Department of Rheumatology, University of Copenhagen, Hospitals at Glostrup, Copenhagen, Denmark.
Paris Ouest-Versailles-Saint Quentin en Yvelines University; EA 2506, Rheumatology Department Ambroise-Paré Hospital, APHP, Boulogne-Billancourt, France.
Ultraschall Med. 2012 Dec;33(7):E173-E178. doi: 10.1055/s-0031-1281973. Epub 2011 Dec 22.
To investigate which knee and probe position best identifies knee inflammation and to determine a cut-off level for abnormal synovial effusion.
18 experienced sonographers (all rheumatologists) performed ultrasound examinations of the knee joint in patients with knee symptoms and in healthy controls. Each sonographer performed longitudinal suprapatellar ultrasound scans using 9 different configurations at each knee: Midline, parapatallar lateral and parapatellar medial from midline in neutral position (0°) with and without quadriceps muscle contraction and in 30° flexion of the knee. The presence of synovial effusion (SE), the effusion measured in millimeters and the presence of synovial hypertrophy (SH) was noted.
A total of 298 knees of 149 subjects (129 patients and 20 controls) were examined. The detection of SH is more sensitive and specific than the detection of SE, independently of the knee and probe position, for the final diagnosis of abnormality. The detection of both synovial hypertrophy and effusion in the knee in neutral position (0°) with quadriceps contraction and with the probe in the midline position, are the best independent predictors for knee abnormalities. Knee effusion > 3.2 mm measured with the probe in the lateral aspect of the knee is the best diagnostic characteristics for predicting pathological SE.
The best combination for detecting SH and SE is obtained by placing the probe in the midline position with the knee in 0° with quadriceps contraction. A cut-off value for pathological effusion may be obtained in the lateral aspect of the knee.
探究最佳的膝关节和探头位置以识别膝关节炎症，并确定异常滑膜积液的截断值。
18 名经验丰富的超声医师（均为风湿病学家）对膝关节有症状的患者和健康对照者进行了膝关节超声检查。每位超声医师在每个膝关节上使用 9 种不同的配置进行纵向髌上囊超声扫描：中立位（0°）时从中线、髌旁外侧和髌旁内侧进行扫描，同时伴有和不伴有股四头肌收缩，以及膝关节 30°屈曲时进行扫描。记录滑膜积液（SE）的存在、以毫米为单位测量的积液量以及滑膜肥厚（SH）的存在。
共检查了 149 名受试者的 298 个膝关节（129 名患者和 20 名对照者）。无论膝关节和探头位置如何，SH 的检测均比 SE 的检测更敏感和特异，是异常最终诊断的独立预测因素。在中立位（0°）时，股四头肌收缩且探头置于中线位置时检测到膝关节中的 SH 和积液，是膝关节异常的最佳独立预测因素。在膝关节外侧用探头测量的膝关节积液>3.2mm 是预测病理性 SE 的最佳诊断特征。
通过将探头置于中线位置，膝关节在 0°时伴股四头肌收缩，可获得检测 SH 和 SE 的最佳组合。在膝关节外侧可能获得病理性积液的截断值。
