Gandjbakhch Frederique, Granger Benjamin, Freund Romain, Foltz Violaine, Jousse-Joulin Sandrine, Devauchelle Valerie, Afshar Mona, Albert Jean David, Bailly Florian, Constant Elodie, Biale Lisa, Milin Morgane, Couderc Marion, Denarie Delphine, Fradin Anne, Martaille Virginie, Pierreisnard Audrey, Poursac Nicolas, Saraux Alain, Fautrel Bruno
Department of Rheumatology, APHP, CHU Pitie-Salpetriere, Paris, France; Paris 6 University, GRC-UPMC 08, Pierre Louis Institute of Epidemiology and Public Health, Paris, France.
Paris 6 University, GRC-UPMC 08, Pierre Louis Institute of Epidemiology and Public Health, Paris, France; Department of Statistics, CHU Pitie Salpetriere, APHP, Paris, France.
RMD Open. 2017 Jan 4;3(1):e000343. doi: 10.1136/rmdopen-2016-000343. eCollection 2017.
Structural damage progression is a major outcome in rheumatoid arthritis (RA). Its evaluation and follow-up in trials should involve radiographic scoring by 1 or 2 readers (reference assessment), which is challenging in large longitudinal cohorts with multiple assessments.
To compare the reproducibility of multireader and reference assessment to improve the feasibility of detecting radiographic progression in a large cohort of patients with early arthritis (ESPOIR).
We used 3 sessions to train 12 rheumatologists in radiographic scoring by the van der Heijde-modified Sharp score (SHS). Multireader scoring was based on 10 trained-reader assessments, each reader scoring a random sample of 1/5 of all available radiographs (for double scoring for each X-ray set) for patients included in the ESPOIR cohort with complete radiographic data at M0 and M60. Reference scoring was performed by 2 experienced readers. Scoring was performed blindly to clinical data, with radiographs in chronological order. We compared multireader and reference assessments by intraclass correlation coefficients (ICCs) for SHS and significant radiographic progression (SRP).
The intrareader and inter-reader reproducibility for trained assessors increased during the training sessions (ICC 0.79 to 0.94 and 0.76 to 0.92), respectively. For the 524 patients included, agreement between multireader and reference assessment of SHS progression between M0 and M60 and SRP assessment were almost perfect, ICC (0.88 (95% CI 0.82 to 0.93)) and (0.99 (95% CI 0.99 to 0.99)), respectively.
Multireader assessment of radiographic structural damage progression is comparable to reference assessment and could be used to improve the feasibility of radiographic scoring in large longitudinal cohort with numerous X-ray evaluations.
结构损伤进展是类风湿关节炎（RA）的主要结局。在试验中对其进行评估和随访应包括由1名或2名阅片者进行影像学评分（参考评估），这在需要多次评估的大型纵向队列研究中具有挑战性。
比较多阅片者评估和参考评估的可重复性，以提高在一大群早期关节炎患者（ESPOIR）中检测影像学进展的可行性。
我们通过3次培训课程，使用范德海伊德改良夏普评分（SHS）对12名风湿病学家进行影像学评分培训。多阅片者评分基于10名经过培训的阅片者的评估，每位阅片者对ESPOIR队列中在M0和M60时具有完整影像学数据的患者的所有可用X线片的1/5随机样本进行评分（每个X线片集进行双重评分）。参考评分由2名经验丰富的阅片者进行。评分对临床数据保密，X线片按时间顺序排列。我们通过组内相关系数（ICC）比较多阅片者评估和参考评估的SHS及显著影像学进展（SRP）情况。
在培训课程期间，经过培训的评估者的阅片者内和阅片者间的可重复性分别有所提高（ICC分别从0.79提高到0.94和从0.76提高到0.92）。对于纳入的524例患者，M0至M60期间多阅片者评估与参考评估的SHS进展以及SRP评估之间的一致性几乎完美，ICC分别为（0.88（95%CI 0.82至0.93））和（0.99（95%CI 0.99至0.99））。
影像学结构损伤进展的多阅片者评估与参考评估相当，可用于提高在有大量X线评估的大型纵向队列中影像学评分的可行性。
