191 - Are Training Sessions Useful for Ultrasound Scan Evaluation of Synovitis In Rheumatoid Arthritis?

Sunday, November 6, 2011: 9:00 AM-6:00 PM
Hall F2 - Poster Hall (McCormick Place West)
Andrés Ponce, Hospital General de Granollers, Granollers, Spain, Juan J. Alegre, Hospital Universitario Dr Peset, Valencia, Spain, Manuel Castaño, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain, Ricardo Gutierrez-Polo, C.H. de Navarra, Pamplona, Spain, Francisco G. Jiménez-Núñez, Hospital Regional Universitario Carlos Haya., Malaga, Spain, María P. Macarrón, Hospital Clínico San Carlos, Madrid, Spain and Jesús Garrido, Facultad de Psicología.Universidad Autónoma de Madrid, Madrid, Spain
Presentation Number: 191

Background/Purpose: US is becoming a realistic tool for synovitis assessment in rheumatoid arthritis (RA), although reliability remains as a challenging issue. Therefore, training sessions (TS) are needed to improve the intra and inter-observer reliability. However, the improvement in reliability due to TS has not been quantified. The aim of this study is to measure the reliability of the US evaluation for different joints, both before and after TS.

Method: 6 rheumatologists expert in US evaluated the presence of synovitis and PD signal in 173 static images of joints from RA patients (45 wrists, 27 metacarpophalangeals, 25 ankles, 36 metatarsophanlangeals, 20 knees, and 20 elbows) recorded in a regular clinical setting by 65 different rheumatologists, with evaluation time limited to 1 minute per image. Fifteen to thirty days later they took a second evaluation of the images of a joint assigned to each researcher (Pre-TS). One month later a 3-hour standardization and training session (TS) took place. Fifteen days after that the rheumatologists evaluated the images following  the same procedure, first all the images and, 15-30 days apart, images of assigned joint (Post-TS).  Intra and inter-observer kappa were calculated, both pre-TS and post-TS.

Result: The intra- and inter-observer kappa values for each joint, pre-TS and post-TS, are shown in the following table:

 

Intra-observer kappa

Inter-observer kappa

 

Power Doppler

Grey scale

Power Doppler

Grey scale

Joint

Pre-TS

Post-TS

Pre-TS

Post-TS

Pre-TS

Post-TS

Pre-TS

Post-TS

wrist

0.562

0.769

0.319

0.644

0.684

0.760

0.373

0.478

MCP

0.710

0.913

0.578

0.777

0.568

0.699

0.359

0.551

Ankle

0.845

0.930

0.699

0.762

0.685

0.676

0.302

0.588

MTP

0.932

0.904

0.273

0.669

0.762

0.924

0.476

0.485

Knee

0.142

0.824

0.027

0.441

0.479

0.921

0.455

0.533

Elbow

0.434

0.855

0.220

0.806

0.518

0.816

0.359

0.439

After TS the magnitude of the reliability statistic kappa increased mainly for those joints that showed the lowest kappa values at the pre-TS evaluation.

Conclusion: The intra an inter-observer reliability in the evaluation of the static images, taken in regular clinical settings, improve clearly after a training session.  


Keywords: rheumatoid arthritis (RA), synovitis and ultrasound

Disclosure: A. Ponce, None; J. J. Alegre, None; M. Castaño, None; R. Gutierrez-Polo, None; F. G. Jiménez-Núñez, None; M. P. Macarrón, None; J. Garrido, None.