Department of Radiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Ann Rheum Dis. 2014 Feb;73(2):365-75. doi: 10.1136/annrheumdis-2012-202515. Epub 2013 Jan 24.
To assess the value of advanced imaging techniques in the detection of hand osteoarthritis (OA) and hand OA progression.
PubMed/Medline and Embase were searched until April 2012 for studies on imaging of hand OA that presented quantitative data on validity, reliability or responsiveness. Articles presenting only data on conventional radiography (CR) were excluded. Methodological quality was assessed by the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) checklist for validity, the Quality Appraisal of Reliability Studies (QAREL) for reliability and the COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) for responsiveness.
Of 627 citations, 25 studies on ultrasonography (US), MRI or scintigraphy were included. No studies on CT, positron emission tomography or single photon emission CT met our eligibility criteria. Validity was generally assessed against healthy controls, CR or clinical examination. Overall, US and MRI detected more disease than CR and found significant differences between patients and healthy controls. Scintigraphy detected fewer pathological joints than CR. Intra- and inter-reader reliability varied for US (κ=0.01-1.0) and MRI (κ=0.15-0.84 and intraclass correlation coefficient=0.21-0.99) and was good for scintigraphy (κ=0.61-0.84). There were no responsiveness studies for MRI. US responsiveness studies showed a reduction of soft-tissue changes after treatment which correlated with decrease in pain (r=0.7-0.8). For scintigraphy, scores decreased over time while CR showed progression of hand OA.
MRI and US seem to be the most promising candidates for early detection of hand OA and for future use in clinical trials. However, further research is needed to improve scoring methods, to compare US with MRI, to confirm reliability of MRI and to further determine the responsiveness of US and MRI.
评估先进影像学技术在手部骨关节炎（OA）检测和手部 OA 进展中的价值。
检索 PubMed/Medline 和 Embase 数据库，截至 2012 年 4 月，以获取有关手部 OA 影像学的研究，这些研究提供了关于有效性、可靠性或反应性的定量数据。排除仅提供常规放射摄影（CR）数据的文章。采用诊断准确性研究的质量评估（QUADAS）清单评估有效性，可靠性评估质量评估（QAREL），反应性评估健康测量仪器选择的共识标准（COSMIN）。
在 627 条引文中有 25 项关于超声（US）、磁共振成像（MRI）或闪烁扫描的研究被纳入。没有符合我们入选标准的 CT、正电子发射断层扫描或单光子发射 CT 的研究。有效性通常针对健康对照组、CR 或临床检查进行评估。总的来说，US 和 MRI 比 CR 检测到更多的疾病，并在患者和健康对照组之间发现了显著差异。闪烁扫描比 CR 发现更少的病理关节。US 的观察者内和观察者间可靠性为（κ=0.01-1.0）和 MRI（κ=0.15-0.84 和组内相关系数=0.21-0.99），闪烁扫描的可靠性良好（κ=0.61-0.84）。没有 MRI 的反应性研究。US 反应性研究显示治疗后软组织变化减少，与疼痛减轻相关（r=0.7-0.8）。对于闪烁扫描，分数随时间降低，而 CR 显示手部 OA 进展。
MRI 和 US 似乎是手部 OA 早期检测和未来临床试验中最有前途的候选方法。然而，需要进一步的研究来改进评分方法，比较 US 与 MRI，确认 MRI 的可靠性，并进一步确定 US 和 MRI 的反应性。
