Ultrasound Imaging Acquisition Procedures for Evaluating the First Metatarsophalangeal Joint: A Scoping Review

Abstract

The aim of this scoping review was to investigate ultrasound imaging (USI) acquisition procedures and guidelines used to assess the first metatarsophalangeal joint (MTPJ). MEDLINE, CINAHL, AMED and SPORTDiscus were systematically searched in May 2021. Studies were included if they used grey-scale USI or power Doppler and reported a USI procedure to assess the first MTPJ. Screening and data extraction were performed by two independent assessors. The scoping review was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for scoping reviews (PRISMA-ScR). A total of 403 citations were identified for screening, with 36 articles included in the final analysis. There was wide variation in USI acquisition procedures used to evaluate the first MTPJ. Inconsistencies in reporting may be attributable to the number of elements the USI acquisition procedure encompasses, which include the model of the USI device, the type of transducer, USI modalities and settings, patient position, transducer orientation, surfaces scanned and the scanning technique used. The review found inconsistencies against international guidelines and limited implementation of consensus-based recommendations to guide image acquisition. Current guidelines require further refinement of anatomical reference points to establish a standardised USI acquisition procedure, subsequently improving interpretability and reproducibility between USI studies that evaluate the first MTPJ.

International multispecialty consensus on how to image, define, and grade ultrasound imaging features of first metatarsophalangeal joint osteoarthritis, a Delphi consensus study

“…Authors identified 50 open-ended items based on the participants free-text responses in Round 1. These items were combined with an additional 12 items generated from the authors’ recent systematic [ 25 ] and scoping reviews [ 26 ] to be considered in Round 2. Participants rated 62 items in Round 2, 23 items reached consensus (medians score of ≥70%), 21 items were considered ambiguous (achieved a median score between 51 and 69% agreement), and 18 items were excluded (median score ≤50%).…”

“…As it stands only two consensus-based guidelines exist to inform the US imaging acquisition procedure to assess the first MTPJ [ 16 , 51 ]. Despite this, there has been marked inconsistency in the application of guidelines across studies [ 26 ]. The 2001 EULAR guidelines included limited instructions on body position, transducer orientation and surfaces of the first MTPJ to scan (supine position for the dorsal scans and prone position for the plantar scans) [ 51 ].…”

“…The Delphi was developed using an evidence driven approach with findings from a systematic review [ 25 ] and scoping review [ 26 ] used to inform Round 1 open-ended questions. The systematic review investigated what US features are associated with OA in peripheral joints and how US features in peripheral joints are defined and graded [ 25 ].…”

“…The systematic review investigated what US features are associated with OA in peripheral joints and how US features in peripheral joints are defined and graded [ 25 ]. The scoping review investigated US imaging acquisition procedures and guidelines used to assess the first MTPJ [ 26 ]. Round 1 included participant information, online consent, instructions, and the Round 1 survey (Supplementary Data 1).…”

“…Themes were developed through qualitative descriptive analysis [ 28 , 29 ] and reviewed by a second author (MC). Open-ended responses from Round 1 were combined with additional items generated from the systematic and scoping reviews [ 25 , 26 ], that were not identified by participants in Round 1.…”