类风湿关节炎患者足底前足的肌肉骨骼超声成像：足病医生和放射科医生之间的观察者间一致性。
Musculoskeletal ultrasound imaging of the plantar forefoot in patients with rheumatoid arthritis: inter-observer agreement between a podiatrist and a radiologist.
机构信息
School of Health Professions and Rehabilitation Sciences, University of Southampton, Southampton, UK.
出版信息
J Foot Ankle Res. 2008 Jul 28;1(1):5. doi: 10.1186/1757-1146-1-5.
BACKGROUND
The use of musculoskeletal ultrasound (MSUS) in the diagnosis and management of foot and ankle musculoskeletal pathology is increasing. Due to the wide use of MSUS and the depth and breadth of training required new proposals advocate tailored learning of the technique to discrete fields of practice. The aims of the study were to evaluate the inter-observer agreement between a MSUS radiologist and a podiatrist, who had completed basic skills training in MSUS, in the MSUS assessment of the forefoot of patients with Rheumatoid Arthritis.
METHODS
A consecutive sample of thirty-two patients with rheumatoid arthritis was assessed for presence of synovitis, erosions and bursitis within the forefoot using MSUS. All MSUS assessments were performed independently on the same day by a podiatrist and one of two Consultant Radiologists experienced in MSUS.
RESULTS
Moderate agreement on image acquisition and interpretation was achieved for bursitis (kappa 0.522; p < 0.01) and erosions (kappa 0.636; p < 0.01) and fair agreement for synovitis (kappa 0.216; p < 0.05) during the primary assessments. Following a further training session, substantial agreement (kappa 0.702) between the two investigators was recorded. The sensitivity of the podiatrist using MSUS was 82.4% for detection of bursitis, 83.0% for detection of erosion and 84.0% for detection of synovitis. Specificity of the podiatrist using MSUS was 88.9% for detection of bursitis, 80.7% for detection of erosion and 35.9% for detection of synovitis.
CONCLUSION
This study demonstrated good inter-observer agreement between a podiatrist and radiologist on MSUS assessment of the forefoot, particularly for bursitis and erosions, in patients with rheumatoid arthritis. There is scope to further evaluate and consider the role of podiatrists in the MSUS imaging of the foot following appropriate training and also in the development of reliable protocols for MSUS assessment of the foot.
背景
肌肉骨骼超声（MSUS）在足部和踝关节肌肉骨骼病理学的诊断和管理中的应用正在增加。由于 MSUS 的广泛应用以及所需的深度和广度的培训，新的建议主张针对特定的实践领域进行技术的针对性学习。本研究的目的是评估一位完成 MSUS 基本技能培训的 MSUS 放射科医生和足病医生在 MSUS 评估类风湿关节炎患者前足时的观察者间一致性。
方法
对 32 例类风湿关节炎患者的前足进行 MSUS 评估，以评估前足的滑膜炎、侵蚀和滑囊炎。所有的 MSUS 评估都是由一位足病医生和两位有经验的 MSUS 顾问放射科医生之一在同一天独立进行的。
结果
在初次评估中，滑囊炎（kappa 0.522；p < 0.01）和侵蚀（kappa 0.636；p < 0.01）的图像采集和解释方面达到了中度一致，滑膜炎（kappa 0.216；p < 0.05）达到了良好一致。在进一步的培训课程后，两位研究者之间记录了实质性的一致（kappa 0.702）。使用 MSUS 时，足病医生对滑囊炎的检出率为 82.4%，对侵蚀的检出率为 83.0%，对滑膜炎的检出率为 84.0%。使用 MSUS 时，足病医生的特异性为 88.9%，对滑囊炎的检出率为 80.7%，对侵蚀的检出率为 35.9%，对滑膜炎的检出率为 35.9%。
结论
本研究在类风湿关节炎患者的前足 MSUS 评估中，放射科医生和足病医生之间表现出良好的观察者间一致性，特别是对滑囊炎和侵蚀的评估。在适当的培训后，足病医生在足部 MSUS 成像方面有进一步评估和考虑的空间，也有在足部 MSUS 评估的可靠协议方面发挥作用的空间。
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