Vicente-Rabaneda Esther Francisca, Möller Ingrid, Mata Abdon, Montes Nuria, Rodríguez-Vargas Gabriel-Santiago, Coronel Luis, Bong David, Castañeda Santos, Santos-Moreno Pedro
Rheumatology Department, Hospital Universitario de La Princesa, IIS-Princesa, C/Diego de León 62, 28006 Madrid, Spain.
Facultad de Medicina, Universidad Autónoma de Madrid, C/del Arzobispo Morcillo 4, 28029 Madrid, Spain.
J Clin Med. 2025 May 25;14(11):3701. doi: 10.3390/jcm14113701.
: The objective of this study is to investigate the intra- and inter-explorer reliability of different lung ultrasound (LUS) scores in patients with suspected rheumatoid arthritis with associated interstitial lung disease (RA-ILD). : Fourteen consecutive patients with suspected RA-ILD based on the presence of respiratory symptoms, lung function tests (LFTs) or imaging alterations were recruited. The screening protocol consisted of an LFT, a chest X-ray, and HRCT. LUS examinations of different B-line and pleural line scores including 14 intercostal spaces were performed by three experienced sonographers, guaranteeing blinding. Intra- and inter-explorer reliability were calculated for all LUS scores and at the intercostal space level by weighted Cohen's kappa and Fleiss' kappa, respectively, relying on absolute differences using Stata/IC 14.2 software (StataCorp, College Station, TX, USA). : Both global (ĸ = 0.73-0.82) and binary (ĸ = 0.80-0.90) scores of B lines showed substantial to excellent intra-explorer reliability, with slightly better results for the binary score. The inter-explorer reliability was equally excellent for the global score (ĸ = 0.93) and the binary score (ĸ = 0.90) of B lines. The intra-explorer reliability of the semiquantitative pleural score was excellent for all the sonographers (ĸ = 0.88-0.91), and the binary pleural score had slightly lower intra-explorer reliability (ĸ = 0.77-0.84). Regarding inter-explorer reliability, both semiquantitative and binary pleural scores were equally excellent (ĸ = 0.84). Good to excellent inter-explorer reliability was found in all the scanned areas. : Substantial to excellent intra- and inter-explorer reliability of different feasible B-line and pleural LUS scores were found, adding evidence in favor of the potential implementation of LUS for RA-ILD diagnosis in clinical practice.
本研究的目的是调查不同肺超声(LUS)评分在疑似类风湿关节炎合并间质性肺疾病(RA-ILD)患者中的检查者内和检查者间可靠性。连续招募了14例基于呼吸道症状、肺功能测试(LFTs)或影像学改变而疑似RA-ILD的患者。筛查方案包括LFT、胸部X线和高分辨率CT(HRCT)。由三名经验丰富的超声检查人员对包括14个肋间间隙在内的不同B线和胸膜线评分进行LUS检查,确保检查人员不知情。使用Stata/IC 14.2软件(美国德克萨斯州大学站市的StataCorp公司),分别根据加权Cohen卡方和Fleiss卡方,依靠绝对差异计算所有LUS评分以及在肋间间隙水平的检查者内和检查者间可靠性。B线的整体(κ = 0.73 - 0.82)和二元(κ = 0.80 - 0.90)评分均显示出检查者内可靠性从较高到极好,二元评分的结果略好。B线的整体评分(κ = 0.93)和二元评分(κ = 0.90)的检查者间可靠性同样出色。半定量胸膜评分的检查者内可靠性对所有超声检查人员而言均为极好(κ = 0.88 - 0.91),二元胸膜评分的检查者内可靠性略低(κ = 0.77 - 0.84)。关于检查者间可靠性,半定量和二元胸膜评分同样出色(κ = 0.84)。在所有扫描区域均发现了良好到极好的检查者间可靠性。不同可行的B线和胸膜LUS评分具有较高到极好的检查者内和检查者间可靠性,这为在临床实践中使用LUS进行RA-ILD诊断的潜在应用增加了证据。
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