Yerich Nadiya V, Alvarez Carolina, Schwartz Todd A, Savage-Guin Serena, Renner Jordan B, Bakewell Catherine J, Kohler Minna J, Lin Janice, Samuels Jonathan, Nelson Amanda E
University of North Carolina at Chapel Hill.
Intermountain Health Care, Salt Lake City, Utah.
ACR Open Rheumatol. 2020 Jul;2(7):438-448. doi: 10.1002/acr2.11159. Epub 2020 Jun 29.
This study sought to develop and employ a comprehensive and standardized ultrasound (US) protocol and scoring atlas for the evaluation of features relevant to knee osteoarthritis (KOA) in a community-based cohort in the United States, with the goals of demonstrating feasibility, reliability, and validity.
We utilized data from the fourth follow-up (2016-2018) of the Johnston County OA Project, which includes individuals with (~50%) and without radiographic KOA. All participants underwent standardized knee radiography and completed standard questionnaires including the Knee Injury and Osteoarthritis Outcome Score (KOOS). Bilateral knee US images were obtained by a trained sonographer using a standardized protocol and scored by trained rheumatologists using an atlas developed for this study. A total of 396 knees were each scored by two readers according to the atlas. Associations between US features, radiographic findings (graded by an expert radiologist), and KOOS scores were assessed.
Overall interreader reliability for US scoring was fair to moderate. The strongest correlations between US and radiographic features were seen for osteophytes, and similarly strong correlations were seen between US osteophytes and overall radiographic Kellgren-Lawrence Grade, demonstrating criterion validity. Features of effusion/synovitis and osteophytes were most associated with KOOS pain and impaired function.
US is a feasible, reliable, and valid method to assess features relevant to KOA in clinical and research settings. The protocol and atlas developed in this study can be utilized to evaluate KOA in a standardized fashion in future clinical studies, enabling greater utilization of this valuable modality in osteoarthritis.
本研究旨在开发并采用一套全面且标准化的超声（US）方案和评分图谱，用于评估美国一个社区队列中与膝关节骨关节炎（KOA）相关的特征，目标是证明其可行性、可靠性和有效性。
我们利用了约翰斯顿县骨关节炎项目第四次随访（2016 - 2018年）的数据，该项目包括有（约50%）和无放射学KOA的个体。所有参与者均接受了标准化的膝关节X线摄影，并完成了包括膝关节损伤和骨关节炎结局评分（KOOS）在内的标准问卷。由一名经过培训的超声检查医师使用标准化方案获取双侧膝关节超声图像，并由经过培训的风湿病学家使用为本研究开发的图谱进行评分。共有396个膝关节由两名阅片者根据图谱进行评分。评估了超声特征、放射学表现（由一名专家放射科医生分级）和KOOS评分之间的关联。
超声评分的总体阅片者间可靠性为中等。超声与放射学特征之间最强的相关性见于骨赘，超声骨赘与总体放射学凯尔格伦 - 劳伦斯分级之间也观察到类似的强相关性，证明了标准效度。积液/滑膜炎和骨赘的特征与KOOS疼痛和功能受损最相关。
超声是在临床和研究环境中评估与KOA相关特征的一种可行、可靠且有效的方法。本研究中开发的方案和图谱可用于未来临床研究中以标准化方式评估KOA，从而在骨关节炎中更广泛地利用这种有价值的检查方法。
