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Reliability of detection of ultrasound and MRI features of hand osteoarthritis: a systematic review and meta-analysis


Rheumatology (Oxford). 2021 Jun 4;keab470. doi: 10.1093/rheumatology/keab470.Online ahead of print.

Abasiama D Obotiba 1 2Subhashisa Swain 1Jaspreet Kaur 1Michael Doherty 1Weiya Zhang 1Abhishek Abhishek 1 3

Author Information

1 Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham, UK.

2 Department of Medical Imaging, College of Medicine and Health, University of Exeter, Exeter, UK.

3 Nottingham NIHR-BRC, Nottingham, UK.


Objectives: To systematically review the literature on inter- and intra-rater reliability of scoring ultrasound and MRI changes in hand osteoarthritis (OA).

Methods: Medline, EMBASE, CINHAL, Web of Science and AMED were searched from inception to January 2020. Kappa (K), weighted Kappa (Kw) and intra-class correlation coefficients (ICC) for dichotomous, semi-quantitative and summated scores respectively, and their 95% confidence intervals (CI) were pooled using random-effects model. Heterogeneity between studies was assessed and reliability estimates were interpreted using Landis-Koch's classification.

Results: Fifty studies met the inclusion criteria (33 ultrasound, 21 MRI). The pooled K(95% CI) for inter-rater reliability was substantial for ultrasound-detected osteophytes [0.66 (0.54, 0.79)], grey-scale synovitis (GSS) [0.64 (0.32, 0.97)], and power Doppler (PD) [0.76, (0.47, 1.05)]; whereas intra-rater reliability was almost perfect for osteophytes [0.82 (0.80, 0.84)], central bone erosions (CBEs) [0.83 (0.78, 0.89)], and effusion [0.83 (0.74, 0.91)]; and substantial for GSS [0.64 (0.49, 0.79)] and PD [0.70 (0.59, 0.80)].Inter-rater reliability for dichotomous assessment was substantial for MRI-detected CBEs [0.75 (0.67, 0.83)] and synovitis [0.69 (0.51, 0.87)]; slight for osteophytes [0.14 (0.04, 0.25)]; and almost perfect for sum score of osteophytes, CBEs, joint space narrowing (JSN), and bone marrow lesions (BMLs) (0.81-0.89). Intra-rater reliability was almost perfect for sum score of MRI synovitis [0.92 (0.87, 0.96)], BMLs [0.88 (0.78, 0.98)], osteophytes [0.86 (0.74, 0.98)], CBEs [0.83 (0.66, 1.00)] and JSN [0.91 (0.87, 0.91)].

Conclusion: Ultrasound and MRI are reliable in detecting hand OA features. Ultrasound may be preferred due to low-cost and increasing availability.