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      Standardized, musculoskeletal ultrasonographic reference values for healthy Korean adults

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          Abstract

          Background/Aims

          To define standard reference values for musculoskeletal ultrasonography (MSUS) in Korea.

          Methods

          A total of 251 healthy adults were recruited for this study. Ultrasonography was performed by experienced rheumatologists who had undergone four appropriate training programs in Korea. A General Electric LOGIQ electronic ultrasound device fitted with a 12 MHz linear transducer was employed. Mean values ± standard deviations (SDs) were defined as standard reference values. Intraclass correlation coefficients was employed to evaluate the extent of inter- and intraobserver agreement when MSUS measurements were made.

          Results

          The 251 study participants included 122 males. Mean subject age was 28.6 years. The average bone-to-capsule distance of the right-side second and third metacarpophalangeal (MCP) joints were 0.68 and 0.72 mm respectively, and those of the left-side joints 0.62 and 0.68 mm. The cartilage thicknesses of the right-side second and third MCP joints were 0.55 and 0.55 mm, and those of the left-side joints were 0.55 and 0.56 mm, respectively. The bone-to-capsule distances of the right and left wrists were 0.80 and 0.82 mm. In 12.4% of participants (31/251), the erosion score of the humeral head was 1.71. In the right-side knee joint, mean cartilage thicknesses of the medial and lateral condyles were 1.86 and 2.03 mm in longitudinal scans. High overall interobserver agreement was evident after appropriate training that included instruction on standard MSUS methodology.

          Conclusions

          We defined standard reference values for MSUS in healthy Korean adults. The reliabilities of interobserver agreements were high after appropriate training program.

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          Most cited references 16

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          Statistical methods for assessing agreement between two methods of clinical measurement.

          In clinical measurement comparison of a new measurement technique with an established one is often needed to see whether they agree sufficiently for the new to replace the old. Such investigations are often analysed inappropriately, notably by using correlation coefficients. The use of correlation is misleading. An alternative approach, based on graphical techniques and simple calculations, is described, together with the relation between this analysis and the assessment of repeatability.
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            Guidelines for musculoskeletal ultrasound in rheumatology.

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              Standard reference values for musculoskeletal ultrasonography.

              To determine standard reference values for musculoskeletal ultrasonography in healthy adults. Ultrasonography was performed on 204 shoulders, elbows, hands, hips, knees, and feet of 102 healthy volunteers (mean age 38.4 years; range 20-60; 54 women) with a linear probe (10-5 MHz; Esaote Technos MP). Diameters of tendons, bursae, cartilage, erosions, hypoechoic rims around tendons and at joints were measured with regard to established standard scans. Mean, minimum, and maximum values, as well as two standard deviations (2 SD) were determined. Mean values +/-2 SD were defined as standard reference values. Hypoechoic rims were normally present in joints and tendon sheaths owing to physiological synovial fluid and/or cartilage. Similarly, fluid was found in the subdeltoid bursa in 173/204 (85%), at the long biceps tendon in 56 (27%), in the suprapatellar recess in 158 (77%), in the popliteal bursae in 32 (16%), and in the retrocalcaneal bursa in 49 (24%). Erosions of >1 mm were seen at the humeral head in 47 (23%). Values for important intervals were determined. The correlation between two investigators was 0.96 (0.78-0.99). The reliability of follow up investigations was 0.83 (0.52-0.99). Fluid in bursae as well as hypoechoic rims within joints and around tendons are common findings in healthy people. This study defines standard reference values for musculoskeletal ultrasonography to prevent misinterpretation of normal fluid as an anatomical abnormality.
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                Author and article information

                Journal
                Korean J Intern Med
                Korean J. Intern. Med
                KJIM
                The Korean Journal of Internal Medicine
                The Korean Association of Internal Medicine
                1226-3303
                2005-6648
                November 2019
                4 May 2018
                : 34
                : 6
                : 1372-1380
                Affiliations
                [1 ]Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea
                [2 ]Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
                [3 ]Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
                [4 ]Department of Internal Medicine, Chosun University College of Medicine, Gwangju, Korea
                [5 ]Department of Internal Medicine, Jung’s Rheumatism Clinic, Seoul, Korea
                [6 ]Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
                [7 ]Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, Korea
                [8 ]Department of Internal Medicine, National Police Hospital, Seoul, Korea
                [9 ]Department of Internal Medicine, Inje University Haeundae Paik Hospital, Busan, Korea
                [10 ]Department of Internal Medicine, Ajou University Hospital, Suwon, Korea
                [11 ]Department of Internal Medicine, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
                [12 ]Department of Internal Medicine, Bundang Jesaeng Hospital, Seongnam, Korea
                [13 ]Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
                [14 ]Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
                Author notes
                Correspondence to Chong-Hyeon Yoon, M.D. Division of Rheumatology, Department of Internal Medicine, College of Medicine, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, 271 Cheonbo-ro, Uijeongbu 11765, Korea Tel: 82-32-820-3653 Fax: 82-32-820-3653 E-mail: chyoon@ 123456catholic.ac.kr
                [*]

                These authors contributed equally to this work.

                Article
                kjim-2016-397
                10.3904/kjim.2016.397
                6823555
                29722248
                Copyright © 2019 The Korean Association of Internal Medicine

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Categories
                Original Article
                Rheumatology

                Internal medicine

                ultrasonography, musculoskeletal, reference standards, education

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