Department of Rheumatology and Immunology, Medical University of Graz, Graz, Austria.
Internal Medicine and Nephrology Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy.
RMD Open. 2021 Nov;7(3). doi: 10.1136/rmdopen-2021-001864.
To summarise current data on the value of imaging to guide interventional procedures in patients with rheumatic and musculoskeletal disease (RMDs) informing an European Alliance of Associations for Rheumatology taskforce.
A systematic literature review was conducted to retrieve prospective and retrospective studies published in English and comparing different (imaging) techniques, different settings and procedural protocols to guide interventions in patients with RMDs. MEDLINE, EMBASE, the Cochrane Library and Epistemonikos databases were searched through October 2021. Risk of bias (RoB) was assessed using the Cochrane RoB tool for randomised trials V.2 (ROB2), the RoB tool for Non-Randomised Studies of Interventions and the appraisal tool for cross-sectional studies.
Sixty-six studies were included (most with moderate/high RoB); 49 were randomised controlled trials, three prospective cohort studies and 14 retrospective studies. Fifty-one studies compared either one imaging technique with another imaging technique, or with palpation-guided interventions. Ultrasound (US) was most frequently studied (49/51), followed by fluoroscopy (10/51). Higher accuracy was found for US or fluoroscopy compared with palpation-guided interventions. Studies comparing different imaging techniques (12/51) did not endorse one specific method. Different settings/equipment for imaging-guided procedures (eg, automatic vs manual syringes) were investigated in three studies, reporting heterogeneous results. Fifteen studies compared different imaging-guided procedures (eg, intra-articular vs periarticular injections).
Higher accuracy of needle positioning at joints and periarticular structures was seen in most studies when using imaging (especially US) guidance as compared with palpation-guided interventions with the limitation of heterogeneity of data and considerable RoB.
总结当前影像学在指导风湿和肌肉骨骼疾病（RMDs）患者介入治疗中的价值的数据，为欧洲风湿病协会联盟的一个工作组提供信息。
进行了系统的文献回顾，以检索发表在英文文献中并比较不同（影像学）技术、不同环境和程序方案以指导 RMD 患者介入治疗的前瞻性和回顾性研究。通过 2021 年 10 月对 MEDLINE、EMBASE、Cochrane 图书馆和 Epistemonikos 数据库进行了搜索。使用随机试验 Cochrane RoB 工具 V.2（ROB2）、干预措施的非随机研究的 RoB 工具和横断面研究的评估工具评估偏倚风险（RoB）。
共纳入 66 项研究（大多数为中/高度 RoB）；其中 49 项为随机对照试验，3 项为前瞻性队列研究，14 项为回顾性研究。51 项研究比较了一种影像学技术与另一种影像学技术，或与触诊引导的干预措施。超声（US）是最常研究的（49/51），其次是透视（10/51）。与触诊引导的干预措施相比，US 或透视的准确性更高。比较不同影像学技术的研究（12/51）并没有支持一种特定的方法。有三项研究调查了影像学引导程序的不同环境/设备（例如，自动与手动注射器），报告了结果存在异质性。有 15 项研究比较了不同的影像学引导程序（例如，关节内与关节周围注射）。
与触诊引导的干预措施相比，大多数研究都发现，在关节和关节周围结构中使用影像学（尤其是 US）引导时，针定位的准确性更高，但存在数据异质性和相当大的 RoB 的局限性。
