Tan York Kiat, Lim Gek Hsiang, Ooi Chin Chin, Ma Voon Chee, Vora Bimal Mayur Kumar
Department of Rheumatology and Immunology, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore.
Duke-NUS Medical School, Singapore, Singapore.
BMC Rheumatol. 2024 Nov 19;8(1):62. doi: 10.1186/s41927-024-00435-1.
Thermography is an emerging imaging modality which allows for a quick and objective measure of joint surface temperature in patients with rheumatoid arthritis (RA). To date, there are no published studies comparing thermography with ultrasonography in the subclinical assessment of joint inflammation at the wrist of patients with RA, and no published data on inter-rater reliability for multiple raters for thermographic assessment at the RA wrist. In our study comparing thermography and ultrasonography at the RA wrist, we aim to determine if thermography can detect subclinical synovitis. Additionally, we performed inter-reliability testing (multiple raters) for both thermography and ultrasonography.
Thermographic (average (Tavg), maximum (Tmax) and minimum (Tmin) temperatures) and ultrasound (total grey-scale (TGS) score and total power Doppler (TPD) scores) parameters were compared between two patient groups: Asymptomatic Group (with non-swollen and non-tender wrists) and Symptomatic Group (with swollen and/or tender wrists). Among Asymptomatic Group patients, thermographic parameters were compared between those with and without wrist joint recess(es) having ultrasound synovitis (PD ≥ 1 or GS ≥ 2); Spearman's correlation and simple linear regression were used to study the relationship between thermographic and ultrasound parameters. Intra-class correlation coefficient (ICC) was used for inter-rater reliability calculation.
Eighty-seven RA patients' right wrists were imaged in this cross-sectional study. Thermographic temperatures, TPD and TGS scores were all significantly (p < 0.05) greater among Symptomatic Group versus Asymptomatic Group patients. Among Asymptomatic Group patients, thermographic temperatures were all significantly higher (P < 0.01) in wrists having joint recess(es) with ultrasound PD ≥ 1 or GS ≥ 2, while all thermographic parameters correlated significantly with TPD (correlation coefficient ranging from 0.43 to 0.48, p < 0.001) and TGS (correlation coefficient ranging from 0.33 to 0.37, p < 0.01). The ICC values based on a subset of images obtained for inter-reliability testing were high for thermography (0.994 to 0.998) and ultrasonography (0.933 to 0.952).
Swollen and/or tender RA wrists displayed greater thermographic and ultrasound-detected joint inflammation. At clinically quiescent (non-swollen; non-tender) wrists, thermographic temperatures significantly correlated with ultrasound-detected joint inflammation.
Not applicable.
热成像技术是一种新兴的成像方式，可快速、客观地测量类风湿关节炎（RA）患者的关节表面温度。迄今为止，尚无已发表的研究比较热成像技术与超声检查在RA患者手腕关节炎症亚临床评估中的差异，也没有关于多名评估者对RA手腕进行热成像评估的评分者间可靠性的已发表数据。在我们比较RA手腕热成像技术和超声检查的研究中，我们旨在确定热成像技术能否检测到亚临床滑膜炎。此外，我们对热成像技术和超声检查均进行了评分者间可靠性测试（多名评估者）。
比较了两组患者的热成像参数（平均温度（Tavg）、最高温度（Tmax）和最低温度（Tmin））和超声参数（总灰阶（TGS）评分和总功率多普勒（TPD）评分）：无症状组（手腕无肿胀和压痛）和有症状组（手腕有肿胀和/或压痛）。在无症状组患者中，比较了手腕关节隐窝处有无超声滑膜炎（PD≥1或GS≥2）的患者的热成像参数；采用Spearman相关性分析和简单线性回归分析来研究热成像参数与超声参数之间的关系。组内相关系数（ICC）用于计算评分者间可靠性。
在这项横断面研究中，对87例RA患者的右手腕进行了成像。有症状组患者的热成像温度、TPD和TGS评分均显著高于无症状组患者（p<0.05）。在无症状组患者中，手腕关节隐窝处超声PD≥1或GS≥2的患者的热成像温度均显著更高（P<0.01），而所有热成像参数均与TPD（相关系数范围为0.43至0.48，p<0.001）和TGS（相关系数范围为0.33至0.37，p<0.01）显著相关。基于用于评分者间可靠性测试的部分图像获得的ICC值，热成像技术（0.994至0.998）和超声检查（0.933至0.952）均较高。
肿胀和/或压痛的RA手腕表现出更大的热成像和超声检测到的关节炎症。在临床上静止（无肿胀、无压痛）的手腕中，热成像温度与超声检测到的关节炎症显著相关。
不适用。
