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中华医学超声杂志（电子版）

中华医学超声杂志（电子版） ›› 2023, Vol. 20 ›› Issue (12) : 1248 -1253. doi: 10.3877/cma.j.issn.1672-6448.2023.12.005

肌肉骨骼超声影像学

基于EULAR-OMERACT评分系统的类风湿关节炎超声评估效果研究
王铭1, 杨萌1,†(), 赵瑞娜1, 王若蛟1, 陶葸茜1, 齐振红1, 张一休1, 苏娜1, 张睿1, 刘思锐1, 李建初1, 姜玉新1   
  1. 1. 100730　中国医学科学院北京协和医学院超声医学科　北京协和医院疑难重症及罕见病国家重点实验室
  • 收稿日期:2023-01-13 出版日期:2023-12-01
  • 通信作者: 杨萌
  • 基金资助:
    中央高水平医院临床科研专项(2022-PUMCH-D-002); 国家自然科学基金面上项目(61971447); 中央级公益性科研院所基本科研业务费(2022-RW320-02)

Ultrasound evaluation of rheumatoid arthritis based on EULAR-OMERACT scoring system

Ming Wang1, Meng Yang1,†(), Ruina Zhao1, Ruojiao Wang1, Xixi Tao1, Zhenhong Qi1, Yixiu Zhang1, Na Su1, Rui Zhang1, Sirui Liu1, Jianchu Li1, Yuxin Jiang1   

  1. 1. Department of Ultrasound, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
  • Received:2023-01-13 Published:2023-12-01
  • Corresponding author: Meng Yang
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王铭, 杨萌, 赵瑞娜, 王若蛟, 陶葸茜, 齐振红, 张一休, 苏娜, 张睿, 刘思锐, 李建初, 姜玉新. 基于EULAR-OMERACT评分系统的类风湿关节炎超声评估效果研究[J]. 中华医学超声杂志（电子版）, 2023, 20(12): 1248-1253.

Ming Wang, Meng Yang, Ruina Zhao, Ruojiao Wang, Xixi Tao, Zhenhong Qi, Yixiu Zhang, Na Su, Rui Zhang, Sirui Liu, Jianchu Li, Yuxin Jiang. Ultrasound evaluation of rheumatoid arthritis based on EULAR-OMERACT scoring system[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(12): 1248-1253.

目的

基于静态及动态视频超声图像探索欧洲抗风湿联盟-风湿病结果测量（EULAR-OMERACT）评分对类风湿关节炎（RA）的超声评估效果。

方法

2022年3月至2022年9月纳入12位北京协和医院超声科医师参与本项研究，均为肌骨超声初学者。基于APP超声教考一体化平台，受试者首先接受EULAR–OMERACT滑膜炎评分（EOSS）灰阶超声（GSUS）及能量多普勒超声（PDUS）分级培训，随后以随机静态超声图像（n=80）、随机视频图像（n=72）以及GS-PD配对静态图像（n=92）三种训练模式进行5关节读图练习[第2/3掌指关节（MCP2/3）、腕关节及第2/3近指关节（PIP2/3）]，考核学员对于RA的超声分级诊断能力。采用超声诊断评分符合率（TOA）及组内相关系数（ICC）对考核结果进行分析。

结果

随机静态超声图像、随机视频图像与GS-PD配对静态图像三种图像训练模式中，基于GS-PD配对静态图像的滑膜炎PDUS评估效果最好（TOA和ICC分别为66.3%、57.8%、82.0%，0.73、0.65、0.88）；而对于滑膜炎GSUS评估，三种图像训练模式下超声诊断评分TOA相近，基于GS-PD配对静态图像时一致性稍高于其他二者（基于静态、视频、GS-PD配对图像的TOA和ICC分别50.4%、46.3%、48.9%，0.50、0.42、0.65）。与随机静态超声图像相比，基于GS-PD配对静态图像可显著提高MCP2关节GSUS分级一致性（ICC分别0.75、0.36），但对于腕关节及PIP2/3无明显改善。

结论

GS-PD配对静态超声图像训练模式有助于肌骨超声初学者掌握EULAR–OMERACT评分，尤其对于提高滑膜炎PDUS分级的准确性具有重要价值。

关键词: 类风湿关节炎, 超声检查, 滑膜炎, 培训
Objective

To explore the performance of the EULAR-OMERACT scoring system in assessing rheumatoid arthritis (RA) based on static and video ultrasound (US) images.

Methods

From March 2022 to June 2022, 12 ultrasound physicians from Peking Union Medical College Hospital were included in this study, all of whom were junior musculoskeletal ultrasound physicians. Based on the APP integrated ultrasound platform of teaching and testing, all the physicians first received training of EULAR-OMERACT synovitis scoring (EOSS) in grey scale US (GSUS) and power Doppler US (PDUS) grading, and then performed 5-joint US image reading exercises [wrist, 2nd and 3rd metacarpophalangeal (MCP), and 2nd and 3rd proximal interphalangeal (PIP) joints] using three training methods [reading in random static images (n=80), random video images (n=72), and GSUS-PDUS paired static images (n=92)] to evaluate their ability to grade RA by US. The overall agreement rates (TOA, %) and intraclass correlation coefficient (ICC) values were calculated to analyze the assessment results.

Results

Among the three training methods used, synovitis PDUS grading in GSUS-PDUS paired static images had the best performance (TOA and ICC based on random static images, random video images, and GSUS-PDUS paired static images were 66.3%, 57.8%, and 82%, and 0.73, 0.65, and 0.88, respectively). For synovitis GSUS grading, the TOA of ultrasound assessment were similar among the three image training methods, but the consistency based on GSUS-PDUS paired static images was slightly higher than that of the other two (TOA and ICC based on random static images, random video images, and GSUS-PDUS paired static images were 50.4%, 46.3%, and 48.9%, and 0.50, 0.42, and 0.65, respectively). Compared with the training method based on random static images, the training method based om GSUS-PDUS paired US images had obviously improved the agreement of synovitis GSUS grading in MCP2 joint (ICC=0.75 and 0.36, respectively), but there was no improvement in wrist and PIP2/3 joints.

Conclusion

The training method based on GSUS-PDUS paired static US images may be helpful for junior musculoskeletal ultrasound physicians to master EULAR-OMERACT scoring for US grading of RA, especially in improving the accuracy of synovitis PDUS grading.

Key words: Rheumatoid arthritis, Ultrasonography, Synovitis, Training
表1 EOSS滑膜炎等级（0~3级）的评分定义
滑膜炎 灰阶超声 能量多普勒超声
0级（正常） 无滑膜肥厚伴或不伴积液 无多普勒血流信号
1级（轻度） 轻度低回声滑膜肥厚达关节骨表面水平连线 滑膜肥厚内可探及≤3处点状血流信号或一个条状及2个点状血流信号，或2处条状血流信号
2级（中度） 中度低回声滑膜肥厚超出关节线，但上表面呈凹陷（向下弯曲）或平坦状 大于1级，但血流信号≤50%滑膜肥厚面积
3级（重度） 重度低回声滑膜肥厚超出关节线，且上表面明显外凸 大于2级，血流信号>50%滑膜肥厚面积
图1 掌指关节滑膜肥厚及血流分级超声图像。图a~c依次为掌指关节滑膜肥厚0~3级（箭头所示为病变区域）；图d~e依次为滑膜血流0~ 3级
图2 三种图像训练模式下5关节滑膜炎灰阶超声、能量多普勒超声诊断评分结果 注：GSUS为灰阶超声；PDUS为能量多普勒超声；ICC为观察者间一致性；TOA为超声诊断评分符合率
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