Reliability and sensitivity of joint space measurements in hand radiographs using computerized image analysis.
OBJECTIVE: To establish the sensitivity and reliability of proximal interphalangeal (PIP) and metacarpophalangeal (MCP) mean joint space measurements using standard clinical radiographs of healthy subjects, in order to determine the limits at which a change in radiographic joint space could indicate a change in actual joint size. METHODS: Repeat hand radiographs of healthy subjects were taken using standard techniques at 3-5 day intervals with the hands flat (5 posteroanterior radiographs in 8 subjects) or in 6 different flexed positions on a single occasion (8 subjects). The mean joint space was determined using custom soft ware and was validated manually. Measurement reproducibility within subjects, within films, and between hand positions was assessed by analysis of variance. RESULTS: In repeat radiographs taken in the standard clinical position, the precision of individual join space measurements indicates that changes > 0.11 mm (approximately 7%) would represent an actual physical change in joint space width (with 95% probability). Averaging measurements across fingers for a single subject decreases the detectable change to 0.05 mm (approximately 3%). With increasing flexure, radiographic joint space tended to increase in MCP and decrease in PIP. CONCLUSION: Mean finger joint space measured from standard clinical radiographs is a reliable and sensitive measurement in healthy subjects even with some change in hand position. Work is required to establish whether the joint space change measured from serial radiographs of patients with arthritis over a period of 6-12 mo exceeds the detectable limits of change derived in this study.