New York University Langone Medical Center, New York University Hospital for Joint Diseases, and New York Harbor VA Health Care System New York Campus, New York, USA.
Arthritis Care Res (Hoboken). 2011 Oct;63(10):1456-62. doi: 10.1002/acr.20527.
Criteria for sonographic diagnosis of monosodium urate (MSU) crystal deposition have been developed, but the interreader reproducibility of this modality is not well established. We therefore assessed agreement using a systematic approach.
Fifty male subjects ages 55-85 years were recruited during primary care visits to an urban Veterans Affairs hospital, and were assessed by musculoskeletal ultrasound (US) of the knees and first metatarsophalangeal (MTP) joints to evaluate for the double contour sign and tophi as evidence of MSU crystal deposition. Images were read by 2 blinded rheumatologists trained in musculoskeletal US, and the degree of concordance was determined for individual subjects, total joints, femoral articular cartilage (FAC), and first MTP joints. Subjects were further categorized into 3 diagnostic groups: gout, asymptomatic hyperuricemia (no gout, serum uric acid [UA] ≥6.9 mg/dl), and controls (no gout, serum UA ≤6.8 mg/dl), and reader concordance within these 3 groups was assessed.
We observed almost perfect agreement between readers for 1) individual subjects (yes/no; n = 50, 100% agreement, κ = 1.000), 2) total joints (n = 200, 99% agreement, κ = 0.942), 3) FAC (n = 100, 99% agreement, κ = 0.942), and 4) first MTP joints (n = 100, 99% agreement, κ = 0.942). Furthermore, findings by side (right/left) and diagnostic group (gout, asymptomatic hyperuricemia, control) showed substantial to almost perfect concordance for all measures. MSU deposition was seen most commonly in gout patients, and deposition was also seen in some subjects with asymptomatic hyperuricemia, but in only 1 control.
Musculoskeletal US is reliable for detecting MSU deposition in FAC and first MTP joints in gout and asymptomatic hyperuricemia.
已经制定了用于超声诊断单钠尿酸盐（MSU）晶体沉积的标准，但这种方法的读者间可重复性尚未得到很好的确立。因此，我们采用系统的方法评估了一致性。
在城市退伍军人事务医院的初级保健就诊期间，招募了 50 名年龄在 55-85 岁的男性受试者，并通过膝关节和第一跖趾关节（MTP）的肌肉骨骼超声（US）进行评估，以评估双轮廓征和痛风石作为 MSU 晶体沉积的证据。由 2 名接受过肌肉骨骼 US 培训的盲法风湿病学家阅读图像，并确定每个受试者、总关节、股骨关节软骨（FAC）和第一 MTP 关节的一致性程度。受试者进一步分为 3 个诊断组：痛风、无症状高尿酸血症（无痛风，血清尿酸[UA]≥6.9mg/dl）和对照组（无痛风，血清 UA≤6.8mg/dl），并评估了这 3 组内的读者一致性。
我们观察到读者之间在以下方面几乎完全一致：1）个体受试者（是/否；n=50，100%一致，κ=1.000），2）总关节（n=200，99%一致，κ=0.942），3）FAC（n=100，99%一致，κ=0.942）和 4）第一 MTP 关节（n=100，99%一致，κ=0.942）。此外，对于所有措施，侧（右/左）和诊断组（痛风、无症状高尿酸血症、对照组）的发现均显示出实质性到几乎完全一致。MSU 沉积最常见于痛风患者，一些无症状高尿酸血症患者也有沉积，但仅在 1 名对照组中发现。
肌肉骨骼 US 对于检测痛风和无症状高尿酸血症患者的 FAC 和第一 MTP 关节中的 MSU 沉积是可靠的。
