
4.
Curr Rheumatol Rep ; 20(8): 46, 2018 06 21.
Artigo em Inglês | MEDLINE | ID: mdl-29931429

RESUMO

PURPOSE OF REVIEW: We review new insights to syndesmophyte growth in axial spondyloarthritis revealed by computed tomography (CT). RECENT FINDINGS: CT allows full reliable quantitation of syndesmophytes. About 70% of patients had detectable growth in syndesmophyte volume or height in 1 year. Syndesmophyte growth is not uniform, but can be highly heterogeneous even within the same disc space of the same patient. Syndesmophytes are not randomly distributed around the vertebral rim but have preferred locations (posterolateral and anterolateral) which vary along the spine. The frequency of syndesmophyte involvement also varies along the spine. It is highest at the thoracolumbar junction and higher in the thoracic than lumbar spine. CT syndesmophyte quantitation is a promising tool for studies of medications or biomarkers and their relations with syndesmophyte progression. The localization and growth patterns of syndesmophytes suggest importance for local factors such as mechanical stress.


Assuntos
Vértebras Lombares/diagnóstico por imagem , Espondilartrite/diagnóstico por imagem , Vértebras Torácicas/diagnóstico por imagem , Progressão da Doença , Humanos , Vértebras Lombares/patologia , Espondilartrite/patologia , Vértebras Torácicas/patologia , Tomografia Computadorizada por Raios X
5.
Curr Opin Rheumatol ; 30(4): 334-339, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29538011

RESUMO

PURPOSE OF REVIEW: Computed tomography (CT) is increasingly being used in ankylosing spondylitis (AS) for imaging the spine and sacroiliac joint (SIJ). We review new insights to diagnosis and evaluation revealed by the use of CT. RECENT FINDINGS: Studies using low-dose CT in AS to detect syndesmophytes can image the entire spine, but semiquantitative scoring of the scans by human readers decreases the reliability and validity of this method. The thoracic spine is the segment most involved with syndesmophytes. Syndesmophytes are not randomly distributed around the vertebral rim but have preferred locations, which vary with the vertebral level and may be related to biomechanics. Examination of SIJ on abdominal CT scans has found structural changes of sacroiliitis in up to 35% of patients with inflammatory bowel disease. The significance of monosodium urate crystal deposition in the pelvis of axial spondyloarthritis patients without coexisting gout is uncertain. SUMMARY: Low-dose CT is a promising tool in AS. Studies of biomarkers or medications and their relations with syndesmophyte progression should take the thoracic spine into account. Abdominal CT scans are useful for detecting changes related to sacroiliitis.


Assuntos
Espondilartrite/diagnóstico por imagem , Progressão da Doença , Gota/complicações , Humanos , Reprodutibilidade dos Testes , Articulação Sacroilíaca/diagnóstico por imagem , Espondilartrite/complicações , Tomografia Computadorizada por Raios X/métodos
6.
J Rheumatol ; 44(12): 1828-1832, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28966206

RESUMO

OBJECTIVE: To determine the extent of thoracic involvement with syndesmophytes in ankylosing spondylitis (AS) relative to lumbar involvement. METHODS: We performed thoracolumbar spine computed tomography (CT) and lumbar radiography on 18 patients. We quantitated syndesmophytes in 11 intervertebral disc spaces and related these to the presence of syndesmophytes on lumbar radiographs. RESULTS: Syndesmophytes were slightly more common in the thoracic than in the lumbar spine and bridging was significantly more common. Thoracic syndesmophytes were universally present in patients without visible lumbar syndesmophytes on either radiographs or CT. CONCLUSION: Syndesmophytes predominate in the thoracic spine. Lumbar radiographs underestimate the degree of thoracic involvement.


Assuntos
Vértebras Lombares/diagnóstico por imagem , Espondilite Anquilosante/diagnóstico por imagem , Vértebras Torácicas/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
7.
J Rheumatol ; 44(7): 1004-1010, 2017 07.
Artigo em Inglês | MEDLINE | ID: mdl-28507186

RESUMO

OBJECTIVE: Because zygapophyseal joints (ZJ) are difficult to visualize on radiographs, little is known about the relationship of ZJ fusion to other features of spinal damage in ankylosing spondylitis (AS). We used computed tomography (CT) to investigate the concordance of ZJ fusion and syndesmophytes, and examined the contribution of both features to spinal motion. METHODS: We performed thoracolumbar CT scans (T10-T11 to L3-L4) on 55 patients. Two readers scored scans for ZJ fusion, which were compared to syndesmophyte height and extent of bridging, measured by computer algorithm at the same levels. We used multiple regression analysis to evaluate the relative contributions of ZJ fusion and syndesmophytes to spinal mobility. RESULTS: Fifty-one percent of patients had ZJ fusion in at least 1 vertebral level. Fusion was present in 129 of 652 individual ZJ. Syndesmophytes and bridging were often present in vertebral levels without ZJ fusion, suggesting that syndesmophytes most often develop first. ZJ fusion was present in 34% of vertebral levels with syndesmophytes and 55.9% of levels with bridging, suggesting a closer association with bridging. Syndesmophytes and ZJ fusion had similar associations with the modified Schober test, but syndesmophytes were more strongly associated with limitations in lateral thoracolumbar flexion. ZJ rarely showed new fusion over 4 years. CONCLUSION: Thoracolumbar ZJ fusion in AS is rarely present at vertebral levels without syndesmophytes. Syndesmophytes, therefore, likely appear before ZJ fusion at a given vertebral level. Both syndesmophytes and ZJ fusion contribute to limited forward lumbar flexion, but syndesmophytes contribute more to limited lateral flexion.


Assuntos
Espondilite Anquilosante/diagnóstico por imagem , Articulação Zigapofisária/diagnóstico por imagem , Adulto , Feminino , Humanos , Vértebras Lombares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular/fisiologia , Vértebras Torácicas/diagnóstico por imagem , Tomografia Computadorizada por Raios X
8.
Ann Rheum Dis ; 75(11): 1951-1957, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26797721

RESUMO

OBJECTIVE: Syndesmophytes in ankylosing spondylitis (AS) can occur anywhere along the vertebral rim, but little is known about how and where they develop, and particularly if they first form in certain locations along the rim. This information might provide clues to their aetiology. We examined the spatial distribution of syndesmophytes in the thoracolumbar spine in patients with AS using CT. METHODS: We performed lumbar spine CT scans in 50 patients and used a validated computer algorithm to measure syndesmophyte heights in six intervertebral disc spaces. We measured heights every five radial degrees around the rim of each superior and inferior vertebral endplate. RESULTS: Syndesmophytes were observed in 208 of 296 intervertebral disc spaces. Both ascending and descending syndesmophytes were non-randomly distributed along the vertebral rim (p<0.0001 for deviation from uniform distribution). Syndesmophytes occurred most often at the posterolateral vertebral rim, and least commonly at the posterior rim and anterior rim. In disc spaces with only small isolated syndesmophytes, these were also most likely to occur at the posterolateral rim. Syndesmophyte distribution varied with the vertebral level. Localisation at the posterolateral rim was most pronounced at T10-T11, T12-T12 and T12-L1, while L2-L3 and L3-L4 exhibited little localisation. CONCLUSIONS: Syndesmophytes are not randomly distributed around the vertebral rim, as might be expected if they develop solely in response to inflammation. Rather, they preferentially occur, and likely develop first, at the posterolateral rim. Studying factors that can lead to this pattern may help elucidate how syndesmophytes develop.


Assuntos
Ossificação Heterotópica/diagnóstico por imagem , Análise Espacial , Espondilite Anquilosante/complicações , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Adulto , Feminino , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/patologia , Masculino , Pessoa de Meia-Idade , Ossificação Heterotópica/etiologia , Ossificação Heterotópica/patologia , Espondilite Anquilosante/diagnóstico por imagem , Espondilite Anquilosante/patologia
9.
Curr Opin Rheumatol ; 27(4): 326-32, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-26002023

RESUMO

PURPOSE OF REVIEW: Syndesmophytes are characteristic components of the spine disorder of ankylosing spondylitis. Understanding their growth may reveal insights to pathogenesis and potential treatment. We review recent studies on rates of development of syndesmophytes, patient characteristics associated with more rapid syndesmophyte growth, local vertebral abnormalities that precede syndesmophytes, systemic biomarkers of syndesmophytes, and studies of medications. RECENT FINDINGS: New syndesmophytes develop in one-third of patients over 2 years. Consistent clinical predictors are male sex, elevated serum C-reactive protein levels, and preexisting syndesmophytes. Concomitant vertebral inflammation and fat dysplasia on MRI predict future syndesmophytes at the same vertebral location, but most syndesmophytes do not have recognized antecedents. Associations with serum levels of Wingless pathway proteins are inconsistent, as are the results of observational studies of tumor necrosis factor-alpha inhibitors. SUMMARY: Although there is better understanding of the frequency of syndesmophyte development, the pathogenesis of syndesmophytes remains unclear.


Assuntos
Coluna Vertebral/patologia , Espondilite Anquilosante/patologia , Anti-Inflamatórios não Esteroides/uso terapêutico , Produtos Biológicos/uso terapêutico , Progressão da Doença , Humanos , Imageamento por Ressonância Magnética , Tomografia por Emissão de Pósitrons , Coluna Vertebral/diagnóstico por imagem , Espondilite Anquilosante/diagnóstico , Tomografia Computadorizada por Raios X , Fator de Necrose Tumoral alfa/antagonistas & inibidores
10.
J Rheumatol ; 42(3): 472-8, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25593240

RESUMO

OBJECTIVE: Using the 3-D imaging capability of computed tomography (CT), we developed an algorithm quantitating syndesmophyte height along the entire vertebral rim. We investigated its reliability and sensitivity to change, performed a 2-year longitudinal study, and compared it to CT measures of syndesmophyte volume. METHODS: We performed thoracolumbar spine CT scans on 33 patients at baseline, Year 1, and Year 2, and computed syndesmophyte height in 4 intervertebral disc spaces (IDS). Height was computed every 5° (72 angular sectors) along the vertebral rim. These 72 measures were summed to form the circumferential height per IDS, and results from 4 IDS were summed to provide results per patient. To assess reliability, we compared results between 2 scans performed on the same day in 9 patients. Validity was assessed by associations with spinal flexibility. RESULTS: Coefficient of variation for circumferential syndesmophyte height was 0.893% per patient, indicating excellent reliability. Based on the Bland-Altman analysis, an increase in circumferential height of more than 3.44% per patient represented a change greater than measurement error. At years 1 and 2, mean (SD) circumferential syndesmophyte height increases were 10.2% (11.7%) and 16.1% (14.0%), respectively. Sensitivity to change was 0.72 and 0.87 at years 1 and 2, respectively. Circumferential syndesmophyte height correlated with the Schober test (r = -0.56, p = 0.0003) and lateral thoracolumbar flexion (r = -0.73, p < 0.0001). CONCLUSION: CT-based circumferential syndesmophyte height had excellent reliability and good sensitivity to change. It was more highly correlated with spine flexibility than syndesmophyte volume. The algorithm shows promise for longitudinal studies of syndesmophyte growth.


Assuntos
Vértebras Lombares/diagnóstico por imagem , Espondilite Anquilosante/diagnóstico por imagem , Vértebras Torácicas/diagnóstico por imagem , Adulto , Algoritmos , Progressão da Doença , Feminino , Humanos , Imageamento Tridimensional , Masculino , Pessoa de Meia-Idade , Radiografia , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
11.
Rheumatology (Oxford) ; 54(6): 972-80, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25394620

RESUMO

OBJECTIVE: Syndesmophytes in AS typically grow slowly, but it is not known whether growth is uniform among syndesmophytes in the same intervertebral disc space (IDS) or among different IDSs in the same patient or if growth is heterogeneous. We examined the dynamics of syndesmophyte growth over 24 months using CT, with the main aim of determining if syndesmophytes in the same IDS or the same patient grow at similar rates. METHODS: We performed lumbar spine CT scans on 33 patients and measured syndesmophytes in four IDSs using a validated computer algorithm. Scans were done at baseline and 12 and 24 months. We compared absolute and percentage changes in volume from baseline to 12 months and to 24 months among syndesmophytes in the same IDS and among four IDSs of each patient. We also examined whether growth among all IDSs differed between study years. RESULTS: Among 60 IDSs with at least two syndesmophytes at baseline (range 2-6), there was substantial heterogeneity in both absolute (P < 0.0001) and percentage (P = 0.0002) volume increases among syndesmophytes in the same IDS. Several IDSs had both syndesmophytes with no growth and syndesmophytes that increased by >100 mm(3). Similarly there was significant heterogeneity in syndesmophyte growth among IDSs of individual patients. Increases in total syndesmophyte volume for each patient also tended to differ between study years (P = 0.07). CONCLUSION: Syndesmophytes in AS do not all grow continuously. Rates of growth over 24 months commonly differ between syndesmophytes in the same IDS and between different IDSs in the same patient, suggesting that local factors regulate syndesmophyte growth.


Assuntos
Disco Intervertebral/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem , Espondilite Anquilosante/diagnóstico por imagem , Vértebras Torácicas/diagnóstico por imagem , Adulto , Algoritmos , Feminino , Humanos , Disco Intervertebral/crescimento & desenvolvimento , Estudos Longitudinais , Vértebras Lombares/crescimento & desenvolvimento , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Espondilite Anquilosante/fisiopatologia , Vértebras Torácicas/crescimento & desenvolvimento , Tomografia Computadorizada por Raios X/métodos
12.
Ann Rheum Dis ; 74(2): 437-43, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24297375

RESUMO

OBJECTIVES: Accurate measurement of syndesmophyte development and growth in ankylosing spondylitis (AS) is needed for studies of biomarkers and of treatments to slow spinal fusion. We tested the longitudinal validity and sensitivity to change of quantitative measurement of syndesmophytes using CT. METHODS: We performed lumbar spine CT scans on 33 patients with AS at baseline, 1 year and 2 years. Volumes and heights of syndesmophytes were computed in four intervertebral disk spaces. We compared the computed changes to a physician's ratings of change based on CT scan inspection. Sensitivity to change of the computed measures was compared with that of the modified Stoke AS Spinal Score (radiography) and a scoring method based on MRI. RESULTS: At years 1 and 2, respectively 24 (73%) and 26 (79%) patients had syndesmophyte volume increases by CT. At years 1 and 2, the mean (SD) computed volume increases per patient were, respectively 87 (186) and 201 (366) mm(3). Computed volume changes were strongly associated with the physician's visual ratings of change (p<0.0002 and p<0.0001 for changes at years 1 and 2, respectively). The sensitivity to change over 1 year was higher for the CT volume measure (1.84) and the CT height measure (1.22) than either the MRI measure (0.50) or radiography (0.29). CONCLUSIONS: CT-based syndesmophytes measurements had very good longitudinal validity and better sensitivity to change than radiography or MRI. This method shows promise for longitudinal clinical studies of syndesmophyte development and growth.


Assuntos
Interpretação de Imagem Assistida por Computador/métodos , Espondilite Anquilosante/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto , Algoritmos , Feminino , Humanos , Estudos Longitudinais , Vértebras Lombares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade
13.
Ann Rheum Dis ; 73(3): 544-50, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23345598

RESUMO

OBJECTIVE: Syndesmophyte growth in ankylosing spondylitis can be difficult to measure using radiographs because of poor visualisation and semiquantitative scoring methods. We developed and tested the reliability and validity of a new computer-based method that fully quantifies syndesmophyte volumes and heights on CT scans. METHODS: In this developmental study, we performed lumbar spine CT scans on 38 patients and used our algorithm to compute syndesmophyte volume and height in four intervertebral disk spaces. To assess reliability, we compared results between two scans performed on the same day in nine patients. To assess validity, we compared computed measures to visual ratings of syndesmophyte volume and height on both CT scans and radiographs by two physician readers. RESULTS: Coefficients of variation for syndesmophyte volume and height, based on repeat scans, were 2.05% and 2.40%, respectively. Based on Bland-Altman analysis, an increase in syndesmophyte volume of more than 4% or in height of more than 0.20 mm represented a change greater than measurement error. Computed volumes and heights were strongly associated with physician ratings of syndesmophyte volume and height on visual examination of both the CT scans (p<0.0001) and plain radiographs (p<0.002). Syndesmophyte volumes correlated with the Schober test (r=-0.48) and lateral thoracolumbar flexion (r=-0.60). CONCLUSIONS: This new CT-based method that fully quantifies syndesmophytes in three-dimensional space had excellent reliability and face and construct validity. Given its high precision, this method shows promise for longitudinal clinical studies of syndesmophyte development and growth.


Assuntos
Vértebras Lombares/patologia , Osteófito/patologia , Espondilite Anquilosante/patologia , Adulto , Algoritmos , Feminino , Humanos , Imageamento Tridimensional/métodos , Estudos Longitudinais , Vértebras Lombares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Osteófito/diagnóstico por imagem , Osteófito/etiologia , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Reprodutibilidade dos Testes , Espondilite Anquilosante/complicações , Espondilite Anquilosante/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adulto Jovem
14.
Med Phys ; 40(1): 011905, 2013 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-23298096

RESUMO

PURPOSE: Evaluation of treatments of many spine disorders requires precise measurement of the heights of vertebral bodies and disk spaces. The authors present a semiautomated computer algorithm measuring those heights from spine computed tomography (CT) scans and evaluate its precision. METHODS: Eight patients underwent two spine CT scans in the same day. In each scan, five thoracolumbar vertebral heights and four disk heights were estimated using the algorithm. To assess precision, the authors computed the differences between the height measurements in the two scans, coefficients of variation (CV), and 95% limits of agreement. Intraoperator and interoperator precisions were evaluated. For local vertebral and disk height measurement (anterior, middle, posterior) the algorithm was compared to a manual mid-sagittal plane method. RESULTS: The mean (standard deviation) interscan difference was as low as 0.043 (0.031) mm for disk heights and 0.044 (0.043) mm for vertebral heights. The corresponding 95% limits of agreement were [-0.085, 0.11] and [-0.10, 0.12] mm, respectively. Intraoperator and interoperator precision was high, with a maximal CV of 0.30%. For local vertebral and disk heights, the algorithm improved upon the precision of the manual mid-sagittal plane measurement by as much as a factor of 6 and 4, respectively. CONCLUSIONS: The authors evaluated the precision of a novel computer algorithm for measuring vertebral body heights and disk heights using short term repeat CT scans of patients. The 95% limits of agreement indicate that the algorithm can detect small height changes of the order of 0.1 mm.


Assuntos
Vértebras Lombares/anatomia & histologia , Vértebras Lombares/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Automação , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Distribuição Normal , Variações Dependentes do Observador , Fatores de Tempo
15.
Phys Med Biol ; 57(14): 4683-704, 2012 Jul 21.
Artigo em Inglês | MEDLINE | ID: mdl-22750760

RESUMO

Ankylosing spondylitis is a disease characterized by abnormal bone formation (syndesmophyte) at the margins of inter-vertebral disc spaces. Syndesmophyte growth is currently typically monitored by the visual inspection of radiographs. The limitations inherent to the modality (2D projection of a 3D object) and rater (qualitative human judgment) may compromise sensitivity. With newly available treatments, more precise measures of syndesmophytes are needed to determine whether treatment can slow rates of syndesmophyte growth. We previously presented a computer algorithm measuring syndesmophyte volumes and heights in the 3D space of CT scans. In this study, we present improvements to the original algorithm and evaluate the gain in precision as applied to an anthropomorphic vertebral phantom and patients. Each patient was scanned twice in one day, thus providing two syndesmophyte volume and height measures. The difference between those two measures (ideally zero) determines our algorithm's precision. The technical improvements to the algorithm decreased the mean volume difference (standard deviation) between scans from 3.01% (2.83%) to 1.31% (0.95%) and the mean height difference between scans from 3.16% (2.99%) to 1.56% (1.13%). The high precision of the improved algorithm holds promise for application to longitudinal clinical studies.


Assuntos
Imagens de Fantasmas , Espondilite Anquilosante/diagnóstico por imagem , Espondilite Anquilosante/fisiopatologia , Tomografia Computadorizada por Raios X/instrumentação , Algoritmos , Humanos , Posicionamento do Paciente , Coluna Vertebral/diagnóstico por imagem , Coluna Vertebral/fisiopatologia
16.
Artigo em Inglês | MEDLINE | ID: mdl-23366200

RESUMO

The measurement of vertebral heights is necessary for the evaluation of many disorders affecting the spine. High precision is particularly important for longitudinal studies where subtle changes are to be detected. Computed tomography (CT) is the modality of choice for high precision studies. Radiography and dual emission X-ray absorptiometry (DXA) use 2D images to assess 3D structures, which can result in poor visualization due to the superimposition of extraneous anatomical objects on the same 2D space. We present a semi-automated computer algorithm to measure vertebral heights in the 3D space of a CT scan. The algorithm segments the vertebral bodies, extracts their end plates and computes vertebral heights as the mean distance between end plates. We evaluated the precision of our algorithm using repeat scans of an anthropomorphic vertebral phantom. Our method has high precision, with a coefficient of variation of only 0.197% and Bland-Altmann 95% limits of agreement of [-0.11, 0.13] mm. For local heights (anterior, middle, posterior) the algorithm was up to 4.2 times more precise than a manual mid-sagittal plane method.


Assuntos
Algoritmos , Processamento de Imagem Assistida por Computador/métodos , Imagens de Fantasmas , Coluna Vertebral/anatomia & histologia , Coluna Vertebral/diagnóstico por imagem , Tomografia Computadorizada por Raios X/instrumentação , Tomografia Computadorizada por Raios X/métodos , Antropometria , Humanos , Reprodutibilidade dos Testes
17.
Artigo em Inglês | MEDLINE | ID: mdl-19964614

RESUMO

CT colonography has emerged as a minimally invasive alternative to optical colonoscopy for the screening of polyps which are the precursors to colon cancer. Accurate polyp measurement is crucial as the size of a polyp is considered an indication of its potential for malignancy. We present a novel method for the automatic measurement of polyps. It is based on a level set algorithm capable of evolving on the surface of a 3D object represented by a triangular mesh. It is guided by curvature features and is capable of segmenting the polyp neck, that is, the ridgeline/crestline formed around the polyp by its merging to the colon wall. Our method was validated on 40 polyp surfaces obtained from real clinical data. A 3D manual measurement was used as the reference standard. A correlation of 0.825 was found between polyp measurements from our new method and the reference standard.


Assuntos
Pólipos do Colo/patologia , Colonografia Tomográfica Computadorizada/instrumentação , Colonografia Tomográfica Computadorizada/métodos , Colonoscopia/métodos , Imageamento Tridimensional/métodos , Tomografia Computadorizada por Raios X/métodos , Algoritmos , Automação , Análise por Conglomerados , Pólipos do Colo/diagnóstico por imagem , Humanos , Modelos Lineares , Modelos Estatísticos , Reconhecimento Automatizado de Padrão/métodos , Interpretação de Imagem Radiográfica Assistida por Computador , Valores de Referência , Software
18.
Artigo em Inglês | MEDLINE | ID: mdl-19965231

RESUMO

Ankylosing Spondylitis is a disease characterized by abnormal bone structures (syndesmophytes) growing at intervertebral disk spaces (IDS). The growth of syndesmophytes is typically monitored by visual inspection of radiographs. The limitations inherent to the modality (2D projection of a 3D object) and rater (qualitative human judgment) entail a possibly important loss in sensitivity. We previously presented a method designed to overcome both limitations: a computer algorithm that quantitatively measures syndesmophytes in the 3D space of a high-resolution computed tomography scan. To establish the method's usefulness for longitudinal studies, it is necessary to assess its precision (repeatability) which can be affected by the limitations of both the algorithm itself and the imaging modality. To this end, an anthropomorphic vertebral phantom with syndesmophytes in 4 IDSs was manufactured. It was scanned 22 times with varying positions and resolutions. The syndesmophyte volumes extracted by our algorithm have an average coefficient of variation of 1.6% per IDS and 0.85% for the total.


Assuntos
Articulações/patologia , Imagens de Fantasmas , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Espondilite Anquilosante/diagnóstico por imagem , Algoritmos , Antropometria , Humanos , Imageamento Tridimensional/métodos , Inflamação , Modelos Anatômicos , Modelos Estatísticos , Reprodutibilidade dos Testes , Coluna Vertebral/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos
19.
IEEE Trans Med Imaging ; 27(9): 1252-67, 2008 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-18779065

RESUMO

Ankylosing Spondylitis is a disease characterized by abnormal bone structures (syndesmophytes) growing at intervertebral disk spaces. Because this growth is so slow as to be undetectable on plain radiographs taken over years, it is desirable to resort to computerized techniques to complement qualitative human judgment with precise quantitative measures. We developed an algorithm with minimal user intervention that provides such measures using high-resolution computed tomography (CT) images. To the best of our knowledge it is the first time that determination of the disease's status is attempted by direct measurement of the syndesmophytes. The first part of our algorithm segments the whole vertebral body using a 3-D multiscale cascade of successive level sets. The second part extracts the continuous ridgeline of the vertebral body where syndesmophytes are located. For that we designed a novel level set implementation capable of evolving on the isosurface of an object represented by a triangular mesh using curvature features. The third part of the algorithm segments the syndesmophytes from the vertebral body using local cutting planes and quantitates them. We present experimental work done with 10 patients from each of which we processed five vertebrae. The results of our algorithm were validated by comparison with a semi-quantitative evaluation made by a medical expert who visually inspected the CT scans. Correlation between the two evaluations was found to be 0.936 ( p < 10(-18)) .


Assuntos
Inteligência Artificial , Imageamento Tridimensional/métodos , Reconhecimento Automatizado de Padrão/métodos , Intensificação de Imagem Radiográfica/métodos , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Espondilite Anquilosante/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Algoritmos , Humanos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
20.
Biol Lett ; 2(1): 101-5, 2006 Mar 22.
Artigo em Inglês | MEDLINE | ID: mdl-17148338

RESUMO

Motion transparency, in which patterns of moving elements group together to give the impression of lacy overlapping surfaces, provides an important challenge to models of motion perception. It has been suggested that we perceive transparent motion when the shape of the velocity histogram of the stimulus is bimodal. To investigate this further, random-dot kinematogram motion sequences were created to simulate segregated (perceptually spatially separated) and transparent (perceptually overlapping) motion. The motion sequences were analysed using the multi-channel gradient model (McGM) to obtain the speed and direction at every pixel of each frame of the motion sequences. The velocity histograms obtained were found to be quantitatively similar and all were bimodal. However, the spatial and temporal properties of the velocity field differed between segregated and transparent stimuli. Transparent stimuli produced patches of rightward and leftward motion that varied in location over time. This demonstrates that we can successfully differentiate between these two types of motion on the basis of the time varying local velocity field. However, the percept of motion transparency cannot be based simply on the presence of a bimodal velocity histogram.


Assuntos
Movimento (Física) , Modelos Teóricos , Redes Neurais de Computação
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