title: Ultrasound in the evaluation of enthesitis: status and perspectives.
abstract: BACKGROUND
  An increasing number of studies have applied ultrasound to the evaluation of entheses in spondyloarthritis patients. However, no clear agreement exists on the definition of enthesitis, on the number and choice of entheses to examine and on ultrasound technique, which may all affect the results of the examination. The objectives of this study were to first determine the level of homogeneity in the ultrasound definitions for the principal lesions of enthesitis in the published literature and second, to evaluate the metric properties of ultrasound for detecting enthesitis according to the OMERACT filter.
  
  
  METHODS
  Search was performed in PUBMED and EMBASE. Both grey-scale and Doppler definitions of enthesitis, including describing features of enthesitis, were collected and metrological qualities of studies were assessed.
  
  
  RESULTS
  After selection, 48 articles were analyzed. The definition of ultrasound enthesitis and elementary features varied among authors. Grey-scale enthesitis was characterized by increasing thickness (94% of studies), hypoechogenicity (83%), enthesophytes (69%), erosions (67%), calcifications (52%), associated bursitis (46%) and cortical irregularities (29%). Only 46% of studies reported the use of Doppler. High discrepancies were observed on frequency, type of probe and Doppler mode used. Face and content validity were the most frequently evaluated criteria (43%) followed by reliability (29%) and responsiveness (19%).
  
  
  CONCLUSIONS
  Ultrasound has evidence to support face, content validity and reliability for the evaluation of enthesitis, though there is a lack of well-reported methodology in most of the studies. Consensus on elementary lesions and standardization of exam is needed to determine the ultrasound definition of enthesitis in grey-scale and in Doppler for future applications.
authors.affiliation: Rheumatology Department, Université Paris 6-Pierre et Marie Curie, Hôpital La Pitié Salpetrière, APHP, 83 Boulevard de l’hôpital 75013 Paris, France.
authors.forename: Frédérique
authors.initials: F
authors.lastname: Gandjbakhch
authors.forename: Lene
authors.initials: L
authors.lastname: Terslev
authors.forename: Fredrick
authors.initials: F
authors.lastname: Joshua
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Wakefield
authors.forename: Esperanza
authors.initials: E
authors.lastname: Naredo
authors.forename: Maria Antonietta
authors.initials: MA
authors.lastname: D'Agostino
mesh_terms: D006801:Humans; D015203:Reproducibility of Results; D012107:Research Design / Q000592:standards; D012216:Rheumatic Diseases / Q000000981:diagnostic imaging*; D025241:Spondylarthritis / Q000000981:diagnostic imaging*; D018608:Ultrasonography, Doppler / Q000379:methods* / Q000592:standards*
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