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Table 4 Description of enthesitis scoring system

From: Ultrasound in the evaluation of enthesitis: status and perspectives

Year Authors Enthesis studied Grey-scale Doppler mode Scoring system Reliability Sensitivity to change
2001 Cosentino [19] PF Y N grade l: thickening of enthesis (<2 mm thicker than the controlateral asymptomatic side), heterogeneous hypoechogenicity of enthesis and enthesophytosis. grade 2: thickening of enthesis (>2 mm thicker than the controlateral asymptomatic side), heterogeneous hypoechogenicity of enthesis, and enthesophytosis. grade 3: grade 2 with peritendinous oedema. NA U
2002 Balint [16] GUESS: A, PF (90°),PTPI, PTDI, Q (30°) Y N GUESS score (0 to 36): Each item scores one point. total possible score on both lower limb is 36 superior pole of the patella- quadriceps tendon enthesis: quadriceps tendon thickness >=6.1mm, suprapatellar bursitis, superior pole of patella erosion, superior pole of patella enthesophyte inferior pole of the patella-proximal patellar ligament enthesis: patellar ligament thickness > = 4 mm, inferior pole of patella erosion, inferior pole of patella enthesophyte tibial tuberosity-distal patellar ligament enthesis: patellar ligament thickness > = 4 mm, infrapatellar bursitis, tibial tuberosity erosion, tibial tuberosity enthesophyte superior pole of the calcaneus-achilles tendon enthesis: Achilles tendon thickness >=5.29 mm, retrocalcaneal bursitis, posterior pole of calcaneus erosion, posterior pole of calcaneus enthesophyte inferior pole of the calcaneus -plantar aponeurosis enthesis: Plantar aponeurosis thickness >=4.4 mm, inferior pole of calcaneus erosion, inferior pole of calcaneus enthesophyte. U NA
2002 Falsetti [28] wrist, elbow, shoulder, hip, knee, ankle, calcaneum Y N each item scored according to a semi quantitative score: 1: mild,2: moderate,3:considerable items scored: synovitis, tenosynovitis, enthesitis U NA
2003 D'Agostino [22] A, PF, tibialis anterior tendon, CET, CFT, PT, Q, trochanter Y Y stage 1: Vascularization at the cortical junction without abnormal findings in Grey-scale stage 2a: Vascularization associated with swelling and/or decreased echogenicity at the cortical junction in Grey-scale stage 3a: Same as stage 2a, plus erosions of cortical bone and/or calcification of enthesis, and optional surrounding bursitis stage 2b: Abnormal findings in B mode as in stage 2a, but without vascularization stage 3b: Abnormal findings in B mode as in stage 3a, but without vascularization Y NA
2003 Falsetti [11] A, PF, retrocalcaneal bursae, subcalcaneal fat pad, cortical bone of posterior and inferior aspects of calcaneum Y N Each inflammatory lesion was graded according to a semi-quantitative scale: grade 1: mild, grade 2: moderate, grade 3: considerable NA NA
2006 Kiris [37] MASES * N Y 0 = absence, 1 = mild, 2 = moderate, 3 = severe Y NA
2007 Alcalde [14] SEI: A, PF (neutral flexion°),PTPI, PTDI, Q (60°) Y N SEI = the total sum of SEI-A and SEI-C. the maximum SEI scoring is 76 points SEI-A (0 to 36): each variable is scored as 0 (absence) or 1 (presence): thickening of tendon/aponeurosis, hypoechogenicity of tendon/aponeurosis, peritendinous/periaponeurotic oedema, bursitis (where applicable) SEI-C (0 to 40): each variable is scored as 0 (absence) or 1 (presence): tendon tear, loss of thickness, tendon calcification, bone erosion. U NA
2008 De Miguel [23] MASEI: A (90°), PF (90°), PTPI and PTDI (70°), distal Q tendon, distal brachial triceps tendon (90°) Y Y MASEI score (0 to 136 on both sides): Calcifications were scored on a semi-quantitative score of 0 to 3 Doppler and erosions were scored as 0 or 3 points Scores for tendon structure, tendon thickness and bursa were either 0 or 1. Calcifications were examined at the area of the enthesis insertion, and scored as 0 if absent, or 1 if a small calcification or ossification with an irregularity of enthesis cortical bone profile was seen. Calcifications were given a score of 2 if there was clear presence of enthesophytes or if medium sized calcifications or ossification were observed. Lastly, they were classified as a 3 if large calcifications or ossifications were present. To simplify things, ossifications and enthesophytes at the enthesis were also included as calcifications. Y NA
2008 Hatemi [7] GUESS ** Y Y GUESS score* + Doppler: one point for each enthese with vascularization. Cumulative score for Doppler (max = 10) U NA
2009 D'Agostino [20] Q, PTPI, CET, A, PF Y Y Grey-scale: hypoechogenicity/thickness: 0 to 1, calcification/enthesophyte: 0 to 1, erosion: 0 to 1 Doppler : (0 to 3): 0: no signal, 1: minimal (1 spot), 2: moderate (2 spot), 3: severe (> = 3 spots)or Doppler scored as 0 to 1 (absent-present) Y NA
2008 Mc Gonagle [44] A (90°) Y N spur (0 to 3):0 absence, 1: minimal, 2: moderate, 3: large NA NA
2009 Filippucci [13] A Y Y soft tissue inflammation (seven items): tendon hypoechogenicity, Entheseal hypoechogenicity, Bursal effusion, PDS signal at tendon level, PDS signal at entheseal level, PDS signal at bursal level tissue damage (five items): Intratendineous calcifications, Entheseal calcifications, Enthesophytes, Bone erosions, Bone irregularities* (not used to calculate total score) (1) a total score for soft tissue inflammation, which resulted from the sum of the scores assigned to the 7 US findings indicative of soft tissue inflammation, ranging from 0 to 7 with presence/absence data and from 0 to 14 with semiquantitative scores; (2) a total score for tissue damage, which resulted from the sum of the scores assigned to the 4 US findings indicative of tissue damage, ranging from 0 to 4 with presence/absence data and from 0 to 8 with semiquantitative scores. Y NA
2009 Iagnocco [8] A (neutral position) Y Y All lesions scored on both a dichotomous scale (present/absent) and a 4-point semiquantitative scale (0 = absent, 1 = mild, 2 = moderate, 3 = severe) enthesopathy: tendon hypoechogenicity at the level of bony attachment, tendon thickening at the at the level of bony attachment, intra-tendinous calcifications, enthesophytes, bony erosions, bony cortex irregularities, presence of Doppler signal at the level of bony attachment, presence of intratendinous Doppler signal bursitis: enlargement of deep calcaneal bursa, enlargement of superficial calcaneal bursa tendon lesion: both partial and full-thickness tendon lesions NA NA
  1. Y, yes; N, no; U, unclear; NA, not available
  2. A, Achilles tendon; ASIS, anterior superior iliac spines; CET, commun extensor tendon insertion on lateral epicondyle; CFT, common flexor tendon insertion on medial epicondyle; PF, Plantar Fascia; PSIS, posterior superior iliac spines; PT, patellar tendon; PTDI, patellar tendon distal insertion; PTPI, patellar tendon proximal insertion; Q, quadriceps
  3. * MASES: 1st and 7th costosternal joints, PSIS, ASIS, iliac crests, A, 5th lumbar spinous process, ** GUESS score: A, PF (90°),PTPI, PTDI, Q (30°)