Graduate School of Peking Union Medical College, China-Japan Friendship Institute of Clinical Medicine, Chaoyang District, Beijing, China.
Centre for Osteonecrosis and Joint-preserving & Reconstruction, Orthopaedic Department, China-Japan Friendship Hospital, Chaoyang District, Beijing, China.
PLoS One. 2018 Jul 6;13(7):e0199672. doi: 10.1371/journal.pone.0199672. eCollection 2018.
Musculoskeletal ultrasound is widely used in diagnosing gout, but its accuracy is debatable. We conducted a systematic review and meta-analysis to quantitatively evaluate the value of ultrasound in the diagnosis of gout.
We systematically searched for publications using Cochrane Library, PubMed/Medline and Embase and manually screened the references of eligible articles for additional relevant publications. Studies were included in this systematic review if they assessed the diagnostic accuracy of ultrasound in gout compared to that of the gold standard, demonstration of monosodium urate crystals in joint fluid or tophi. We then conducted quantitative analyses by extracting data from each study and calculating the pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR) and diagnostic odds ratio (DOR). The summary receiver operating characteristic curves (sROCs) were constructed to obtain the Q*-index and the area under the curve (AUC).
Thirteen studies were included in this meta-analysis. The diagnostic performances of three distinctive ultrasonographic features of gout, double contour sign (DCS), the presence of tophi and the snowstorm sign, were evaluated. For person-based evaluations, the pooled sensitivity, specificity, DOR, AUC and Q* were as follows: for the DCS, 66% (95% confidence interval (CI) 62%-69%), 92% (95% CI 90%-94%), 25.91 (95% CI 11.80-56.89), 0.8163 and 0.7503, respectively; for the presence of tophi, 56% (95% CI 52%-60%), 94% (95% CI 92%-96%), 21.11 (95% CI 7.84-56.89), 0.8928 and 0.8236, respectively; for the snowstorm sign, 31% (95% CI 27%-36%), 91% (95% CI 88%-93%), 4.54(95% CI 3.13-6.58), 0.5946 and 0.5712, respectively; and for simultaneous consideration of these ultrasonographic features, 80% (95% CI 76%-83%), 83% (95% CI 79%-86%), 19.03 (95% CI 13.97-25.93), 0.889 and 0.8197, respectively. For the joint-/location-based evaluations, the pooled sensitivity, specificity, DOR, AUC and Q* were as follows: for the DCS, 75% (95% CI 68%-80%), 65% (95% CI 59%-70%), 16.90 (95% CI 5.10-56.03), 0.871 and 0.8014, respectively; and for the presence of tophi, 48% (95% CI 40%-57%), 96% (95% CI 91%-99%), 30.20 (95% CI 9.23-98.87), 0.8776 and 0.8081, respectively.
In this meta-analysis, relatively high specificity but modest or low sensitivity were demonstrated in the diagnosis of gout using each of the three ultrasonographic features for person-based evaluations. Simultaneous consideration of these ultrasound findings may improve the diagnostic sensitivity. However, the double contour sign alone is weak in the differentiation of gout and non-gout for joint-/location-based evaluations. Further well-designed studies are still needed to support the current findings.
肌肉骨骼超声广泛用于诊断痛风，但准确性存在争议。我们进行了系统评价和荟萃分析，以定量评估超声在痛风诊断中的价值。
我们系统地检索了 Cochrane 图书馆、PubMed/Medline 和 Embase 中的出版物，并手动筛选了合格文章的参考文献，以获取其他相关出版物。如果研究评估了超声在痛风中的诊断准确性与金标准（关节液或痛风石中尿酸单钠晶体的显示）相比，我们将其纳入本系统评价。然后，我们从每项研究中提取数据并计算汇总敏感性、特异性、阳性似然比（PLR）、阴性似然比（NLR）和诊断比值比（DOR），进行定量分析。构建综合接收者操作特征曲线（sROC）以获得 Q*-指数和曲线下面积（AUC）。
本荟萃分析纳入了 13 项研究。评估了三种独特的痛风超声特征（双轮廓征、痛风石存在和暴风雪征）的诊断性能。对于个体评估，汇总敏感性、特异性、DOR、AUC 和 Q如下：对于双轮廓征，66%（95%CI 62%-69%）、92%（95%CI 90%-94%）、25.91（95%CI 11.80-56.89）、0.8163 和 0.7503；对于痛风石存在，56%（95%CI 52%-60%）、94%（95%CI 92%-96%）、21.11（95%CI 7.84-56.89）、0.8928 和 0.8236；对于暴风雪征，31%（95%CI 27%-36%）、91%（95%CI 88%-93%）、4.54（95%CI 3.13-6.58）、0.5946 和 0.5712；同时考虑这些超声特征时，80%（95%CI 76%-83%）、83%（95%CI 79%-86%）、19.03（95%CI 13.97-25.93）、0.889 和 0.8197。对于关节/部位评估，汇总敏感性、特异性、DOR、AUC 和 Q如下：对于双轮廓征，75%（95%CI 68%-80%）、65%（95%CI 59%-70%）、16.90（95%CI 5.10-56.03）、0.871 和 0.8014；对于痛风石存在，48%（95%CI 40%-57%）、96%（95%CI 91%-99%）、30.20（95%CI 9.23-98.87）、0.8776 和 0.8081。
在本荟萃分析中，对于个体评估，三种超声特征中的每一种在诊断痛风时均表现出较高的特异性，但敏感性较低或中等。同时考虑这些超声发现可能会提高诊断敏感性。然而，在关节/部位评估中，单独的双轮廓征在区分痛风和非痛风时较弱。仍需要进一步的精心设计研究来支持当前的发现。
