title: Interobserver reliability in musculoskeletal ultrasonography: results from a "Teach the Teachers" rheumatologist course.
abstract: OBJECTIVE
  To assess the interobserver reliability of the main periarticular and intra-articular ultrasonographic pathologies and to establish the principal disagreements on scanning technique and diagnostic criteria between a group of experts in musculoskeletal ultrasonography.
  
  
  METHODS
  The shoulder, wrist/hand, ankle/foot, or knee of 24 patients with rheumatic diseases were evaluated by 23 musculoskeletal ultrasound experts from different European countries randomly assigned to six groups. The participants did not reach consensus on scanning method or diagnostic criteria before the investigation. They were unaware of the patients' clinical and imaging data. The experts from each group undertook a blinded ultrasound examination of the four anatomical regions. The ultrasound investigation included the presence/absence of joint effusion/synovitis, bony cortex abnormalities, tenosynovitis, tendon lesions, bursitis, and power Doppler signal. Afterwards they compared the ultrasound findings and re-examined the patients together while discussing their results.
  
  
  RESULTS
  Overall agreements were 91% for joint effusion/synovitis and tendon lesions, 87% for cortical abnormalities, 84% for tenosynovitis, 83.5% for bursitis, and 83% for power Doppler signal; kappa values were good for the wrist/hand and knee (0.61 and 0.60) and fair for the shoulder and ankle/foot (0.50 and 0.54). The principal differences in scanning method and diagnostic criteria between experts were related to dynamic examination, definition of tendon lesions, and pathological v physiological fluid within joints, tendon sheaths, and bursae.
  
  
  CONCLUSIONS
  Musculoskeletal ultrasound has a moderate to good interobserver reliability. Further consensus on standardisation of scanning technique and diagnostic criteria is necessary to improve musculoskeletal ultrasonography reproducibility.
authors.affiliation: Rheumatology, Hospital Severo Ochoa, Madrid, Spain. esnaredo@eresmas.com
authors.forename: E
authors.initials: E
authors.lastname: Naredo
authors.forename: I
authors.initials: I
authors.lastname: Möller
authors.forename: C
authors.initials: C
authors.lastname: Moragues
authors.forename: J J
authors.initials: JJ
authors.lastname: de Agustín
authors.forename: A K
authors.initials: AK
authors.lastname: Scheel
authors.forename: W
authors.initials: W
authors.lastname: Grassi
authors.forename: E
authors.initials: E
authors.lastname: de Miguel
authors.forename: M
authors.initials: M
authors.lastname: Backhaus
authors.forename: P
authors.initials: P
authors.lastname: Balint
authors.forename: G A W
authors.initials: GA
authors.lastname: Bruyn
authors.forename: M A
authors.initials: MA
authors.lastname: D'Agostino
authors.forename: E
authors.initials: E
authors.lastname: Filippucci
authors.forename: A
authors.initials: A
authors.lastname: Iagnocco
authors.forename: D
authors.initials: D
authors.lastname: Kane
authors.forename: J M
authors.initials: JM
authors.lastname: Koski
authors.forename: L
authors.initials: L
authors.lastname: Mayordomo
authors.forename: W A
authors.initials: WA
authors.lastname: Schmidt
authors.forename: W A A
authors.initials: WA
authors.lastname: Swen
authors.forename: M
authors.initials: M
authors.lastname: Szkudlarek
authors.forename: L
authors.initials: L
authors.lastname: Terslev
authors.forename: S
authors.initials: S
authors.lastname: Torp-Pedersen
authors.forename: J
authors.initials: J
authors.lastname: Uson
authors.forename: R J
authors.initials: RJ
authors.lastname: Wakefield
authors.forename: C
authors.initials: C
authors.lastname: Werner
mesh_terms: D000328:Adult; D000368:Aged; D002983:Clinical Competence; D004502:Education, Medical, Continuing / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009141:Musculoskeletal System / Q000000981:diagnostic imaging*; D015588:Observer Variation; D015203:Reproducibility of Results; D012216:Rheumatic Diseases / Q000000981:diagnostic imaging*; D012219:Rheumatology / Q000193:education* / Q000592:standards; D016037:Single-Blind Method; D014463:Ultrasonography / Q000592:standards