Article
Accuracy and performance of a handheld ultrasound device to assess articular and periarticular pathologies in patients with inflammatory arthritis
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Authors
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Giulia Corte
- Department of Internal Medicine 3, Friedrich-Alexander University (FAU) Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen; Deutsches Zentrum für Immuntherapie (DZI), FAU Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen
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Sara Bayat
- Department of Internal Medicine 3, Friedrich-Alexander University (FAU) Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen; Deutsches Zentrum für Immuntherapie (DZI), FAU Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen
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Koray Tascilar
- Department of Internal Medicine 3, Friedrich-Alexander University (FAU) Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen; Deutsches Zentrum für Immuntherapie (DZI), FAU Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen
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Larissa Valor-Méndez
- Department of Internal Medicine 3, Friedrich-Alexander University (FAU) Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen; Deutsches Zentrum für Immuntherapie (DZI), FAU Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen
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Louis Schuster
- Department of Internal Medicine 3, Friedrich-Alexander University (FAU) Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen; Deutsches Zentrum für Immuntherapie (DZI), FAU Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen
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Johannes Knitza
- Department of Internal Medicine 3, Friedrich-Alexander University (FAU) Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen; Deutsches Zentrum für Immuntherapie (DZI), FAU Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen
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Georg Schett
- Department of Internal Medicine 3, Friedrich-Alexander University (FAU) Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen; Deutsches Zentrum für Immuntherapie (DZI), FAU Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen
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Arnd Kleyer
- Department of Internal Medicine 3, Friedrich-Alexander University (FAU) Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen; Deutsches Zentrum für Immuntherapie (DZI), FAU Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen
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David Simon
- Department of Internal Medicine 3, Friedrich-Alexander University (FAU) Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen; Deutsches Zentrum für Immuntherapie (DZI), FAU Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen
| Published: | September 14, 2021 |
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Outline
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Introduction: Handheld ultrasound (HHUS) devices have increasingly found their way into clinical practice due to several advantages (e.g. portability, significantly lower purchase cost). However, there is no evidence to date on the accuracy and performance of HHUS in patients with inflammatory arthritis (IA). With this study we assessed the performance of a new HHUS machine in comparison to a conventional cart-based sonographic machine in patients with IA.
Methods: Consecutive IA patients of our outpatient clinic with at least one tender and swollen joint in the 66/68 joint count were enrolled. US was performed on clinically affected joints with corresponding tendons/entheses using both a cart-based sonographic device (“Samsung HS40”) and a HHUS device (“Butterfly iQ”) in standard scan positions. To avoid bias by the blinded reader, who otherwise would have been tempted to identify pathological findings for each examined joint, healthy volunteers were also included into the evaluation. One blinded reader scored all images for the presence of following pathologic findings: erosions, bony enlargement, synovial hyperthrophy, joint effusion, bursitis, tenosynovitis and enthesitis. In addition, synovitis was graded (B Mode and power Doppler (PD)) by the 4-level EULAR-OMERACT scale [1]. We calculated the overall concordance and the concordance by type of joint and type of pathological finding between the two devices (percentage of observation pairs in which the same rating was given by both devices). The Cohen’s kappa coefficient (κ) with 95% bootstrap confidence intervals was used to assess the agreement between the two US devices. To assess wether using the HHUS machine results in a time saving, we measured the time required to examine each one joint with both devices.
Results: 32 patients (20 rheumatoid arthritis, 10 psoriatic arthritis, 1 gouty arthritis, 1 systemic lupus erythematosus) ans 2 healthy volunteers were included in this study. 186 joints were examined, 67 (36%) of healthy volunteers. The overall concordance between the two devices in B-mode was 97 % (κappa: 0.90, 95%CI (0.89 - 0.94)). No significant differences were found in relation to type of joint or pathological finding. No PD-signal was detected by the HHUS device, whereas the cart-based device detected PD-signal in 61 joints (33%). The mean time per joint was 47.0 seconds for the HHUS devices versus 46.3 for the cart-based device.
Conclusion: The HHUS device has been shown to be accurate in the assessment of structural joint damage and inflammation in patients with IA, but only in B-mode. Significant improvements are still needed to reliable demonstrate blood flow detection by PD mode. No time saving using the HHUS device was found.
Disclosures: None to declare
References
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