Eugenio de Miguel Mendieta

Índices ecográficos en espondiloartritis

Ultrasound is proving its validity in the assessment of patients with spondyloarthritis. This paper reviews the various indices validated for the quantification of the activity or for the diagnosis of involvement of peripheral joints, enthesis and sacroiliac joints of these patients. The studies are still preliminary but point to future uses of ultrasound in spondyloarthritis.

Utilidad de la ecografía en la evaluación de las entesis periféricas en las espondiloartritis

Enthesitis is one of the characteristic etiopathogenic manifestations of spondyloarthritis. However, in clinical practice, its presence often goes unnoticed because of the lack of precision and sensitivity of physical examination to detect it. Viable, valid and reliable imaging tests are needed for early diagnosis, as well as a good sensitivity to change to monitor therapeutic response. In this paper we review the most relevant aspects of current knowledge of the enthesis and discusses the validity of ultrasound for assessing enthesitis in spondyloarthritis and its sensitivity to change to monitor therapeutic response.

Validez y utilidad de la ecografía en el síndrome del túnel carpiano

OBJECTIVE To evaluate the accuracy and utility of ultrasonography for the diagnosis of carpal tunnel syndrome (CTS). MATERIAL AND METHOD Prospective and blind study of 75 wrists in 42 consecutive patients with suspected CTS. Electrodiagnostic testing (EDT) was used as gold standard. We measure different ultrasonographic parameters and based on a fitted receiver operating characteristic curve, we estimated post-test probabilities for the proximal, middle and distal cross-sectional area of median nerve. We analyzed interobserver and interreader reliability by 3 different explorers and 2 different readers, cost and the patient discomfort. RESULTS Mean ultrasound measurements were significantly higher in the EDT positive group. There was a high concordance between sonography and nerve conduction. A cut-off of 9.5 mm(2) resulted in the correct classification of 83% of cases (sensitivity 88% and specificity 67%). Conversely, a cut-off of >14 mm(2) or <7 mm(2) had excellent power to rule in CTS, with a post-test probability of 100% of specificity and sensitivity respectively. The interobserver acquisition ICC was 0.915-0.980, and the inter-reader ICC was 0.912-0.987. Ultrasound cost savings in this study were €J3217.59 (€42.9 per symptomatic wrist) and the discomfort perceived by the patient was significantly lesser 6.3 vs 56 in EDT (P <.0005). CONCLUSIONS Ultrasound median nerve crosssectional area is reliable and may be used to accurately rule in or rule out CTS. Sonography as a first-line test is cost-effective and is more satisfactory to the patients.Objetivo Evaluar la validez y la utilidad de la ecografia en el sindrome del tunel carpiano (STC). Material y metodo Estudio ecografico ciego y prospective en 75 carpos de 42 pacientes consecutivos con sospecha de STC. Se utiliza la electromiografia (EMG) como prueba de referencia. Se miden distintos parametros ecograficos y mediante curvas ROC se estiman las probabilidades tras la prueba para los diferentes cortes del area de seccion transversal del mediano (AST). Se analiza la fiabilidad entre explorador y lector con tres exploradores diferentes y dos lectores. Finalmente se efectua un estudio de costes y de satisfaccion del paciente. Resultados Las medias de los parametros ecograficos son significativamente mayores en el grupo con STC. Hay una alta concordancia entre la ecografia y la conduccion nerviosa. Un punto de corte del AST en 9,5 mm 2 clasifica correctamente el 83% de los casos (sensibilidad del 88% y especificidad del 67%). Un punto de corte mayor de 14 mm 2 o menor de 7 mm 2 tiene una probabilidad tras la prueba para el STC del 100% de especificidad y sensibilidad respectivamente. Los coeficientes de correlacion intraclase (ICC) entre observadores fueron 0,915-0,980, y entre lectores, 0,912-0,987. La ecografia puede resultar mas economica y ahorrar en el estudio 3.217,59 euros (42,9 euros por muneca sintomatica). El malestar percibido por los pacientes fue significativamente menor: EVA, 6,3 con ecografia frente a 56 con el EMG (p Conclusiones La ecografia es fiable y valida para definir si hay o no STC. La ecografia como prueba de primera linea es coste-efectiva y mas satisfactoria para los pacientes.

Validity and Usefulness of Echography in the Carpal Tunnel Syndrome

Objective To evaluate the accuracy and utility of ultrasonography for the diagnosis of carpal tunnel syndrome (CTS). Material and method Prospective and blind study of 75 wrists in 42 consecutive patients with suspected CTS. Electrodiagnostic testing (EDT) was used as gold standard. We measure different ultrasonographic parameters and based on a fitted receiver operating characteristic curve, we estimated post-test probabilities for the proximal, middle, and distal cross-sectional area of median nerve. We analyzed interobserver and interreader reliability by 3 different explorers and 2 different readers, cost and the patient discomfort. Results Mean ultrasound measurements were significantly higher in the EDT positive group. There was a high concordance between sonography and nerve conduction. A cut-off of 9.5 mm 2 resulted in the correct classification of 83% of cases (sensitivity 88% and specificity 67%). Conversely, a cut-off of >14 mm 2 or 2 had excellent power to rule in CTS, with a post-test probability of 100% of specificity and sensitivity respectively. The interobserver acquisition ICC was 0.915-0.980, and the inter-reader ICC was 0.912-0.987. Ultrasound cost savings in this study were €3217.59 (€42.9 per symptomatic wrist) and the discomfort perceived by the patient was significantly lesser 6.3 versus 56 in EDT ( P Conclusions Ultrasound median nerve crosssectional area is reliable and may be used to accurately rule in or rule out CTS. Sonography as a first-line test is costeffective and is more satisfactory to the patients.

OriginaleValidez y utilidad de la ecografía en el síndrome del túnel carpianoValidity and Usefulness of Echography in the Carpal Tunnel Syndrome

OBJECTIVE To evaluate the accuracy and utility of ultrasonography for the diagnosis of carpal tunnel syndrome (CTS). MATERIAL AND METHOD Prospective and blind study of 75 wrists in 42 consecutive patients with suspected CTS. Electrodiagnostic testing (EDT) was used as gold standard. We measure different ultrasonographic parameters and based on a fitted receiver operating characteristic curve, we estimated post-test probabilities for the proximal, middle and distal cross-sectional area of median nerve. We analyzed interobserver and interreader reliability by 3 different explorers and 2 different readers, cost and the patient discomfort. RESULTS Mean ultrasound measurements were significantly higher in the EDT positive group. There was a high concordance between sonography and nerve conduction. A cut-off of 9.5 mm(2) resulted in the correct classification of 83% of cases (sensitivity 88% and specificity 67%). Conversely, a cut-off of >14 mm(2) or <7 mm(2) had excellent power to rule in CTS, with a post-test probability of 100% of specificity and sensitivity respectively. The interobserver acquisition ICC was 0.915-0.980, and the inter-reader ICC was 0.912-0.987. Ultrasound cost savings in this study were €J3217.59 (€42.9 per symptomatic wrist) and the discomfort perceived by the patient was significantly lesser 6.3 vs 56 in EDT (P <.0005). CONCLUSIONS Ultrasound median nerve crosssectional area is reliable and may be used to accurately rule in or rule out CTS. Sonography as a first-line test is cost-effective and is more satisfactory to the patients.Objetivo Evaluar la validez y la utilidad de la ecografia en el sindrome del tunel carpiano (STC). Material y metodo Estudio ecografico ciego y prospective en 75 carpos de 42 pacientes consecutivos con sospecha de STC. Se utiliza la electromiografia (EMG) como prueba de referencia. Se miden distintos parametros ecograficos y mediante curvas ROC se estiman las probabilidades tras la prueba para los diferentes cortes del area de seccion transversal del mediano (AST). Se analiza la fiabilidad entre explorador y lector con tres exploradores diferentes y dos lectores. Finalmente se efectua un estudio de costes y de satisfaccion del paciente. Resultados Las medias de los parametros ecograficos son significativamente mayores en el grupo con STC. Hay una alta concordancia entre la ecografia y la conduccion nerviosa. Un punto de corte del AST en 9,5 mm 2 clasifica correctamente el 83% de los casos (sensibilidad del 88% y especificidad del 67%). Un punto de corte mayor de 14 mm 2 o menor de 7 mm 2 tiene una probabilidad tras la prueba para el STC del 100% de especificidad y sensibilidad respectivamente. Los coeficientes de correlacion intraclase (ICC) entre observadores fueron 0,915-0,980, y entre lectores, 0,912-0,987. La ecografia puede resultar mas economica y ahorrar en el estudio 3.217,59 euros (42,9 euros por muneca sintomatica). El malestar percibido por los pacientes fue significativamente menor: EVA, 6,3 con ecografia frente a 56 con el EMG (p Conclusiones La ecografia es fiable y valida para definir si hay o no STC. La ecografia como prueba de primera linea es coste-efectiva y mas satisfactoria para los pacientes.