{
  "abstract": "Objectives To provide a comprehensive description of a standardised, landmark-based ultrasound (US) technique for evaluating the lateral costotransverse (LCTL), supraspinous (SSL) and iliolumbar (ILL) ligaments of the thoracolumbar spine and to assess its reliability, feasibility and its potential applicability in spondyloarthritis (SpA).Methods LCTL, SSL and ILL were examined using US in specimens, followed by dissection to confirm structure location and validate US findings using a standardised anatomic-based and sonoanatomic-based landmark approach. The US technique was subsequently applied in 20 healthy controls (HC), in whom feasibility and inter-rater and intra-rater reliability among four operators with different expertise were assessed. Ligament visualisation was scored as: 0, not visualised; 1, incompletely visualised; 2, perfectly visualised. The technique was tested in three patients with SpA to evaluate its applicability.Results Anatomical study confirmed location and landmarks for all three ligaments. 120 ligaments were assessed in two rounds in HC. Visualisation scores ranged from 1 to 2 in 100% LCTL, 99.1% SSL and 85.9% ILL, with score 2 obtained in 69.6% of 960 assessments. Mean examination time decreased from 12′17″ to 10′56″ between rounds, with no significant differences between operators. Intra-rater and inter-rater agreement ranged from moderate to high. In patients with SpA, US detected both inflammatory and structural lesions in the three ligament entheses.Conclusion The proposed standardised US approach allows reliable assessment of LCTL, SSL and ILL. This technique provides a robust and reproducible method for evaluating the ligaments of the thoracolumbar spine and opens a new approach to the US assessment of patients with spinal inflammatory diseases, including SpA.",
  "authors": [
    {
      "affiliations": [
        "Instituto Poal de Reumatologia, Barcelona, Spain"
      ],
      "name": "Chiara Rizzo"
    },
    {
      "affiliations": [
        "Rheumatology Unit, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Campus, Barcelona, Spain",
        "Department of Pathology and Experimental Therapeutics (Campus of Bellvitge), Unit of Human Anatomy and Embryology, University of Barcelona, Barcelona, Spain"
      ],
      "name": "Luis Coronel"
    },
    {
      "affiliations": [
        "Department of Pathology and Experimental Therapeutics (Campus of Bellvitge), Unit of Human Anatomy and Embryology, University of Barcelona, Barcelona, Spain"
      ],
      "name": "Maribel Miguel-Perez"
    },
    {
      "affiliations": [
        "Department of Pathology and Experimental Therapeutics (Campus of Bellvitge), Unit of Human Anatomy and Embryology, University of Barcelona, Barcelona, Spain"
      ],
      "name": "David Bong"
    },
    {
      "affiliations": [
        "IMIDomics, Inc, Barcelona, Spain"
      ],
      "name": "Juan Angel Patiño-Galindo"
    },
    {
      "affiliations": [
        "Rheumatology Research Group, Vall d’Hebron Research Institute, Barcelona, Spain"
      ],
      "name": "Mariona Colom"
    },
    {
      "affiliations": [
        "Instituto Poal de Reumatologia, Barcelona, Spain"
      ],
      "name": "Diana Marcela Padilla-Ortiz"
    },
    {
      "affiliations": [
        "Department of Internal Disease Propaedeutics and Rheumatology, Medical University of Plovdiv, Clinic of Rheumatology, University Hospital Kaspela, Plovdiv, Bulgaria"
      ],
      "name": "Plamen Todorov"
    },
    {
      "affiliations": [
        "Rheumatology Division, Hospital Universitario de La Princesa, IIS-Princesa, Universidad Autonoma de Madrid, Madrid, Spain"
      ],
      "name": "Esther Francisca Vicente-Rabaneda"
    },
    {
      "affiliations": [
        "Division of Rheumatology and Clinical Immunology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy",
        "Università Cattolica del Sacro Cuore, Rome, Italy"
      ],
      "name": "Stefano Alivernini"
    },
    {
      "affiliations": [
        "Biomab – Centro de Artritis Reumatoide, Bogotá, Colombia"
      ],
      "name": "Pedro Santos-Moreno"
    },
    {
      "affiliations": [
        "Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet Glostrup, Copenhagen, Denmark",
        "Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark"
      ],
      "name": "Lene Terslev"
    },
    {
      "affiliations": [
        "Division of Rheumatology and Clinical Immunology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy",
        "Università Cattolica del Sacro Cuore, Rome, Italy"
      ],
      "name": "Maria Antonietta D’Agostino"
    },
    {
      "affiliations": [
        "Instituto Poal de Reumatologia, Barcelona, Spain",
        "Department of Pathology and Experimental Therapeutics (Campus of Bellvitge), Unit of Human Anatomy and Embryology, University of Barcelona, Barcelona, Spain"
      ],
      "name": "Ingrid Möller"
    }
  ],
  "title": "Ultrasound assessment of vertebral ligaments: development and validation of a landmark-based scanning protocol with potential applicability in spondyloarthritis",
  "uid": "19150829-1d0c-5963-9591-09e25ddfd81f"
}