Husic Rusmir, Lackner Angelika, Stradner Martin H, Hermann Josef, Dejaco Christian
Department of Rheumatology and Immunology, Medical University Graz, Graz, Austria.
Rheumatology Service, South Tyrolean Health Trust, Hospital of Bruneck, Bruneck, Italy.
Rheumatology (Oxford). 2017 Aug 1;56(8):1312-1319. doi: 10.1093/rheumatology/kex153.
Position of joints might influence the result of US examination in patients with RA. The purpose of this work was to compare grey-scale (GS) and power Doppler (PWD) findings obtained in neutral vs flat position of hands.
A cross-sectional study of 42 RA patients with active disease. Two dimensional and 3D sonography of wrists and MCP joints were conducted in two different joint positions: neutral position, which is a slight flexion of the fingers with relaxed extensor muscles; and flat position, where all palm and volar sides of fingers touch the Table. Two dimensional GS synovitis (GSS) and PWD signals were scored semi-quantitatively (0-3). For 3D sonography, the percentage of PWD voxels within a region of interest was calculated. GSS was not quantified using 3D sonography.
Compared with neutral position, 2D PWD signals disappeared in 28.3% of joints upon flattening. The median global 2D PWD score (sum of all PWD scores of an individual patient) decreased from 8 to 3 ( P < 0.001), and the global 3D PWD voxel score from 3.8 to 0.9 ( P < 0.001). The reduction of PWD scores was similar in all joints (2D: minus 50%, 3D: minus 66.4-80.1%). Inter- and intrareader agreement of PWD results was good (intraclass correlation coefficient: 0.75-0.82).
In RA, a neutral position of the hands is linked to a higher sensitivity of 2D and 3D sonography in detecting PWD signals at wrists and MCP joints, compared with a flat position. Standardization of the scanning procedure is essential for obtaining comparable US results in RA patients in trials and clinical routines.
关节位置可能会影响类风湿关节炎(RA)患者超声检查的结果。本研究的目的是比较手部处于自然位与平放位时的灰阶(GS)和能量多普勒(PWD)检查结果。
对42例活动性RA患者进行横断面研究。在两个不同的关节位置对手腕和掌指关节进行二维和三维超声检查:自然位,即手指轻度屈曲且伸肌放松;平放位,即手掌和手指的掌侧全部接触检查台。对二维GS滑膜炎(GSS)和PWD信号进行半定量评分(0 - 3分)。对于三维超声检查,计算感兴趣区域内PWD体素的百分比。三维超声未对GSS进行量化。
与自然位相比,在平放时28.3%的关节二维PWD信号消失。个体患者的二维PWD总分中位数(所有PWD评分之和)从8分降至3分(P < 0.001),三维PWD体素总分从3.8分降至0.9分(P < 0.001)。所有关节的PWD评分降低情况相似(二维:降低50%,三维:降低66.4% - 80.1%)。PWD结果在不同阅片者之间和同一阅片者内部的一致性良好(组内相关系数:0.75 - 0.82)。
在RA患者中,与平放位相比,手部自然位时二维和三维超声在检测手腕和掌指关节PWD信号方面具有更高的敏感性。在试验和临床常规中,扫描程序的标准化对于在RA患者中获得可比的超声检查结果至关重要。