Polachek Ari, Furer Victoria, Zureik Mirna, Nevo Sharon, Mendel Liran, Levartovsky David, Wollman Jonathan, Aloush Valerie, Tzemah Reut, Elalouf Ofir, Anouk Marina, Berman Mark, Kaufman Ilana, Lahat Yael, Sarbagil-Maman Hagit, Borok Sara, Broyde Adi, Eder Lihi, Paran Daphna, Iluz Moshe, Eshed Iris, Elkayam Ori
Department of Rheumatology, Tel Aviv Sourasky Medical Center.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Rheumatology (Oxford). 2022 Feb 2;61(2):563-571. doi: 10.1093/rheumatology/keab272.
To report the discrepancies and agreements between US, MRI and radiography of the hand in PsA, and to compare the sensitivity and specificity of US and radiography to MRI as the gold standard imaging study in PsA.
All of the 100 prospectively recruited consecutive PsA patients underwent clinical assessment and concomitant radiographic, US and MRI studies of the MCP, PIP and DIP joints of one hand. Synovitis, flexor tenosynovitis, extensor paratenonitis, erosions and bone proliferations were identified and scored. All readers were blinded to clinical data, and agreement was calculated based on prevalence-adjusted bias-adjusted kappa (PABAK).
The prevalence of synovitis, flexor tenosynovitis, extensor paratenonitis and erosions was similar for US and MRI, while that of bone proliferation was significantly increased in US and radiography compared with MRI (P < 0.001). The absolute agreement between US and MRI was good-to-very good for synovitis (85-96%, PABAK = 0.70-0.92), flexor tenosynovitis (93-98%, PABAK = 0.87-0.96) and extensor paratenonitis (95-98%, PABAK = 0.90-0.97). Agreement between US, MRI and radiography was 96-98% (PABAK = 0.92-0.97) for erosions and 71-93% (PABAK = 0.47-0.87) for bone proliferations. Sensitivity of US with MRI as gold standard was higher for synovitis (0.5-0.86) and extensor paratenonitis (0.63-0.85) than for flexor tenosynovitis (0.1-0.75), while the specificity was high for each pathology (0.89-0.98).
There is very good agreement between US and MRI for the detection of inflammatory changes in finger joints in PsA. US, radiography and MRI have a good-to-very good agreement for destructive changes.
报告银屑病关节炎（PsA）患者手部超声（US）、磁共振成像（MRI）和X线摄影之间的差异与一致性，并比较以MRI作为PsA金标准影像学检查时，US和X线摄影的敏感性和特异性。
前瞻性连续纳入100例PsA患者，对其进行临床评估，并对手部的掌指关节（MCP）、近端指间关节（PIP）和远端指间关节（DIP）同时进行X线摄影、US和MRI检查。识别并记录滑膜炎、屈肌腱腱鞘炎、伸肌腱周围炎、骨侵蚀和骨质增生情况并评分。所有阅片者均不知晓临床资料，基于患病率调整偏倚调整kappa值（PABAK）计算一致性。
US和MRI检查滑膜炎、屈肌腱腱鞘炎、伸肌腱周围炎和骨侵蚀的患病率相似，而与MRI相比，US和X线摄影检查骨质增生的患病率显著增加（P＜0.001）。US和MRI检查滑膜炎的绝对一致性良好至极优（85%-96%，PABAK=0.70-0.92）、屈肌腱腱鞘炎（93%-98%，PABAK=0.87-0.96）和伸肌腱周围炎（95%-98%，PABAK=0.90-0.97）。US、MRI和X线摄影检查骨侵蚀的一致性为96%-98%（PABAK=0.92-0.97），骨质增生的一致性为71%-93%（PABAK=0.47-0.87）。以MRI作为金标准时，US检查滑膜炎（0.5-0.86）和伸肌腱周围炎（0.63-0.85）的敏感性高于屈肌腱腱鞘炎（0.1-0.75），而每种病变的特异性均较高（0.89-0.98）。
在PsA患者手指关节炎症改变的检测方面，US和MRI之间具有非常好的一致性。在破坏性改变方面，US、X线摄影和MRI具有良好至极优的一致性。
