Janta Iustina, Morán Julio, Naredo Esperanza, Nieto Juan Carlos, Uson Jacqueline, Möller Ingrid, Bong David, Bruyn George A W, D Agostino Maria Antonietta, Filippucci Emilio, Hammer Hilde Berner, Iagnocco Annamaria, Terslev Lene, González Jorge Murillo, Mérida José Ramón, Carreño Luis
Department of Rheumatology, Faculty of Medicine, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Doctor Esquerdo 46, 28007, Madrid, Spain.
Department of Traumatology and Orthopaedic Surgery, Faculty of Medicine, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, Spain.
Rheumatol Int. 2016 Jun;36(6):863-9. doi: 10.1007/s00296-016-3460-0. Epub 2016 Mar 19.
To establish whether a cadaver model can serve as an effective surrogate for the detection of tendon damage characteristic of rheumatoid arthritis (RA). In addition, we evaluated intraobserver and interobserver agreement in the grading of RA-like tendon tears shown by US, as well as the concordance between the US findings and the surgically induced lesions in the cadaver model. RA-like tendon damage was surgically induced in the tibialis anterior tendon (TAT) and tibialis posterior tendon (TPT) of ten ankle/foot fresh-frozen cadaveric specimens. Of the 20 tendons examined, six were randomly assigned a surgically induced partial tear; six a complete tear; and eight left undamaged. Three rheumatologists, experts in musculoskeletal US, assessed from 1 to 5 the quality of US imaging of the cadaveric models on a Likert scale. Tendons were then categorized as having either no damage, (0); partial tear, (1); or complete tear (2). All 20 tendons were blindly and independently evaluated twice, over two rounds, by each of the three observers. Overall, technical performance was satisfactory for all items in the two rounds (all values over 2.9 in a Likert scale 1-5). Intraobserver and interobserver agreement for US grading of tendon damage was good (mean κ values 0.62 and 0.71, respectively), with greater reliability found in the TAT than the TPT. Concordance between US findings and experimental tendon lesions was acceptable (70-100 %), again greater for the TAT than for the TPT. A cadaver model with surgically created tendon damage can be useful in evaluating US metric properties of RA tendon lesions.
为确定尸体模型是否可作为检测类风湿关节炎（RA）特征性肌腱损伤的有效替代物。此外，我们评估了超声显示的类RA肌腱撕裂分级中的观察者内和观察者间一致性，以及超声检查结果与尸体模型中手术诱导损伤之间的一致性。在10个踝关节/足部新鲜冷冻尸体标本的胫前肌腱（TAT）和胫后肌腱（TPT）中手术诱导出类RA肌腱损伤。在所检查的20条肌腱中，6条被随机分配为手术诱导的部分撕裂；6条为完全撕裂；8条未受损。三位肌肉骨骼超声专家的风湿病学家，使用李克特量表从1到5评估尸体模型的超声成像质量。然后将肌腱分类为无损伤（0）、部分撕裂（1）或完全撕裂（2）。三位观察者中的每一位对所有20条肌腱进行两轮盲法独立评估。总体而言，两轮中所有项目的技术性能均令人满意（在1 - 5的李克特量表中所有值均超过2.9）。超声对肌腱损伤分级的观察者内和观察者间一致性良好（平均κ值分别为0.62和0.71），TAT的可靠性高于TPT。超声检查结果与实验性肌腱损伤之间的一致性可接受（70 - 100%），同样TAT的一致性高于TPT。具有手术造成肌腱损伤的尸体模型可用于评估RA肌腱损伤的超声测量特性。
