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Musculoskeletal ultrasound imaging of the plantar forefoot in patients with rheumatoid arthritis: inter-observer agreement between a podiatrist and a radiologist.

Bowen CJ, Dewbury K, Sampson M, Sawyer S, Burridge J, Edwards CJ, Arden NK - J Foot Ankle Res (2008)

Bottom Line: Moderate agreement on image acquisition and interpretation was achieved for bursitis (kappa 0.522; p < 0.01) and erosions (kappa 0.636; p < 0.01) and fair agreement for synovitis (kappa 0.216; p < 0.05) during the primary assessments.Following a further training session, substantial agreement (kappa 0.702) between the two investigators was recorded.This study demonstrated good inter-observer agreement between a podiatrist and radiologist on MSUS assessment of the forefoot, particularly for bursitis and erosions, in patients with rheumatoid arthritis.

View Article: PubMed Central - HTML - PubMed

Affiliation: School of Health Professions and Rehabilitation Sciences, University of Southampton, Southampton, UK. cjb5@soton.ac.uk.

ABSTRACT

Background: The use of musculoskeletal ultrasound (MSUS) in the diagnosis and management of foot and ankle musculoskeletal pathology is increasing. Due to the wide use of MSUS and the depth and breadth of training required new proposals advocate tailored learning of the technique to discrete fields of practice. The aims of the study were to evaluate the inter-observer agreement between a MSUS radiologist and a podiatrist, who had completed basic skills training in MSUS, in the MSUS assessment of the forefoot of patients with Rheumatoid Arthritis.

Methods: A consecutive sample of thirty-two patients with rheumatoid arthritis was assessed for presence of synovitis, erosions and bursitis within the forefoot using MSUS. All MSUS assessments were performed independently on the same day by a podiatrist and one of two Consultant Radiologists experienced in MSUS.

Results: Moderate agreement on image acquisition and interpretation was achieved for bursitis (kappa 0.522; p < 0.01) and erosions (kappa 0.636; p < 0.01) and fair agreement for synovitis (kappa 0.216; p < 0.05) during the primary assessments. Following a further training session, substantial agreement (kappa 0.702) between the two investigators was recorded. The sensitivity of the podiatrist using MSUS was 82.4% for detection of bursitis, 83.0% for detection of erosion and 84.0% for detection of synovitis. Specificity of the podiatrist using MSUS was 88.9% for detection of bursitis, 80.7% for detection of erosion and 35.9% for detection of synovitis.

Conclusion: This study demonstrated good inter-observer agreement between a podiatrist and radiologist on MSUS assessment of the forefoot, particularly for bursitis and erosions, in patients with rheumatoid arthritis. There is scope to further evaluate and consider the role of podiatrists in the MSUS imaging of the foot following appropriate training and also in the development of reliable protocols for MSUS assessment of the foot.

No MeSH data available.


Related in: MedlinePlus

A MSUS image of the left foot plantar metatarsal area of a study participant with RA. The MSUS image demonstrates bursitis as a demarcated complex mass protruding beyond the 3rd and 4th metatarsal heads with hypertrophied synovium and anechoic spaces containing synovial fluid (arrow). The image is seen from the plantar aspect and in the transverse plane. M4: 4th metatarsal head; M3: 3rd metatarsal head; P: plantar fat pad.
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Figure 1: A MSUS image of the left foot plantar metatarsal area of a study participant with RA. The MSUS image demonstrates bursitis as a demarcated complex mass protruding beyond the 3rd and 4th metatarsal heads with hypertrophied synovium and anechoic spaces containing synovial fluid (arrow). The image is seen from the plantar aspect and in the transverse plane. M4: 4th metatarsal head; M3: 3rd metatarsal head; P: plantar fat pad.

Mentions: The presence and location of any bursitis (see Figure 1) across the plantar forefoot region and any synovial thickening/synovitis and erosion (see Figure 2) within the second and fifth MTPJs identified by MSUS was recorded. Thirty minutes was allowed for each assessment and thus was limited to two joints within each foot. The second MTPJ was selected for investigation because it is in line with the centre of load through the forefoot during gait [22], it is easily accessible for the MSUS probes, and was considered representative of the MTPJs. The first MTPJ was excluded due to the sesamoid bones underlying its plantar aspect. The fifth MTPJ was also selected for its ease of accessibility with the MSUS probes and as it has been reported as being the most common site of radiographic and sonographic erosion in RA [23].


Musculoskeletal ultrasound imaging of the plantar forefoot in patients with rheumatoid arthritis: inter-observer agreement between a podiatrist and a radiologist.

Bowen CJ, Dewbury K, Sampson M, Sawyer S, Burridge J, Edwards CJ, Arden NK - J Foot Ankle Res (2008)

A MSUS image of the left foot plantar metatarsal area of a study participant with RA. The MSUS image demonstrates bursitis as a demarcated complex mass protruding beyond the 3rd and 4th metatarsal heads with hypertrophied synovium and anechoic spaces containing synovial fluid (arrow). The image is seen from the plantar aspect and in the transverse plane. M4: 4th metatarsal head; M3: 3rd metatarsal head; P: plantar fat pad.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2553775&req=5

Figure 1: A MSUS image of the left foot plantar metatarsal area of a study participant with RA. The MSUS image demonstrates bursitis as a demarcated complex mass protruding beyond the 3rd and 4th metatarsal heads with hypertrophied synovium and anechoic spaces containing synovial fluid (arrow). The image is seen from the plantar aspect and in the transverse plane. M4: 4th metatarsal head; M3: 3rd metatarsal head; P: plantar fat pad.
Mentions: The presence and location of any bursitis (see Figure 1) across the plantar forefoot region and any synovial thickening/synovitis and erosion (see Figure 2) within the second and fifth MTPJs identified by MSUS was recorded. Thirty minutes was allowed for each assessment and thus was limited to two joints within each foot. The second MTPJ was selected for investigation because it is in line with the centre of load through the forefoot during gait [22], it is easily accessible for the MSUS probes, and was considered representative of the MTPJs. The first MTPJ was excluded due to the sesamoid bones underlying its plantar aspect. The fifth MTPJ was also selected for its ease of accessibility with the MSUS probes and as it has been reported as being the most common site of radiographic and sonographic erosion in RA [23].

Bottom Line: Moderate agreement on image acquisition and interpretation was achieved for bursitis (kappa 0.522; p < 0.01) and erosions (kappa 0.636; p < 0.01) and fair agreement for synovitis (kappa 0.216; p < 0.05) during the primary assessments.Following a further training session, substantial agreement (kappa 0.702) between the two investigators was recorded.This study demonstrated good inter-observer agreement between a podiatrist and radiologist on MSUS assessment of the forefoot, particularly for bursitis and erosions, in patients with rheumatoid arthritis.

View Article: PubMed Central - HTML - PubMed

Affiliation: School of Health Professions and Rehabilitation Sciences, University of Southampton, Southampton, UK. cjb5@soton.ac.uk.

ABSTRACT

Background: The use of musculoskeletal ultrasound (MSUS) in the diagnosis and management of foot and ankle musculoskeletal pathology is increasing. Due to the wide use of MSUS and the depth and breadth of training required new proposals advocate tailored learning of the technique to discrete fields of practice. The aims of the study were to evaluate the inter-observer agreement between a MSUS radiologist and a podiatrist, who had completed basic skills training in MSUS, in the MSUS assessment of the forefoot of patients with Rheumatoid Arthritis.

Methods: A consecutive sample of thirty-two patients with rheumatoid arthritis was assessed for presence of synovitis, erosions and bursitis within the forefoot using MSUS. All MSUS assessments were performed independently on the same day by a podiatrist and one of two Consultant Radiologists experienced in MSUS.

Results: Moderate agreement on image acquisition and interpretation was achieved for bursitis (kappa 0.522; p < 0.01) and erosions (kappa 0.636; p < 0.01) and fair agreement for synovitis (kappa 0.216; p < 0.05) during the primary assessments. Following a further training session, substantial agreement (kappa 0.702) between the two investigators was recorded. The sensitivity of the podiatrist using MSUS was 82.4% for detection of bursitis, 83.0% for detection of erosion and 84.0% for detection of synovitis. Specificity of the podiatrist using MSUS was 88.9% for detection of bursitis, 80.7% for detection of erosion and 35.9% for detection of synovitis.

Conclusion: This study demonstrated good inter-observer agreement between a podiatrist and radiologist on MSUS assessment of the forefoot, particularly for bursitis and erosions, in patients with rheumatoid arthritis. There is scope to further evaluate and consider the role of podiatrists in the MSUS imaging of the foot following appropriate training and also in the development of reliable protocols for MSUS assessment of the foot.

No MeSH data available.


Related in: MedlinePlus