Laboratorio de Ultrasonido Musculoesquelético y Articular, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra, Ibarra, Mexico.
Servicio de Medicina Interna, Hospital General de Tlahuác, México City, Mexico.
Clin Rheumatol. 2017 Dec;36(12):2799-2804. doi: 10.1007/s10067-017-3662-1. Epub 2017 May 5.
This study aims to test the reliability of ultrasound to graduate synovitis in static and video images, evaluating separately grayscale and power Doppler (PD), and combined. Thirteen trained rheumatologist ultrasonographers participated in two separate rounds reading 42 images, 15 static and 27 videos, of the 7-joint count [wrist, 2nd and 3rd metacarpophalangeal (MCP), 2nd and 3rd interphalangeal (IPP), 2nd and 5th metatarsophalangeal (MTP) joints]. The images were from six patients with rheumatoid arthritis, performed by one ultrasonographer. Synovitis definition was according to OMERACT. Scoring system in grayscale, PD separately, and combined (GLOESS-Global OMERACT-EULAR Score System) were reviewed before exercise. Reliability intra- and inter-reading was calculated with Cohen's kappa weighted, according to Landis and Koch. Kappa values for inter-reading were good to excellent. The minor kappa was for GLOESS in static images, and the highest was for the same scoring in videos (k 0.59 and 0.85, respectively). Excellent values were obtained for static PD in 5th MTP joint and for PD video in 2nd MTP joint. Results for GLOESS in general were good to moderate. Poor agreement was observed in 3rd MCP and 3rd IPP in all kinds of images. Intra-reading agreement were greater in grayscale and GLOESS in static images than in videos (k 0.86 vs. 0.77 and k 0.86 vs. 0.71, respectively), but PD was greater in videos than in static images (k 1.0 vs. 0.79). The reliability of the synovitis scoring through static images and videos is in general good to moderate when using grayscale and PD separately or combined.
本研究旨在测试超声在静态和视频图像中评估滑膜炎的可靠性，分别评估灰度和能量多普勒（PD），以及两者的联合。 13 名经过培训的风湿病超声医师在两轮中分别阅读了 42 张图像，包括 15 张静态图像和 27 张视频，涉及 7 关节计数[腕关节、第 2 和第 3 掌指关节（MCP）、第 2 和第 3 指间关节（IPP）、第 2 和第 5 跖趾关节（MTP）]。这些图像来自一位超声医师对 6 名类风湿关节炎患者的检查。滑膜炎的定义根据 OMERACT 标准。在练习之前，回顾了灰度、PD 分别和联合（GLOESS-Global OMERACT-EULAR 评分系统）的评分系统。根据 Landis 和 Koch，计算了阅读内和阅读间的可靠性，并使用 Cohen's kappa 加权。阅读间的 kapp 值为好到极好。在静态图像中，GLOESS 的最小 kapp 值为差，在视频中，同一评分的最高 kapp 值为极好（分别为 k 0.59 和 0.85）。在第 5 MTP 关节的静态 PD 和第 2 MTP 关节的 PD 视频中，获得了极好的 GLOESS 结果。GLOESS 在一般情况下的结果为好到中度。在所有图像中，3 号 MCP 和 3 号 IPP 的一致性都很差。在静态图像中，灰度和 GLOESS 的阅读内一致性大于视频（k 0.86 与 0.77 和 k 0.86 与 0.71），但 PD 在视频中大于静态图像（k 1.0 与 0.79）。使用灰度和 PD 分别或联合评估时，静态和视频图像中滑膜炎评分的可靠性通常为好到中度。
