Centenario Hospital Miguel Hidalgo, Aguascalientes, Aguascalientes, Mexico.
Rheumatol Int. 2013 Jan;33(1):173-7. doi: 10.1007/s00296-011-2297-9. Epub 2012 Jan 25.
To assess the inter- and intra-observer reproducibility of musculoskeletal ultrasonography among rheumatologist in detecting inflammatory and morphostructural changes in small joints of the hands in patients with rheumatoid arthritis (RA). Five members of the "Escuela de Ecografía del Colegio Mexicano de Reumatología" tested their inter- and intra-observer reliabilities in the assessment of basic sonographic findings of joint inflammation and bone erosion. Their results were compared to those obtained by a group of international experts from European League Against Rheumatism. A clinical rheumatologist evaluated eight RA patients. Five Siemens Acuson Antares ultrasound machines (7-13 MHz linear probes) were used. The OMERACT preliminary definitions of joint effusion, synovial hypertrophy, bone erosions and tenosynovitis were adopted. Inter-observer and intra-observer agreement was calculated by overall agreement and kappa statistics. Mean kappa value for joint effusion was good, 0.654 (85%); synovial hypertrophy, 0.550 (77.2%); power Doppler signal, 0.550 (82.5%); bone erosions, 0.549 (81%); and tenosynovitis, 0.500 (91.5%). Mean and overall intra-observer agreement for semiquantitative score was good for joint effusion, 0.630 (77.2%) and bone erosions, 0.605 (56.25%); and moderate to synovial hypertrophy, 0.476 (65%) and power Doppler signal, 0.471 (80%). Mean kappa value for joint effusion was 0.381 (95%), synovial hypertrophy, 0.447 (72%); power Doppler signal, 0.496 (81%); bone erosions, 0.294 (81%); and tenosynovitis, 0.030 (66%). Mean and overall inter-observer agreement for semiquantitative score was poor for joint effusion, 0.325 (57%) and bone erosions, 0.360 (43%); and moderate to synovial hypertrophy, 0.431 (55%) and power Doppler signal, 0.496 (81%). Intra-observer variability reached the highest levels of agreement. Factors related to the experience of the rheumatologist, the time spent in each examination and knowledge of the software ultrasound equipment could influence the lower level of inter-observer agreement in this study.
评估在类风湿关节炎患者手部小关节中检测炎症和形态结构变化方面，风湿病学家之间和内部的肌肉骨骼超声检查的重现性。“墨西哥风湿病学会超声学院”的五名成员测试了他们在评估关节炎症和骨侵蚀的基本超声发现方面的内部和内部观察者可靠性。他们的结果与来自欧洲抗风湿病联盟的一组国际专家的结果进行了比较。一位临床风湿病学家评估了 8 名类风湿关节炎患者。使用了五台西门子 Acuson Antares 超声机（7-13 MHz 线性探头）。采用了 OMERACT 关节积液、滑膜肥厚、骨侵蚀和腱鞘炎的初步定义。通过总一致性和 Kappa 统计数据计算了观察者间和观察者内的一致性。关节积液的平均 Kappa 值为 0.654（85％）；滑膜肥厚，0.550（77.2％）；能量多普勒信号，0.550（82.5％）；骨侵蚀，0.549（81％）；腱鞘炎，0.500（91.5％）。关节积液半定量评分的平均和整体内部观察者一致性良好，骨侵蚀为 0.630（77.2％）和 0.605（56.25％）；中度到滑膜肥厚为 0.476（65％）和能量多普勒信号为 0.471（80％）。关节积液的平均 Kappa 值为 0.381（95％），滑膜肥厚，0.447（72％）；能量多普勒信号，0.496（81％）；骨侵蚀，0.294（81％）；腱鞘炎，0.030（66％）。关节积液和骨侵蚀的半定量评分的平均和整体观察者间一致性较差，分别为 0.325（57％）和 0.360（43％）；滑膜肥厚为 0.431（55％），能量多普勒信号为 0.496（81％）。内部观察者的变异性达到了最高的一致性水平。与风湿病学家的经验、每次检查花费的时间以及对超声设备软件的了解等因素有关的因素可能会影响本研究中观察者间一致性的较低水平。
