Rehabilitation II Department, Division of Rheumatology, Clinical Rehabilitation Hospital, Cluj-Napoca, 400306, Viilor str. no. 46-50, Romania.
Rheumatology (Oxford). 2011 Jun;50(6):1120-4. doi: 10.1093/rheumatology/keq441. Epub 2011 Jan 25.
To assess inter-observer reliability in US detection of tendon inflammatory and structural changes at wrists and ankles in RA patients.
Fourteen consecutive RA patients underwent bilateral US assessment of the extensor carpi ulnaris (ECUT) and tibialis posterior tendons (TPTs) by two blinded rheumatologists, with different level of experience in musculoskeletal (MS) US. Grey scale and power Doppler (PD) US assessment was focused on detection of tenosynovitis, tenosynovial and intra-tendon PD signal and structural lesions (i.e. tendinosis, tendon erosion, partial or total rupture).
The frequency of US findings detected by Investigator 1 was 28.6% for inflammatory changes and 51.8% for structural damage changes while Investigator 2 detected 34 and 53.6% for the corresponding abnormalities. A high overall agreement (82.7%) was found for inflammatory pathology and 89.7% for structural lesions in all tendons. Mean kappa (κ) values for all tendons and pathology was moderate (κ = 0.42), with fair level of agreement for the wrist region (0.27-0.34) and moderate to good values for the ankle region (κ = 0.47-0.62). Subclinical abnormalities were detected in 37.5% of the tendons by Investigator 1 and 28.6% of the tendons by Investigator 2.
MSUS showed high overall agreement and fair to moderate inter-observer κ-values between investigators with different levels of experience in detection of tendon pathology at the wrist and ankle in RA patients. Further standardization of scanning method and pathology definitions may improve MSUS reproducibility.
评估在 RA 患者手腕和踝关节处使用 US 检测肌腱炎症和结构变化时的观察者间可靠性。
14 例连续的 RA 患者接受了两位经验不同的关节肌肉超声（MSUS）盲法风湿病学家对伸肌肌腱（ECUT）和比目鱼肌肌腱（TPT）进行双侧 US 评估。灰阶和功率多普勒（PD）US 评估重点是检测腱鞘炎、肌腱滑膜和肌腱内 PD 信号以及结构病变（即肌腱病、肌腱侵蚀、部分或完全断裂）。
调查员 1 发现的 US 结果的频率为炎症变化 28.6%，结构损伤变化 51.8%，而调查员 2 发现相应异常的频率分别为 34%和 53.6%。在所有肌腱中，炎症病理学和结构病变的总体一致性很高（82.7%）。所有肌腱和病理学的平均κ（κ）值为中度（κ=0.42），腕部区域的一致性为一般（0.27-0.34），踝关节区域的一致性为中度至良好（κ=0.47-0.62）。调查员 1 在 37.5%的肌腱中检测到亚临床异常，而调查员 2 在 28.6%的肌腱中检测到亚临床异常。
MSUS 在检测 RA 患者手腕和踝关节处肌腱病变时，具有较高的总体一致性和不同经验水平的观察者之间的中等至适度κ值。进一步规范扫描方法和病理学定义可能会提高 MSUS 的可重复性。
