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Multiple radiographic views increased detection of early OA
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Use of different radiographic views appears to increase the frequency of radiographic osteoarthritis detection, according to results from the CHECK study.
Researchers obtained baseline and 5-year follow-up radiographs of 894 patients with early symptomatic hip or knee OA. For the hips, these included weight-bearing anteroposterior (AP) radiographs of the pelvis and weight-bearing faux profile (FP) radiographs of both hips.
In imaging the knee, researchers acquired semi-fixed (7° to 10°) weight-bearing posterior-anterior (PA) radiographs of the tibiofemoral joints, as well as standing mediolateral views in 30° flexion to assess the tibiofemoral and patellofemoral joints. Skyline (inferior to superior) views of the patellofemoral joints were also made.
The radiographs were independently scored by five trained observers, who analyzed whether the different radiographic views were useful in identifying radiographic OA and monitoring its progression. The different views were compared to standard projections.
On the AP view of the hip radiographs, researchers found 23.4% of hips had OA, with a Kellgren/Lawrence (KL) grade of at least 1. On the FP view of the hip, researchers saw joint space narrowing (JSN) in 12.5%. An analysis of these views combined revealed radiographic OA in 28.8%, which equaled an increase of 22.9% more cases vs. the K/L score on only the AP view.
At 5-year follow-up, researchers observed an increase in at least 1 K/L grade on the AP view in 15.5%. An assessment of pooled AP and FP views found 185 hips had progressed, representing an increase of 46 hip radiographic OA cases (33.1%) vs. the K/L score for only the AP view.
In terms of knees, researchers found OA of K/L grade of at least 1 severity on radiographs done with a PA view in 36.9%. The mediolateral view found 40.6% of knees demonstrated at least one osteophyte, while the skyline view detected at least one osteophyte in 44.3%. An assessment of the two views combined revealed radiographic OA in 65.4% of knees, an increase of 77.3% vs. the K/L score on the AP-only view.
On the skyline view, the researchers observed JSN of at least one in 9.5% of knees. A combined assessment of skyline and AP views identified radiographic OA in 65.4% of knees. This reflected an increase of 7.3% of cases vs. the K/L score on only the AP view. Additionally, an evaluation of all views combined (K/L grade ≥1 on the PA view, at least one osteophytes on the mediolateral view, and at least one osteophytes and/or JSN ≥1 on the skyline view) identified radiographic OA in 593 knees, amounting to 263 additional radiographic OA cases (79.7%) vs. the K/L score on AP view only. At 5-year follow-up, researchers saw an increase of at least one grade in the K/L score on the PA view in 318 knees (35.%). A combined analysis of all views found progression in 525 knees (58.7%), an increase of 207 cases of knee OA seen on radiography.
“The use of different radiographic views yields a higher number of radiographic OA cases in a symptomatic, early OA cohort, both at baseline and at 5 years of follow-up,” the researchers wrote. “Moreover, the use of multiple radiographic views leads to more frequent detection of progression over 5 years’ of follow-up.” -by Jennifer Byrne
Disclosures: The authors report no relevant disclosures.
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Damen J, et al. Arthritis Care Res (Hoboken). 2017;doi:10.1002/acr.23206.
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