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Aktuelle Rheumatologie 2006; 31(3): 128-133
DOI: 10.1055/s-2006-926802
Originalarbeit

© Georg Thieme Verlag KG Stuttgart · New York

Arthrosonographie ist ein untersucherabhängiges Verfahren. Stimmt diese Aussage heute noch?

Musculoskeletal Ultrasonography is an Examiner-Dependent Technique. Is this Statement still Valid?A. K. Scheel1 , M. Backhaus2
  • 1Abteilung für Nephrologie und Rheumatologie (Direktor: Prof. Dr. med. G.A. Müller), Georg-August-Universität Göttingen
  • 2Medizinische Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie (Direktor: Prof. Dr. med. G.-R. Burmester), Charité Universitätsklinik, Berlin
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Publication History

Publication Date:
16 February 2007 (online)

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Zusammenfassung

Die Arthrosonographie hat sich in der Rheumatologie als bildgebendes Verfahren insbesondere zur Darstellung früh entzündlicher Veränderungen etabliert. Als Nachteil wird hervorgehoben, dass es sich hierbei um ein stark untersucherabhängiges Verfahren handelt, was jedoch bisher nie systematisch untersucht wurde. Auf der anderen Seite gilt die Magnetresonanztomographie als weniger untersucherabhängig. Entgegen bisheriger Meinungen konnte jedoch kürzlich in Studien gezeigt werden, dass moderate bis gute Übereinstimmung zwischen den Untersuchern vorliegen. Die für die Arthrosonographie erhobenen Kappa-Werte als Ausdruck der Untersucherübereinstimmung waren vergleichbar mit den in Magnetresonanztomographiestudien erhobenen Werten. Die Studien zeigen jedoch auch, dass eine dynamische Untersuchung aller Gelenke vermehrt durchgeführt und die palmare und dorsale Seite der Fingergelenke miteinbezogen werden sollte. Zur arthrosonographischen Differenzierung zwischen gesunden und pathologischen Strukturen ist annäherungsweise der Mittelwert der gesunden Strukturen mit einer 2fachen Standardabweichung anzuwenden, genauer ist eine Differenzierung unter Hinzunahmen von pathologischen Strukturen nach Berechnung mit ROC-Kurven möglich.

Abstract

Musculoskeletal ultrasonography has become an established imaging technique in rheumatology, especially in the detection of early inflammation. It has been stated that the main disadvantage is its examiner-dependency. However, an inter-reader reliability between a larger number of ultrasonographers has not yet been systematically evaluated. Contrary to previous opinions, recent studies showed moderate to good inter-observer reliabilities between ultrasonographers. The kappa values were comparable to those achieved by radiologists evaluating magnetic resonance imaging. However, the studies also show that a dynamic examination of all joints and an inclusion of the palmar and dorsal sides of the finger joints are necessary. In musculoskeletal ultrasonography a differentiation between healthy and pathological tissue can roughly be performed by taking the mean with a 2-fold standard deviation of healthy tissue, a more precise cut-off can be calculated by ROC analysis with the necessity of adding data of pathological tissue.

Schlüsselwörter

Arthrosonographie - untersucherabhängiges Verfahren - Übereinstimmung zwischen den Untersuchern - Kappa-Werte - früh entzündliche Veränderungen

Key words

Musculoskeletal ultrasonography - examiner-dependency - inter-observer reliabilities - kappa values - early inflammation

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Priv.-Doz. Dr. med. Alexander K. Scheel

Abteilung für Nephrologie und Rheumatologie, Georg-August-Universität Göttingen

Robert-Koch-Straße 40

37075 Göttingen

Phone: ++49/5 51/39 63 31

Fax: ++49/5 51/39 89 06

Email: ascheel@gwdg.de

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