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Ultraschall Med 2012; 33(7): E173-E178
DOI: 10.1055/s-0031-1281973
Original Article
© Georg Thieme Verlag KG Stuttgart · New York

Which Knee and Probe Position Determines the Final Diagnosis of Knee Inflammation by Ultrasound? Results from a European Multicenter Study

Welche Knie- und Sondenposition entscheidet über die endgültige Diagnose einer Knieentzündung im Ultraschall? Ergebnisse einer Europäischen Multizenterstudie
L. Terslev
1   Department of Rheumatology, University of Copenhagen, Hospitals at Glostrup, Copenhagen, Denmark
,
M. A. D’Agostino
2   Paris Ouest-Versailles-Saint Quentin en Yvelines University; EA 2506, Rheumatology Department Ambroise-Paré Hospital, APHP, Boulogne-Billancourt, France
,
M. Brossard
2   Paris Ouest-Versailles-Saint Quentin en Yvelines University; EA 2506, Rheumatology Department Ambroise-Paré Hospital, APHP, Boulogne-Billancourt, France
,
P. Aegerter
3   Paris Ouest-Versailles-Saint Quentin en Yvelines University; EA 2506, Public Health Department Ambroise-Paré-Hospital, APHP, Boulogne-Billancourt, France
,
P. Balint
4   National Institute of Rheumatology and Physiotherapy, 3rd Department of Pediatric and General Rheumatology Budapese, Hungary
,
M. Backhaus
5   Department of Rheumatology and Clinical Immunology, Charité, Berlin, Gremany
,
G. A. Bruyn
6   MC Groep hospitals, Lelystad, Netherlands
,
I. Chary-Valckenare
7   Department of Rheumatology, University of Nancy, Le Brabois Hospital, Nancy, France
,
E. Filippucci
8   Cattedra di Reumatologia, Università Politecnica delle Marche, Ancona, Italy
,
J. Freeston
9   LIMM Section of Musculoskeletal Disease, University of Leeds, Chapel Allerton Hospital, Leeds, England
,
F. Gandjbakhch
10   Department of Rheumatology, la Pitié-Salpêtrière Hospital, APHP, Paris, France
,
A. Iagnocco
11   Rheumatology Unit, Clinica e Terapia Medica Department, Sapienza Università di Roma, Rome, Italy
,
S. Jousse-Joulin
12   Rheumatology Department, La Cavale Blanche Brest Teaching Hospital, Brest, France
,
P. Mandl
4   National Institute of Rheumatology and Physiotherapy, 3rd Department of Pediatric and General Rheumatology Budapese, Hungary
,
I. Möller
13   Instituto Poal de Reumatologia, Barcelona, Spain
,
E. Naredo
14   Rheumatology Department, Hospital Severo Ochoa, Madrid, Spain
,
M. Szkudlarek
15   Department of Rheumatology, University of Copenhagen Hospital at Koege, Koege, Denmark
,
R. J. Wakefield
9   LIMM Section of Musculoskeletal Disease, University of Leeds, Chapel Allerton Hospital, Leeds, England
,
A. Zayat
9   LIMM Section of Musculoskeletal Disease, University of Leeds, Chapel Allerton Hospital, Leeds, England
,
W. A. Schmidt
16   Immanuel Krankenhaus Berlin, Medical Centre for Rheumatology Berlin-Buch, Berlin, Germany
› Author Affiliations
Further Information

Publication History

21 November 2010

12 October 2011

Publication Date:
22 December 2011 (online)

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Which Knee and Probe Position Determines the Final Diagnosis of Knee Inflammation by Ultrasound? Results from a European Multicenter StudyUltraschall Med 2012; 33(07): e374-e374
DOI: 10.1055/s-0031-1299322

Abstract

Purpose: To investigate which knee and probe position best identifies knee inflammation and to determine a cut-off level for abnormal synovial effusion.

Materials and Methods: 18 experienced sonographers (all rheumatologists) performed ultrasound examinations of the knee joint in patients with knee symptoms and in healthy controls. Each sonographer performed longitudinal suprapatellar ultrasound scans using 9 different configurations at each knee: Midline, parapatallar lateral and parapatellar medial from midline in neutral position (0°) with and without quadriceps muscle contraction and in 30° flexion of the knee. The presence of synovial effusion (SE), the effusion measured in millimeters and the presence of synovial hypertrophy (SH) was noted.

Results: A total of 298 knees of 149 subjects (129 patients and 20 controls) were examined. The detection of SH is more sensitive and specific than the detection of SE, independently of the knee and probe position, for the final diagnosis of abnormality. The detection of both synovial hypertrophy and effusion in the knee in neutral position (0°) with quadriceps contraction and with the probe in the midline position, are the best independent predictors for knee abnormalities. Knee effusion > 3.2 mm measured with the probe in the lateral aspect of the knee is the best diagnostic characteristics for predicting pathological SE.

Conclusion: The best combination for detecting SH and SE is obtained by placing the probe in the midline position with the knee in 0° with quadriceps contraction. A cut-off value for pathological effusion may be obtained in the lateral aspect of the knee.

Zusammenfassung

Ziel: Untersuchung, welche Knie- und Sondenposition eine Knientzündung am besten erkennt und die Bestimmung eines Grenzwertes für das Ausmaß eines abnormalen Synovialergusses.

Material und Methoden: Achtzehn erfahrene Ultraschaller (alles Rheumatologen) führten bei Patienten mit Kniesymptomen sowie gesunden Kontrollprobanden Ultraschalluntersuchungen des Kniegelenks durch. Jeder Ultraschaller führte longitudinale suprapatellare Ultraschalluntersuchungen unter Verwendung von 9 verschiedenen Konfigurationen an jedem Knie durch: Mittellinie, parapatellar lateral, parapatellar medial der Mittellinie in Neutralposition (0°) jeweils mit und ohne muskulärer Anspannung des Quadrizeps und Beugung des Knies um 30°. Festgehalten wurde das Vorhandensein eines Synovialerguss (SE), der Erguss gemessen in Millimetern und das Vorhandensein einer synovialen Hypertrophie (SH).

Ergebnisse: Insgesamt wurden 298 Knie von 149 Personen (129 Patienten und 20 Kontrollen) untersucht. Für die endgültige Diagnose der Anomalie ist der Nachweis einer SH sensitiver und spezifischer als der Nachweis eines SE, unabhängig von der Position des Knies und der Sonde. Die besten unabhängigen Prädiktoren für Knieanomalien sind der Nachweis von sowohl synovialer Hypertrophie als auch eines Ergusses im Knie in der Neutralposition (0°) unter Kontraktion des Quadrizeps und der Sonde in der Mittellinienposition. Das beste diagnostische Kriterium, um einen pathologischen SE vorherzusagen, ist der Knieerguss > 3,2 mm gemessen mit der Sonde in der Lateralansicht des Knies.

Schlussfolgerung: Die beste Kombination, um eine SH und einen SE nachzuweisen, wird durch die Platzierung der Sonde auf der Mittellinienposition mit dem Knie in 0° und unter Quadrizepskontraktion erreicht. Der Grenzwert für einen pathologischen Erguss kann in der Lateralsicht des Knies ermittelt werden.

Key words

inflammation - ultrasound-spectral doppler - ultrasound-doppler - ultrasound - arthritis
 

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