title: Examination of intra and interrater reliability with a new ultrasonographic reference atlas for scoring of synovitis in patients with rheumatoid arthritis.
abstract: OBJECTIVE
  Synovitis in patients with rheumatoid arthritis (RA) may be scored semiquantitatively (0-3) for B-mode (BM) and power Doppler (PD) ultrasonography. The objective was to assess the reliability of BM and PD examinations with a novel ultrasonographic atlas as reference.
  
  
  METHODS
  Representative ultrasound images (including scores 0-3) of BM and PD from 24 different joints were collected to develop an ultrasonographic atlas. Ten RA patients were assessed twice by five rheumatologists performing BM and PD scoring (0-3) of 16 joints bilaterally (metacarpophalangeal 1-5, wrist (radiocarpal, intercarpal, radioulnar), elbow, knee, talocrural and metatarsophalangeal 1-5), with the novel ultrasonographic atlas as a reference.
  
  
  RESULTS
  The median (range) percentages of exact agreements for BM/PD assessments were 73.1 (70.3-80.6)/83.7 (76.7-87.6) and for close agreement 98.1 (96.2-99.7)/98.0 (96.8-98.4) with weighted κ values of median (range) 0.77 (0.70-0.83) for BM and 0.83 (0.73-0.86) for PD. The intrarater intraclass correlation coefficients (ICC) for BM/PD scores were 0.95 (0.93-0.99)/0.97 (0.95-0.99) and interrater ICC were 0.95 (0.86-0.99)/0.97 (0.94-1.00). Scoring of 32 joints was completed in median 15 min (range 12-20).
  
  
  CONCLUSIONS
  With the use of an ultrasonographic atlas as reference high intra and interrater reliability was found for BM and PD scoring. This novel atlas may be a useful resource in clinical practice and research.
authors.affiliation: Department of Rheumatology, Diakonhjemmet Hospital, Box 23, Vinderen, N-0319 Oslo, Norway. hbham@online.no
authors.forename: Hilde Berner
authors.initials: HB
authors.lastname: Hammer
authors.forename: Pernille
authors.initials: P
authors.lastname: Bolton-King
authors.forename: Vivi
authors.initials: V
authors.lastname: Bakkeheim
authors.forename: Torill Helene
authors.initials: TH
authors.lastname: Berg
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Sundt
authors.forename: Anne Katrine
authors.initials: AK
authors.lastname: Kongtorp
authors.forename: Espen A
authors.initials: EA
authors.lastname: Haavardsholm
mesh_terms: D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000000981:diagnostic imaging; D001271:Atlases as Topic; D005260:Female; D006801:Humans; D008297:Male; D008662:Metacarpophalangeal Joint / Q000000981:diagnostic imaging; D008683:Metatarsophalangeal Joint / Q000000981:diagnostic imaging; D008875:Middle Aged; D015588:Observer Variation; D015203:Reproducibility of Results; D013585:Synovitis / Q000000981:diagnostic imaging* / Q000209:etiology*; D018608:Ultrasonography, Doppler / Q000379:methods