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Clausen S, Kjær S, Fredberg U, Terslev L, Hartvigsen J, Arnbak B. Ultrasound imaging in patients with hip pain and suspected hip osteoarthritis: an inter-rater and intra-rater reliability study. BMJ Open 2020; 10:e038643. [PMID: 33154052 PMCID: PMC7646344 DOI: 10.1136/bmjopen-2020-038643] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 10/05/2020] [Accepted: 10/17/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The objectives of this study were to asses (1) inter-rater and intrarater reliability of ultrasound imaging in patients with hip osteoarthritis, and (2) agreement between ultrasound and X-ray findings of hip osteoarthritis using validated Outcome Measures in Rheumatology ultrasound definitions for pathology. DESIGN An inter-rater and intrarater reliability study. SETTING A single-centre study conducted at a regional hospital. PARTICIPANTS 50 patients >39 years of age referred for radiography due to hip pain and suspected hip osteoarthritis were included. Exclusion criteria were previous hip surgery in the painful hip, suspected fracture or malignant changes in the hip. INTERVENTION Bilateral ultrasound examinations (n=92) were performed continuously by two experienced operators blinded to clinical information and other imaging findings. After 4-6 weeks, one operator reassessed the images. X-rays were assessed by a third imaging specialist. PRIMARY AND SECONDARY OUTCOME MEASURES Inter-rater and intrarater reliability and agreement between ultrasound imaging and X-ray were assessed using Cohen's ordinal kappa statistics for binary categorical variables and weighted kappa for ordered categorical variables. RESULTS Kappa values (κ) for inter-rater reliability were 0.9 and 0.8 for hip effusion/synovitis and osteoarthritis grading, respectively. For acetabular and femoral osteophytes, femoral cartilage changes and labrum changes κ ranged from 0.4 to 0.7. Intrarater reliability had κ equal or higher compared with inter-rater reliability. Agreement between ultrasound and X-ray findings ranged from κ=0.2 to κ=0.5. CONCLUSION This study demonstrated substantial to almost perfect reliability on the most common ultrasound findings related to hip osteoarthritis and osteoarthritis grading. Agreement on the grade of osteoarthritis between ultrasound and X-ray was moderate. Overall, these results support ultrasound imaging as a reliable tool in the assessment of hip osteoarthritis.
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Affiliation(s)
- Stine Clausen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark Faculty of Health Sciences, Odense, Denmark
- Department of Radiology, Lillebaelt Hospital Vejle, Vejle, Denmark
| | - Søren Kjær
- Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Ulrich Fredberg
- Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg, Denmark
- The Rheumatology Research Unit, Odense University Hospital, Odense, Denmark
| | - Lene Terslev
- Copenhagen Center for Arthritis Research and Center for Rheumatology and Spine Diseases, Rigshospitalet Glostrup, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | - Jan Hartvigsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark Faculty of Health Sciences, Odense, Denmark
- Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark
| | - Bodil Arnbak
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark Faculty of Health Sciences, Odense, Denmark
- Department of Radiology, Lillebaelt Hospital Vejle, Vejle, Denmark
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102
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Felbo SK, Østergaard M, Sørensen IJ, Terslev L. Which ultrasound lesions contribute to dactylitis in psoriatic arthritis and their reliability in a clinical setting. Clin Rheumatol 2020; 40:1061-1067. [PMID: 33155158 DOI: 10.1007/s10067-020-05483-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/22/2020] [Accepted: 10/26/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To explore the frequency of ultrasound elementary lesions in dactylitis in psoriatic arthritis (PsA), and the reliability of scoring these lesions in a clinical setting. METHODS In 31 patients with PsA and clinical dactylitis, ultrasound assessment of the affected finger or toe was performed using greyscale and color Doppler mode. One examiner scanned all patients and a second examiner scanned 10 patients for inter-reader reliability. For each digit, the following lesions were evaluated: subcutaneous edema; soft tissue thickening; synovitis of the digital joints; tenosynovitis of the flexor tendon; enthesitis at the deep flexor tendon and the extensor tendon entheses; and paratenonitis of the extensor tendon. A dactylitis sum-score was calculated. Findings in clinically tender and non-tender digits were compared. RESULTS The most frequent lesions were soft tissue thickening (81%) and subcutaneous edema (74%) followed by synovitis (56-68%) and flexor tenosynovitis (52%). Color Doppler was most frequently found subcutaneously (55%) and around the flexor tendons (45%). All lesions were typically found in combinations, most commonly subcutaneous edema and synovitis (71%), subcutaneous edema and flexor tenosynovitis (52%), and all three in combination (52%). Tender digits had a higher dactylitis sum-score and numerically higher prevalence of most lesions than non-tender digits. Intra- and inter-reader agreements were moderate to excellent, though lower for few components of digital enthesitis, especially hypoechogenicity. CONCLUSION Dactylitis in PsA appears to encompass several lesions, most often subcutaneous changes combined with synovitis and/or flexor tenosynovitis. Reliability of scoring established ultrasound lesions of dactylitis in a clinical setting is moderate-excellent. Key Points • Dactylitis in psoriatic arthritis consists of multiple ultrasound lesions • A dactylitis ultrasound sum-score gives an impression of severity by including all lesions • Reliability of ultrasound scoring of dactylitis components is good.
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Affiliation(s)
- Sara K Felbo
- Copenhagen Center for Arthritis Research and Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark. .,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research and Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Inge J Sørensen
- Copenhagen Center for Arthritis Research and Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark
| | - Lene Terslev
- Copenhagen Center for Arthritis Research and Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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103
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Musculoskeletal Ultrasound in Monitoring Clinical Response to Treatment in Acute Symptomatic Psoriatic Dactylitis: Results from a Multicentre Prospective Observational Study. J Clin Med 2020; 9:jcm9103127. [PMID: 32992634 PMCID: PMC7601129 DOI: 10.3390/jcm9103127] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 09/25/2020] [Indexed: 02/07/2023] Open
Abstract
This observational and prospective study evaluated the clinical correlations of sonographic lesions in consecutive psoriatic arthritis (PsA) dactylitis cases. Eighty-three dactylitic digits were evaluated clinically and sonographically before treatment and at one-month (T1) and three-month (T3) follow-up. Clinical evaluation included the Leeds Dactylitis Index-basic (LDI-b) score and the visual analogue scales for pain (VAS-p) and functional impairment (VAS-FI). High-frequency ultrasound with grey scale (GS) and power Doppler (PD) assessed flexor tenosynovitis (FT), soft tissue oedema (STO), extensor tendon paratenonitis, and joint synovitis. There was a statistically significant correlation between the clinical parameters (VAS-p, VAS-FI, and LDI-b) and FT and STO at T1 and T3. We found statistically significant improvement in FT and STO for the cases with clinically meaningful treatment responses (p < 0.001). After a multiple conditional logistic regression analysis, the only variables that correlated with a T1 clinical response were the resolutions of PD FT (OR 15.66) and PD STO (OR 6.23), while the resolution of PD FT (OR 27.77) and of GS STO (OR 7.29) correlated with a T3 clinical response. The clinical improvements of active dactylitis are linked to the regression of sonographic evidence of extracapsular inflammation (particularly FT and STO).
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104
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Smerilli G, Di Matteo A, Cipolletta E, Carloni S, Incorvaia A, Di Carlo M, Grassi W, Filippucci E. Ultrasound assessment of carpal tunnel in rheumatoid arthritis and idiopathic carpal tunnel syndrome. Clin Rheumatol 2020; 40:1085-1092. [PMID: 32696282 PMCID: PMC7895772 DOI: 10.1007/s10067-020-05293-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/09/2020] [Accepted: 07/13/2020] [Indexed: 11/29/2022]
Abstract
Objectives To comparatively assess the sonographic spectrum of carpal tunnel syndrome (CTS) in patients with rheumatoid arthritis (RA) and in patients with idiopathic CTS. Methods Fifty-seven RA patients and 25 idiopathic CTS patients were consecutively enrolled. The diagnosis of CTS in RA patients was made according to clinical history and examination. The following sonographic findings were assessed at carpal tunnel level: median nerve cross-sectional area (CSA) at the carpal tunnel proximal inlet, finger flexor tendons tenosynovitis, radio-carpal synovitis and intraneural power Doppler (PD) signal. Results CTS was diagnosed in 15/57 RA patients (26.3%). Twenty-three RA wrists with CTS, 84 RA wrists without CTS and 34 idiopathic CTS wrists were evaluated. The average CSA of the median nerve was higher in idiopathic CTS than in RA wrists with CTS (17.7 mm2 vs 10.6 mm2, p < 0.01). A higher rate of inflammation of synovial structures (flexor tendons sheath and/or radio-carpal joint) was found in RA wrists with CTS compared with those without CTS (p = 0.04) and idiopathic CTS (p = 0.02). Intraneural PD signal was more common in CTS (in both RA and idiopathic CTS) wrists compared with wrists without CTS (p < 0.01). Conclusion The sonographic spectrum of CTS in RA patients is characterized by an inflammatory pattern, defined by the presence of finger flexor tendons tenosynovitis and/or radio-carpal joint synovitis. Conversely, a marked median nerve swelling is the dominant feature in idiopathic CTS. Intraneural PD signal is a frequent finding in both conditions.Key Points • Carpal tunnel syndrome (CTS) associated with rheumatoid arthritis (RA) and idiopathic CTS have distinct ultrasound patterns. • The most characteristic sonographic features of CTS in RA patients are those indicative of synovial tissue inflammation at carpal tunnel level. Conversely, marked median nerve swelling is the dominant finding in idiopathic CTS. • Intraneural power Doppler signal is a frequent finding in both conditions. • In patients with CTS, differently from electrophysiology, US can provide clues prompting a rheumatology referral in case of prominent inflammatory findings at carpal tunnel level. |
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Affiliation(s)
- Gianluca Smerilli
- Rheumatology Unit, Department of Clinical and Molecular Sciences, "Carlo Urbani" Hospital, Polytechnic University of Marche, Via Aldo Moro 25, 60035, Jesi, Italy.
| | - Andrea Di Matteo
- Rheumatology Unit, Department of Clinical and Molecular Sciences, "Carlo Urbani" Hospital, Polytechnic University of Marche, Via Aldo Moro 25, 60035, Jesi, Italy.,Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Edoardo Cipolletta
- Rheumatology Unit, Department of Clinical and Molecular Sciences, "Carlo Urbani" Hospital, Polytechnic University of Marche, Via Aldo Moro 25, 60035, Jesi, Italy
| | - Sergio Carloni
- Orthopaedic Unit, "Carlo Urbani" Hospital, Via Aldo Moro 25, Jesi, Italy
| | - Antonella Incorvaia
- Rheumatology Unit, Department of Clinical and Molecular Sciences, "Carlo Urbani" Hospital, Polytechnic University of Marche, Via Aldo Moro 25, 60035, Jesi, Italy
| | - Marco Di Carlo
- Rheumatology Unit, Department of Clinical and Molecular Sciences, "Carlo Urbani" Hospital, Polytechnic University of Marche, Via Aldo Moro 25, 60035, Jesi, Italy
| | - Walter Grassi
- Rheumatology Unit, Department of Clinical and Molecular Sciences, "Carlo Urbani" Hospital, Polytechnic University of Marche, Via Aldo Moro 25, 60035, Jesi, Italy
| | - Emilio Filippucci
- Rheumatology Unit, Department of Clinical and Molecular Sciences, "Carlo Urbani" Hospital, Polytechnic University of Marche, Via Aldo Moro 25, 60035, Jesi, Italy
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105
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Torralba KD, Choi KS, Salto LM, Fairchild R, Cannella AC, Kissin EY, Thiele R, Evangelisto A, Nishio MJ. Musculoskeletal Ultrasound Scanning Protocol Consensus Statements on Scanning Conventions and Documentation in the
US. Arthritis Care Res (Hoboken) 2020; 72:1177-1184. [DOI: 10.1002/acr.24005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 06/11/2019] [Indexed: 02/06/2023]
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106
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Di Matteo A, Mankia K, Azukizawa M, Wakefield RJ. The Role of Musculoskeletal Ultrasound in the Rheumatoid Arthritis Continuum. Curr Rheumatol Rep 2020; 22:41. [PMID: 32562012 PMCID: PMC7305070 DOI: 10.1007/s11926-020-00911-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE OF REVIEW Rheumatoid arthritis (RA) is no longer considered a fixed phenotype but rather a disease continuum. This review outlines the current and potential value of applying ultrasound (US) along this continuum: from the prediction of progression to RA in at-risk individuals, to confirmation of the early diagnosis of RA, as well as the consideration of differential diagnoses, and the use in disease monitoring and defining remission. RECENT FINDINGS In individuals at-risk of RA (i.e., positive autoantibodies with symptoms but without synovitis), US has shown a promising predictive value for the development of clinical arthritis, providing the opportunity to improve risk stratification (and disease prevention) of these individuals. The detection of inflammation on US in patients with early undifferentiated arthritis, in which a definite diagnosis cannot be reached, could predict evolution to persistent arthritis, mostly RA. This, in addition to the US potential ability to identify disease specific patterns for different rheumatic conditions, might facilitate early diagnosis and, therefore, improve the management of patients with RA, or other types of inflammatory arthritides. US has also demonstrated the capability to predict radiographic progression, and relapse risk after treatment discontinuation, in RA patients in remission according to the clinical instruments, raising implications in the management, including therapy discontinuation, of these patients. US has an undeniable value in the management of patients at different stages along the RA continuum. Further research is needed to identify which groups of patients benefit the most from US imaging.
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Affiliation(s)
- Andrea Di Matteo
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- National Institute for Health Research Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Rheumatology Unit, Carlo Urbani Hospital, Jesi, Ancona, Italy
| | - Kulveer Mankia
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- National Institute for Health Research Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Masayuki Azukizawa
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
- Department of Orthopaedic Surgery, Himeji Medical Center, 68 Honmachi, Himeji, Hyogo, 670-8520, Japan
| | - Richard J Wakefield
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.
- National Institute for Health Research Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
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107
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Șerban O, Papp I, Bocșa CD, Micu MC, Bădărînză M, Albu A, Fodor D. Do ankle, hindfoot, and heel ultrasound findings predict the symptomatology and quality of life in rheumatoid arthritis patients? J Ultrason 2020; 20:e70-e82. [PMID: 32609963 PMCID: PMC7409561 DOI: 10.15557/jou.2020.0012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 02/16/2020] [Indexed: 11/22/2022] Open
Abstract
Objectives: To evaluate the ankle, hindfoot, and heel changes (determined by physical examination, ultrasound and baropodometry) in patients with rheumatoid arthritis, to compare the findings with healthy subjects, and to analyze if these findings are associated with ankle pain and could affect the quality of life. Methods: We enrolled 35 rheumatoid arthritis patients and 35 healthy controls, and evaluated their ankles (tibiotalar joints, tendons), hindfeet (talonavicular, subtalar joints) and heels using clinical examination, DAS28-CRP, RAPID3 for the evaluation of functional status, quality of life in rheumatoid arthritis questionnaire, ultrasound, and baropodometry. Results: The ultrasound inter-observer agreement was good for the subtalar joint, and very good for the other structures. Flat foot was identified in 50% of feet in rheumatoid arthritis patients, with 83.8% having concomitant hindfoot valgus and less subtalar joint synovitis visible from the lateral approach (32.4% vs 55.6%, p = 0.041). The body mass index, RAPID3 and subtalar synovitis were independent predictors for the symptomatic ankle (all p <0.05). Midfoot and heel plantar pressures were higher in rheumatoid arthritis patients compared to healthy controls, but when subtalar synovitis was present, the pressures decreased (avoidance of heel support). Poor quality of life in rheumatoid arthritis patients was independently predicted by DAS28-CRP, RAPID3, disease stage, hindfoot valgus, tibiotalar and subtalar synovitis, tendon pathology, Achilles tendon enthesophytes, calcaneal erosions, plantar fasciitis, and perifasciitis (all p <0.05). Conclusion: The quality of life of rheumatoid arthritis patients is significantly affected by ankle and hindfoot pathology (inflammatory modifications, but also degenerative findings and deformities). Ultrasound scanning is an important tool in the evaluation of inflammatory and degenerative lesions in these regions, and their early detection might contribute to a better therapeutic management in these patients. Objectives: To evaluate the ankle, hindfoot, and heel changes (determined by physical examination, ultrasound and baropodometry) in patients with rheumatoid arthritis, to compare the findings with healthy subjects, and to analyze if these findings are associated with ankle pain and could affect the quality of life. Methods: We enrolled 35 rheumatoid arthritis patients and 35 healthy controls, and evaluated their ankles (tibiotalar joints, tendons), hindfeet (talonavicular, subtalar joints) and heels using clinical examination, DAS28-CRP, RAPID3 for the evaluation of functional status, quality of life in rheumatoid arthritis questionnaire, ultrasound, and baropodometry. Results: The ultrasound inter-observer agreement was good for the subtalar joint, and very good for the other structures. Flat foot was identified in 50% of feet in rheumatoid arthritis patients, with 83.8% having concomitant hindfoot valgus and less subtalar joint synovitis visible from the lateral approach (32.4% vs 55.6%, p = 0.041). The body mass index, RAPID3 and subtalar synovitis were independent predictors for the symptomatic ankle (all p <0.05). Midfoot and heel plantar pressures were higher in rheumatoid arthritis patients compared to healthy controls, but when subtalar synovitis was present, the pressures decreased (avoidance of heel support). Poor quality of life in rheumatoid arthritis patients was independently predicted by DAS28-CRP, RAPID3, disease stage, hindfoot valgus, tibiotalar and subtalar synovitis, tendon pathology, Achilles tendon enthesophytes, calcaneal erosions, plantar fasciitis, and perifasciitis (all p <0.05). Conclusion: The quality of life of rheumatoid arthritis patients is significantly affected by ankle and hindfoot pathology (inflammatory modifications, but also degenerative findings and deformities). Ultrasound scanning is an important tool in the evaluation of inflammatory and degenerative lesions in these regions, and their early detection might contribute to a better therapeutic management in these patients.
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Affiliation(s)
- Oana Șerban
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy , Cluj-Napoca , Romania
| | - Iulia Papp
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy , Cluj-Napoca , Romania
| | - Corina Delia Bocșa
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy , Cluj-Napoca , Romania
| | | | - Maria Bădărînză
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy , Cluj-Napoca , Romania
| | - Adriana Albu
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy , Cluj-Napoca , Romania
| | - Daniela Fodor
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy , Cluj-Napoca , Romania
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108
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Jiménez Díaz F, Gitto S, Sconfienza LM, Draghi F. Ultrasound of iliotibial band syndrome. J Ultrasound 2020; 23:379-385. [PMID: 32514741 DOI: 10.1007/s40477-020-00478-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 05/09/2020] [Indexed: 12/29/2022] Open
Abstract
Iliotibial band syndrome or friction syndrome is an overuse disorder of the lateral knee. It is commonly reported in athletes, such as runners and cyclists, and refers to pain related to physical activity. The diagnosis is based on clinical history and physical assessment. Imaging, including ultrasound, is mainly performed in recurrent or refractory cases. The purpose of this paper is to review the etiology, diagnosis, and therapy of iliotibial band syndrome with a focus on ultrasound imaging and ultrasound-guided treatment. Ultrasound findings include soft-tissue edematous swelling or discrete fluid collection, suggestive of bursitis, between the iliotibial band and the lateral femoral epicondyle. The thickening of the iliotibial band has been inconsistently reported. Treatment varies according to the disease phase and, in the acute phase, consists of rest, physical therapy, and anti-inflammatory medications. Ultrasound-guided local steroid injections are effective in relieving symptoms.
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Affiliation(s)
- Fernando Jiménez Díaz
- Sport Sciences Faculty, Castilla La Mancha University, Toledo, Spain
- San Antonio Catholic University (UCAM), Murcia, Spain
| | - Salvatore Gitto
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Luigi Mangiagalli 31, 20133, Milan, Italy.
| | - Luca Maria Sconfienza
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Luigi Mangiagalli 31, 20133, Milan, Italy
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Ferdinando Draghi
- Istituto di Radiologia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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109
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Becciolini A, Ariani A, Becciolini M. Pisotriquetral arthritis: 'forgotten' joint in ultrasound imaging of the wrist. Ann Rheum Dis 2020; 81:e97. [PMID: 32513648 DOI: 10.1136/annrheumdis-2020-217980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 05/15/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Andrea Becciolini
- Department of Medicine, Internal Medicine and Rheumatology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Alarico Ariani
- Department of Medicine, Internal Medicine and Rheumatology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Marco Becciolini
- Misericordia di Pistoia, Pistoia, Italy.,Scuola SIUMB di Ecografia Muscolo-Scheletrica, Pisa, Italy
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110
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Smerilli G, Cipolletta E, Di Carlo M, Di Matteo A, Grassi W, Filippucci E. Power Doppler Ultrasound Assessment of A1 Pulley. A New Target of Inflammation in Psoriatic Arthritis? Front Med (Lausanne) 2020; 7:204. [PMID: 32582725 PMCID: PMC7290420 DOI: 10.3389/fmed.2020.00204] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 04/27/2020] [Indexed: 11/28/2022] Open
Abstract
Objective: To determine the prevalence of grey scale and power Doppler (PD) ultrasound (US) features of A1 pulley inflammation in a cohort of psoriatic arthritis (PsA) patients compared with rheumatoid arthritis (RA) patients. Methods: Sixty patients (30 with PsA and 30 with RA) were consecutively enrolled. The main clinimetric indexes were recorded, and US assessment of A1 pulleys from second to fifth fingers bilaterally was carried out. The presence of A1 pulley inflammation, defined as PD signal within a thickened pulley, was registered. Results: A1 pulley inflammation was found in 15 of 240 fingers (6.3%) of eight PsA patients (26.7%) and in one of 240 fingers (0.4%) of one RA patient (3.3%) (p < 0.01 and p = 0.03, respectively). Seven of eight PsA patients (88%) with at least one inflamed A1 pulley had a moderate/high disease activity score. The regression linear analysis (R2 = 0.36, adjusted R2 = 0.31) showed that A1 pulley inflammation was correlated with Disease Activity Index for Psoriatic Arthritis (DAPSA) (β = 0.43, p = 0.03). Conclusion: US A1 pulley inflammation appears to be relatively common at patient level in PsA, seems to be a characteristic feature of PsA compared to RA, and correlates with DAPSA.
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Affiliation(s)
- Gianluca Smerilli
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, "Carlo Urbani" Hospital, Jesi, Ancona, Italy
| | - Edoardo Cipolletta
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, "Carlo Urbani" Hospital, Jesi, Ancona, Italy
| | - Marco Di Carlo
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, "Carlo Urbani" Hospital, Jesi, Ancona, Italy
| | - Andrea Di Matteo
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, "Carlo Urbani" Hospital, Jesi, Ancona, Italy.,Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom
| | - Walter Grassi
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, "Carlo Urbani" Hospital, Jesi, Ancona, Italy
| | - Emilio Filippucci
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, "Carlo Urbani" Hospital, Jesi, Ancona, Italy
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111
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Serralta San Martín G, Canora Lebrato J. Clinical ultrasonography in systemic autoimmune diseases. Rev Clin Esp 2020. [DOI: 10.1016/j.rceng.2019.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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112
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Cipolletta E, Smerilli G, Mashadi Mirza R, Di Matteo A, Carotti M, Salaffi F, Grassi W, Filippucci E. Sonographic assessment of calcium pyrophosphate deposition disease at wrist. A focus on the dorsal scapho-lunate ligament. Joint Bone Spine 2020; 87:611-617. [PMID: 32438060 DOI: 10.1016/j.jbspin.2020.04.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 04/24/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVES To investigate the diagnostic accuracy of ultrasound and conventional radiography in the evaluation of calcium pyrophosphate crystal deposits at wrist level. METHODS Consecutive patients with a "definite" diagnosis of calcium pyrophosphate deposition disease and disease-controls were prospectively included in this cross-sectional single-centre study. Scapho-lunate ligament, triangular fibrocartilage complex, and volar recess of the radio-lunate joint were explored using ultrasound, conventional radiography and computed tomography. RESULTS Sixty one patients and 39 disease controls were enrolled. Two-hundred wrists were evaluated using both conventional radiography and ultrasound and 26 using computed tomography. Ultrasound findings indicative of crystal deposits were found in at least one wrist in 95.1% of patients and in 15.4% of controls (P<0.001). Scapho-lunate ligament calcifications were reported in 83.6% of patients and in 5.1% of controls (P<0.001). On conventional radiography, calcifications were found in at least one wrist in 72.1% of patients and in 0% of controls (P<0.001). Using the Ryan-McCarty criteria as a gold standard, sensitivity, specificity and diagnostic accuracy were 0.72 (0.59-0.83), 1.0 (0.91-1.0) and 0.83 (0.74-0.90) for conventional radiography and 0.95 (0.86-0.99), 0.85 (0.69-0.94) and 0.91 (0.84-0.96) for ultrasound. The agreement between ultrasound and computed tomography was substantial when assessing triangular fibrocartilage complex (kappa=0.70; 0.43-0.97) and scapho-lunate ligament (kappa=0.69; 0.41-0.97), and moderate for radio-lunate joint (kappa=0.46; 0.12-0.80). CONCLUSIONS This study supports the diagnostic accuracy of ultrasound in evaluating wrist involvement in calcium pyrophosphate deposition disease. The inclusion of the scapho-lunate ligament in a disease-oriented scanning protocol could improve the diagnostic performance of ultrasound.
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Affiliation(s)
- Edoardo Cipolletta
- Polytechnic University of Marche, Department of Clinical and Molecular Sciences, Rheumatology Unit, "Carlo Urbani" Hospital, Via Aldo Moro 25, Jesi 60035, Italy.
| | - Gianluca Smerilli
- Polytechnic University of Marche, Department of Clinical and Molecular Sciences, Rheumatology Unit, "Carlo Urbani" Hospital, Via Aldo Moro 25, Jesi 60035, Italy
| | - Riccardo Mashadi Mirza
- Azienda Ospedali Riuniti Marche Nord, Radiology Department, Piazzale Carlo Cinelli, 1, Pesaro 61121, Italy
| | - Andrea Di Matteo
- Polytechnic University of Marche, Department of Clinical and Molecular Sciences, Rheumatology Unit, "Carlo Urbani" Hospital, Via Aldo Moro 25, Jesi 60035, Italy; University of Leeds, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Woodhouse Lane, Leeds LS2 9JT, United Kingdom
| | - Marina Carotti
- Polytechnic University of Marche, Radiology Department, Via Conca 71, Ancona 60126, Italy
| | - Fausto Salaffi
- Polytechnic University of Marche, Department of Clinical and Molecular Sciences, Rheumatology Unit, "Carlo Urbani" Hospital, Via Aldo Moro 25, Jesi 60035, Italy
| | - Walter Grassi
- Polytechnic University of Marche, Department of Clinical and Molecular Sciences, Rheumatology Unit, "Carlo Urbani" Hospital, Via Aldo Moro 25, Jesi 60035, Italy
| | - Emilio Filippucci
- Polytechnic University of Marche, Department of Clinical and Molecular Sciences, Rheumatology Unit, "Carlo Urbani" Hospital, Via Aldo Moro 25, Jesi 60035, Italy
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Terslev L, Hammer HB. Ultrasound may improve patient care. Clin Rheumatol 2020; 39:1715-1717. [PMID: 32358662 DOI: 10.1007/s10067-020-05071-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 03/19/2020] [Accepted: 03/23/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Lene Terslev
- Copenhagen Center for Arthritis Research and Center for Rheumatology, Spine Diseases, Rigshospitalet-Glostrup, Copenhagen, Denmark. .,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark. .,Center for Rheumatology and Spinal Diseases, Copenhagen University Hospital, Rigshsopitalet, Nordre Ringvej 57, 2600, Glostrup, Copenhagen, Denmark.
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Karapantzou C, Jakob M, Canis M. Neurotoxin injection in benign submandibular gland hypertrophy: A first choice treatment. Laryngoscope Investig Otolaryngol 2020; 5:217-220. [PMID: 32337352 PMCID: PMC7178459 DOI: 10.1002/lio2.363] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 01/12/2020] [Accepted: 02/08/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Various benign clinical entities with a symptomatology of hypertrophic submandibular glands like sialadenitis, sialadenosis, sialolithiasis, or an ageing neck have been described. Botulinum toxin type A is an elegant tool in the management of these conditions. METHODS This article is an original article, describing the Munich Concept of treating persistent submandibular swelling with Botulinum Toxin Type A from aesthetic and functional aspect. To shrink the affected tissue, 15 Units of Botox or Xeomin are applied in a single injection technique and under ultrasound guidance into the glands. Therefore, the 100 Units vial is being diluted with 3.5 of NaCl. RESULTS Intraglandular injections, using a specific dilution and dosage of the neurotoxin preparations, are very effective in the management of these swellings, offering safe and long-lasting results, with a high satisfaction rate. Our working group treated in the last 18 months 23 patients with benign, bilateral submandibular gland hypertrophies, which did not have any major complications. CONCLUSION As there is not yet described an ideal therapeutic strategy for the management of this symptomatology, we suggest, based on our experience, a concept with very promising results from functional and cosmetic aspect.
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Affiliation(s)
- Chrisanthi Karapantzou
- Facial Rejuvenation OfficeORL Clinic, Ludwigs‐Maximillians‐University MunichMunichGermany
| | - Mark Jakob
- ORL University DepartmentLudwig‐Maximillians University MunichMunichGermany
| | - Martin Canis
- ORL University DepartmentLudwig‐Maximillians University MunichMunichGermany
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115
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Future use of musculoskeletal ultrasonography and magnetic resonance imaging in rheumatoid arthritis. Curr Opin Rheumatol 2020; 32:264-272. [PMID: 32205568 DOI: 10.1097/bor.0000000000000709] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW Musculoskeletal ultrasonography (MSUS) and magnetic resonance imaging (MRI) play important roles in diagnosis, monitoring, and prognostication of rheumatoid arthritis. This review highlights recent literature in this field and aims to provide insight into the future use in clinical practice. RECENT FINDINGS Recent studies concerning the use of MSUS and MRI in clinical practice show how MSUS and MRI can improve diagnosis and monitoring of rheumatoid arthritis and how they can predict both radiographic progression and clinical outcome (e.g., successful tapering of medical treatment). Moreover, novel technical developments of the two imaging modalities, such as 3D ultrasonography, ultrasound image reading with convolutional neural network, image fusion (MSUS and MRI) and whole-body MRI show promising results. Further validation of these novel techniques is required prior to implementation. SUMMARY MSUS and MRI will be important parts of the future management of rheumatoid arthritis patients, mostly because of their ability to detect rheumatoid arthritis changes at a very early stage and to predict the course of disease. However, the exact role in routine clinical practice is still to be defined.
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The occurrence of sacroiliitis in HLA-B*35-positive patients with undifferentiated spondyloarthritis. A cross sectional MRI study. Clin Rheumatol 2020; 39:2299-2306. [PMID: 32107663 DOI: 10.1007/s10067-020-04999-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 02/07/2020] [Accepted: 02/14/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To investigate possible association between sacroiliitis and HLA-B*35 positivity. METHOD After excluding patients with axial spondyloarthritis and HLA-B*27 positivity, psoriasis inflammatory bowel disease, preceding infections, or juvenile type of spondyloarthritis, 110 patients were recruited with a diagnosis of undifferentiated axial spondyloarthritis. All of them had inflammatory back pain of short duration (3 months to 2 years) and 72 were HLA-B*35 positive. In order to determine if there is a possible association of sacroiliitis and HLA-B*35 positivity, all patients underwent MRI of sacroiliac joints. RESULTS A statistically significant association between the detection of bone marrow edema at sacroiliac joints on MRI and HLA-B*35 positivity (χ2 = 6.25; p = 0.022) was found. A logistic regression analysis revealed that the presence of HLA-B*35 allele was associated with a 6 times greater chance of identifying bone marrow edema at sacroiliac joints on MRI (OR 6, 95% CI 1.3-27, p = 0.021). HLA-B*35 positivity was also associated with a 4.7 times greater chance of finding elevated CRP (OR 4.7, 95% CI 1-11.9, p = 0.047) and a 5 times greater chance of finding peripheral joint synovitis (OR 5, 95% CI 1.75-14.3, p = 0.003). HLA-B*35-positive patients had high disease activity (mean ± SD of Bath Ankylosing Spondylitis Disease Activity Index 6.1 ± 1.72 and Ankylosing Spondylitis Disease Activity Score C-reactive protein Index 3 ± 0.64) with a high degree of functional limitations (mean ± SD of Bath Ankylosing Spondylitis Functional Index 5.3 ± 2.16). CONCLUSION The data clearly show the association between bone marrow edema on MRI at sacroiliac joints and HLA-B*35 allele in patients with undifferentiated spondyloarthritis. Further work is needed to understand how much this result may influence follow-up of these patients. Key Points • HLA-B*35 allele was associated with a 6 times greater chance of identifying bone marrow edema at sacroiliac joints on MRI in un-axSpa patients. • HLA-B*35 allele was also associated with a 4.7 times greater chance of finding elevated CRP and a 5 times greater chance of finding peripheral joint synovitis in un-axSpa patients. • HLA-B*35 allele could be a potential risk factor for developing sacroiliitis and axSpA.
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Gitto S, Messina C, Chianca V, Tuscano B, Lazzara A, Corazza A, Pedone L, Albano D, Sconfienza LM. Superb microvascular imaging (SMI) in the evaluation of musculoskeletal disorders: a systematic review. Radiol Med 2020; 125:481-490. [DOI: 10.1007/s11547-020-01141-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 01/16/2020] [Indexed: 12/12/2022]
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Current status and recent advances on the use of ultrasonography in pediatric rheumatic diseases. World J Pediatr 2020; 16:52-59. [PMID: 31515696 DOI: 10.1007/s12519-019-00312-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 08/26/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Ultrasonography has become a useful tool in the clinical rheumatology settings in the last two decades, but its use has only recently been explored by pediatric rheumatologists. The aim of this article is to review the literature on the current status and recent advances on the use of ultrasound in pediatric rheumatic diseases. DATA SOURCES We have retrieved and reviewed the relevant articles from MEDLINE/PubMed databases published so far, on the applications of ultrasound in juvenile idiopathic arthritis (JIA), systemic lupus erythematosus, dermatomyositis, enthesitis, Sjogren's syndrome, and other rheumatic diseases. In addition, articles on novel ultrasound imaging technology of potential use in pediatric rheumatology are also reviewed. RESULTS In JIA, ultrasound can be used to detect subclinical synovitis, to improve the classification of patients in JIA subtypes, to capture early articular damage, to monitor treatment response, and to guide intraarticular injections. Ultrasound is also considered useful in other rheumatic disorders for the evaluation of musculoskeletal symptoms, assessment of parotid gland pathology, and measurement of skin thickness and pathology. Novel ultrasound techniques developed to augment the functionality of ultrasonography may also be applicable in pediatric rheumatic disorders. CONCLUSIONS Ultrasound shows great promise in the assessment and management of children with rheumatologic disorders. However, standardization and validation of ultrasound in healthy children and in patients with rheumatic diseases are still needed.
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Kunz P, Kiesl S, Groß S, Kauczor HU, Schmidmaier G, Fischer C. Intra-observer and Device-Dependent Inter-observer Reliability of Contrast-Enhanced Ultrasound for Muscle Perfusion Quantification. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:275-285. [PMID: 31733932 DOI: 10.1016/j.ultrasmedbio.2019.10.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 10/06/2019] [Accepted: 10/11/2019] [Indexed: 06/10/2023]
Abstract
Muscle perfusion quantification by contrast-enhanced ultrasound (CEUS) may facilitate treatment decisions in musculoskeletal disorders. Translation into clinical routine relies on high intra-observer and inter-observer reliability and transferability between ultrasound devices to enable validation and multicenter studies. This study evaluates these aspects for deltoid muscle perfusion quantification, including possible multicenter study setups. One hundred sixty-six CEUS quantifications were conducted on 42 shoulders. Intra-observer reliability revealed a high intra-class correlation coefficient (ICC, r = 0.91) and low coefficient of variation (CV, 10.28%). Inter-observer reliability revealed an ICC of .84 and a CV of 17.1%, but these values decreased when different ultrasound devices were used (ICC = .60, CV = 18.6%). Re-evaluating subgroups with high sectional plane concordance significantly increased reliability (intra-observer: ICC = .97, CV = 5.49%, inter-observer/same device: ICC = .98, CV = 5.83%, varying devices: ICC = .78, CV = 9.8%). CEUS perfusion quantification of the deltoid seems applicable for multicenter studies, yet pooling different ultrasound devices remains critical. Sectional plane concordance appears to be crucial for reliability and transferability of CEUS muscle perfusion quantifications.
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Affiliation(s)
- Pierre Kunz
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Ultrasound Centre, HTRG, Heidelberg University Hospital, Heidelberg, Germany; Clinic for Shoulder and Elbow Surgery, Catholic Hospital Mainz, Mainz, Germany.
| | - Sophia Kiesl
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Ultrasound Centre, HTRG, Heidelberg University Hospital, Heidelberg, Germany
| | - Sascha Groß
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Ultrasound Centre, HTRG, Heidelberg University Hospital, Heidelberg, Germany
| | - Hans-Ulrich Kauczor
- Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Gerhard Schmidmaier
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Ultrasound Centre, HTRG, Heidelberg University Hospital, Heidelberg, Germany
| | - Christian Fischer
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Ultrasound Centre, HTRG, Heidelberg University Hospital, Heidelberg, Germany
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Manghani M, Cheung PP, Mogali SR, Prakash A, Chew LC. An evaluation of the effectiveness of teaching anatomy to rheumatologists through combined musculoskeletal sonoanatomy and human cadaveric dissection. Rheumatol Adv Pract 2020; 4:rkaa010. [PMID: 32582878 PMCID: PMC7302048 DOI: 10.1093/rap/rkaa010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 04/02/2020] [Indexed: 12/03/2022] Open
Abstract
Objective Our aim was to evaluate the effectiveness of teaching anatomy through combined musculoskeletal sonoanatomy and human cadaveric dissection for rheumatologists practising musculoskeletal US. Methods The principal focus was on scanning and then dissecting relevant musculoskeletal structures. Outcomes measured included confidence levels and objective knowledge. A mixed-methods approach of evaluation and descriptive statistical data analysis was performed. Results The change in confidence ratings by delegates after the teaching event as represented by the mean difference (s.d.) (s.e.m.) for identification of surface anatomy was 1.846 (1.281) (0.355), with Student’s paired t = 5.196 and P=0.000223. The mean difference (s.d.) (s.e.m) for performing IA injections was 1.538 (1.266) (0.351), with Student’s paired t = 4.382, P=0.001, and for recognizing sonoanatomical structures it was 1.769 (1.235) (0.343), with Student’s paired t = 5.165 and P= 0.000235. There was a significant increase in correct identification of anatomical and sonoanatomical knowledge in the pre- and post-course assessments. Rotator cuff interval region improved from 13 to 73%, P = 0.004; knee tendons insertion sites from 47 to 93%, P = 0.016; and muscles not adjacent to joints from 27 to 93%, P = 0.002. Conclusion Dissection of joints enabled a three-dimensional relational mind map of the relevant regions of the human body, producing clarity in understanding regional relational topographic anatomy and sonoanatomy. The combination of US and cadaveric dissection improved learners’ satisfaction, confidence and knowledge in areas where soft tissue complaints are common, which is likely to lead to accurate early diagnosis and cost-conscious, better overall care.
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Affiliation(s)
- Mona Manghani
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital
- Lee Kong Chian School of Medicine, Nanyang Technological University
- Department of Medicine, Yong Loo Lin School of Medicine
| | - Peter P Cheung
- Department of Medicine, Yong Loo Lin School of Medicine
- Division of Rheumatology, University Medicine Cluster, National University Health System
| | | | - Ashutosh Prakash
- Lee Kong Chian School of Medicine, Nanyang Technological University
- Department of Diagnostic Radiology, Tan Tock Seng Hospital
| | - Li-Ching Chew
- Department of Medicine, Yong Loo Lin School of Medicine
- Department of Rheumatology and Immunology, Singapore General Hospital
- Department of Medicine, DukeNUS Medical School, Singapore, Singapore
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La Paglia GMC, Sanchez-Pernaute O, Alunno A, Martínez-Becerra MJ, Romero-Bueno F, Recuero S, Borges PE, Mahillo-Fernández I, Garrido J, Gerli R, Herrero-Beaumont G, Naredo E. Ultrasound salivary gland involvement in Sjogren's syndrome vs. other connective tissue diseases: is it autoantibody and gland dependent? Clin Rheumatol 2019; 39:1207-1215. [PMID: 31676972 DOI: 10.1007/s10067-019-04780-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 08/30/2019] [Accepted: 09/11/2019] [Indexed: 01/11/2023]
Abstract
This study aims to investigate ultrasound (US) findings on salivary glands (SG) in patients with Sjögren syndrome (SS) vs. other connective tissue diseases (CTDs) and to assess the relationship of SGUS abnormalities with autoantibody profile in both groups. We enrolled 81 patients, 45 diagnosed with SS (39 with primary SS, 6 with secondary SS) and 36 diagnosed with other CTDs. All patients underwent a prospective evaluation of sicca symptoms, a Schirmer's test, and a B-mode US assessment of the parotid and submandibular glands, all blinded to the diagnosis. Each SG was semi-quantitatively scored 0-3; a grade ≥ 2 was considered pathological. SGUS involvement was classified as normal or pathological at the patient level and for each pair at the gland level. In addition, a total SGUS score of 0-12 and a parotid/submandibular score of 0-6 were calculated for each patient. Autoimmunity laboratory data were also obtained. All SGUS scores were higher in SS patients than in those with CTD (p < 0.001) and significantly more SS patients showed a pathological global (p < 0.001), parotid (p < 0.001), or submandibular (p = 0.001) US score compared with CTD patients. In SS patients, the presence of autoantibodies was significantly associated with pathological SGUS and higher scores, particularly at the parotid level, while in CTD patients, xerostomia and a pathological Schirmer's test were associated with pathological US and higher scores at the submandibular level (p < 0.05). SGUS showed a different grade of abnormality, site involvement, and associated autoantibody profile in SS patients as compared with other CTD. KEY POINTS: • Patients with SS and other CTDs showed different grades of SGUS abnormality. • Patients with SS and other CTDs showed different gland involvement and associated autoantibody profiles. • Anti-Ro60 and anti-Ro52 Ro60 positivity were associated with the severity of parotid involvement in SS patients.
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Affiliation(s)
- Giuliana Maria Concetta La Paglia
- Department of Rheumatology, Bone and Joint Research Unit, Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Av. Reyes Católicos, 2, 28040, Madrid, Spain.,Division of Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Olga Sanchez-Pernaute
- Department of Rheumatology, Bone and Joint Research Unit, Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Av. Reyes Católicos, 2, 28040, Madrid, Spain
| | - Alessia Alunno
- Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, Italy
| | | | - Fredeswinda Romero-Bueno
- Department of Rheumatology, Bone and Joint Research Unit, Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Av. Reyes Católicos, 2, 28040, Madrid, Spain
| | - Sheila Recuero
- Department of Rheumatology, Bone and Joint Research Unit, Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Av. Reyes Católicos, 2, 28040, Madrid, Spain
| | - Pablo Eder Borges
- Department of Rheumatology, Bone and Joint Research Unit, Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Av. Reyes Católicos, 2, 28040, Madrid, Spain
| | | | - Jesús Garrido
- Department of Social Psychology and Methodology, Facultad de Psicología, Universidad Autónoma de Madrid, Madrid, Spain
| | - Roberto Gerli
- Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, Italy
| | - Gabriel Herrero-Beaumont
- Department of Rheumatology, Bone and Joint Research Unit, Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Av. Reyes Católicos, 2, 28040, Madrid, Spain
| | - Esperanza Naredo
- Department of Rheumatology, Bone and Joint Research Unit, Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Av. Reyes Católicos, 2, 28040, Madrid, Spain.
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Di Matteo A, Filippucci E, Cipolletta E, Musca A, Carotti M, Mashadi Mirza R, Jesus D, Martire V, Pierucci D, Di Carlo M, Salaffi F, Grassi W. Hip Involvement in Patients With Calcium Pyrophosphate Deposition Disease: Potential and Limits of Musculoskeletal Ultrasound. Arthritis Care Res (Hoboken) 2019; 71:1671-1677. [DOI: 10.1002/acr.23814] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 11/16/2018] [Indexed: 12/12/2022]
Affiliation(s)
| | | | | | - Alice Musca
- Dr. I. Cantacuzino Clinical Hospital Bucharest Romania
| | | | | | - Diogo Jesus
- Centro Hospitalar e Universitario de Coimbra Coimbra Portugal
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Ogura T, Hirata A, Hayashi N, Imaizumi C, Ito H, Takenaka S, Inoue Y, Takakura Y, Mizushina K, Katagiri T, Kameda H. Finger Joint Cartilage Evaluated by Semiquantitative Ultrasound Score in Patients With Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2019; 73:173-179. [PMID: 31651103 PMCID: PMC7898608 DOI: 10.1002/acr.24101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 10/22/2019] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Joint destruction in rheumatoid arthritis (RA) includes both bone and cartilage lesions. Since joint space narrowing (JSN) is not a direct evaluation of cartilage using radiography, we aimed to examine the validity of ultrasound (US) cartilage evaluation using a semiquantitative method in patients with RA. METHODS We enrolled 103 patients with RA who were in remission or showing low disease activity and 42 healthy subjects. The cartilage thickness of the bilateral metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints of the second to fifth fingers was measured by US, and the recorded images were scored semiquantitatively using a scale of 0-2. In addition, the JSN of the corresponding joints was scored using a hand radiograph. The relationships between total cartilage thickness, its semiquantitative score, and JSN score were assessed using Spearman's rank correlation coefficients. RESULTS Total cartilage thickness was significantly thinner in patients with RA compared to healthy subjects for both the MCP and PIP joints (both P < 0.001). The semiquantitative sum of 16 joints ranged from 2 to 26 (median 8) in patients with RA, which was significantly greater than the 0-11 (median 4) in healthy subjects (P < 0.001). In patients with RA, the semiquantitative score showed a significant negative correlation with cartilage thickness (ρ = -0.64, P < 0.001) and a significant positive correlation with JSN score (ρ = 0.66, P < 0.001). Furthermore, these scores showed a significant correlation with RA disease duration. CONCLUSION A simplified and direct evaluation of finger joint cartilage damage by semiquantitative US score is valid and useful for patients with RA.
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Serralta San Martín G, Canora Lebrato J. Clinical ultrasonography in systemic autoimmune diseases. Rev Clin Esp 2019; 220:297-304. [PMID: 31635810 DOI: 10.1016/j.rce.2019.07.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 07/25/2019] [Indexed: 11/17/2022]
Abstract
Clinical ultrasonography should be considered a complementary examination that can change clinical practice, as well as a tool to add to the medical history. Systemic autoimmune diseases (SAD) can involve numerous structures and organs. Ultrasonography has broad applied utility in detecting complications such as the presence of free intraabdominal, pleural and pericardial fluid in polyserositis, left ventricular systolic dysfunction in myocarditis and deep vein thrombosis in antiphospholipid syndrome. Specifically for SAD, ultrasonography helps examine the salivary glands in Sjögren's syndrome, determines the presence of the halo sign in giant cell arteritis and the presence of tendon or joint inflammation, quantifies pulmonary hypertension in scleroderma and assesses the presence of interstitial pulmonary disease in dermatomyositis. Clinical ultrasonography performed by internists is therefore an extremely useful technique in the diagnosis and follow-up of patients with SAD.
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Affiliation(s)
- G Serralta San Martín
- Servicio de Medicina Interna, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes (Madrid), España.
| | - J Canora Lebrato
- Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, Fuenlabrada (Madrid), España
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Zardi EM, Franceschetti E, Giorgi C, Palumbo A, Franceschi F. Accuracy and performance of a new handheld ultrasound machine with wireless system. Sci Rep 2019; 9:14599. [PMID: 31601957 PMCID: PMC6787338 DOI: 10.1038/s41598-019-51160-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 09/11/2019] [Indexed: 12/11/2022] Open
Abstract
We verified the accuracy and performance of a new handheld ultrasound machine, in comparison to a high-end sonographic machine. We performed bilateral measurements of the following tendon districts (supraspinatus, flexor of the middle finger, patellar and Achilles) and of the cross sectional area of the median nerve in 21 patients using a musculoskeletal ultrasound linear scanner of a handheld sonographic machine and a high-end sonographic machine. Two tail T test was used to evaluate whether there were differences in the measurements between the two sonographic machines. Agreement was evaluated by Pearson's correlation. The mean time requested for the examinations was 18 and 9 minutes for the handheld and high-end sonographic machines, respectively. No significant differences were found between the measurements obtained with the handheld ultrasound machine and those with the high-end sonographic machine (p value ranging between 0.31 and 0.97, according to the examined district), whereas, a moderate correlation was found (r coefficient ranging between 0.43 and 0.77, according to the examined district). Although the examination with the handheld ultrasound machine took more time, it showed adequate accuracy and performance; this palmar tool might be also useful in operating rooms.
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Affiliation(s)
- Enrico Maria Zardi
- Internistic Ultrasound Service, "Campus Bio-Medico" University, Rome, Italy.
| | - Edoardo Franceschetti
- Department Upper and Lower Limb Surgery Unit, University Campus Bio-Medico, Rome, Italy
| | - Chiara Giorgi
- Radiology Department, S. Maria della Misericordia Hospital, Urbino, Italy
| | - Alessio Palumbo
- Department Upper and Lower Limb Surgery Unit, University Campus Bio-Medico, Rome, Italy
| | - Francesco Franceschi
- Department Upper and Lower Limb Surgery Unit, University Campus Bio-Medico, Rome, Italy
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126
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Zufferey P, Courvoisier DS, Nissen MJ, Möller B, Brulhart L, Ziswiler HR, Tamborrini G, Ciurea A, D'Agostino MA, Finckh A. Discordances between clinical and ultrasound measurements of disease activity among RA patients followed in real life. Joint Bone Spine 2019; 87:57-62. [PMID: 31557525 DOI: 10.1016/j.jbspin.2019.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 09/11/2019] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Measurements of disease activity, such as the clinical disease activity score (DAS28) or ultrasound (US) scores, often yield discordant results. This study's objectives were to determine the proportion of disagreements between the two assessment methods in patients with rheumatoid arthritis (RA) and to describe factors associated with discrepancy in assessment. METHODS All RA patients in the Swiss registry for inflammatory arthritides (SCQM) with at least one concomitant DAS28 and US score, were included. Disease activity was categorized as remission, low-to-moderate, and high, based on previously established cut-offs, for both the DAS28 and the US score. A longitudinal analysis was performed among patients who underwent at least two assessments. RESULTS Of 2369 assessments included (1091 patients), 1196 (50.4%) were discordant. The US score both over- and under-estimated disease activity compared to the DAS28 score (23.5% and 26.8% respectively). Clinical and demographic factors significantly associated with discordant results were the individual components of the DAS28 score when US was used as the reference and age, disease duration, and the swollen joint count when the DAS28 was used as the reference. The main US-related factor associated with discordance was the presence of US tenosynovitis. In the longitudinal analysis of 1081 patients, the proportion of disagreements remained essentially unchanged. CONCLUSION Rates of disagreement between clinical and US assessments of disease activity among RA patients are high and remain high during follow-up, even when the US assessors were aware of the clinical examination findings. Both clinical- and ultrasound- related factors were associated with discordances.
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Affiliation(s)
| | | | | | | | - Laure Brulhart
- Hôpital neuchatelois, La chaud de fonds 2300, Switzerland
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Murayama M, Nishida M, Kudo Y, Deguchi T, Marukawa K, Fujieda Y, Abe N, Kato M, Shibuya H, Matsuno Y, Atsumi T. Case with long-standing gout showing various ultrasonographic features caused by monosodium urate monohydrate crystal deposition. Mod Rheumatol Case Rep 2019; 4:110-115. [PMID: 33086974 DOI: 10.1080/24725625.2019.1662987] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Gout, which is characterized by the deposition of monosodium urate monohydrate (MSU) in the synovial fluid and other tissues, is the most common form of inflammatory arthritis. Unlike the easily recognized acute and monoarticular gouty arthritis, advanced gout induces multiple finger joint disorders and may sometimes mimic rheumatoid arthritis (RA) or vice versa. The gold standard for gout diagnosis is the identification of MSU crystals via aspiration in the symptomatic joints or nodules; however, its feasibility and specificity may be inadequate. Recently, there have been important advances in imaging techniques, assisting in the non-invasive diagnosis of gout. Ultrasonography (US) has been known to have the ability to detect deposition of MSU crystals in patients with gout. Herein, we report an evocative case of long-standing gout with precisely detected specific US features indicating MSU crystal deposition and inflammation in multiple joints. Comprehensive US assessment included the bone, hyaline cartilage, soft tissue, subcutaneous nodules and tendon; we also discriminated gouty arthritis from RA.
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Affiliation(s)
- Michito Murayama
- Diagnostic Center for Sonography, Hokkaido University Hospital, Sapporo, Japan
| | - Mutsumi Nishida
- Diagnostic Center for Sonography, Hokkaido University Hospital, Sapporo, Japan
| | - Yusuke Kudo
- Diagnostic Center for Sonography, Hokkaido University Hospital, Sapporo, Japan
| | - Takahiro Deguchi
- Department of Surgical Pathology, Hokkaido University Hospital, Sapporo, Japan
| | - Katsuji Marukawa
- Department of Surgical Pathology, Hokkaido University Hospital, Sapporo, Japan
| | - Yuichiro Fujieda
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Nobuya Abe
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Masaru Kato
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hitoshi Shibuya
- Diagnostic Center for Sonography, Hokkaido University Hospital, Sapporo, Japan
| | - Yoshihiro Matsuno
- Department of Surgical Pathology, Hokkaido University Hospital, Sapporo, Japan
| | - Tatsuya Atsumi
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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128
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Seifeldein GS, Haseib A, Hassan HA, Ahmed G. Correlation of knee ultrasonography and Western Ontario and McMaster University (WOMAC) osteoarthritis index in primary knee osteoarthritis. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2019. [DOI: 10.1186/s43055-019-0029-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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129
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Rossi F, Zaottini F, Picasso R, Martinoli C, Tagliafico AS. Ankle and Foot Ultrasound: Reliability of Side-to-Side Comparison of Small Anatomic Structures. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:2143-2153. [PMID: 30592321 DOI: 10.1002/jum.14911] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 11/12/2018] [Accepted: 11/19/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVES In sonography of clinically relevant small structures of the ankle and foot, the healthy contralateral side can be used as a reference to identify subtle abnormalities. Intrasubject side-to-side variability must be minimal. The aim of this study was to assess the reliability of side-to-side sonographic evaluation of small structures of the ankle and foot. METHODS Thirty healthy volunteers were prospectively studied. Small structures of the ankle and foot were evaluated bilaterally by 2 musculoskeletal radiologists in separate sessions. The deep peroneal nerve, superior extensor retinacula, calcaneofibular ligament, superior peroneal retinacula, tibialis posterior tendon, tibial nerve, Achilles tendon, plantaris tendon, plantar fascia, and sural nerve were considered. To assess intra- and interreader agreements, 30 (100%) examinations were repeated. A nonparametric statistic was used. RESULTS Data were not normally distributed (P > .001). Intrareader agreement was k = 0.67 (95% confidence interval, 0.57-0.78) and interreader agreement was k = 0.73 (95% confidence interval, 0.68-0.77). The mean values and standard deviation for all the structures were 0.36 ± 1.85 mm. The overall coefficient of variation was 18.5%. The intraclass correlation coefficient was 0.93 (95% confidence interval, 0.92-0.94). CONCLUSIONS In ankle and foot sonography, the healthy contralateral side can be used as a reference during a real-time musculoskeletal ultrasound evaluation of small structures.
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Affiliation(s)
- Federica Rossi
- Department of Health Sciences (DISSAL), University of Genova, Genoa, Italy
| | - Federico Zaottini
- Department of Health Sciences (DISSAL), University of Genova, Genoa, Italy
| | - Riccardo Picasso
- Department of Health Sciences (DISSAL), University of Genova, Genoa, Italy
| | - Carlo Martinoli
- Department of Health Sciences (DISSAL), University of Genova, Genoa, Italy
- Department of Radiology, Ospedale Policlinico San Martino, Genoa, Italy
| | - Alberto Stefano Tagliafico
- Department of Health Sciences (DISSAL), University of Genova, Genoa, Italy
- Department of Radiology, Ospedale Policlinico San Martino, Genoa, Italy
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130
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Bockbrader MA, Thompson RD, Way DP, Colachis SC, Siddiqui IJ, Luz J, Borg-Stein J, OʼConnor K, Kohler MJ, Bahner DP. Toward a Consensus for Musculoskeletal Ultrasonography Education in Physical Medicine and Rehabilitation: A National Poll of Residency Directors. Am J Phys Med Rehabil 2019; 98:715-724. [PMID: 31318753 PMCID: PMC6635046 DOI: 10.1097/phm.0000000000001195] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
OBJECTIVES The aims of the study were to evaluate integration of musculoskeletal ultrasonography education in physical medicine and rehabilitation training programs in 2014-2015, when the American Academy of Physical Medicine & Rehabilitation and Accreditation Council for Graduate Medical Education Residency Review Committee both recognized it as a fundamental component of physiatric practice, to identify common musculoskeletal ultrasonography components of physical medicine and rehabilitation residency curricula, and to identify common barriers to integration. DESIGN Survey of 78 Accreditation Council for Graduate Medical Education-accredited physical medicine and rehabilitation residency programs was conducted. RESULTS The 2015 survey response rate was more than 50%, and respondents were representative of programs across the United States. Most programs (80%) reported teaching musculoskeletal ultrasonography, whereas a minority (20%) required mastery of ultrasonography skills for graduation. Ultrasonography curricula varied, although most programs agreed that the scope of resident training in physical medicine and rehabilitation should include diagnostic and interventional musculoskeletal ultrasonography, especially for key joints (shoulder, elbow, knee, wrist, hip, and ankle) and nerves (median, ulnar, fibular, tibial, radial, and sciatic). Barriers to teaching included insufficient expertise of instructors, poor access to equipment, and lack of a structured curriculum. CONCLUSIONS Musculoskeletal ultrasonography has become a required component of physical medicine and rehabilitation residency training. Based on survey responses and expert recommendations, we propose a structure for musculoskeletal ultrasonography curricular standards and milestones for trainee competency.
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Affiliation(s)
- Marcia A Bockbrader
- From the Department of Physical Medicine & Rehabilitation, The Ohio State University Wexner Medical Center, Columbus, Ohio (MAB, RDT, SCC); Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio (DPW, DPB); Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts (IJS, JL, JB-S, KO); Regenerative Orthopedics and Sports Medicine (ROSM), Washington, DC (IJS); Department of Orthopedics, Tufts University School of Medicine, St. Elizabeth's Medical Center, Boston, Massachusetts (JL); and Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (MJK)
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131
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Baston CM, Wallace P, Chan W, Dean AJ, Panebianco N. Innovation Through Collaboration: Creation of a Combined Emergency and Internal Medicine Point-of-Care Ultrasound Fellowship. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:2209-2215. [PMID: 30592332 DOI: 10.1002/jum.14908] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/26/2018] [Indexed: 06/09/2023]
Affiliation(s)
- Cameron M Baston
- Department of Medicine, Division of Pulmonary and Critical Care, Division of Emergency Ultrasound, Department of Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Paul Wallace
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Wilma Chan
- Division of Emergency Ultrasound, Department of Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Anthony J Dean
- Division of Emergency Ultrasound, Department of Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nova Panebianco
- Division of Emergency Ultrasound, Department of Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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132
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Girolimetto N, Macchioni P, Tinazzi I, Costa L, Peluso R, Tasso M, Bascherini V, Addimanda O, Marchetta A, Possemato N, Salvarani C, McGonagle D, Scarpa R, Caso F. Predominant ultrasonographic extracapsular changes in symptomatic psoriatic dactylitis: results from a multicenter cross-sectional study comparing symptomatic and asymptomatic hand dactylitis. Clin Rheumatol 2019; 39:1157-1165. [PMID: 31302859 DOI: 10.1007/s10067-019-04683-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 06/19/2019] [Accepted: 07/05/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Despite diffuse digital swelling, dactylitis may sometimes be asymptomatic. The objective of this study was to compare the clinical and ultrasonographic features of symptomatic with asymptomatic psoriatic arthritis (PsA) dactylitis. METHODS One hundred and twenty-five hand dactylitis were evaluated in a multicenter cross-sectional study for the presence of pain, subjective functional limitation, and tenderness (4-points scale) with the calculation of a Leeds Dactylitis Index (LDI) score. Fingers were subsequently investigated using high-frequency ultrasound (US) both in gray-scale (GS) and power Doppler (PD), for the presence and grading of flexor tenosynovitis, soft tissue edema, subcutaneous PD signal (PDUS), extensor tendon involvement, and joints synovitis. Clinical and US characteristics of symptomatic dactylitic fingers were compared with the asymptomatic dactylitic ones. RESULTS Symptomatic fingers (n = 80) had a significantly lower dactylitis duration compared to asymptomatic fingers (n = 36) (p < 0.001). Values of LDI, patient VAS-pain, and VAS-functional score were significantly higher in fingers with symptomatic dactylitis (p < 0.001 and p = 0.010, respectively). Symptomatic dactylitis had a higher prevalence of flexor tenosynovitis of grade > 2, soft tissue edema and subcutaneous PDUS signal (p < 0.001). Asymptomatic dactylitis showed a greater prevalence of joint synovitis (both in GS and in PD) than symptomatic dactylitis (p < 0.001). CONCLUSIONS Digital tenderness and pain are linked to US tenosynovitis of grade > 2 and extra synovial abnormalities and conversely asymptomatic dactylitis is associated with joint-based synovitis.Key Points• Digital tenderness and local pain in psoriatic arthritis dactylitis are strongly associated with flexor tenosynovitis of grade> 2, soft tissue edema, and subcutaneous PD signal.• In psoriatic arthritis, asymptomatic dactylitis showed a greater prevalence of joint synovitis than symptomatic dactylitis.• In psoriatic arthritis, ultrasound inflammatory abnormalities are present in about 70% of cold dactylitis which is linked for disease chronicity.• In psoriatic arthritis, the flexor tendon and adjacent soft tissues play a significant role in symptomatic dactylitis.
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Affiliation(s)
- Nicolò Girolimetto
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II, via S. Pansini 5, 80131, Naples, Italy
| | - Pierluigi Macchioni
- Department of Rheumatology, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Ilaria Tinazzi
- Rheumatology Unit, Ospedale Sacro Cuore, Negrar, Verona, Italy
| | - Luisa Costa
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II, via S. Pansini 5, 80131, Naples, Italy
| | - Rosario Peluso
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II, via S. Pansini 5, 80131, Naples, Italy
| | - Marco Tasso
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II, via S. Pansini 5, 80131, Naples, Italy
| | - Vittoria Bascherini
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II, via S. Pansini 5, 80131, Naples, Italy
| | - Olga Addimanda
- Department of Rheumatology, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Niccolò Possemato
- Department of Rheumatology, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Carlo Salvarani
- Department of Rheumatology, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.,Rheumatology Unit, University of Modena and Reggio Emilia, Reggio Emilia, Italy
| | - Dennis McGonagle
- NIHR Leeds Musculoskeletal Biomedical Research Centre, Leeds Teaching Hospitals Trust and the University of Leeds, Leeds, UK
| | - Raffaele Scarpa
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II, via S. Pansini 5, 80131, Naples, Italy.
| | - Francesco Caso
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II, via S. Pansini 5, 80131, Naples, Italy
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Just SA, Nielsen C, Werlinrud JC, Larsen PV, Klinkby CS, Schrøder HD, Humby F, Torfing T, Lindegaard H. Six-month prospective trial in early and long-standing rheumatoid arthritis: evaluating disease activity in the wrist through sequential synovial histopathological analysis, RAMRIS magnetic resonance score and EULAR-OMERACT ultrasound score. RMD Open 2019; 5:e000951. [PMID: 31413866 PMCID: PMC6667976 DOI: 10.1136/rmdopen-2019-000951] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 06/10/2019] [Accepted: 06/14/2019] [Indexed: 11/04/2022] Open
Abstract
Introduction Standardised scoring systems for rheumatoid arthritis (RA) joint disease activity include Larsen score for radiographs, rheumatoid arthritis magnetic resonance imaging score (RAMRIS) for MRI and using the European League Against Rheumatisms-Outcome Measures in Rheumatology (EULAR-OMERACT) score for ultrasound (US) images. The aim of this prospective study was to investigate the relationship between histological synovitis and radiological synovitis, assessed by conventional X-ray, US and MRI of the wrist radiocarpal joint. Methods 20 patients with treatment naive early RA (ERA) and 20 with long-standing RA (LRA) were enrolled in a 6-month prospective study. Patients with RA underwent US-guided synovial biopsy, X-ray and US of the wrist at enrolment and 6 months. MRI at baseline and also at 6 months for the ERA group, and scored with the RAMRIS system. X-ray was scored by Larsen score and US by the EULAR-OMERACT system. Synovial biopsy inflammation was determined by the Krenn score. Results In the ERA group at baseline, Krenn score was correlated strongly with both US combined score (r = 0.77 p < 0.001) and MRI synovitis score (r = 0.85 p < 0.001), while uncorrelated at 6 months. In the LRA group at baseline, these scores correlated strongly (r = 0.83, p < 0.001) to moderately (r = 0.61, p = 0.002), and persisted at 6 months for US score (r = 0.81 p < 0.001). For all patients with RA, change in Krenn score between baseline and 6 months was correlated with both change in US combined score (r = 0.65, p < 0.001) and change in MRI synovitis score (r = 0.50, p = 0.03). Conclusion The MRI RAMRIS synovitis score and EULAR-OMERACT US scoring system are sensitive measures of histological synovitis in LRA and ERA. After 6 months, this correlation persists in the established RA group, but not in the ERA group. Overall, decreases in MRI/US synovitis are associated with reductions in histological synovitis. The study validates the use of MRI RAMRIS and EULAR-OMERACT US scores as surrogate markers of histological synovitis in established RA and early untreated RA.
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Affiliation(s)
- Søren Andreas Just
- Department of Rheumatology, Odense University Hospital, Odense, Denmark.,Section of Rheumatology, Department of Medicine, Svendborg Sygehus OUH, Svendborg, Denmark
| | - Christian Nielsen
- Department of Clinical Immunology, Odense University Hospital, Odense, Denmark.,Odense Patient data Explorative Network (OPEN), Odense University Hospital, Odense, Denmark
| | | | - Pia Veldt Larsen
- Department of Epidemiology and Biostatistics, University of Southern Denmark, Odense, Denmark
| | | | | | - Fran Humby
- Centre for Experimental Medicine and Rheumatology, Barts and the London School of Medicine and Dentistry, London, UK
| | - Trine Torfing
- Section of musculoskeletal radiology, Department of Radiology, Odense University Hospital, Odense, Denmark
| | - Hanne Lindegaard
- Department of Rheumatology, Odense University Hospital, Odense, Denmark
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134
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Mandl P, Ciechomska A, Terslev L, Baraliakos X, Conaghan PG, D'Agostino MA, Iagnocco A, van der Laken CJ, Ostergaard M, Naredo E. Implementation and role of modern musculoskeletal imaging in rheumatological practice in member countries of EULAR. RMD Open 2019; 5:e000950. [PMID: 31321076 PMCID: PMC6606074 DOI: 10.1136/rmdopen-2019-000950] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 05/11/2019] [Accepted: 05/15/2019] [Indexed: 11/04/2022] Open
Abstract
Objectives To document the current training, implementation and role of modern musculoskeletal imaging techniques: ultrasound, magnetic resonance imaging, computed tomography and positron emission tomography, among rheumatologists in the member countries of the EULAR. Methods English-language questionnaires for each imaging modality developed by a EULAR task force were sent out to national and international scientific societies as well as imaging experts in the given modalities involved in research and/or training. The surveys were distributed via an online survey tool (SurveyMonkey). Simple descriptive and summary statistics were calculated from the responses. Results More than 90% of ultrasound (US) experts reported the availability of a US unit in their department. Suspicion of rheumatoid arthritis and spondyloarthritides were the main clinical indications for performing US for diagnostic purposes. Suspicion of sacroiliitis and degenerative spine disease were the most common indications to perform magnetic resonance imaging (MRI) or computed tomography (CT) for diagnostic purposes, while positron emission tomography was mainly performed to diagnose large vessel vasculitis and to investigate fever of unknown origin. The reported percentage of rheumatologists performing US was highly variable, ranging from more than 80% in 6% of countries to less than 10% in 15% of countries. The majority of experts (77%) reported that their national rheumatology societies organise musculoskeletal US courses, while courses in MRI or CT organised by the national rheumatology societies were less commonly reported (29% and 8%, respectively). Conclusions Rheumatologists in Europe utilise modern imaging techniques; however, access to the techniques and training offered is varied.
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Affiliation(s)
- Peter Mandl
- Department of Rheumatology, Medical University Vienna, Vienna, Austria
| | - Anna Ciechomska
- Department of Rheumatology, Wishaw General Hospital, Wishaw, UK
| | - L Terslev
- Center for Rheumatology and Spine Diseases, Copenhagen University Hospital Glostrup, Copenhagen, Denmark
| | - Xenofon Baraliakos
- Rheumazentrum Ruhrgebiet Sankt Josefs-Krankenhaus, Herne, Nordrhein-Westfalen, Germany.,Rheumatology Department, Rheumazentrum Ruhrgebiet, Ruhr-University Bochum, Herne, Germany
| | - P G Conaghan
- Rheumatology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Maria Antonietta D'Agostino
- Rheumatology, Ambroise Paré Hospital, APHP, Université Versailles-Saint-Quentin en Yvelines, Boulogne-Billancourt, France
| | - Annamaria Iagnocco
- Scienze Cliniche e Biologiche, Università degli Studi di Torino, Rome, Italy
| | - Conny J van der Laken
- Department of Rheumatology, VU University Medical Center, Amsterdam, Noord-Holland, The Netherlands
| | - Mikkel Ostergaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet Glostrup, Glostrup, Denmark
| | - E Naredo
- Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jiménez Díaz and Autónoma University, Madrid, Spain
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135
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Ting TV, Vega-Fernandez P, Oberle EJ, De Ranieri D, Bukulmez H, Lin C, Moser D, Barrowman NJ, Zhao Y, Benham HM, Tasan L, Thatayatikom A, Roth J. Novel Ultrasound Image Acquisition Protocol and Scoring System for the Pediatric Knee. Arthritis Care Res (Hoboken) 2019; 71:977-985. [PMID: 30192069 DOI: 10.1002/acr.23746] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 09/04/2018] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The use of musculoskeletal ultrasound is increasing among pediatric rheumatologists. Reliable scoring systems are needed for the objective assessment of synovitis. The aims of this study were to create a standardized and reproducible image acquisition protocol for B-mode and Doppler ultrasound of the pediatric knee, and to develop a standardized scoring system and determine its reliability for pediatric knee synovitis. METHODS Six pediatric rheumatologists developed a set of standard views for knee assessment in children with juvenile arthritis. Subsequently, a comprehensive literature review, practical exercises, and a consensus process were performed. A scoring system for both B-mode and Doppler was then developed and assessed for reliability. Interreader reliability or agreement among a total of 16 raters was determined using 2-way single-score intraclass correlation coefficient (ICC) analysis. RESULTS Twenty-one views to assess knee arthritis were initially identified. Following completion of practical exercises and subsequent consensus processes, 3 views in both B-mode and Doppler were selected: suprapatellar longitudinal and medial/lateral parapatellar transverse views. Several rounds of scoring and modifications resulted in a final ICC of suprapatellar view B-mode 0.89 (95% confidence interval [95% CI] 0.86-0.92) and Doppler 0.55 (95% CI 0.41-0.69), medial parapatellar view B-mode 0.76 (95% CI 0.68-0.83) and Doppler 0.75 (95% CI 0.66-0.83), and lateral parapatellar view B-mode 0.82 (95% CI 0.75-0.88) and Doppler 0.76 (95% CI 0.66-0.84). CONCLUSION A novel B-mode and Doppler image acquisition and scoring system for assessing synovitis in the pediatric knee was successfully developed through practical exercises and a consensus process. Study results demonstrate overall good-to-excellent reliability.
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Affiliation(s)
- Tracy V Ting
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Patricia Vega-Fernandez
- Emory University School of Medicine and the Children's Hospital of Atlanta, Atlanta, Georgia
| | | | - Deirdre De Ranieri
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | | | - Clara Lin
- Children's Hospital Colorado and University of Colorado Denver
| | | | | | | | | | - Laura Tasan
- University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Johannes Roth
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
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Volland LM, Zhou JY, Barnes RFW, Kruse-Jarres R, Steiner B, Quon DV, Bailey C, Hughes TH, Moore RE, Chang EY, von Drygalski A. Development and Reliability of the Joint Tissue Activity and Damage Examination for Quantitation of Structural Abnormalities by Musculoskeletal Ultrasound in Hemophilic Joints. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:1569-1581. [PMID: 30371941 DOI: 10.1002/jum.14846] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 09/24/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES Musculoskeletal ultrasound (US) is used increasingly to examine hemophilic arthropathy. However, quantitative algorithms to document findings are lacking. We developed and sought to validate a protocol quantifying hemophilic joint abnormalities. METHODS Thirty-one patients with hemophilia were examined serially for 2 years with musculoskeletal US (≈600 joint examinations and ≈6000 images). Based on the spectrum of pathologies, a quantitative algorithm, named Joint Tissue Activity and Damage Examination (JADE), was developed for soft tissue and osteochondral measurements, including power Doppler, using nominal group techniques. To study intra- and inter-rater reliability, 8 musculoskeletal US-experienced hemophilia providers performed anatomic landmark recognition and tissue measurements on 86 images with arthropathic changes, with repetition 1 month later. Twenty-three musculoskeletal US-inexperienced providers performed similar assessments. Inter-operator reliability was established by 6 musculoskeletal US-experienced hemophilia providers, each acquiring images and JADE assessments of 3 hemophilic arthropathic joints. A radiologist and musculoskeletal sonographer functioned as adjudicators. The statistical analysis was performed with the intraclass correlation coefficient (ICC), Fleiss κ, and Cohen κ where appropriate. RESULTS The musculoskeletal US-experienced providers showed excellent intra-and inter-rater reliability for tissue measurements (ICCs, 0.94-0.96). Agreement was good to excellent for landmark recognition (Fleiss κ, 0.87-0.94). Inter-operator reliability was excellent for measurements and landmark recognition (ICC, 0.90; Fleiss κ, 1.0). Agreement with adjudicators was mostly good to excellent. Musculoskeletal US-inexperienced providers showed excellent inter-rater reliability for measurements (ICC, 0.96) and moderate agreement for landmark recognition (Fleiss κ, 0.58). CONCLUSIONS The JADE protocol appears feasible for quantifying hemophilic intra-articular abnormalities. Musculoskeletal US-trained hemophilia providers showed high intra-rater, inter-rater, and inter-operator reliability, supporting JADE as a protocol for clinical management and research.
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Affiliation(s)
- Lena M Volland
- Department of Medicine, Division of Hematology/Oncology, University of California, San Diego, California, USA
| | - Jenny Y Zhou
- Department of Medicine, Division of Hematology/Oncology, University of California, San Diego, California, USA
| | - Richard F W Barnes
- Department of Medicine, Division of Hematology/Oncology, University of California, San Diego, California, USA
| | - Rebecca Kruse-Jarres
- Washington Center for Bleeding Disorders at Bloodworks Northwest, Seattle, Washington, USA
| | - Bruno Steiner
- Washington Center for Bleeding Disorders at Bloodworks Northwest, Seattle, Washington, USA
| | - Doris V Quon
- Orthopedic Hemophilia Treatment Center, Orthopedic Institute for Children, Los Angeles, California, USA
| | - Cindy Bailey
- Orthopedic Hemophilia Treatment Center, Orthopedic Institute for Children, Los Angeles, California, USA
| | - Tudor H Hughes
- Department of Radiology, University of California, San Diego, California, USA
| | - Randy E Moore
- General Musculoskeletal Imaging, Inc, Cincinnati, Ohio, USA
| | - Eric Y Chang
- Radiology Service, VA San Diego Healthcare System, San Diego, California, USA
| | - Annette von Drygalski
- Department of Medicine, Division of Hematology/Oncology, University of California, San Diego, California, USA
- Department of Molecular Medicine, Scripps Research Institute, La Jolla, California, USA
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Girolimetto N, Macchioni P, Tinazzi I, Costa L, McGonagle D, Peluso R, Del Puente A, Addimanda O, Marchetta A, Possemato N, Tasso M, Salvarani C, Scarpa R, Caso F. Ultrasonographic Evidence of Predominance of Acute Extracapsular and Chronic Intrasynovial Patterns in 100 Cases of Psoriatic Hand Dactylitis. J Rheumatol 2019; 47:227-233. [PMID: 31092722 DOI: 10.3899/jrheum.190046] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To use ultrasonography to study whether the duration of psoriatic dactylitis was associated with different patterns of extracapsular and synovial-based involvement. METHODS One hundred cases of hand dactylitis from 85 patients with psoriatic arthritis (PsA) were consecutively enrolled in a multicenter cross-sectional study and divided into 2 groups according to dactylitis duration (shorter or longer than the median: 20 weeks). All dactylitis fingers were investigated using high-frequency ultrasound both in greyscale (GS) and power Doppler (PD), evaluating the presence of flexor tenosynovitis, soft tissue edema, subcutaneous PD signal (PDS), extensor tendon involvement, and joint synovitis. RESULTS Cases with a shorter dactylitis duration (< 20 weeks) had a significantly higher prevalence of GS flexor tenosynovitis of grade > 2, PD flexor tenosynovitis, soft tissue edema, and subcutaneous PDS (p = 0.001, p < 0.001, p < 0.05, and p = 0.001, respectively). However, the presence of synovitis in GS and PD mode (in both cases at proximal interphalangeal level) was more frequent in patients with longer dactylitis duration (p < 0.001). When detected in the chronic form, flexor tenosynovitis was grade 2 or lower. CONCLUSION In a large cohort of PsA hand dactylitis, we found a predominant extracapsular inflammation (flexor tenosynovitis and soft tissue edema) in early cases and a high prevalence of joint synovitis at proximal interphalangeal level in the chronic form. However, longitudinal imaging studies are needed to clarify these aspects.
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Affiliation(s)
- Nicolò Girolimetto
- From the Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II, Naples; Department of Rheumatology, Azienda USL-Institute for Research and Health Care (IRCCS) di Reggio Emilia, Reggio Emilia; Unit of Rheumatology, Ospedale Sacro Cuore, Negrar, Verona, Italy; UK National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Centre, Leeds Teaching Hospitals Trust and the University of Leeds, UK; Rheumatology Unit, University of Modena and Reggio Emilia, Reggio Emilia, Italy.,N. Girolimetto, MD, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II; P. Macchioni, MD, Department of Rheumatology, Azienda USL-IRCCS di Reggio Emilia; I. Tinazzi, MD, Unit of Rheumatology, Ospedale Sacro Cuore; L. Costa, MD, PhD, Assistant Professor, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II; D. McGonagle, MD, PhD, Professor, FRCPI, NIHR Leeds Musculoskeletal Biomedical Research Centre, Leeds Teaching Hospitals Trust and the University of Leeds; R. Peluso, MD, PhD, Assistant Professor, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II; A. Del Puente, MD, Assistant Professor, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II; O. Addimanda, MD, Department of Rheumatology, Azienda USL-IRCCS di Reggio Emilia; A. Marchetta, MD, Unit of Rheumatology, Ospedale Sacro Cuore; N. Possemato, MD, Department of Rheumatology, Azienda USL-IRCCS di Reggio Emilia;. Tasso, MD, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II; C. Salvarani, MD, Full Professor, Department of Rheumatology, Azienda USL-IRCCS di Reggio Emilia, and Rheumatology Unit, University of Modena and Reggio Emilia; R. Scarpa, MD, Full Professor, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II; F. Caso, MD, PhD, Assistant Professor, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II
| | - Pierluigi Macchioni
- From the Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II, Naples; Department of Rheumatology, Azienda USL-Institute for Research and Health Care (IRCCS) di Reggio Emilia, Reggio Emilia; Unit of Rheumatology, Ospedale Sacro Cuore, Negrar, Verona, Italy; UK National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Centre, Leeds Teaching Hospitals Trust and the University of Leeds, UK; Rheumatology Unit, University of Modena and Reggio Emilia, Reggio Emilia, Italy.,N. Girolimetto, MD, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II; P. Macchioni, MD, Department of Rheumatology, Azienda USL-IRCCS di Reggio Emilia; I. Tinazzi, MD, Unit of Rheumatology, Ospedale Sacro Cuore; L. Costa, MD, PhD, Assistant Professor, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II; D. McGonagle, MD, PhD, Professor, FRCPI, NIHR Leeds Musculoskeletal Biomedical Research Centre, Leeds Teaching Hospitals Trust and the University of Leeds; R. Peluso, MD, PhD, Assistant Professor, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II; A. Del Puente, MD, Assistant Professor, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II; O. Addimanda, MD, Department of Rheumatology, Azienda USL-IRCCS di Reggio Emilia; A. Marchetta, MD, Unit of Rheumatology, Ospedale Sacro Cuore; N. Possemato, MD, Department of Rheumatology, Azienda USL-IRCCS di Reggio Emilia;. Tasso, MD, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II; C. Salvarani, MD, Full Professor, Department of Rheumatology, Azienda USL-IRCCS di Reggio Emilia, and Rheumatology Unit, University of Modena and Reggio Emilia; R. Scarpa, MD, Full Professor, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II; F. Caso, MD, PhD, Assistant Professor, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II
| | - Ilaria Tinazzi
- From the Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II, Naples; Department of Rheumatology, Azienda USL-Institute for Research and Health Care (IRCCS) di Reggio Emilia, Reggio Emilia; Unit of Rheumatology, Ospedale Sacro Cuore, Negrar, Verona, Italy; UK National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Centre, Leeds Teaching Hospitals Trust and the University of Leeds, UK; Rheumatology Unit, University of Modena and Reggio Emilia, Reggio Emilia, Italy.,N. Girolimetto, MD, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II; P. Macchioni, MD, Department of Rheumatology, Azienda USL-IRCCS di Reggio Emilia; I. Tinazzi, MD, Unit of Rheumatology, Ospedale Sacro Cuore; L. Costa, MD, PhD, Assistant Professor, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II; D. McGonagle, MD, PhD, Professor, FRCPI, NIHR Leeds Musculoskeletal Biomedical Research Centre, Leeds Teaching Hospitals Trust and the University of Leeds; R. Peluso, MD, PhD, Assistant Professor, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II; A. Del Puente, MD, Assistant Professor, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II; O. Addimanda, MD, Department of Rheumatology, Azienda USL-IRCCS di Reggio Emilia; A. Marchetta, MD, Unit of Rheumatology, Ospedale Sacro Cuore; N. Possemato, MD, Department of Rheumatology, Azienda USL-IRCCS di Reggio Emilia;. Tasso, MD, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II; C. Salvarani, MD, Full Professor, Department of Rheumatology, Azienda USL-IRCCS di Reggio Emilia, and Rheumatology Unit, University of Modena and Reggio Emilia; R. Scarpa, MD, Full Professor, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II; F. Caso, MD, PhD, Assistant Professor, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II
| | - Luisa Costa
- From the Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II, Naples; Department of Rheumatology, Azienda USL-Institute for Research and Health Care (IRCCS) di Reggio Emilia, Reggio Emilia; Unit of Rheumatology, Ospedale Sacro Cuore, Negrar, Verona, Italy; UK National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Centre, Leeds Teaching Hospitals Trust and the University of Leeds, UK; Rheumatology Unit, University of Modena and Reggio Emilia, Reggio Emilia, Italy.,N. Girolimetto, MD, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II; P. Macchioni, MD, Department of Rheumatology, Azienda USL-IRCCS di Reggio Emilia; I. Tinazzi, MD, Unit of Rheumatology, Ospedale Sacro Cuore; L. Costa, MD, PhD, Assistant Professor, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II; D. McGonagle, MD, PhD, Professor, FRCPI, NIHR Leeds Musculoskeletal Biomedical Research Centre, Leeds Teaching Hospitals Trust and the University of Leeds; R. Peluso, MD, PhD, Assistant Professor, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II; A. Del Puente, MD, Assistant Professor, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II; O. Addimanda, MD, Department of Rheumatology, Azienda USL-IRCCS di Reggio Emilia; A. Marchetta, MD, Unit of Rheumatology, Ospedale Sacro Cuore; N. Possemato, MD, Department of Rheumatology, Azienda USL-IRCCS di Reggio Emilia;. Tasso, MD, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II; C. Salvarani, MD, Full Professor, Department of Rheumatology, Azienda USL-IRCCS di Reggio Emilia, and Rheumatology Unit, University of Modena and Reggio Emilia; R. Scarpa, MD, Full Professor, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II; F. Caso, MD, PhD, Assistant Professor, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II
| | - Dennis McGonagle
- From the Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II, Naples; Department of Rheumatology, Azienda USL-Institute for Research and Health Care (IRCCS) di Reggio Emilia, Reggio Emilia; Unit of Rheumatology, Ospedale Sacro Cuore, Negrar, Verona, Italy; UK National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Centre, Leeds Teaching Hospitals Trust and the University of Leeds, UK; Rheumatology Unit, University of Modena and Reggio Emilia, Reggio Emilia, Italy.,N. Girolimetto, MD, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II; P. Macchioni, MD, Department of Rheumatology, Azienda USL-IRCCS di Reggio Emilia; I. Tinazzi, MD, Unit of Rheumatology, Ospedale Sacro Cuore; L. Costa, MD, PhD, Assistant Professor, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II; D. McGonagle, MD, PhD, Professor, FRCPI, NIHR Leeds Musculoskeletal Biomedical Research Centre, Leeds Teaching Hospitals Trust and the University of Leeds; R. Peluso, MD, PhD, Assistant Professor, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II; A. Del Puente, MD, Assistant Professor, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II; O. Addimanda, MD, Department of Rheumatology, Azienda USL-IRCCS di Reggio Emilia; A. Marchetta, MD, Unit of Rheumatology, Ospedale Sacro Cuore; N. Possemato, MD, Department of Rheumatology, Azienda USL-IRCCS di Reggio Emilia;. Tasso, MD, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II; C. Salvarani, MD, Full Professor, Department of Rheumatology, Azienda USL-IRCCS di Reggio Emilia, and Rheumatology Unit, University of Modena and Reggio Emilia; R. Scarpa, MD, Full Professor, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II; F. Caso, MD, PhD, Assistant Professor, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II
| | - Rosario Peluso
- From the Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II, Naples; Department of Rheumatology, Azienda USL-Institute for Research and Health Care (IRCCS) di Reggio Emilia, Reggio Emilia; Unit of Rheumatology, Ospedale Sacro Cuore, Negrar, Verona, Italy; UK National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Centre, Leeds Teaching Hospitals Trust and the University of Leeds, UK; Rheumatology Unit, University of Modena and Reggio Emilia, Reggio Emilia, Italy.,N. Girolimetto, MD, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II; P. Macchioni, MD, Department of Rheumatology, Azienda USL-IRCCS di Reggio Emilia; I. Tinazzi, MD, Unit of Rheumatology, Ospedale Sacro Cuore; L. Costa, MD, PhD, Assistant Professor, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II; D. McGonagle, MD, PhD, Professor, FRCPI, NIHR Leeds Musculoskeletal Biomedical Research Centre, Leeds Teaching Hospitals Trust and the University of Leeds; R. Peluso, MD, PhD, Assistant Professor, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II; A. Del Puente, MD, Assistant Professor, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II; O. Addimanda, MD, Department of Rheumatology, Azienda USL-IRCCS di Reggio Emilia; A. Marchetta, MD, Unit of Rheumatology, Ospedale Sacro Cuore; N. Possemato, MD, Department of Rheumatology, Azienda USL-IRCCS di Reggio Emilia;. Tasso, MD, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II; C. Salvarani, MD, Full Professor, Department of Rheumatology, Azienda USL-IRCCS di Reggio Emilia, and Rheumatology Unit, University of Modena and Reggio Emilia; R. Scarpa, MD, Full Professor, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II; F. Caso, MD, PhD, Assistant Professor, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II
| | - Antonio Del Puente
- From the Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II, Naples; Department of Rheumatology, Azienda USL-Institute for Research and Health Care (IRCCS) di Reggio Emilia, Reggio Emilia; Unit of Rheumatology, Ospedale Sacro Cuore, Negrar, Verona, Italy; UK National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Centre, Leeds Teaching Hospitals Trust and the University of Leeds, UK; Rheumatology Unit, University of Modena and Reggio Emilia, Reggio Emilia, Italy.,N. Girolimetto, MD, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II; P. Macchioni, MD, Department of Rheumatology, Azienda USL-IRCCS di Reggio Emilia; I. Tinazzi, MD, Unit of Rheumatology, Ospedale Sacro Cuore; L. Costa, MD, PhD, Assistant Professor, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II; D. McGonagle, MD, PhD, Professor, FRCPI, NIHR Leeds Musculoskeletal Biomedical Research Centre, Leeds Teaching Hospitals Trust and the University of Leeds; R. Peluso, MD, PhD, Assistant Professor, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II; A. Del Puente, MD, Assistant Professor, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II; O. Addimanda, MD, Department of Rheumatology, Azienda USL-IRCCS di Reggio Emilia; A. Marchetta, MD, Unit of Rheumatology, Ospedale Sacro Cuore; N. Possemato, MD, Department of Rheumatology, Azienda USL-IRCCS di Reggio Emilia;. Tasso, MD, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II; C. Salvarani, MD, Full Professor, Department of Rheumatology, Azienda USL-IRCCS di Reggio Emilia, and Rheumatology Unit, University of Modena and Reggio Emilia; R. Scarpa, MD, Full Professor, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II; F. Caso, MD, PhD, Assistant Professor, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II
| | - Olga Addimanda
- From the Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II, Naples; Department of Rheumatology, Azienda USL-Institute for Research and Health Care (IRCCS) di Reggio Emilia, Reggio Emilia; Unit of Rheumatology, Ospedale Sacro Cuore, Negrar, Verona, Italy; UK National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Centre, Leeds Teaching Hospitals Trust and the University of Leeds, UK; Rheumatology Unit, University of Modena and Reggio Emilia, Reggio Emilia, Italy.,N. Girolimetto, MD, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II; P. Macchioni, MD, Department of Rheumatology, Azienda USL-IRCCS di Reggio Emilia; I. Tinazzi, MD, Unit of Rheumatology, Ospedale Sacro Cuore; L. Costa, MD, PhD, Assistant Professor, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II; D. McGonagle, MD, PhD, Professor, FRCPI, NIHR Leeds Musculoskeletal Biomedical Research Centre, Leeds Teaching Hospitals Trust and the University of Leeds; R. Peluso, MD, PhD, Assistant Professor, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II; A. Del Puente, MD, Assistant Professor, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II; O. Addimanda, MD, Department of Rheumatology, Azienda USL-IRCCS di Reggio Emilia; A. Marchetta, MD, Unit of Rheumatology, Ospedale Sacro Cuore; N. Possemato, MD, Department of Rheumatology, Azienda USL-IRCCS di Reggio Emilia;. Tasso, MD, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II; C. Salvarani, MD, Full Professor, Department of Rheumatology, Azienda USL-IRCCS di Reggio Emilia, and Rheumatology Unit, University of Modena and Reggio Emilia; R. Scarpa, MD, Full Professor, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II; F. Caso, MD, PhD, Assistant Professor, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II
| | - Antonio Marchetta
- From the Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II, Naples; Department of Rheumatology, Azienda USL-Institute for Research and Health Care (IRCCS) di Reggio Emilia, Reggio Emilia; Unit of Rheumatology, Ospedale Sacro Cuore, Negrar, Verona, Italy; UK National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Centre, Leeds Teaching Hospitals Trust and the University of Leeds, UK; Rheumatology Unit, University of Modena and Reggio Emilia, Reggio Emilia, Italy.,N. Girolimetto, MD, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II; P. Macchioni, MD, Department of Rheumatology, Azienda USL-IRCCS di Reggio Emilia; I. Tinazzi, MD, Unit of Rheumatology, Ospedale Sacro Cuore; L. Costa, MD, PhD, Assistant Professor, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II; D. McGonagle, MD, PhD, Professor, FRCPI, NIHR Leeds Musculoskeletal Biomedical Research Centre, Leeds Teaching Hospitals Trust and the University of Leeds; R. Peluso, MD, PhD, Assistant Professor, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II; A. Del Puente, MD, Assistant Professor, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II; O. Addimanda, MD, Department of Rheumatology, Azienda USL-IRCCS di Reggio Emilia; A. Marchetta, MD, Unit of Rheumatology, Ospedale Sacro Cuore; N. Possemato, MD, Department of Rheumatology, Azienda USL-IRCCS di Reggio Emilia;. Tasso, MD, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II; C. Salvarani, MD, Full Professor, Department of Rheumatology, Azienda USL-IRCCS di Reggio Emilia, and Rheumatology Unit, University of Modena and Reggio Emilia; R. Scarpa, MD, Full Professor, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II; F. Caso, MD, PhD, Assistant Professor, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II
| | - Niccolò Possemato
- From the Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II, Naples; Department of Rheumatology, Azienda USL-Institute for Research and Health Care (IRCCS) di Reggio Emilia, Reggio Emilia; Unit of Rheumatology, Ospedale Sacro Cuore, Negrar, Verona, Italy; UK National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Centre, Leeds Teaching Hospitals Trust and the University of Leeds, UK; Rheumatology Unit, University of Modena and Reggio Emilia, Reggio Emilia, Italy.,N. Girolimetto, MD, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II; P. Macchioni, MD, Department of Rheumatology, Azienda USL-IRCCS di Reggio Emilia; I. Tinazzi, MD, Unit of Rheumatology, Ospedale Sacro Cuore; L. Costa, MD, PhD, Assistant Professor, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II; D. McGonagle, MD, PhD, Professor, FRCPI, NIHR Leeds Musculoskeletal Biomedical Research Centre, Leeds Teaching Hospitals Trust and the University of Leeds; R. Peluso, MD, PhD, Assistant Professor, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II; A. Del Puente, MD, Assistant Professor, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II; O. Addimanda, MD, Department of Rheumatology, Azienda USL-IRCCS di Reggio Emilia; A. Marchetta, MD, Unit of Rheumatology, Ospedale Sacro Cuore; N. Possemato, MD, Department of Rheumatology, Azienda USL-IRCCS di Reggio Emilia;. Tasso, MD, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II; C. Salvarani, MD, Full Professor, Department of Rheumatology, Azienda USL-IRCCS di Reggio Emilia, and Rheumatology Unit, University of Modena and Reggio Emilia; R. Scarpa, MD, Full Professor, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II; F. Caso, MD, PhD, Assistant Professor, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II
| | - Marco Tasso
- From the Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II, Naples; Department of Rheumatology, Azienda USL-Institute for Research and Health Care (IRCCS) di Reggio Emilia, Reggio Emilia; Unit of Rheumatology, Ospedale Sacro Cuore, Negrar, Verona, Italy; UK National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Centre, Leeds Teaching Hospitals Trust and the University of Leeds, UK; Rheumatology Unit, University of Modena and Reggio Emilia, Reggio Emilia, Italy.,N. Girolimetto, MD, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II; P. Macchioni, MD, Department of Rheumatology, Azienda USL-IRCCS di Reggio Emilia; I. Tinazzi, MD, Unit of Rheumatology, Ospedale Sacro Cuore; L. Costa, MD, PhD, Assistant Professor, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II; D. McGonagle, MD, PhD, Professor, FRCPI, NIHR Leeds Musculoskeletal Biomedical Research Centre, Leeds Teaching Hospitals Trust and the University of Leeds; R. Peluso, MD, PhD, Assistant Professor, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II; A. Del Puente, MD, Assistant Professor, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II; O. Addimanda, MD, Department of Rheumatology, Azienda USL-IRCCS di Reggio Emilia; A. Marchetta, MD, Unit of Rheumatology, Ospedale Sacro Cuore; N. Possemato, MD, Department of Rheumatology, Azienda USL-IRCCS di Reggio Emilia;. Tasso, MD, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II; C. Salvarani, MD, Full Professor, Department of Rheumatology, Azienda USL-IRCCS di Reggio Emilia, and Rheumatology Unit, University of Modena and Reggio Emilia; R. Scarpa, MD, Full Professor, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II; F. Caso, MD, PhD, Assistant Professor, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II
| | - Carlo Salvarani
- From the Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II, Naples; Department of Rheumatology, Azienda USL-Institute for Research and Health Care (IRCCS) di Reggio Emilia, Reggio Emilia; Unit of Rheumatology, Ospedale Sacro Cuore, Negrar, Verona, Italy; UK National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Centre, Leeds Teaching Hospitals Trust and the University of Leeds, UK; Rheumatology Unit, University of Modena and Reggio Emilia, Reggio Emilia, Italy.,N. Girolimetto, MD, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II; P. Macchioni, MD, Department of Rheumatology, Azienda USL-IRCCS di Reggio Emilia; I. Tinazzi, MD, Unit of Rheumatology, Ospedale Sacro Cuore; L. Costa, MD, PhD, Assistant Professor, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II; D. McGonagle, MD, PhD, Professor, FRCPI, NIHR Leeds Musculoskeletal Biomedical Research Centre, Leeds Teaching Hospitals Trust and the University of Leeds; R. Peluso, MD, PhD, Assistant Professor, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II; A. Del Puente, MD, Assistant Professor, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II; O. Addimanda, MD, Department of Rheumatology, Azienda USL-IRCCS di Reggio Emilia; A. Marchetta, MD, Unit of Rheumatology, Ospedale Sacro Cuore; N. Possemato, MD, Department of Rheumatology, Azienda USL-IRCCS di Reggio Emilia;. Tasso, MD, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II; C. Salvarani, MD, Full Professor, Department of Rheumatology, Azienda USL-IRCCS di Reggio Emilia, and Rheumatology Unit, University of Modena and Reggio Emilia; R. Scarpa, MD, Full Professor, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II; F. Caso, MD, PhD, Assistant Professor, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II
| | - Raffaele Scarpa
- From the Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II, Naples; Department of Rheumatology, Azienda USL-Institute for Research and Health Care (IRCCS) di Reggio Emilia, Reggio Emilia; Unit of Rheumatology, Ospedale Sacro Cuore, Negrar, Verona, Italy; UK National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Centre, Leeds Teaching Hospitals Trust and the University of Leeds, UK; Rheumatology Unit, University of Modena and Reggio Emilia, Reggio Emilia, Italy. .,N. Girolimetto, MD, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II; P. Macchioni, MD, Department of Rheumatology, Azienda USL-IRCCS di Reggio Emilia; I. Tinazzi, MD, Unit of Rheumatology, Ospedale Sacro Cuore; L. Costa, MD, PhD, Assistant Professor, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II; D. McGonagle, MD, PhD, Professor, FRCPI, NIHR Leeds Musculoskeletal Biomedical Research Centre, Leeds Teaching Hospitals Trust and the University of Leeds; R. Peluso, MD, PhD, Assistant Professor, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II; A. Del Puente, MD, Assistant Professor, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II; O. Addimanda, MD, Department of Rheumatology, Azienda USL-IRCCS di Reggio Emilia; A. Marchetta, MD, Unit of Rheumatology, Ospedale Sacro Cuore; N. Possemato, MD, Department of Rheumatology, Azienda USL-IRCCS di Reggio Emilia;. Tasso, MD, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II; C. Salvarani, MD, Full Professor, Department of Rheumatology, Azienda USL-IRCCS di Reggio Emilia, and Rheumatology Unit, University of Modena and Reggio Emilia; R. Scarpa, MD, Full Professor, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II; F. Caso, MD, PhD, Assistant Professor, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II.
| | - Francesco Caso
- From the Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II, Naples; Department of Rheumatology, Azienda USL-Institute for Research and Health Care (IRCCS) di Reggio Emilia, Reggio Emilia; Unit of Rheumatology, Ospedale Sacro Cuore, Negrar, Verona, Italy; UK National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Centre, Leeds Teaching Hospitals Trust and the University of Leeds, UK; Rheumatology Unit, University of Modena and Reggio Emilia, Reggio Emilia, Italy.,N. Girolimetto, MD, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II; P. Macchioni, MD, Department of Rheumatology, Azienda USL-IRCCS di Reggio Emilia; I. Tinazzi, MD, Unit of Rheumatology, Ospedale Sacro Cuore; L. Costa, MD, PhD, Assistant Professor, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II; D. McGonagle, MD, PhD, Professor, FRCPI, NIHR Leeds Musculoskeletal Biomedical Research Centre, Leeds Teaching Hospitals Trust and the University of Leeds; R. Peluso, MD, PhD, Assistant Professor, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II; A. Del Puente, MD, Assistant Professor, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II; O. Addimanda, MD, Department of Rheumatology, Azienda USL-IRCCS di Reggio Emilia; A. Marchetta, MD, Unit of Rheumatology, Ospedale Sacro Cuore; N. Possemato, MD, Department of Rheumatology, Azienda USL-IRCCS di Reggio Emilia;. Tasso, MD, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II; C. Salvarani, MD, Full Professor, Department of Rheumatology, Azienda USL-IRCCS di Reggio Emilia, and Rheumatology Unit, University of Modena and Reggio Emilia; R. Scarpa, MD, Full Professor, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II; F. Caso, MD, PhD, Assistant Professor, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, University Federico II
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138
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Bird P. Imaging in the Mobile Domain. Rheum Dis Clin North Am 2019; 45:291-302. [DOI: 10.1016/j.rdc.2019.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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139
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Vivino FB, Bunya VY, Massaro-Giordano G, Johr CR, Giattino SL, Schorpion A, Shafer B, Peck A, Sivils K, Rasmussen A, Chiorini JA, He J, Ambrus JL. Sjogren's syndrome: An update on disease pathogenesis, clinical manifestations and treatment. Clin Immunol 2019; 203:81-121. [PMID: 31022578 DOI: 10.1016/j.clim.2019.04.009] [Citation(s) in RCA: 95] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 04/19/2019] [Indexed: 12/23/2022]
Affiliation(s)
- Frederick B Vivino
- Penn Sjögren's Center, Penn Presbyterian Medical Center, University of Pennsylvania Perelman School of Medicine, 3737 Market Street, Philadelphia, PA 19104, USA.
| | - Vatinee Y Bunya
- Scheie Eye Institute, University of Pennsylvania Perelman School of Medicine, 51 N. 39(th) Street, Philadelphia, PA 19104, USA.
| | - Giacomina Massaro-Giordano
- Scheie Eye Institute, University of Pennsylvania Perelman School of Medicine, 51 N. 39(th) Street, Philadelphia, PA 19104, USA.
| | - Chadwick R Johr
- Penn Sjögren's Center, Penn Presbyterian Medical Center, University of Pennsylvania Perelman School of Medicine, 3737 Market Street, Philadelphia, PA 19104, USA.
| | - Stephanie L Giattino
- Penn Sjögren's Center, Penn Presbyterian Medical Center, University of Pennsylvania Perelman School of Medicine, 3737 Market Street, Philadelphia, PA 19104, USA.
| | - Annemarie Schorpion
- Penn Sjögren's Center, Penn Presbyterian Medical Center, University of Pennsylvania Perelman School of Medicine, 3737 Market Street, Philadelphia, PA 19104, USA.
| | - Brian Shafer
- Scheie Eye Institute, University of Pennsylvania Perelman School of Medicine, 51 N. 39(th) Street, Philadelphia, PA 19104, USA.
| | - Ammon Peck
- Department of Infectious Diseases and Immunology, University of Florida College of Veterinary Medicine, PO Box 100125, Gainesville, FL 32610, USA.
| | - Kathy Sivils
- Oklahoma Medical Research Foundation, Arthritis and Clinical Immunology Program, 825 NE 13th Street, OK 73104, USA.
| | - Astrid Rasmussen
- Oklahoma Medical Research Foundation, Arthritis and Clinical Immunology Program, 825 NE 13th Street, OK 73104, USA.
| | - John A Chiorini
- NIH, Adeno-Associated Virus Biology Section, National Institute of Dental and Craniofacial Research, Building 10, Room 1n113, 10 Center DR Msc 1190, Bethesda, MD 20892-1190, USA.
| | - Jing He
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing 100044, China
| | - Julian L Ambrus
- Division of Allergy, Immunology and Rheumatology, SUNY at Buffalo School of Medicine, 100 High Street, Buffalo, NY 14203, USA.
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140
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Alberich-Bayarri Á, Tomás-Cucarella J, Torregrosa-Lloret A, Sáiz Rodriguez J, Martí-Bonmatí L. Optimisation of ultrasound liver perfusion through a digital reference object and analysis tool. Eur Radiol Exp 2019; 3:15. [PMID: 30945029 PMCID: PMC6447630 DOI: 10.1186/s41747-019-0086-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 01/04/2019] [Indexed: 11/10/2022] Open
Abstract
Background Conventional ultrasound (US) provides important qualitative information, although there is a need to evaluate the influence of the input parameters on the output signal and standardise the acquisition for an adequate quantitative perfusion assessment. The present study analyses how the variation in the input parameters influences the measurement of the perfusion parameters. Methods A software tool with simulator of the conventional US signal was created, and the influence of the different input variables on the derived biomarkers was analysed by varying the image acquisition configuration. The input parameters considered were the dynamic range, gain, and frequency of the transducer. Their influence on mean transit time (MTT), the area under the curve (AUC), maximum intensity (MI), and time to peak (TTP) parameters as outputs of the quantitative perfusion analysis was evaluated. A group of 13 patients with hepatocarcinoma was analysed with both a commercial tool and an in-house developed software. Results The optimal calculated inputs which minimise errors while preserving images’ readability consisted of gain of 15 dB, dynamic range of 60 dB, and frequency of 1.5 MHz. The comparison between the in-house developed software and the commercial software provided different values for MTT and AUC, while MI and TTP were highly similar. Conclusion Input parameter selection introduces variability and errors in US perfusion parameter estimation. Our results may add relevant insight into the current knowledge of conventional US perfusion and its use in lesions characterisation, playing in favour of optimised standardised parameter configuration to minimise variability.
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Affiliation(s)
- Ángel Alberich-Bayarri
- Biomedical Imaging Research Group (GIBI2^30), Hospital Universitari i Politècnic La Fe, Avda. Fernando Abril Martorell 106, Torre A, 46026, Valencia, Spain. .,Quantitative Imaging Biomarkers in Medicine, QUIBIM SL, Valencia, Spain.
| | - Jose Tomás-Cucarella
- Biomedical Imaging Research Group (GIBI2^30), Hospital Universitari i Politècnic La Fe, Avda. Fernando Abril Martorell 106, Torre A, 46026, Valencia, Spain
| | | | - Javier Sáiz Rodriguez
- Department of Electronics Engineering, Polytechnics University of Valencia, Valencia, Spain
| | - Luis Martí-Bonmatí
- Biomedical Imaging Research Group (GIBI2^30), Hospital Universitari i Politècnic La Fe, Avda. Fernando Abril Martorell 106, Torre A, 46026, Valencia, Spain
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141
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Hernández-Díaz C, Sánchez-Bringas G, Ventura-Ríos L, Robles-San Román M, Filippucci E. Ankle pain in rheumatoid arthritis: comparison of clinical and sonographic findings. Clin Rheumatol 2019; 38:2891-2895. [DOI: 10.1007/s10067-019-04532-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 03/20/2019] [Accepted: 03/22/2019] [Indexed: 12/30/2022]
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142
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Ultrasound imaging in rheumatoid arthritis. Radiol Med 2019; 124:1087-1100. [DOI: 10.1007/s11547-019-01002-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 02/04/2019] [Indexed: 12/13/2022]
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143
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Han N, Tian X. Detection of subclinical synovial hypertrophy by musculoskeletal gray-scale/ power Doppler ultrasonography in systemic lupus erythematosus patients: A cross-sectional study. Int J Rheum Dis 2019; 22:1058-1069. [PMID: 30834675 DOI: 10.1111/1756-185x.13525] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Revised: 01/12/2019] [Accepted: 02/01/2019] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Laboratory investigations are invasive methods. Magnetic resonance imaging (MRI) has a small field of view. Ultrasound can be performed at multiple parts of the body. The objective of the study was to find out subclinical synovial hypertrophy in systemic lupus erythematosus patients using gray-scale/power Doppler ultrasonography. METHODS A total of 247 systemic lupus erythematosus (without musculoskeletal involvement) patients from 21 February 2017 to 28 October 2018 were included in the cross-sectional study. Patients were subjected to physical examinations, laboratory tests, and gray-scale/power Doppler ultrasonography examinations. Synovial hypertrophy was confirmed if it was present in at least 4 out of 100 of the examined location sites. MRI examinations were performed for confirmation purposes. Spearman correlation was performed between imaging and laboratory investigations at the 99% confidence level. RESULTS No correlation was observed for results of synovial hypertrophy between physical examinations/laboratory tests and gray-scale/power Doppler ultrasonography examinations except erythrocyte sedimentation rate (r = 0.354). Cost of laboratory tests (315.47 ± 19.15 ¥/person) for subclinical synovial hypertrophy detection was higher than that of gray-scale/power Doppler ultrasonography examinations (135.47 ± 8.17 ¥/person, P <0.0001, q = 230.87). Results of gray-scale/power Doppler ultrasonography have a correlation with results of MRI (r = 0.34). CONCLUSION Only perform gray-scale/power Doppler ultrasonography examinations for regular maintenance of rheumatologic disease in systemic lupus erythematosus patients.
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Affiliation(s)
- Nan Han
- Department of Ultrasonography, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Xiliang Tian
- Department of Orthopedics, The First Affiliated Hospital of Dalian Medical University, Dalian, China
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144
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Ultrasound and clinical features of hip involvement in patients with gout. Joint Bone Spine 2019; 86:633-636. [PMID: 30779966 DOI: 10.1016/j.jbspin.2019.01.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 01/30/2019] [Indexed: 01/15/2023]
Abstract
OBJECTIVES To investigate the prevalence of the ultrasound findings indicative of monosodium urate crystal deposits at the hip joint in patients with gout and to explore the association between the ultrasound findings and the clinical and serological features. METHODS Bilateral ultrasound assessment of the hip joint was carried out in 40 consecutive patients with gout, diagnosed according to the latest Gout American College of Rheumatology/European League Against Rheumatism classification criteria, and 25 disease controls. Ultrasound evidence of crystal deposits was obtained using the Outcome Measures in Rheumatology definitions: hip intra-articular aggregates and/or tophi, and "double contour" sign over the hyaline cartilage of the femoral head. RESULTS The ultrasound examination revealed crystal deposits in at least one hip in 17 out of 40 patients (42.5%) with gout, and in 2 out of 25 disease controls (8.0%) (P = 0.0029). Aggregates, tophi, and "double contour" sign were found in at least one hip in 13 (32.5%), 6 (15.0%) and 6 (15.0%) out of 40 patients with gout, respectively. A moderate association between disease duration (P = 0.004, Rpb = 0.442), number of gouty "attacks" in the previous year (P = 0.029, Rpb = 0.346), presence of subcutaneous tophi (P = 0.037, V = 0.330) and ultrasound crystal deposits was found. CONCLUSION Our results indicate that detecting monosodium urate crystals by ultrasound is common at hip joint in patients with gout.
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Symptomatic psoriatic dactylitis is associated with ultrasound determined extra-synovial inflammatory features and shorter disease duration. Clin Rheumatol 2018; 38:903-911. [PMID: 30569440 DOI: 10.1007/s10067-018-4400-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 12/03/2018] [Accepted: 12/09/2018] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To explore the link between ultrasonographic features of dactylitis in psoriatic arthritis (PsA) and symptoms, digital tenderness and duration of dactylitis. METHODS Forty-eight cases of PsA dactylitis were investigated using high frequency ultrasound (US) both in grey scale (GS) and Power Doppler (PD), evaluating the presence and the degree of flexor tenosynovitis, peri-tendinous oedema, subcutaneous PD, extensor tendon involvement, GS synovitis and intra-articular PD signal (PDS) of the involved digits. Patients were compared according to the presence of local pain and digital tenderness, the duration of dactylitis and the concomitant treatment. RESULTS The presence of pain/tenderness was positively associated with US GS flexor tenosynovitis of grade > 2 (p < 0.001), PD-flexor tenosynovitis (p < 0.001), peri-tendinous oedema (p < 0.001) and subcutaneous PDS (p < 0.001); moreover, it was negatively associated with GS synovitis (p < 0.001) and intra-articular PD (p < 0.001). The same positive and negative association with US findings were found comparing patients with duration of dactylitis shorter or longer than the median (24 weeks) (p < 0.001 for all comparisons). CONCLUSIONS Pain and digital tenderness are linked to dactylitis duration and earlier lesions are associated with extra synovial inflammatory changes. These findings suggest a hitherto unappreciated extra synovial basis for symptoms in PsA dactylitis.
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146
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Rossi F, Romano N, Muda A, Martinoli C, Tagliafico A. Wrist and Hand Ultrasound: Reliability of Side-to-Side Comparisons of Very Small (<2-mm) Clinically Relevant Anatomic Structures. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:2785-2795. [PMID: 29689624 DOI: 10.1002/jum.14635] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 02/19/2018] [Accepted: 02/21/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES In ultrasound (US) examinations of clinically relevant very small structures of the wrist and hand, the healthy contralateral side can be used as a reference to identify subtle abnormalities. Intraindividual side-to-side variability must be minimal. The aim of this study was to assess the reliability of side-to-side US evaluations of very small structures of the wrist and hand. METHODS Forty-one healthy volunteers were prospectively studied. Small structures of the wrist and hand were evaluated bilaterally by 2 musculoskeletal radiologists in separate sessions. The first annular pulleys of the second finger and the thumb, sagittal band of the third finger, extensor and flexor retinacula, ulnar collateral ligament of the thumb, radial collateral ligament of the second finger, and palmar cutaneous branches of the median and ulnar nerves were considered. To assess intra- and inter-reader agreement, 10 of 41 (24%) examinations were repeated. Nonparametric statistics were used. RESULTS Data were not normally distributed (P > .001). Intra-reader agreement was κ = 0.674 (95% confidence interval [CI], 0.57-0.78), and inter-reader agreement was κ = 0.935 (95% CI, 0.92-0.95). The mean value ± SD for all of the structures was 0.78 ± 0.44 mm. The overall coefficient of variation was 9.8% ± 0.07%. The intraclass correlation coefficient was 0.97 (95% CI, 0.96-0.98). CONCLUSIONS In clinical practice, the healthy contralateral side can be used as a reference during a real-time musculoskeletal US evaluation of small (<2-mm) structures.
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Affiliation(s)
- Federica Rossi
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Nicola Romano
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Alessandro Muda
- Department of Radiology, Ospedale Policlinico San Martino, Genoa, Italy
| | - Carlo Martinoli
- Department of Health Sciences, University of Genoa, Genoa, Italy
- Department of Radiology, Ospedale Policlinico San Martino, Genoa, Italy
| | - Alberto Tagliafico
- Department of Health Sciences, University of Genoa, Genoa, Italy
- Department of Radiology, Ospedale Policlinico San Martino, Genoa, Italy
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147
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Asano T, Furuya MY, Fujita Y, Matsuoka N, Sato S, Kobayashi H, Watanabe H, Honda A, Migita K. Diagnostic value of ultrasonography in synovitis-acne-pustulosis-hyperostosis-osteitis (SAPHO) syndrome: A case report. Medicine (Baltimore) 2018; 97:e12725. [PMID: 30313072 PMCID: PMC6203473 DOI: 10.1097/md.0000000000012725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Synovitis-acne-pustulosis-hyperostosis-osteitis (SAPHO) syndrome is a rare condition that affects the skin, bones, and joints. Diagnosis of SAPHO syndrome is established based on clinical manifestations and imaging features on radiography or magnetic resonance imaging. PATIENT CONCERNS We report a 44-year-old male with a 20-year history of pustulosis who presented with pain in the lower extremities. Plain radiography demonstrated hyperostosis with subperiosteal erosions in the right tibia. Magnetic resonance imaging and computed tomography showed inflammatory accumulation, whereas musculoskeletal ultrasonography clearly depicted a periosteal reaction, osteitis, and enthesitis with abnormal blood flow in the surface of the right tibia. DIAGNOSES A diagnosis of SAPHO syndrome was made. INTERVENTIONS The patient was treated with combination therapy comprising prednisolone, methotrexate, and infliximab, which resulted in clinical improvement. OUTCOMES The elevated levels of C-reactive protein and matrix metalloproteinase-3 normalized, and the abnormal ultrasonographic findings disappeared. LESSONS The present case report demonstrates that multiple imaging modalities are important for the definitive diagnosis of SAPHO syndrome. Ultrasonography might be a useful tool for evaluating local musculoskeletal inflammation in patients with SAPHO syndrome.
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Affiliation(s)
| | | | | | | | | | | | | | - Aki Honda
- Department of Dermatology, School of Medicine, Fukushima Medical University, Fukushima, Japan
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Sconfienza LM, Albano D, Allen G, Bazzocchi A, Bignotti B, Chianca V, Facal de Castro F, Drakonaki EE, Gallardo E, Gielen J, Klauser AS, Martinoli C, Mauri G, McNally E, Messina C, Mirón Mombiela R, Orlandi D, Plagou A, Posadzy M, de la Puente R, Reijnierse M, Rossi F, Rutkauskas S, Snoj Z, Vucetic J, Wilson D, Tagliafico AS. Clinical indications for musculoskeletal ultrasound updated in 2017 by European Society of Musculoskeletal Radiology (ESSR) consensus. Eur Radiol 2018; 28:5338-5351. [DOI: 10.1007/s00330-018-5474-3] [Citation(s) in RCA: 132] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 04/02/2018] [Accepted: 04/11/2018] [Indexed: 12/11/2022]
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Schirmer M, Puchner R. Rheumatologie in Österreich. Z Rheumatol 2018. [DOI: 10.1007/s00393-018-0430-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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