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Interobserver reliability in musculoskeletal ultrasonography: results from a “Teach the Teachers” rheumatologist course
  1. E Naredo1,
  2. I Möller2,
  3. C Moragues3,
  4. J J de Agustín4,
  5. A K Scheel5,
  6. W Grassi6,
  7. E de Miguel7,
  8. M Backhaus8,
  9. P Balint9,
  10. G A W Bruyn10,
  11. M A D’Agostino11,
  12. E Filippucci12,
  13. A Iagnocco13,
  14. D Kane14,
  15. J M Koski15,
  16. L Mayordomo16,
  17. W A Schmidt17,
  18. W A A Swen18,
  19. M Szkudlarek19,
  20. L Terslev20,
  21. S Torp-Pedersen21,
  22. J Uson22,
  23. R J Wakefield23,
  24. C Werner24,
  25. EULAR Working Group for Musculoskeletal Ultrasound
  1. 1Rheumatology, Hospital Severo Ochoa, Madrid, Spain
  2. 2Department of Rheumatology, Instituto Poal, Barcelona, Spain
  3. 3Rheumatology, Hospital de Bellvitge, Barcelona
  4. 4Rheumatology, Hospital Vall d’Hebron, Barcelona
  5. 5Nephrology and Rheumatology, Georg-August-University, Göttingen, Germany
  6. 6Department of Rheumatology, Universita Politecnica delle Marche, Ancona, Italy
  7. 7Rheumatology, Hospital La Paz, Madrid, Spain
  8. 8Rheumatology and Clinical Immunology, Charité University Hospital, Berlin, Germany
  9. 9Third General and Paediatric Rheumatology Department, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
  10. 10Rheumatology, Medisch Centrum Leeuwarden, Leeuwarden, Netherlands
  11. 11Rheumatology, Ambroise Paré Hospital, UVSQ University, Boulogne Billancourt, France
  12. 12Rheumatology, Universita Politecnica delle Marche, Ancona, Italy
  13. 13Rheumatology, University La Sapienza, Rome, Italy
  14. 14Rheumatology, University of Newcastle upon Tyne, Newcastle upon Tyne, UK
  15. 15Rheumatology, Mikkeli Central Hospital, Mikkeli, Finland
  16. 16Rheumatology, Hospital de Valme, Sevilla, Spain
  17. 17Medical Centre for Rheumatology Berlin-Buch, Berlin, Germany
  18. 18Rheumatology, Medisch Centrum Alkmaar, Alkmaar, Netherlands
  19. 19Rheumatology, University of Copenhagen, Hvidovre Hospital, Copenhagen, Denmark
  20. 20Rheumatology, The Parker Institute, Frederiksberg Hospital, Frederiksberg, Denmark
  21. 21Radiology, The Parker Institute, Frederiksberg Hospital
  22. 22Rheumatology, Hospital de Mostoles, Madrid, Spain
  23. 23Academic Department of Musculoskeletal Medicine, Leeds General Infirmary, Leeds, UK
  24. 24Medical Statistics, Georg-August-University Göttingen, Göttingen, Germany
  1. Correspondence to:
    Dr E Naredo
    Calle Arturo Soria 259, 4° A, 28033 Madrid, Spain; esnaredo{at}


Objective: To assess the interobserver reliability of the main periarticular and intra-articular ultrasonographic pathologies and to establish the principal disagreements on scanning technique and diagnostic criteria between a group of experts in musculoskeletal ultrasonography.

Methods: The shoulder, wrist/hand, ankle/foot, or knee of 24 patients with rheumatic diseases were evaluated by 23 musculoskeletal ultrasound experts from different European countries randomly assigned to six groups. The participants did not reach consensus on scanning method or diagnostic criteria before the investigation. They were unaware of the patients’ clinical and imaging data. The experts from each group undertook a blinded ultrasound examination of the four anatomical regions. The ultrasound investigation included the presence/absence of joint effusion/synovitis, bony cortex abnormalities, tenosynovitis, tendon lesions, bursitis, and power Doppler signal. Afterwards they compared the ultrasound findings and re-examined the patients together while discussing their results.

Results: Overall agreements were 91% for joint effusion/synovitis and tendon lesions, 87% for cortical abnormalities, 84% for tenosynovitis, 83.5% for bursitis, and 83% for power Doppler signal; κ values were good for the wrist/hand and knee (0.61 and 0.60) and fair for the shoulder and ankle/foot (0.50 and 0.54). The principal differences in scanning method and diagnostic criteria between experts were related to dynamic examination, definition of tendon lesions, and pathological v physiological fluid within joints, tendon sheaths, and bursae.

Conclusions: Musculoskeletal ultrasound has a moderate to good interobserver reliability. Further consensus on standardisation of scanning technique and diagnostic criteria is necessary to improve musculoskeletal ultrasonography reproducibility.

  • musculoskeletal ultrasonography
  • interobserver reliability

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