Page 52 - Imaging of Osteoarthritis and Rheumatoid Arthritis in Hand Joints
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                                Chapter 3
The purpose of this study was to compare CT with digital radiography for inter- reader reliability and detection rate of CMC1 and STT OA.
Material and Methods
Patient selection
In our centre patients who are clinically suspected for symptomatic OA of the CMC1 or STT joint and eligible for surgery are sometimes referred for CT examination of the wrist.
We searched in our PACS (Picture Archiving and Communication System) system for patients who had a CT-scan and radiograph of the wrist joint between January 2008 and March 2011. We selected only the patients who had been referred by the Department of Plastic, Reconstructive, and Hand Surgery for CT to assess possible CMC1 and/or STT OA, and who were 18 years or older without a history of hand trauma, congenital hand anomalies, or a known inflammatory disease. All patients needed to have a digital radiographic examination of the wrist within a 3–month period of the CT without relevant medical interventions within that period. The study was approved by the local medical ethics review committee.
Image evaluation
All CT scans and radiographs were scored for each feature that contributes to the radiographical classification system of Eaton and Glickel.13 This system was designed to help treatment selection in symptomatic OA patients and assigns a grade between I and IV to the CMC1 joint, according to the severity of OA. Grades I-III describe isolated CMC1 OA in increasing severity, while the highest stage IV encompasses OA in both the CMC1 and STT joints. We chose to evaluate the differences between CT and radiography for each individual feature used in this system.
For the CMC1 joint, joint space narrowing (JSN) was assessed as the joint space between the first metacarpal bone and the trapezium and was compared with the joint space of the 2nd and 3rd CMC joints. JSN was scored as 0 = normal, 1 = 50% or more of the estimated original joint space left, 2 = less than 50%
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