Reliability assessment of ultrasound muscle echogenicity in patients with rheumatic diseases: Results of a multicenter international web-based study

Andrea Di Matteo, Erica Moscioni, Maria Giovanna Lommano, Edoardo Cipolletta, Gianluca Smerilli, Sonia Farah, Carla Airoldi, Sibel Zehra Aydin, Andrea Becciolini, Karina Bonfiglioli, Marina Carotti, Greta Carrara, Tomas Cazenave, Davide Corradini, Micaela Ana Cosatti, Juan Josè de Agustin, Giulia Maria Destro Castaniti, Marco Di Carlo, Eleonora Di Donato, Luca Di GesoAshley Elliott, Daniela Fodor, Francesca Francioso, Alessandra Gabba, Cristina Hernández-Díaz, Rudolf Horvath, Jana Hurnakova, Diogo Jesus, Josefina Marin, Maria Victoria Martire, Riccardo Mashadi Mirza, Marco Massarotti, Alice Andreea Musca, Jagdish Nair, Tadashi Okano, Ioannis Papalopoulos, Javier Rosa, Marcos Rosemffet, João Rovisco, Davide Rozza, Fausto Salaffi, Crescenzio Scioscia, Carlo Alberto Scirè, Maria-Magdalena Tamas, Shun Tanimura, Lucio Ventura-Rios, Catalina Villota-Eraso, Orlando Villota, Paraskevi V Voulgari, Florentin Ananu Vreju, Gentiana Vukatana, Johana Zacariaz Hereter, Anna Zanetti, Walter Grassi, Emilio Filippucci

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Abstract

To investigate the inter/intra-reliability of ultrasound (US) muscle echogenicity in patients with rheumatic diseases. Forty-two rheumatologists and 2 radiologists from 13 countries were asked to assess US muscle echogenicity of quadriceps muscle in 80 static images and 20 clips from 64 patients with different rheumatic diseases and 8 healthy subjects. Two visual scales were evaluated, a visual semi-quantitative scale (0-3) and a continuous quantitative measurement ("VAS echogenicity," 0-100). The same assessment was repeated to calculate intra-observer reliability. US muscle echogenicity was also calculated by an independent research assistant using a software for the analysis of scientific images (ImageJ). Inter and intra reliabilities were assessed by means of prevalence-adjusted bias-adjusted Kappa (PABAK), intraclass correlation coefficient (ICC) and correlations through Kendall's Tau and Pearson's Rho coefficients. The semi-quantitative scale showed a moderate inter-reliability [PABAK = 0.58 (0.57-0.59)] and a substantial intra-reliability [PABAK = 0.71 (0.68-0.73)]. The lowest inter and intra-reliability results were obtained for the intermediate grades (i.e., grade 1 and 2) of the semi-quantitative scale. "VAS echogenicity" showed a high reliability both in the inter-observer [ICC = 0.80 (0.75-0.85)] and intra-observer [ICC = 0.88 (0.88-0.89)] evaluations. A substantial association was found between the participants assessment of the semi-quantitative scale and "VAS echogenicity" [ICC = 0.52 (0.50-0.54)]. The correlation between these two visual scales and ImageJ analysis was high (tau = 0.76 and rho = 0.89, respectively). The results of this large, multicenter study highlighted the overall good inter and intra-reliability of the US assessment of muscle echogenicity in patients with different rheumatic diseases.
Original languageEnglish
Article number1090468
JournalFrontiers in Medicine
Volume9
DOIs
Publication statusPublished - 17 Jan 2023

Keywords

  • reliability
  • rheumatic diseases
  • musculoskeletal ultrasound
  • sarcopenia
  • muscle echogenicity

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