Ultraschall Med 2022; 43(05): e65-e72
DOI: 10.1055/a-1285-4602
Technical Development

The Reliability of Ultrasound in the Assessment of Hyaline Cartilage in Rheumatoid Arthritis and Healthy Metacarpal Heads

Zuverlässigkeit des Ultraschalls bei der Beurteilung des hyalinen Knorpels bei rheumatoiden und gesunden Metakarpalknochenköpfen
1   Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
,
Emilio Filippucci
1   Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
,
Andrea Di Matteo
1   Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
2   Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, United Kingdom of Great Britain and Northern Ireland
,
Giulia Tesei
3   Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Florence, Firenze, Italy
,
Micaela Ana Cosatti
4   Rheumatology and Immunology Unit, Norberto Quirno Center for Medical Education and Clinical Research, Buenos Aires, Argentina
,
Marco Di Carlo
1   Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
,
Walter Grassi
1   Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
› Institutsangaben

Abstract

Purpose i) To assess the inter- and intra-observer reliability of ultrasound (US) in the evaluation of the hyaline cartilage (HC) of the metacarpal head (MH) in patients with rheumatoid arthritis (RA) and in healthy subjects (HS) both qualitatively and quantitatively. ii) To calculate the smallest detectable difference (SDD) of the MH cartilage thickness measurement. iii) To correlate the qualitative scoring system and the quantitative assessment.

Materials and Methods US examination was performed on 280 MHs of 20 patients with RA and 15 HS using a very high frequency probe (up to 22 MHz). HC status was evaluated both qualitatively (using a five-grade scoring system) and quantitatively (using the average value of the longitudinal and transverse measures). The HC of MHs from II to V metacarpophalangeal joint of both hands were scanned independently on the same day by two rheumatologists to assess inter-observer reliability. All subjects were re-examined using the same scanning protocol and the same US setting by one sonographer after a week to assess intra-observer reliability.

Results The inter-observer agreement and intra-observer agreement were moderate to substantial (k = 0.66 and k = 0.73) for the qualitative scoring system and high (ICC = 0.93 and ICC = 0.94) for the quantitative assessment. The SDD of the MH cartilage thickness measurement was 0.09 mm. A significant correlation between the two scoring systems was found (r = –0.35; p < 0.001).

Conclusion The present study describes the main methodological issues of HC assessment. Using a standardized protocol, both the qualitative and the quantitative scoring systems can be reliable.

Zusammenfassung

Ziel i) Qualitative und quantitative Beurteilung der Inter- und Intraobserver-Reliabilität des Ultraschalls bei der Beurteilung des hyalinen Knorpels (HC) der Metakarpalknochenköpfe (MH) bei Patienten mit rheumatoider Arthritis und bei gesunden Probanden. ii) Berechnung der kleinsten nachweisbaren Differenz (SDD) der MH-Knorpeldickenmessung. iii) Korrelation des qualitativen Scoring-Systems und der quantitativen Bewertung.

Material und Methoden Die US-Untersuchung wurde an 280 MHs von 20 Patienten mit rheumatoider Arthritis (RA) und 15 gesunden Probanden (HS) unter Verwendung einer Hochfrequenzsonde (bis zu 22 MHz) durchgeführt. Der HC-Status wurde sowohl qualitativ (mit einem 5-stufigen Scoring-System) als auch quantitativ (mit dem Mittelwert der longitudinalen und transversalen Messungen) bewertet. Die HC der MH II bis V der Metacarpophalangealgelenke beider Hände wurden am selben Tag von 2 Rheumatologen unabhängig voneinander gescannt, um die Interobserver-Reliabilität zu bewerten. Alle Probanden wurden nach einer Woche von einem Sonografen nach dem gleichen Untersuchungsprotokoll und gleichen US-Einstellungen erneut untersucht, um die Intraobserver-Reliabilität zu beurteilen.

Ergebnisse Die Inter- und die Intraobserver-Reliabilität waren für das qualitative Bewertungssystem moderat bis erheblich (k = 0,66 und k = 0,73) und für die quantitative Bewertung hoch (ICC = 0,94 und ICC = 0,93). Der SDD der MH-Knorpeldickenmessung betrug 0,09 mm. Es wurde eine signifikante Korrelation zwischen den beiden Scoring-Systemen gefunden (r = –0,35; p < 0,001).

Schlussfolgerung Die vorliegende Studie beschreibt die wichtigsten methodischen Probleme der HC-Bewertung. Durch Verwendung eines standardisierten Protokolls kann sowohl das qualitative als auch das quantitative Scoring-System zuverlässig sein.

Supporting information



Publikationsverlauf

Eingereicht: 02. Juni 2019

Angenommen: 15. September 2020

Artikel online veröffentlicht:
30. Oktober 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
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