Mueller Ruediger, Grunke Mathias, Wendler Jörg, Schuch Florian, Hofmann-Preiss Karina, Boettger Ina, Jakobs Rüdiger, Schulze-Koops Hendrik, von Kempis Johannes
Division of Rheumatology, Kantonsspital St. Gallen, St. Gallen, Switzerland.
Munich University Hospital, Division of Rheumatology, Munich, Germany.
Ultrasound Int Open. 2018 Apr;4(2):E61-E68. doi: 10.1055/a-0612-7852. Epub 2018 Jul 11.
The detection of joint swelling caused by synovitis is important for the diagnosis of inflammatory arthritis. Ultrasound (US) and MRI have proven to be more sensitive and reliable than physical examination, but they are time-consuming and expensive. The automated breast volume scanner was developed to acquire serial B-mode pictures of the female breast and these can be analyzed in all three dimensions.
To analyze the value of automated B-mode ultrasound employing the ABVS system in detecting synovitis of the finger joints compared to manual ultrasound (mUS) and physical examination, using MRI as the gold standard.
19 consecutive patients suffering from active rheumatoid (n=15) or psoriatic (n=4) arthritis were included. Automated and mUS were conducted with a linear array (ACUSON S2000™, 11 MHz). Multiplanar reconstruction enabled examination of the images for the presence of synovitis.
90% of the hand joints were assessable by automated ultrasound. Automated US detected 12.0, mUS 14.2, MRI 13.4, and clinical examination 4.1 positive joints - i. e. joints with synovitis - on average per patient. The inter-observer reliability of both assessors for automated and mUS, MRI, and physical examination, was 66.9%, 72.7%, 95.1%, and 88.9%, respectively. 84.3% of the joints classified as positive on MRI were confirmed by automated ultrasound, 85.5% on mUS, and 36.0 on physical examination. This translated into a sensitivity of 83.5%, 85.5%, and 36.0% for the three methods, respectively. Conclusion: Automated ultrasound is a promising ultrasound method for assessing small joints in patients with inflammatory arthritis.
滑膜炎所致关节肿胀的检测对炎性关节炎的诊断至关重要。超声（US）和磁共振成像（MRI）已被证明比体格检查更敏感、更可靠，但它们耗时且昂贵。自动乳腺容积扫描仪是为获取女性乳房的系列B超图像而开发的，这些图像可进行三维分析。
以MRI作为金标准，分析采用自动乳腺容积扫描仪系统的自动B超在检测手指关节滑膜炎方面相对于手动超声（mUS）和体格检查的价值。
纳入19例连续的活动性类风湿关节炎（n = 15）或银屑病关节炎（n = 4）患者。使用线性阵列（ACUSON S2000™，11MHz）进行自动超声和mUS检查。多平面重建可用于检查图像中是否存在滑膜炎。
90%的手部关节可通过自动超声进行评估。自动超声平均每位患者检测到12.0个、mUS检测到14.2个、MRI检测到13.4个、临床检查检测到4.1个阳性关节，即有滑膜炎的关节。两位评估者对自动超声、mUS、MRI和体格检查的观察者间可靠性分别为66.9%、72.7%、95.1%和88.9%。MRI分类为阳性的关节中，84.3%被自动超声证实，85.5%被mUS证实，36.0%被体格检查证实。这三种方法的敏感性分别为83.5%、85.5%和36.0%。结论：自动超声是评估炎性关节炎患者小关节的一种有前景的超声方法。
