Reliability of Ultrasound Elementary Lesions in Gout: Results from an Inter- and Intra-Reading International Multicenter Exercise By 62 Sonographers

Tomas Cazenave¹, María Victoria Martire², Christian A. Waimann³, Ana Bertoli⁴, Anthony Reginato⁵, Andy Abril⁶, Eliana Natalí Ayala Ledesma⁷, Maximiliano Bravo⁸, César Cefferino⁹, Carla Airoldi¹⁰, Carla Saucedo¹¹, Carlos Pineda¹², Gustavo Rodriguez Gil¹³, Cecilia Urquiola¹⁴, Cesar Graf¹⁵, Clarisa Sandobal¹⁶, M. Concepción Castillo Gallego¹⁷, Cristian Troitiño¹⁸, Cristina Hernandez-Diaz¹⁹, David Navarta²⁰, Diana Peiteado²¹, MARIO DIAZ²², Diego Saaibi²³, Henry Julio Colon Castillo²⁴, Marwin Gutierrez²⁵, Ana Laura Alvarez del Castillo Araujo²⁶, Oscar Sedano²⁷, Edith Alarcón²⁸, Erika Catay⁸, Claudia Mora²⁹, Eugenio De Miguel³⁰, Félix Fernández Castillo³¹, Florencia Marengo³², Gabriel Aguilar³³, Irene Monjo³⁴, Javier Rosa³⁵, José Francisco Díaz Coto³⁶, Jorge Saavedra Muñoz³⁷, Josefina Marin³⁸, Lida Santiago³⁹, Magalí Alva⁴⁰, Manuella Lima Gomes Ochtrop⁴¹, Mara Guinsburg⁴², Mariana Benegas⁴³, María Julia Santa Cruz⁴⁴, Paula Kohan⁴⁵, Natalia Estrella⁴⁶, Mariana Pera⁴⁷, Patricio Tate⁴⁸, Priscila Marcaida⁴⁹, Guillermo Py⁵⁰, RICARDO PAVAO⁵¹, R Munoz-Louis⁵², Roser Areny Micas⁵³, Rodolfo Arape⁵⁴, Santiago Ruta³⁵, María Soledad Gálvez Elkin⁵⁵, Lorena Urioste⁵⁶, Lina Saldarriaga Rivera⁵⁷, OSCAR VEGA-HINOJOSA⁵⁸, Lucio Ventura⁵⁹, Walter J. Spindler⁶⁰, Yvonne Rengel⁶¹, Maritza Quintero⁶² and Marcos G. Rosemffet⁶³, ¹Instituto de Rehabilitación Psicofísica, Buenos Aires, Argentina, ²Instituto Médico Platense, La Plata, Argentina, ³Hospital Dr. Hector Cura, Olavarria, Argentina, ⁴Instituto Reumatológico Strusberg, Córdoba, Argentina, ⁵Rhode Island Hospital, The Warren Alpert School of Medicine at Brown University, Providence, RI, ⁶Rheumatology, Mayo Clinic Florida, Jacksonville, FL, ⁷Hospital Nacional Arzobispo Loayza, Lima, Peru, ⁸Consultorios Moreno, Formosa, Argentina, ⁹HOSPITAL NACIONAL DOS DE MAYO, Lima, Peru, ¹⁰Hospital Provincial, Rosario, Argentina, ¹¹Hospital Anita Elicagaray, Adolfo Gonzales Chaves, Argentina, ¹²Instituto Nacional de Rehabilitation, Mexico, Mexico, ¹³Hospital Municipal de Agudos "Dr Leónidas Lucero", Bahía Blanca, Argentina, ¹⁴Hospital Municipal Dr. Leónidas Lucero, Bahia Blanca, Argentina, ¹⁵Centro Médico Mitre, Paraná, Argentina, ¹⁶Hospital José María Cullen, Santa Fe, Argentina, ¹⁷Complejo Hospitalario Torrecárdenas, Almería, Spain, ¹⁸Reumatologia, Hospital Bernardino Rivadavia, CAPITAL FEDERAL, Argentina, ¹⁹Instituto Nacional de Rehabilitación, Mexico City, Mexico, ²⁰Hospital Marcial Quiroga, San Juan, Argentina, ²¹Rheumatology, La Paz University Hospital, Madrid, Spain, ²²Unidad de Reumatologia, Fundación Santa Fe de Bogotá, Bogota, Colombia, ²³MEDICITY S.A.S, Bucaramanga, Colombia, ²⁴RADES, Santo Domingo Este, Dominican Republic, ²⁵Rheumatology, Instituto Nacional de Rehabilitación, Mexico City, Mexico, ²⁶IMSS HES 25, Monterrey, Mexico, ²⁷ULTRASOUND, ECOSERMEDIC, LIMA, Peru, ²⁸Hospital San Juan de Lurigancho, Lima, Peru, ²⁹Hospital Nacional Edgardo Rebagliati Martins, Lima, Peru, ³⁰Rheumatology, University Hospital La Paz, IdiPaz, Madrid, Spain, ³¹Clínica Razetti, Barquisimeto, Venezuela (Bolivarian Republic of), ³²Olavarria, Olavarria, Argentina, ³³Centro de Diagnostico Rossi, Buenos Aires, Argentina, ³⁴Rheumatology, Rheumatology. La Paz University Hospital, Spain., MADRID, Spain, ³⁵Rheumatology Unit, Internal Medicine Service, Hospital Italiano de Buenos Aires, CABA, Argentina, ³⁶Rheumatology, Hospital Clínica Bíblica, San José, Costa Rica, ³⁷Hospital San Juan De Dios, Santiago, Chile, ³⁸Rheumatology Unit, Internal Medicine Service, Hospital Italiano de Buenos Aires, Instituto Universitario Hospital Italiano de Buenos Aires, and Fundacion PM Catoggio, Buenos Aires, Argentina, ³⁹Organizacion Medica de Investigacion, Buenos Aires, Argentina, ⁴⁰Hospital Rebagliati, Jesús María, Peru, ⁴¹University Hospital Pedro Ernesto,, Rio de Janeiro,, Brazil, ⁴²Rheumatology, Hospital Municipal Dr. Leónidas Lucero, Bahia Blanca, Argentina, ⁴³Rheumatology Department, Sanatorio de la Providencia, Buenos Aires, Argentina, ⁴⁴Section of Rheumatology, Hospital General de Agudos Dr. Enrique Tornú, Buenos Aires, Argentina, ⁴⁵Hospital Dr. E. Tornu, Buenos Aires, Argentina, ⁴⁶Consultorio Privado, Buenos Aires, Argentina, ⁴⁷Hospital San Martín, La Plata, Argentina, ⁴⁸Organizacion Médica de Investigación, Buenos Aires, Argentina, ⁴⁹Hospital Rivadavia, Buenos Aires, Argentina, ⁵⁰Servicio de Reumatología del Hospital Nacional de Clínicas, Córdoba., Cordoba, Argentina, ⁵¹GRE.ME.DA, Artigas, Uruguay, ⁵²Rheumatology, Hospital Docente Padre Billini (HDPB), Santo Domingo, Dominican Republic, ⁵³Hospital Dr. Félix Bulnes Cerda, Santiago, Chile, ⁵⁴Centro Clinico la Isabelica, Valencia, Venezuela (Bolivarian Republic of), ⁵⁵Instituto de Cardiología, Rosario, Argentina, ⁵⁶Reumatología Diagnóstica Especializada, Santa Cruz de la Sie, Bolivia, ⁵⁷Instituto Nacional de Rehabilitación, Mexico, Mexico, ⁵⁸Clínica Reumacenter,, Juliaca, Peru, ⁵⁹Instituto Nacional de Rehabilitación, Ciudad de México, Mexico, ⁶⁰Centro Médico Privado de Reumatología, Tucuman, Argentina, ⁶¹Reumatologos en la Red, Caracas, Venezuela (Bolivarian Republic of), ⁶²Instituto Autónomo Hospital Universitario de Los Andes, Universidad de Los Andes, Mérida, Venezuela, ⁶³Rheumatology, Instituto de Rehabilitación Psicofísica, Buenos Aires, Argentina

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords: gout and ultrasound

Session Information

Date: Tuesday, November 7, 2017

Title: Imaging of Rheumatic Diseases Poster II

Session Type: ACR Poster Session C

Session Time: 9:00AM-11:00AM

Background/Purpose: The OMERACT ultrasound (US) Gout Task Force has defined four US elementary lesions to evaluate patients with gout: double contour (DC), aggregates, tophus and erosions. The objective of this study was to evaluate intra and inter-reader reliability of the US definitions of elementary lesions in gout and to assess the Influence of Sonographer Experience.

Methods: We conducted a cross-sectional study. Sixty-two sonographers from several countries and different degree of experience took part in an US reading exercise. All observers evaluated 50 ultrasound videos from patients with gout diagnoses. In addition, a group of 15 videos was displayed twice to assess intra-reader reliability. We evaluated the presence of the four elementary lesions described by OMERACT US Gout Task Force: double contour (DC), tophus, aggregates and erosion. Intra and Inter-reader reliability was calculated by the Cohen’s kappa coefficient and classified according to Landis and Koch criteria. Sonographers were stratiified according to US experience (defining High experience as at least ≥5 years of experience, ≥100 US assessments/month and ≥10 US in gout patients/month), evaluating differences in intra, inter – reader reliability and overall agreement. Bias-adjusted and prevalence-adjusted kappa (PABAK) was calculated to overcome prevalence bias in kappa estimates.

Results: A total of 3100 US assessment were performed. Prevalence of lesions were: Tophus (34%), Aggregates (29%), Erosions (22%) and DC (20%). The mean intra-reader values were good to excellent in all lesions (table 1). Mean Kappa inter-reader correlation coefficients, were fair for aggregates, moderate for tophus and erosions, and good for DC (Table 1). Adjusting for low-prevalence using PABAK estimates, inter-rater reliability increased to 0.42 (moderate), 0.49 (moderate), 0.69 (good) and 0.79 (good); respectively. There was not significant difference between experience and non-experience sonographers regarding to agreement and inter-rater reliability. Experience sonographers showed better intra-rater reliability for the detection of erosions (table 1).

Conclusion: The inter-rater reliability of the OMERACT US elementary lesions for gout is still a concern, especially in others than Double Contour. This results should be taken into account in the design of future multicenter studies.

Table 1. Agreement and kappa estimates stratified by evaluator experience

Group	US experience [median, (p25-75)]	US assessment per months [median, (p25-75)]	US assessment in gout patients per months [median, (p25-75)]	Reliability assessment (Intra or Inter rater)	Aggregates		DC		Tophus		Erosions
Group	US experience [median, (p25-75)]	US assessment per months [median, (p25-75)]		Reliability assessment (Intra or Inter rater)	%	k	%	k	%	k	%	k
All Examiners (n=62)	8 (4-10)	65 (43-130)	5 (2-8)	Inter	71%	0.31	89%	0.67	74%	0.43	84%	0.56
All Examiners (n=62)	8 (4-10)	65 (43-130)	5 (2-8)	Intra	83%	0.62	95%	0.85	85%	0.69	93%	0.77
High experience (n=9)	10 (8-12)	130 (130-174)	15 (10-20)	Inter	68%	0.27	93%	0.73	74%	0.37	88%	0.62
High experience (n=9)	10 (8-12)	130 (130-174)	15 (10-20)	Intra	83%	0.64	95%	0..84	84%	0.61	99%	0.94
Low experience (n=53)	8 (4-10)	52 (43-130)	4 (1-5)	Inter	71%	0.31	89%	0.67	74%	0.43	84%	0.56
Low experience (n=53)	8 (4-10)	52 (43-130)	4 (1-5)	Intra	83%	0.62	95%	0.85	86%	0.70	92%	0.74

Abbreviations: p25-75 – percentile 25 and 75; DC – double contour; k – Light’s kappa; % – proportion of observed agreement.

Disclosure: T. Cazenave, None; M. V. Martire, None; C. A. Waimann, None; A. Bertoli, None; A. Reginato, None; A. Abril, None; E. N. Ayala Ledesma, None; M. Bravo, None; C. Cefferino, None; C. Airoldi, None; C. Saucedo, None; C. Pineda, None; G. Rodriguez Gil, None; C. Urquiola, None; C. Graf, None; C. Sandobal, None; M. C. Castillo Gallego, None; C. Troitiño, None; C. Hernandez-Diaz, None; D. Navarta, None; D. Peiteado, None; M. DIAZ, None; D. Saaibi, None; H. J. Colon Castillo, None; M. Gutierrez, None; A. L. Alvarez del Castillo Araujo, None; O. Sedano, None; E. Alarcón, None; E. Catay, None; C. Mora, None; E. De Miguel, None; F. Fernández Castillo, None; F. Marengo, None; G. Aguilar, None; I. Monjo, None; J. Rosa, None; J. F. Díaz Coto, None; J. S. Muñoz, None; J. Marin, None; L. Santiago, None; M. Alva, None; M. Lima Gomes Ochtrop, None; M. Guinsburg, None; M. Benegas, None; M. J. Santa Cruz, None; P. Kohan, None; N. Estrella, None; M. Pera, None; P. Tate, None; P. Marcaida, None; G. Py, None; R. PAVAO, None; R. Munoz-Louis, None; R. Areny Micas, None; R. Arape, None; S. Ruta, None; M. S. Gálvez Elkin, None; L. Urioste, None; L. Saldarriaga Rivera, None; O. VEGA-HINOJOSA, None; L. Ventura, None; W. J. Spindler, None; Y. Rengel, None; M. Quintero, None; M. G. Rosemffet, None.

To cite this abstract in AMA style:

Cazenave T, Martire MV, Waimann CA, Bertoli A, Reginato A, Abril A, Ayala Ledesma EN, Bravo M, Cefferino C, Airoldi C, Saucedo C, Pineda C, Rodriguez Gil G, Urquiola C, Graf C, Sandobal C, Castillo Gallego MC, Troitiño C, Hernandez-Diaz C, Navarta D, Peiteado D, DIAZ M, Saaibi D, Colon Castillo HJ, Gutierrez M, Alvarez del Castillo Araujo AL, Sedano O, Alarcón E, Catay E, Mora C, De Miguel E, Fernández Castillo F, Marengo F, Aguilar G, Monjo I, Rosa J, Díaz Coto JF, Muñoz JS, Marin J, Santiago L, Alva M, Lima Gomes Ochtrop M, Guinsburg M, Benegas M, Santa Cruz MJ, Kohan P, Estrella N, Pera M, Tate P, Marcaida P, Py G, PAVAO R, Munoz-Louis R, Areny Micas R, Arape R, Ruta S, Gálvez Elkin MS, Urioste L, Saldarriaga Rivera L, VEGA-HINOJOSA O, Ventura L, Spindler WJ, Rengel Y, Quintero M, Rosemffet MG. Reliability of Ultrasound Elementary Lesions in Gout: Results from an Inter- and Intra-Reading International Multicenter Exercise By 62 Sonographers [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/reliability-of-ultrasound-elementary-lesions-in-gout-results-from-an-inter-and-intra-reading-international-multicenter-exercise-by-62-sonographers/. Accessed .

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