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Imaging Features of Systemic Sclerosis-Associated Interstitial Lung Disease
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Upper Extremity Angiographic Patterns in Systemic Sclerosis: Implications for Surgical Treatment.
Jacinta Leyden1, Matthew B Burn2, Victor Wong1
1Division of Plastic & Reconstructive Surgery, Stanford University School of Medicine, Palo Alto, CA.
The Journal of Hand Surgery
|February 25, 2019
Summary
A new classification system for upper extremity angiograms in systemic sclerosis patients shows high reliability when using arterial types alone. This system aids in risk stratification and targeted research for scleroderma patients.
Area of Science:
- Vascular Surgery
- Radiology
- Rheumatology
Background:
- Systemic sclerosis frequently affects the upper extremities, necessitating detailed vascular assessment.
- Conventional angiography is a standard tool for preoperative evaluation in these patients.
- A standardized classification for angiographic findings is lacking.
Purpose of the Study:
- To develop and validate a classification system for upper extremity arterial patterns in systemic sclerosis.
- To assess the inter- and intrarater reliability of this proposed classification system.
Main Methods:
- Retrospective review of 110 upper extremity angiograms from systemic sclerosis patients.
- Classification based on radial and ulnar artery patency at the wrist (types) and palmar arch patency (subtypes).
- Reliability assessed using Fleiss' Kappa and Cohen's coefficient among 5 observers.
Main Results:
- High inter-rater reliability (0.83) and intrarater reliability (0.80-0.95) were achieved using the arterial types classification.
- Reliability decreased when subtypes were incorporated.
- Type 2 (loss of ulnar artery patency) was observed in 57% of cases, often with type 2A (loss of superficial palmar arch patency) in 77% of those.
Conclusions:
- A classification system for conventional angiography in systemic sclerosis demonstrates high reliability using arterial types.
- This system provides a foundation for future research in risk stratification and treatment for systemic sclerosis.
- Further refinement may be needed when incorporating subtypes for enhanced diagnostic precision.
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