title: Defining enthesitis in spondyloarthritis by ultrasound: results of a Delphi process and of a reliability reading exercise.
abstract: OBJECTIVE
  To standardize ultrasound (US) in enthesitis.
  
  
  METHODS
  An initial Delphi exercise was undertaken to define US-detected enthesitis and its core components. These definitions were subsequently tested on static images taken from spondyloarthritis patients in order to evaluate their reliability.
  
  
  RESULTS
  Excellent agreement (>80%) was obtained for including hypoechogenicity, increased thickness of the tendon insertion, calcifications, enthesophytes, erosions, and Doppler activity as core elementary lesions of US-detected enthesitis. US definitions were subsequently obtained for each elementary component. On static images, the intraobserver reliability showed a high degree of variability for the detection of elementary lesions, with kappa coefficients ranging from 0.13-1. The interobserver kappa values were variable, with the lowest kappa coefficient for enthesophytes (0.24) and the highest coefficient for Doppler activity at the enthesis (0.63).
  
  
  CONCLUSIONS
  This is the first consensus-based US definition of enthesitis and its elementary components and the first step performed to ensure a higher degree of homogeneity and comparability of results between studies and in daily clinical work.
authors.affiliation: Copenhagen University Hospital at Glostrup, Copenhagen, Denmark.
authors.forename: L
authors.initials: L
authors.lastname: Terslev
authors.forename: E
authors.initials: E
authors.lastname: Naredo
authors.forename: A
authors.initials: A
authors.lastname: Iagnocco
authors.forename: P V
authors.initials: PV
authors.lastname: Balint
authors.forename: R J
authors.initials: RJ
authors.lastname: Wakefield
authors.forename: P
authors.initials: P
authors.lastname: Aegerter
authors.forename: S Z
authors.initials: SZ
authors.lastname: Aydin
authors.forename: A
authors.initials: A
authors.lastname: Bachta
authors.forename: H B
authors.initials: HB
authors.lastname: Hammer
authors.forename: G A W
authors.initials: GA
authors.lastname: Bruyn
authors.forename: E
authors.initials: E
authors.lastname: Filippucci
authors.forename: F
authors.initials: F
authors.lastname: Gandjbakhch
authors.forename: P
authors.initials: P
authors.lastname: Mandl
authors.forename: C
authors.initials: C
authors.lastname: Pineda
authors.forename: W A
authors.initials: WA
authors.lastname: Schmidt
authors.forename: M A
authors.initials: MA
authors.lastname: D'Agostino
mesh_terms: D001171:Arthritis, Juvenile / Q000000981:diagnostic imaging* / Q000453:epidemiology; D003697:Delphi Technique; D006801:Humans; D010819:Physician's Role; D011932:Reading; D015203:Reproducibility of Results; D025241:Spondylarthritis / Q000000981:diagnostic imaging* / Q000453:epidemiology; D011795:Surveys and Questionnaires / Q000592:standards; D014463:Ultrasonography