Abstract
To compare the intra- and interobserver reliability of three-dimensional (3D) volumetric versus conventional two-dimensional (2D) power Doppler ultrasonography (US) in the assessment of peripheral enthesitis in spondylarthritis (SpA). Sixteen patients with SpA according to ASAS criteria were included. Two rheumatologists (one experimented in musculoskeletal US (sonographer 1) and one beginner (sonographer 2)) performed independently a 2D US scoring of the enthesis using the Madrid Sonographic Enthesis Index score followed by a 3D acquisition of the same entheseal sites. The reading of the 3D acquisition was performed a minimum of 1 week apart. Intraobserver reliability was evaluated by a second reading of the same images. The duration of 2D US scanning, 3D US acquisition and reading was recorded. Intraclass correlation coefficients (ICCs) were used for the reliability analysis. Intraobserver reproducibility was good to excellent for 2D US and good for 3D US (ICC (95 %CI) 2D US 0.776 (0.471–0.916) and 0.96 (0.892–0.986) and ICC (95 %CI) 3D US 0.796 (0.498–0.921) and 0.703 (0.325–0.886) for sonographer 1 and 2, respectively). Interobserver reliability was slightly better for 3D US than for 2D US (ICC (95 %CI) 0.776 (0.471–0.916) for 3D US versus 0.641 (0.221–0.859) for 2D US). The mean time (±SD) for 2D US scanning was 23 min (±4) whereas the mean time for 3D US volume acquisition and reading was 16.5 min (±2.6) (p < 0.001). 3D US showed good intra- and interobserver reliability in the assessment of enthesitis in SpA and shortened the needed time for scanning. It can be performed by a nonexperienced examiner without loss of reliability.
Similar content being viewed by others
References
Spadaro A, Iagnocco A, Perotta FM et al (2011) Clinical and ultrasonography assessment of peripheral enthesitis in ankylosing spondylitis. Rheumatology 50:2080–2086
Gutierrez M, Zeiler M, Filippucci E et al (2011) Sonographic subclinical entheseal involvement in dialysis patients. Clin Rheumatol 30:907–913
Queiro R, Alonso S, Alperi M et al (2012) Entheseal ultrasound abnormalities in patients with SAPHO syndrome. Clin Rheumatol 31:913–919
Koski JM, Saarakkala S, Helle M et al (2006) Power Doppler ultrasonography and synovitis: correlating ultrasound imaging with histopathological findings and evaluating the performance of ultrasound equipments. Ann Rheum Dis 65:1590–1595
De Miguel E, Cobo T, Munoz-Fernandez S et al (2009) Validity of enthesis ultrasound assessment in spondyloarthropathy. Ann Rheum Dis 68:169–174
D’agostino MA, Said-Nahal R, Hacquard-Bouder C et al (2003) Assessment of peripheral enthesitis in the spondylarthropathies by ultrasonography combined with Power Doppler: a cross-sectional study. Arthritis Rheum 48:523–533
Watanabe T, Takemura M, Sato M et al (2012) Quantitative analysis of vascularization in the finger joints in patients with rheumatoid arthritis using three-dimensional volumetric ultrasonography with power Doppler. Clin Rheumatol 31:299–307
Strunk J, Klingenberger P, Strube K et al (2006) Three-dimensional Doppler sonographic vascular imaging in regions with increased MR enhancement in inflamed wrists of patients with rheumatoid arthritis. Joint Bone Spine 73:518–522
Naredo E, Moller I, Acebes C et al (2010) Three-dimensional volumetric ultrasonography, does it improve reliability of musculoskeletal ultrasound. Clin Exp Rheumatol 28:79–82
Filippucci E, Meenagh G, De Agustin JJ et al (2007) Level of agreement between rheumatologists on US image acquisition using a 3D volumetric probe. Clin Exp Rheumatol 25:116
Filippucci E, Meenagh G, Delle Sedie A et al (2009) Ultrasound imaging for the rheumatologist XX. Sonographic assessment of hand and wrist joint involvement in rheumatoid arthritis: comparison between two- and three-dimensional ultrasonography. Clin Exp Rheumatol 27:197–200
De Miguel E, Falcao S, Castillo C et al (2011) Enthesis erosion in spondyloarthritis is not a persistent structural lesion. Ann Rheum Dis 70:2008–2010
Iagnocco A, Riente L, Delle Sedie A et al (2009) Ultrasound imaging for the rheumatologist. XXII. Achilles tendon involvement in spondyloarthritis. A multi-centre study using high frequency volumetric probe. Clin Exp Rheumatol 27:547–551
Rudwaleit M, Van Der Heijde D, Landewe R et al (2011) The assessment of Spondylarthritis International Society classification criteria for peripheral spondyloarthritis and for spondyloarthritis in general. Ann Rheum Dis 70:25–31
Pyun SB, Kang CH, Yoon JS et al (2011) Application of 3-dimensional ultrasonography in assessing carpal tunnel syndrome. J Ultrasound Med 30:3–10
Van Der Heijde DM (1996) Plain X-rays in rheumatoid arthritis: overview of scoring methods, their reliability and applicability. Baillieres Clin Rheumatol 10:435–453
D’agostino MA, Aegerter P, Jousse-Joulin S et al (2009) How to evaluate and improve the reliability of power Doppler ultrasonography for assessing enthesitis in spondylarthritis. Arthritis Rheum 61:61–69
Disclosures
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Mérot, O., Guillot, P., Maugars, Y. et al. Three-dimensional versus two-dimensional ultrasonographic assessment of peripheral enthesitis in spondylarthritis. Clin Rheumatol 33, 131–135 (2014). https://doi.org/10.1007/s10067-013-2424-y
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10067-013-2424-y