超声评估类风湿关节炎第二掌指关节多平面全面图像的滑膜病理特征：确定对整个关节整体评估具有可靠性和影响力的成分。

Ultrasound assessment of synovial pathologic features in rheumatoid arthritis using comprehensive multiplane images of the second metacarpophalangeal joint: identification of the components that are reliable and influential on the global assessment of the whole joint.

机构信息

Chiba University Hospital, Chiba, Japan.

出版信息

Arthritis Rheumatol. 2014 Mar;66(3):523-32. doi: 10.1002/art.38280.

DOI:10.1002/art.38280

PMID:24574211

Abstract

OBJECTIVE

The aim of this pilot study was to provide groundwork that could be utilized to optimize the global ultrasound (US) assessment of the whole joint for synovial pathologic features in patients with rheumatoid arthritis (RA).

METHODS

US images of the second metacarpophalangeal joint in 8 predefined imaging planes, comprising regions that comprehensively capture the synovial pathologic features of the whole joint, were obtained from 30 patients with RA. Twelve experienced sonographers evaluated these images at the level of both the individual image and the whole joint, using a visual analog scale (VAS) to assess pathologic severity. Interrater reproducibility of the VAS scores was evaluated with intraclass correlation coefficients (ICCs), and factors that independently influenced the global assessment of the whole joint were identified using multiple linear regression analysis.

RESULTS

A total of 14,276 VAS scores were analyzed. Interrater reproducibility of any eligible VAS assessment of synovial pathologic features was good (ICC 0.65). US assessment of synovial pathologic features in joints with mild inflammation was less reproducible than that in joints with severe inflammation. Although the most severely affected region in a joint did not always represent the average pathologic severity among the 8 regions, global assessment of the whole joint strongly correlated with assessment of the most severely affected region (P < 0.001). Importantly, the standard, midline imaging plane was not the most influential plane on the global assessment of the whole joint. Assessment of synovial fluid accumulation was not reproducible (ICCs 0.20-0.42) and did not substantially influence the global assessment of synovial inflammation (β = 0.06).

CONCLUSION

The results of this study provide a unique data set that could be utilized to optimize the global US assessment of synovial pathologic features of the whole joint in patients with RA.

摘要

目的

本初步研究旨在为优化类风湿关节炎（RA）患者整个关节的全身超声（US）评估中滑膜病理特征的全球评估提供基础。

方法

从 30 名 RA 患者的 8 个预定义成像平面中获取第二掌指关节的 US 图像，这些平面包含全面捕获整个关节滑膜病理特征的区域。12 名经验丰富的超声医师使用视觉模拟量表（VAS）评估这些图像的个体图像和整个关节水平，以评估病理严重程度。使用组内相关系数（ICC）评估 VAS 评分的组内再现性，并使用多元线性回归分析确定独立影响整个关节整体评估的因素。

结果

共分析了 14276 个 VAS 评分。任何合格的滑膜病理特征的 VAS 评估的组内再现性良好（ICC 0.65）。关节轻度炎症的 US 评估不如关节重度炎症的再现性好。虽然关节中受影响最严重的区域并不总是代表 8 个区域中的平均病理严重程度，但整个关节的整体评估与受影响最严重区域的评估强烈相关（P<0.001）。重要的是，标准的中线成像平面并不是对整个关节的整体评估最有影响的平面。滑膜液积聚的评估不可再现（ICC 0.20-0.42），并且不会对滑膜炎症的整体评估产生实质性影响（β=0.06）。