title: Is entheses ultrasound reliable? A reading Latin American exercise.
abstract: The objective of this study is to evaluate inter-reader entheses ultrasound (US) reliability and the influence of the type of image or degree of sonographer experience on US reliability in patients with spondyloarthritis (SpA). Eighteen Latin American ultrasonographers with different experience took part in an US reading exercise evaluating 60 entheseal images (50 % static images and 50 % videos) from healthy controls and SpA patients. The following sonographic lesions were assessed: structure, thickness, bone proliferation/tendon calcification, erosions, bursitis, and Doppler signal. Another group of three experts with significant experience in entheses US read all images too. Inter-reader reliability among participants and experts was calculated by the Cohen's kappa coefficient. Thresholds for kappa values were <0.2 poor, 0.21-0.4 fair, 0.41-0.6 moderate, 0.61-0.8 good, and 0.81-1 excellent. Furthermore, the results for the expert group were stratified based on the type of image. Kappa correlation coefficients among participants, showed variability depending on the type of lesion, being fair for structure and thickness, moderate for calcifications, erosions, and bursitis, and excellent for Doppler signal. Inter-reader reliability among experts was higher, being moderate for structure and thickness, good for calcifications and bursitis, and excellent for erosions and Doppler. Inter-reader reliability for assessing calcification and structure using static images was significantly higher than for videos. Overall inter-reader reliability for assessing entheses by US in SpA is moderate to excellent for most of the lesions. However, special training seems fundamental to achieve better inter-reader reliability. Moreover, the type of image influenced these results, where evaluation of entheses by videos was more difficult than by static images.
authors.affiliation: Musculoskeletal Ultrasound Laboratory, Instituto Nacional de Rehabilitación, México City, México.
authors.forename: L
authors.initials: L
authors.lastname: Ventura-Ríos
authors.affiliation: Rheumatology Unit, La Paz University Hospital, P° de la Castellana 261, 28046, Madrid, Spain.
authors.forename: V
authors.initials: V
authors.lastname: Navarro-Compan
authors.affiliation: Rheumatology Unit, Centro Médico Clínica Santa María La Dehesa, Santiago, Chile.
authors.forename: M
authors.initials: M
authors.lastname: Aliste
authors.affiliation: Rheumatology Unit, Hospital Edgardo Rebagliati Martins, Lima, Perú
authors.forename: M Alva
authors.initials: MA
authors.lastname: Linares
authors.affiliation: Rheumatology Unit, Hospital Félix Bulnes Cerda-Universidad Mayor, Santiago, Chile.
authors.forename: R
authors.initials: R
authors.lastname: Areny
authors.affiliation: Rheumatology Unit, Facultad de Ciencias Médicas, Hospital Nacional de Clínicas, Córdoba, Argentina.
authors.forename: M
authors.initials: M
authors.lastname: Audisio
authors.affiliation: Rheumatology Unit, Instituto Reumatológico Strusberg, Córdoba, Argentina.
authors.forename: A M
authors.initials: AM
authors.lastname: Bertoli
authors.affiliation: Rheumatology Unit, Instituto de Rehabilitación Psicofísica, Buenos Aires, Argentina.
authors.forename: T
authors.initials: T
authors.lastname: Cazenave
authors.affiliation: Reumatoligya SA, Rheumatology Medellin, Medellin, Colombia.
authors.forename: C
authors.initials: C
authors.lastname: Cerón
authors.affiliation: Rheumatology Unit, Hospital Universitario Fundación Santa Fé de Bogotá, Bogotá, Colombia.
authors.forename: M E
authors.initials: ME
authors.lastname: Díaz
authors.affiliation: Clinica Reumatologica, Universitá Politecnica delle Marche, Jesi, Ancona, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Gutiérrez
authors.affiliation: Musculoskeletal Ultrasound Laboratory, Instituto Nacional de Rehabilitación, México City, México.
authors.forename: C
authors.initials: C
authors.lastname: Hernández
authors.affiliation: Rheumatology Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
authors.forename: D A
authors.initials: DA
authors.lastname: Navarta
authors.affiliation: Dirección de Investigación, Instituto Nacional de Rehabilitación, México City, México.
authors.forename: C
authors.initials: C
authors.lastname: Pineda
authors.affiliation: Rheumatology Unit, Facultad de Ciencias Médicas, Hospital Nacional de Clínicas, Córdoba, Argentina.
authors.forename: G E
authors.initials: GE
authors.lastname: Py
authors.affiliation: Rheumatology Research and Musculoskeletal Ultrasound, Brown University, Providence VAMC, University Medicine Foundation/RIH, Providence, RI, USA.
authors.forename: A M
authors.initials: AM
authors.lastname: Reginato
authors.affiliation: Rheumatology Unit, Instituto de Rehabilitación Psicofísica, Buenos Aires, Argentina.
authors.forename: J
authors.initials: J
authors.lastname: Rosa
authors.affiliation: Rheumatology Ubit, Centro Médico Carlos Ardila Lulle, Bucaramanga, Colombia.
authors.forename: D L
authors.initials: DL
authors.lastname: Saaibi
authors.affiliation: Rheumatology Lima, Hospital Marino Molina Scippa ESSALUD, Lima, Peru.
authors.forename: O
authors.initials: O
authors.lastname: Sedano
authors.affiliation: Rheumatology Unit, Hospital Nacional Rosales, San Salvador, El Salvador.
authors.forename: C
authors.initials: C
authors.lastname: Solano
authors.affiliation: Rheumatology Unit, La Paz University Hospital, P° de la Castellana 261, 28046, Madrid, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Castillo-Gallego
authors.affiliation: Serviço de Reumatologia do Centro Hospitalar de Lisboa Ocidental, EPE, Hospital Egas Moniz, Lisbon, Portugal.
authors.forename: S
authors.initials: S
authors.lastname: Falçao
authors.affiliation: Rheumatology Unit, La Paz University Hospital, P° de la Castellana 261, 28046, Madrid, Spain. eugenio.demiguel@gmail.com.
authors.forename: E
authors.initials: E
authors.lastname: De Miguel
mesh_terms: D002983:Clinical Competence; D000070676:Enthesopathy / Q000000981:diagnostic imaging*; D006801:Humans; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D025241:Spondylarthritis / Q000000981:diagnostic imaging*; D014463:Ultrasonography
keywords: Entheses; Enthesitis; Enthesopathy; Reliability; Spondyloarthritis; Ultrasound