ArticleClinical rheumatology2026
Histological validation of barium-filled vascular channels detected by high-resolution peripheral quantitative computed tomography in rheumatoid arthritis: an exploratory cadaveric study.
Article in Clinical rheumatology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundHigh-resolution peripheral quantitative computed tomography (HR-pQCT) enables visualization of erosions and vascular channels (VCs); however, precise characterization of VCs remains challenging. Barium sulfate, an established contrast agent for microvascular imaging, may enhance VC detection on HR-pQCT. However, no study has systematically investigated barium-filled vessels in rheumatoid arthritis (RA) using both histology and HR-pQCT.
methodsWe examined the 2nd and 3rd metacarpophalangeal joints from a deceased patient with RA, which were perfused with barium sulfate, scanned using first-generation HR-pQCT, and subsequently analyzed histologically.
resultsHistological analysis identified 96 cortical breaks, of which 79 (82%) were confirmed as VCs. HR-pQCT identified 48 VCs in the two fingers. Thirty-three of 51 (65%) histological barium-filled channels were visible on HR-pQCT compared to 15 of 28 (54%) non-barium-filled channels. Barium perfusion was associated with increased VC detectability on HR-pQCT, particularly for larger, collar-shaped cortical breaks. However, smaller or angled VCs were frequently missed due to resolution and preparation constraints, reflecting incomplete vascular perfusion.
conclusionThe findings from this single-specimen exploratory cadaveric study highlight the difficulties of defining VCs on HR-pQCT. Although HR-pQCT provides high spatial resolution, further advancements in imaging techniques are needed to improve the identification of VCs in inflammatory joint diseases. Key Points • HR-pQCT detected only a subset of histologically confirmed vascular channels in rheumatoid arthritis. • A greater proportion of barium-filled vascular channels were visible on HR-pQCT in this specimen with RA. • Despite barium perfusion, small and angled vascular channels were frequently missed by HR-pQCT, and some histologically confirmed VCs did not fulfil the current SPECTRA morphological criteria. • Given that this study is based on a single-specimen, the findings should be considered descriptive and hypothesis-generating rather than confirmatory.
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