Tang Tianmin, Jin Hongyu, Yang Yujia
Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, China.
Department of Liver Surgery & Liver Transplantation, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, China.
Quant Imaging Med Surg. 2024 Feb 1;14(2):1541-1552. doi: 10.21037/qims-23-1211. Epub 2024 Jan 10.
The European League Against Rheumatism-Outcomes Measures in Rheumatology (EULAR-OMERACT) recommend only scanning dorsal spaces for scoring ultrasound-detected hand synovitis. This study evaluated the efficiency of the combined scoring system only depending on dorsal joint spaces synovitis in diagnosing and evaluating ultrasound-detected hand synovitis.
The data of 56 patients who underwent hand joint ultrasonography exams in the Ultrasound Department of West China Hospital, Sichuan University were prospectively collected. The participants formed a random series. The images of each patient included gray-scale (GS) and power Doppler (PD) images of bilateral first to fifth metacarpophalangeal joints (MCP) and the thumb and second to fifth proximal interphalangeal joints (IP). The synovial thickness was measured quantitatively in GS images, and the synovial GS scores in the dorsal joint spaces and PD scores in the dorsal and volar joint spaces were calculated according to the combined EULAR-OMERACT scoring system.
The detection rate of synovitis in the first to fifth MCP, thumb and second to fifth proximal IP synovitis were 41.4% (232/560) and 33.9% (190/560), respectively. The sensitivity of only inspecting the dorsal joint spaces with GS ultrasound was 79.3% for MCP and 52.6% for the thumb and second to fifth proximal IPs. The PD scores were higher in the dorsal joint spaces than in the volar joint spaces (P value <0.001). The combined scores were higher than either the GS or PD scores alone in the dorsal joint spaces (P value of the combined scores GS scores =0.001; P value of the combined scores PD scores <0.001).
Adopting the EULAR-OMERACT combined scoring standard is recommended to evaluate ultrasound-detected hand synovitis, as determined by the highest value of the GS scores or the PD scores. More specifically, PD scores can mainly be used to appraise the dorsal joint spaces. However, GS scores should be used to evaluate both the dorsal joint spaces and the volar joint spaces.
欧洲抗风湿病联盟-风湿病学疗效指标（EULAR-OMERACT）建议仅扫描背侧间隙以对手部超声检测到的滑膜炎进行评分。本研究评估了仅依赖背侧关节间隙滑膜炎的联合评分系统在诊断和评估超声检测到的手部滑膜炎方面的效率。
前瞻性收集四川大学华西医院超声科56例行手部关节超声检查患者的数据。参与者形成一个随机序列。每位患者的图像包括双侧第一至第五掌指关节（MCP）以及拇指和第二至第五近端指间关节（IP）的灰阶（GS）和能量多普勒（PD）图像。在GS图像中定量测量滑膜厚度，并根据EULAR-OMERACT联合评分系统计算背侧关节间隙的滑膜GS评分以及背侧和掌侧关节间隙的PD评分。
第一至第五MCP、拇指以及第二至第五近端IP滑膜炎的检出率分别为41.4%（232/560）和33.9%（190/560）。仅用GS超声检查背侧关节间隙时，MCP的敏感性为79.3%，拇指以及第二至第五近端IP的敏感性为52.6%。背侧关节间隙的PD评分高于掌侧关节间隙（P值<0.001）。背侧关节间隙的联合评分高于单独的GS评分或PD评分（联合评分与GS评分比较的P值=0.001；联合评分与PD评分比较的P值<0.001）。
建议采用EULAR-OMERACT联合评分标准来评估超声检测到的手部滑膜炎，以GS评分或PD评分的最高值为准。更具体地说，PD评分主要用于评估背侧关节间隙。然而，GS评分应同时用于评估背侧关节间隙和掌侧关节间隙。
