Reliability assessment of the definition of ultrasound enthesitis in SpA: results of a large, multicentre, international, web-based study.

OBJECTIVES: To investigate the reliability of the OMERACT US Task Force definition of US enthesitis in SpA. METHODS: In this web exercise, based on the evaluation of 101 images and 39 clips of the main entheses of the lower limbs, the elementary components included in the OMERACT definition of US enthesitis in SpA (hypoechoic areas, entheseal thickening, power Doppler signal at the enthesis, enthesophytes/calcifications, bone erosions) were assessed by 47 rheumatologists from 37 rheumatology centres in 15 countries. Inter- and intra-observer reliability of the US components of enthesitis was calculated using Light's kappa, Cohen's kappa, Prevalence And Bias Adjusted Kappa (PABAK) and their 95% CIs. RESULTS: Bone erosions and power Doppler signal at the enthesis showed the highest overall inter-reliability [Light's kappa: 0.77 (0.76-0.78), 0.72 (0.71-0.73), respectively; PABAK: 0.86 (0.86-0.87), 0.73 (0.73-0.74), respectively], followed by enthesophytes/calcifications [Light's kappa: 0.65 (0.64-0.65), PABAK: 0.67 (0.67-0.68)]. This was moderate for entheseal thickening [Light's kappa: 0.41 (0.41-0.42), PABAK: 0.41 (0.40-0.42)], and fair for hypoechoic areas [Light's kappa: 0.37 (0.36-0.38); PABAK: 0.37 (0.37-0.38)]. A similar trend was observed in the intra-reliability exercise, although this was characterized by an overall higher degree of reliability for all US elementary components compared with the inter-observer evaluation. CONCLUSIONS: The results of this multicentre, international, web-based study show a good reliability of the OMERACT US definition of bone erosions, power Doppler signal at the enthesis and enthesophytes/calcifications. The low reliability of entheseal thickening and hypoechoic areas raises questions about the opportunity to revise the definition of these two major components for the US diagnosis of enthesitis.

Reliability assessment of ultrasound muscle echogenicity in patients with rheumatic diseases: Results of a multicenter international web-based study.

Objectives: To investigate the inter/intra-reliability of ultrasound (US) muscle echogenicity in patients with rheumatic diseases. Methods: Forty-two rheumatologists and 2 radiologists from 13 countries were asked to assess US muscle echogenicity of quadriceps muscle in 80 static images and 20 clips from 64 patients with different rheumatic diseases and 8 healthy subjects. Two visual scales were evaluated, a visual semi-quantitative scale (0-3) and a continuous quantitative measurement ("VAS echogenicity," 0-100). The same assessment was repeated to calculate intra-observer reliability. US muscle echogenicity was also calculated by an independent research assistant using a software for the analysis of scientific images (ImageJ). Inter and intra reliabilities were assessed by means of prevalence-adjusted bias-adjusted Kappa (PABAK), intraclass correlation coefficient (ICC) and correlations through Kendall's Tau and Pearson's Rho coefficients. Results: The semi-quantitative scale showed a moderate inter-reliability [PABAK = 0.58 (0.57-0.59)] and a substantial intra-reliability [PABAK = 0.71 (0.68-0.73)]. The lowest inter and intra-reliability results were obtained for the intermediate grades (i.e., grade 1 and 2) of the semi-quantitative scale. "VAS echogenicity" showed a high reliability both in the inter-observer [ICC = 0.80 (0.75-0.85)] and intra-observer [ICC = 0.88 (0.88-0.89)] evaluations. A substantial association was found between the participants assessment of the semi-quantitative scale and "VAS echogenicity" [ICC = 0.52 (0.50-0.54)]. The correlation between these two visual scales and ImageJ analysis was high (tau = 0.76 and rho = 0.89, respectively). Conclusion: The results of this large, multicenter study highlighted the overall good inter and intra-reliability of the US assessment of muscle echogenicity in patients with different rheumatic diseases.

The value of osteopontin in the assessment of bone mineral density status in postmenopausal women.

BACKGROUND: Osteopontin (OPN) has been implicated in bone remodeling by activating the resorption process. We aimed to study the relationship between OPN, bone mineral density (BMD), bone turnover markers, vitamin D, and osteoporotic vertebral fractures in postmenopausal women. MATERIALS AND METHODS: Serum levels of OPN, osteocalcin, collagen type 1 cross-linked C-telopeptide (CTX), bone alkaline phosphatase, and vitamin D were assessed in 214 postmenopausal women. Bone mineral density was assessed by dual-energy x-ray absorptiometry in lumbar spine and femoral neck, and osteoporotic vertebral fractures by radiographs. RESULTS: Osteopontin levels were significantly higher in osteoporosis group versus osteopenic and normal group (all P < 0.05). The cutoff values of OPN for osteoporosis diagnosis were of 9.47 µg/L at the lumbar spine (area under the curve, 0.67; 95% confidence interval, 0.58-0.75; P < 0.001) and 10.15 µg/L at the femoral neck (area under the curve, 0.69; 95% confidence interval, 0.624-0.77; P = 0.0001), respectively. Postmenopausal women with osteoporosis-related vertebral fractures had significantly higher levels of OPN than those without vertebral fractures (15.69 ± 13.26 vs 12.63 ± 12.46 µg/L; P = 0.02). Significant negative correlations were found between OPN and BMD, which persisted after the adjustment for age at the lumbar spine. Osteopontin levels were directly correlated with bone turnover markers (osteocalcin, bone alkaline phosphatase, and CTX). No significant correlation was found between OPN and vitamin D. Multiple regression analysis showed that age, waist circumference, and CTX were independent predictors of serum OPN levels. CONCLUSIONS: High levels of OPN in postmenopausal women are associated with low BMD, increased levels of bone turnover markers, and osteoporotic vertebral fractures. These findings suggest that OPN might play some role in the pathophysiology of postmenopausal osteoporosis and warrant further clinical investigations.

The role of contrast enhanced ultrasound in the assessment of superficial lymph nodes.

Evaluation of superficial lymphadenopathy is important for patients with pathologies like head and neck cancers or breast cancer, as it helps the assessment of patient prognosis and the selection of treatment method. Cervical lymph nodes are also common sites of involvement in lymphoma. Lymphomatous nodes are usually difficult to differentiate from metastatic nodes in clinical examinations. As the treatment for lymphoma and metastases is different, accurate differential diagnosis between the two conditions is important. Ultrasound is a useful imaging modality in evaluation of superficial lymphadenopathy because of its high sensitivity and specificity, especially when combined histopathology. With the use of power Doppler sonography, the vasculature of the lymph nodes can also be evaluated, which provides additional information in the sonographic examination of superficial lymph nodes. But there are still nodes that cannot be examined by Doppler or their vasculature cannot be visualized. So, in the last decade, contrast-enhanced ultrasound was more and more discussed as a non-invasive method for a more accurate differential diagnosis of cervical lymphadenopathy.

Correlations between clinical probability and Doppler ultrasound results in the assessment of deep venous thrombosis.

UNLABELLED: Although the assessment of deep venous thrombosis (DVT) is based on clinical examination, the complementary tests and especially Doppler ultrasound plays the most important role in DVT diagnosis. OBJECTIVES: We aimed to establish the correlations between the clinical probability of DVT based on Wells score and the results of Doppler ultrasound exam. METHOD: We included 382 patients with clinical supposition of DVT divided into 3 groups based upon the probability of DVT (Wells score): low, moderate and high, respectively. All the patients were examined by Doppler ultrasonography. RESULTS: We noticed that DVT was confirmed by Doppler ultrasonography in more than half of the cases; the highest percent of confirmed cases were in the patients with a high probability of DVT (70.58%) whereas the lowest percent was associated with the low clinical probability (14.63%). DISCUSSIONS: These findings show the importance of the correct management of cases, starting with clinical data and including a complete anamnesis to identify the risk factors for DVT. CONCLUSIONS: There is a significant correlation between the Wells score reflected in the probability of DVT and the Doppler ultrasonography findings.