一种新型参考图谱有助于提高超声检查RA关节的可信度

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Ann Rheum Dis. 2011 Jul 22. [Epub ahead of print]   Examination of intra and interrater reliability with a new ultrasonographic reference atlas for scoring of synovitis in patients with rheumatoid arthritis.   Hammer HB, Bolton-King P, Bakkeheim V, Berg TH, Sundt E, Kongtorp AK, Haavardsholm EA.   Source 1Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.   Abstract   OBJECTIVE: Synovitis in patients with rheumatoid arthritis (RA) may be scored semiquantitatively (0-3) for B-mode (BM) and power Doppler (PD) ultrasonography. The objective was to assess the reliability of BM and PD examinations with a novel ultrasonographic atlas as reference. METHODS: Representative ultrasound images (including scores 0-3) of BM and PD from 24 different joints were collected to develop an ultrasonographic atlas. Ten RA patients were assessed twice by five rheumatologists performing BM and PD scoring (0-3) of 16 joints bilaterally (metacarpophalangeal 1-5, wrist (radiocarpal, intercarpal, radioulnar), elbow, knee, talocrural and metatarsophalangeal 1-5), with the novel ultrasonographic atlas as a reference. RESULTS: The median (range) percentages of exact agreements for BM/PD assessments were 73.1 (70.3-80.6)/83.7 (76.7-87.6) and for close agreement 98.1 (96.2-99.7)/98.0 (96.8-98.4) with weighted κ values of median (range) 0.77 (0.70-0.83) for BM and 0.83 (0.73-0.86) for PD. The intrarater intraclass correlation coefficients (ICC) for BM/PD scores were 0.95 (0.93-0.99)/0.97 (0.95-0.99) and interrater ICC were 0.95 (0.86-0.99)/0.97 (0.94-1.00). Scoring of 32 joints was completed in median 15 min (range 12-20). CONCLUSION: With the use of an ultrasonographic atlas as reference high intra and interrater reliability was found for BM and PD scoring. This novel atlas may be a useful resource in clinical practice and research.   PMID: 21784724

一种新型参考图谱有助于提高超声检查RA关节的可信度   Hammer HB, et al. Ann Rheum Dis. 2011 Jul 22. 提前在线发表.     目的: 类风湿关节炎(RA)患者的滑膜炎可以通过B超(BM)和多普勒超声(PD)进行半定量评分(0 ~ 3)。本研究旨在以一种新版超声图谱为参照评估BM和PD检查的可信度。 方法: 收集有代表性的24个关节超声影像学资料(包括评分)并制备成标准图谱。以该图谱为参照，由5名风湿病医生操作BM和PD分别两次检查10例RA病人16个关节对(掌指关节1 ~ 5，腕关节(桡腕, 掌骨间, 尺桡)，肘关节，膝关节，踝关节以及跖趾关节1 ~ 5)并评分(0 ~ 3)。 结果: 不同操作者对BM/PD评估的完全一致性中位数(范围)是73.1 (70.3 ~ 80.6)和83.7 (76.7 ~ 87.6)，接近一致率为98.1 (96.2 ~ 99.7)和 98.0 (96.8 ~ 98.4)，BM和PD中位数(范围)的加权κ值为0.77 (0.70 ~ 0.83)和0.83 (0.73 ~ 0.86)。BM/PD的同一判读者组内相关系数 (ICC)为分别为0.95 (0.93 ~ 0.99)和0.97 (0.95 ~ 0.99)和判读者之间ICC分别为0.95 (0.86 ~ 0.99)和0.97 (0.94 ~ 1.00)。完成32个关节评估的耗时中位数为15分钟(范围: 12 ~ 20分钟)。 结论: 以超声图谱为参照对BM和PD评分时，操作者自身以及不同操作者之间的可信度是高的。这种新型图谱对临床实践和科研而言可能是一种有用的资源。