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Logo of annrheumdAnnals of the Rheumatic DiseasesVisit this articleSubmit a manuscriptReceive email alertsContact usBMJ
Ann Rheum Dis. 2005 July; 64(7): 1043–1049.
Published online 2005 January 7. doi:  10.1136/ard.2004.030387
PMCID: PMC1755572

Interobserver reliability of rheumatologists performing musculoskeletal ultrasonography: results from a EULAR "Train the trainers" course


Objective: To evaluate the interobserver reliability among 14 experts in musculoskeletal ultrasonography (US) and to determine the overall agreement about the US results compared with magnetic resonance imaging (MRI), which served as the imaging "gold standard".

Methods: The clinically dominant joint regions (shoulder, knee, ankle/toe, wrist/finger) of four patients with inflammatory rheumatic diseases were ultrasonographically examined by 14 experts. US results were compared with MRI. Overall agreements, sensitivities, specificities, and interobserver reliabilities were assessed.

Results: Taking an agreement in US examination of 10 out of 14 experts into account, the overall κ for all examined joints was 0.76. Calculations for each joint region showed high κ values for the knee (1), moderate values for the shoulder (0.76) and hand/finger (0.59), and low agreement for ankle/toe joints (0.28). κ Values for bone lesions, bursitis, and tendon tears were high (κ = 1). Relatively good agreement for most US findings, compared with MRI, was found for the shoulder (overall agreement 81%, sensitivity 76%, specificity 89%) and knee joint (overall agreement 88%, sensitivity 91%, specificity 88%). Sensitivities were lower for wrist/finger (overall agreement 73%, sensitivity 66%, specificity 88%) and ankle/toe joints (overall agreement 82%, sensitivity 61%, specificity 92%).

Conclusion: Interobserver reliabilities, sensitivities, and specificities in comparison with MRI were moderate to good. Further standardisation of US scanning techniques and definitions of different pathological US lesions are necessary to increase the interobserver agreement in musculoskeletal US.

Figure 1
 Shoulder joint. (A and B) Humeral head erosions. (A) In MRI, multiple erosions can be seen from the anterior and posterior sides of the humeral head as bone defects with sharp margins (arrows). (B) Distinct bone defects below the bone surface ...
Figure 2
 Finger joint (MCP II). (A) The MR image shows the MCP joints II–V in transverse section. Focusing on MCP joint II shows slight contrast enhancement from the dorsal and palmar aspects, representing synovitis (arrowheads). Also, tenosynovitis ...
Figure 3
 Knee joint. (A) MRI shows some contrast agent enhancement in the suprapatellar recess, reflecting inflammatory effusion (two arrows). (B) US also clearly depicts the effusion in the suprapatellar recess (arrows). (C) In MRI, a popliteal cyst ...
Figure 4
 Ankle/toe joints. (A) MRI of the ankle shows contrast enhancement in the tibiotalar joint from anterior and posterior aspects (arrows). (B) The longitudinal US image is an example of the anterior side of the tibiotalar joint. The anechoic area ...

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