How to evaluate and improve the reliability of power Doppler ultrasonography for assessing enthesitis in spondylarthritis |
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| Authors: | Maria Antonietta D'agostino Philippe Aegerter Sandrine Jousse‐Joulin Isabelle Chary‐Valckenaere Bertrand Lecoq Philippe Gaudin Isabelle Brault Jérôme Schmitz François‐Xavier Dehaut Jean‐marie Le Parc Maxime Breban Paul Landais |
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| Institution: | 1. Université de Versailles‐St.‐Quentin‐en‐Yvelines, Assistance Publique H?pitaux de Paris, Ambroise Paré Hospital, Boulogne‐Billancourt, and Université Paris Descartes‐UPRES EA 4067, Assistance Publique H?pitaux de Paris, Necker Hospital, Paris, France;2. Université de Versailles‐St. Quentin‐en‐Yvelines, Assistance Publique H?pitaux de Paris, Ambroise Paré Hospital, Boulogne‐Billancourt, France;3. Centre Hospitalier Universitaire La Cavale Blanche, Brest, France;4. Centre Hospitalier Universitaire le Brabois, Vandoeuvre‐lès‐Nancy, France;5. Centre Hospitalier Universitaire C?te de Nacre, Caen, France;6. Centre Hospitalier Universitaire Sud, Grenoble, France;7. Centre Hospitalier Universitaire La Timone, Marseille, France;8. Université de Versailles‐St. Quentin‐en‐Yvelines, Assistance Publique H?pitaux de Paris, Ambroise Paré Hospital, Boulogne‐Billancourt, and INSERM U567, CNRS UMR8104, Université Paris Descartes, Institut Cochin, Paris, France;9. Université Paris Descartes‐UPRES EA 4067, Assistance Publique H?pitaux de Paris, Necker Hospital, Paris, France |
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| Abstract: | Objective To evaluate and improve the reliability of power Doppler ultrasonography (PDUS) for detecting and scoring enthesitis in patients with spondylarthitis, using a 3‐step procedure. Methods In the first step, we evaluated the reliability of 5 sonographers by bilaterally scanning 5 entheses twice in 5 patients. In the second step, starting from disagreements observed during the first step, we established consensus guidelines. The sonographers' implementation was further evaluated in 2 reliability exercises: one on 60 PDUS enthesitis images and the other by scanning 5 new patients. In the third step, we performed a final reliability evaluation of 5 additional patients after 1 year. Kappa coefficients (κ) as well as variance component analysis (VCA) and generalizability theory (GT) were used to assess reliability. Results The initial intra‐ and interobserver reliability were poor, especially for detecting and scoring Doppler signal. VCA and GT showed that most variability was accounted for by interaction between sonographer and enthesis. Implementation of consensus guidelines was associated with a significant improvement in Doppler reliability between the first and second steps (mean interobserver κ increased from 0.13 to 0.51 for binary Doppler scoring in patients; P < 0.005), which persisted in the third step (mean interobserver κ = 0.57). The high GT coefficients reached in the last steps supported such improvement. Conclusion The 3‐step procedure used in this study to standardize PDUS technique was associated with a significant improvement in interobserver reliability for detecting enthesitis in spondylarthritis patients. Such an approach can be useful to standardize PDUS assessment of musculoskeletal disorders. |
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