Performance of a Handheld Ultrasound Device to Assess Articular and Periarticular Pathologies in Patients with Inflammatory Arthritis.

Giulia Corte,Koray Tascilar,Filippo Fagni,Johannes Knitza,Larissa Valor-Mendez,Louis Schuster,Arnd Kleyer,Sara Bayat,David Simon,Georg Schett

doi:10.3390/diagnostics11071139

Giulia Corte, Koray Tascilar + Show 8 more

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https://doi.org/10.3390/diagnostics11071139

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Abstract

The purpose of this study was to assess the accuracy and performance of a new handheld ultrasound (HHUS) machine in comparison to a conventional cart-based sonographic machine in patients with inflammatory arthritis (IA). IA patients with at least one tender and swollen joint count were enrolled. US was performed on the clinically affected joints using a cart-based sonographic device (Samsung HS40) and a HHUS device (Butterfly iQ). One blinded reader scored all images for the presence of erosions, bony enlargement, synovial hypertrophy, joint effusion, bursitis, tenosynovitis, and enthesitis. Synovitis was graded (B mode and power Doppler (PD)) by the 4-level EULAR-OMERACT scale. To avoid bias by the blinded reader, we included 67 joints of two healthy volunteers in the evaluation. We calculated the overall concordance and the concordance by type of joint and pathological finding. We also measured the time required for the US examination per joint with both devices. Thirty-two patients (20 with RA, 10 with PsA, and one each with gout and SLE-associated arthritis) were included, and 186 joints were examined. The overall raw concordance in B mode was 97% (κappa 0.90, 95% CI (0.89, 0.94)). In B mode, no significant differences were found in relation to type of joint or pathological finding examined. The PD mode of the HHUS device did not detect any PD signal, whereas the cart-based device detected a PD signal in 61 joints (33%). The portable device did not offer any time savings compared to the cart-based device (47.0 versus 46.3 s). The HHUS device was accurate in the assessment of structural damage and inflammation in patients with IA, but only in the B mode. Significant improvements are still needed for HHUS to reliably demonstrate blood flow detection in PD mode.

Highlights

In recent years this development has led to the market entry of handheld ultrasound (HHUS) devices, which are increasingly used in clinical practice thanks to their greater portability and significantly lower purchase cost compared to conventional cart-based US devices [1]
We investigated whether HHUS devices are suitable to assess articular and periarticular inflammation as well as structural damage in patients with inflammatory arthritis (IA)
This limitation seems to be a general problem of HHUS devices at present, this shortcoming applies to other portable devices [9]

Summary

Introduction

Medical ultrasound (US) technology is in continuous evolution, in terms of image resolution, and with regard to processing speed, data storage, software features, and, compactness of ultrasound devices. In recent years this development has led to the market entry of handheld ultrasound (HHUS) devices, which are increasingly used in clinical practice thanks to their greater portability and significantly lower purchase cost compared to conventional cart-based US devices [1]. Because HHUS devices are affordable and simple to handle, a growing number of physicians will have convenient access to diagnostic ultrasound in clinical practice, even in rural areas or developing countries [1,2]. Some studies have already shown the good applicability of HHUS devices for musculoskeletal ultrasound (MSUS) examinations, e.g., for hemarthrosis and local degenerative changes such as tendinopathies. [6,7,8,9]

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