Four-Dimensional CT Analysis of Dorsal Intercalated Segment Instability in patients with Suspected Scapholunate Instability

2021 ◽  
Author(s):  
Lionel Athlani ◽  
Jonathan Granero ◽  
Kamel Rouizi ◽  
Gabriela Hossu ◽  
Alain Blum ◽  
...  
Keyword(s):  
Interobserver Variability ◽  
Intraclass Correlation ◽  
Threshold Values ◽  
Level Of Evidence ◽  
Ct Arthrography ◽  
Scapholunate Instability ◽  
Ct Analysis ◽  
The Difference ◽  
Dorsal Intercalated Segment Instability ◽  
Work Up

Abstract Background In this study we sought to evaluate the contribution of dynamic four-dimensional computed tomography (4DCT) relative to the standard imaging work-up for the identification of the dorsal intercalated segment instability (DISI) in patients with suspected chronic scapholunate instability (SLI). Methods Forty patients (22 men, 18 women; mean age 46.5 ± 13.1 years) with suspected SLI were evaluated prospectively with radiographs, arthrography, and 4DCT. Based on radiographs and CT arthrography, three groups were defined: positive SLI (n = 16), negative SLI (n = 19), and questionable SLI (n = 5). Two independent readers used 4DCT to evaluate the lunocapitate angle (LCA) (mean, max, coefficient of variation [CV], and range values) during radioulnar deviation. Results The interobserver variability of the 4DCT variables was deemed excellent (intraclass correlation coefficient = 0.79 to 0.96). Between the three groups, there was no identifiable difference for the LCAmean. The LCAmax values were lower in the positive SLI group (88 degrees) than the negative SLI group (102 degrees). The positive SLI group had significantly lower LCAcv (7% vs. 12%, p = 0.02) and LCArange (18 vs. 27 degrees, p = 0.01) values than the negative SLI group. The difference in all the LCA parameters between the positive SLI group and the questionable SLI group was not statistically significant. When comparing the negative SLI and questionable SLI groups, the LCAcv (p = 0.03) and LCArange (p = 0.02) values were also significantly different. The best differentiation between patients with and without SLI was obtained with a LCAcv and LCArange threshold values of 9% (specificity of 63% and sensitivity of 62%) and 20 degrees (specificity of 71% and sensitivity of 63%), respectively. Conclusion In this study, 4DCT appeared as a quantitative and reproducible relevant tool for the evaluation of DISI deformity in cases of SLI, including for patients presenting with questionable initial radiography findings. Level of evidence This is a Level III study.

Interobserver Reliability of Neovascularization Score Using Power Doppler Ultrasonography in Midportion Achilles Tendinopathy

2009 ◽  
Vol 37 (8) ◽  
pp. 1627-1631 ◽  
Author(s):  
Pieter M. Sengkerij ◽  
Robert-Jan de Vos ◽  
Adam Weir ◽  
Bert J. G. van Weelde ◽  
Johannes L. Tol
Keyword(s):  
Correlation Coefficient ◽  
Doppler Ultrasonography ◽  
Interobserver Reliability ◽  
Intraclass Correlation ◽  
Power Doppler ◽  
Achilles Tendinopathy ◽  
Power Doppler Ultrasonography ◽  
Level Of Evidence ◽  
The Difference ◽  
Control Study

Background Power Doppler ultrasonography is widely used to examine neovascularization in midportion Achilles tendinopathy. The reliability of the grading of the degree of neovascularization has not been examined previously. Hypothesis Power Doppler ultrasonography can be performed with a high interobserver reliability to determine the neovascularization score in patients with midportion Achilles tendinopathy. Study Design Case control study (diagnosis); Level of evidence, 4. Methods Thirty-three symptomatic and 17 asymptomatic Achilles tendons from 25 consecutive patients were included for ultrasound examination. Victorian Institute of Sport Assessment–Achilles score was used to assess the severity of the Achilles tendinopathy. Each tendon was scored twice by different radiologists using the modified Öhberg score for neovascularization. Results The intraclass correlation coefficient for interobserver reliability was 0.85. Neovascularization was observed in 70% (23/33) of the symptomatic tendons and in 29% (5/17) of the asymptomatic tendons. The Spearman correlation coefficient between the Victorian Institute of Sport Assessment–Achilles score and the degree of neovascularization was −0.16 (P =. 10). Conclusion An excellent interobserver reliability was found for determining the degree of neovascularization on power Doppler ultrasonography examination. Neovessels were present in a majority of symptomatic tendons. The severity of symptoms was not correlated with the neovascularization score. Clinical Relevance Power Doppler ultrasonography is widely used to evaluate tendinopathy without knowledge of the difference in observations between several testers. Interobserver reliability of the evaluation of the degree of neovascularization in chronic midportion Achilles tendinopathy is excellent.

Glenoid version: the role of genetic and environmental factors on its variability. An MRI study on asymptomatic elderly twins

2020 ◽  
pp. 175857322094702
Author(s):  
S Gumina ◽  
C Villani ◽  
S Carbone ◽  
T Venditto ◽  
V Candela
Keyword(s):  
Intraclass Correlation ◽  
Variable Parameter ◽  
Correlation Coefficients ◽  
Total Sample ◽  
Shared Environment ◽  
Glenoid Version ◽  
Level Of Evidence ◽  
Dizygotic Twins ◽  
The Difference ◽  
Job Category

Background Glenoid version is the most variable parameter of the shoulder joint. No authors investigated if intrinsic genetic factors or influences from extrinsic sources are responsible for its variability. Aim We compared glenoid version between elderly monozygotic and dizygotic twins intending to separate the contributions of genetics from shared and unique environments. Methods Glenoid version of the dominant shoulder was assessed by MRI using Friedman’s method in 30 pairs of elderly twins (16 monozygotic–14 dizygotic; mean age ± SD: 63.72 ± 3.37, 53–72). Heritability was estimated as twice the difference between the intraclass correlation coefficients for monozygotic and dizygotic pairs. The influence of shared environment was calculated as the difference between monozygotic correlation coefficient and the heritability index. According to job category, one way analysis of variance was used to estimate the differences between groups in the total sample and within zygosity groups. Results Glenoid version angle in monozygotic and dizygotic twins was −2° (SD: 2°) and −3° (SD: 3°), respectively (p = 0.334). Heritability index was 0.98, while the contributions of shared and unique environment were 0 and 0.02, respectively. According to working classes, no significant differences were found between the groups (p = 0.732, F = 0.31). Conclusions Glenoid version is mainly genetically determined and only marginally influenced by environments. Level of evidence: III.

scholarly journals Comparison of the Mayo Endoscopy Score and the Ulcerative Colitis Endoscopy Index of Severity and the Ulcerative Colitis Colonoscopy Index of Severity

2021 ◽  
Vol 09 (02) ◽  
pp. E130-E136
Author(s):  
María Belvis Jiménez ◽  
Pedro Hergueta-Delgado ◽  
Blas Gómez Rodríguez ◽  
Belén Maldonado Pérez ◽  
Luisa Castro Laria ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Interobserver Variability ◽  
Intraclass Correlation ◽  
Weighted Kappa ◽  
Clinical Situation ◽  
Kappa Index ◽  
Perfect Correlation ◽  
Index Of Severity ◽  
Severity Of The Disease ◽  
Normal Clinical Practice

Abstract Background and study aims: Endoscopy plays an essential role in managing patients with ulcerative colitis (UC), as it allows us to visualize and assess the severity of the disease. As such assessments are not always objective, different scores have been devised to standardize the findings. The main aim of this study was to assess the interobserver variability between the Mayo Endoscopy Score (MES), Ulcerative Colitis Endoscopy Index of Severity (UCEIS) and Ulcerative Colitis Colonoscopy Index of Severity (UCCIS) analyzing the severity of the endoscopic lesions in patients with ulcerative colitis. Patients and methods: This was a single-cohort observational study in which a colonoscopy was carried out on patients with UC, as normal clinical practice, and a video was recorded. The results from the video were classified according to the MES, UCEIS and UCCIS by three endoscopic specialists independently, and they were compared to each other. The Mayo Endoscopy Score (MES) was used to assess the clinical situation of the patient. The therapeutic impact was analyzed after colonoscopy was carried out. Results: Sixty-seven patients were included in the study. The average age was 51 (SD ± 16.7) and the average MES was 3.07 (SD ± 2.54). The weighted Kappa index between endoscopists A and B for the MES was 0.8; between A and C 0.52; and between B and C 0.49. The intraclass correlation coefficient for UCEIS was 0.92 among the three endoscopists (CI 95 %: 0.83–0.96) and 0.96 for UCCIS among the three endoscopists (CI 95 % 0.94–0.97). A change in treatment for 34.3 % of the patients was implemented on seeing the results of the colonoscopy. Conclusions: There was an adequate, but not perfect, correlation between the different endoscopists for MES, UCEIS, UCCIS. This was higher with the last two scores. Thus, there is still some subjectivity to be minimized through special training, on assessing the seriousness of the endoscopic lesions in patients with UC.

scholarly journals Assessment of reliability and validity of the 5-scale grading system of the point-of-care immunoassay for tear matrix metalloproteinase-9

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Minjeong Kim ◽  
Ja Young Oh ◽  
Seon Ha Bae ◽  
Seung Hyeun Lee ◽  
Won Jun Lee ◽  
...  
Keyword(s):  
Matrix Metalloproteinase ◽  
Calibration Curve ◽  
Point Of Care ◽  
Interobserver Reliability ◽  
Intraclass Correlation ◽  
Reliability And Validity ◽  
Correlation Coefficients ◽  
Grading System ◽  
Intraclass Correlation Coefficients ◽  
The Difference

AbstractWe evaluated the reliability and validity of the 5-scale grading system to interpret the point-of-care immunoassay for tear matrix metalloproteinase (MMP)-9. Six observers graded red bands of photographs of the readout window in MMP-9 immunoassay kit (InflammaDry) two times with 2-week interval based on the 5-scale grading system (i.e. grade 0–4). Interobserver and intraobserver reliability were evaluated using intraclass correlation coefficients. The interobserver agreements were analyzed according to the severity of tear MMP-9 expression. To validate the system, a concentration calibration curve was made using MMP-9 solutions with reference concentrations, then the distribution of MMP-9 concentrations was analyzed according to the 5-scale grading system. Both intraobserver and interobserver reliability was excellent. The readout grades were significantly correlated with the quantified colorimetric densities. The interobserver variance of readout grades had no correlation with the severity of the measured densities. The band density continued to increase up to a maximal concentration (i.e. 5000 ng/mL) according to the calibration curve. The difference of grades reflected the change of MMP-9 concentrations sensitively, especially between grade 2 and 4. Together, our data indicate that the subjective 5-scale grading system in the point-of-care MMP-9 immunoassay is an easy and reliable method with acceptable accuracy.

scholarly journals Comparing the Tibial Tuberosity–Trochlear Groove Distance Between CT and MRI in Skeletally Immature Patients With and Without Patellar Instability

2021 ◽  
Vol 9 (1) ◽  
pp. 232596712097366
Author(s):  
Zhen-Zhen Dai ◽  
Lin Sha ◽  
Zi-Ming Zhang ◽  
Zhen-Peng Liang ◽  
Hao Li ◽  
...  
Keyword(s):  
Patellar Instability ◽  
Intraclass Correlation ◽  
Mean Difference ◽  
Tibial Tubercle ◽  
Control Group ◽  
Trochlear Groove ◽  
Skeletally Immature ◽  
Bony Landmarks ◽  
The Difference ◽  
Ct And Mri

Background: The tibial tubercle–trochlear groove (TT-TG) distance was originally described for computed tomography (CT), but it has been measured on magnetic resonance imaging (MRI) in patients with patellar instability (PI). Whether the TT-TG measured on CT versus MRI can be considered equivalent in skeletally immature children remains unclear. Purpose: To investigate in skeletally immature patients (1) the effects of CT versus MRI imaging modality and cartilage versus bony landmarks on consistency of TT-TG measurement, (2) the difference between CT and MRI measurements of the TT-TG, and (3) the difference in TT-TG between patients with and without PI. Study Design: Cross-sectional study; Level of evidence, 3. Methods: We retrospectively identified 24 skeletally immature patients with PI and 24 patients with other knee disorders or injury but without PI. The bony and cartilaginous TT-TG distances on CT and MRI were measured by 2 researchers, and related clinical data were collected. The interrater, interperiod (bony vs cartilaginous), and intermethod (CT vs MRI) reliabilities of TT-TG measurement were assessed with intraclass correlation coefficients. Results: The 48 study patients (19 boys, 29 girls) had a mean age of 11.3 years (range, 7-14 years). TT-TG measurements had excellent interrater reliability and good or excellent interperiod reliability but fair or poor intermethod reliability. TT-TG distance was greater on CT versus MRI (mean difference, 4.07 mm; 95% CI, 2.6-5.5 mm), and cartilaginous distance was greater than bony distance (mean difference, 2.3 mm; 95% CI, 0.79-3.8 mm). The TT-TG measured on CT was found to increase with the femoral width. Patients in the PI group had increased TT-TG distance compared with those in the control group, regardless of landmarks or modality used ( P > .05 for all). Conclusion: For skeletally immature patients, the TT-TG distance could be evaluated on MRI, regardless of whether cartilage or bony landmarks were used. Its value could not be interchanged with CT according to our results; however, further research on this topic is needed.

scholarly journals Is T2 mapping reliable in evaluation of native and repair cartilage tissue of the knee?

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Hasan Banitalebi ◽  
Christian Owesen ◽  
Asbjørn Årøen ◽  
Hang Thi Tran ◽  
Tor Åge Myklebust ◽  
...  
Keyword(s):  
T2 Mapping ◽  
Intraclass Correlation ◽  
Cartilage Tissue ◽  
Intraobserver Agreement ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Repair Tissue ◽  
Native Cartilage ◽  
Link Type ◽  
Imaging Plane

Abstract Purpose To evaluate the effect of imaging plane and experience of observers on the reliability of T2 mapping of native and repair cartilage tissue of the knee. Methods Fifteen consecutive patients from two randomised controlled trials (RCTs) were included in this cross-sectional study. Patients with an isolated knee cartilage lesion were randomised to receive either debridement or microfracture (RCT 1) or debridement or autologous chondrocyte implantation (RCT 2). T2 mapping was performed in coronal and sagittal planes two years postoperatively. A musculoskeletal radiologist, a resident of radiology and two orthopaedic surgeons measured the T2 values independently. Intraclass Correlation Coefficient (ICC) with 95% Confidence Intervals was used to calculate the inter- and intraobserver agreement. Results Mean age for the patients was 36.8 ± 11 years, 8 (53%) were men. The overall interobserver agreement varied from poor to good with ICCs in the range of 0.27– 0.76 for native cartilage and 0.00 – 0.90 for repair tissue. The lowest agreement was achieved for evaluations of repair cartilage tissue. The estimated ICCs suggested higher inter- and intraobserver agreement for radiologists. On medial femoral condyles, T2 values were higher for native cartilage on coronal images (p < 0.001) and for repair tissue on sagittal images (p < 0.001). Conclusions The reliability of T2 mapping of articular cartilage is influenced by the imaging plane and the experience of the observers. This influence may be more profound for repair cartilage tissue. This is important to consider when using T2 mapping to measure outcomes after cartilage repair surgery. Trial registration ClinicalTrials.gov, NCT02637505 and NCT02636881, registered December 2015. Level of evidence II, based on prospective data from two RCTs.

Linear Mandibular Measurements: Comparison between Orthopantomograms and Lateral Cephalograms

2009 ◽  
Vol 46 (2) ◽  
pp. 147-153 ◽  
Author(s):  
E. M. Ongkosuwito ◽  
M. M. J. Dieleman ◽  
A. M. Kuijpers-Jagtman ◽  
P. G. H. Mulder ◽  
J. W. van Neck
Keyword(s):  
Interobserver Variability ◽  
Intraclass Correlation ◽  
Kappa Statistics ◽  
Magnification Factor ◽  
Linear Measurements ◽  
Lateral Cephalogram ◽  
X Ray ◽  
Lateral Cephalograms ◽  
Left And Right ◽  
Cephalometric Measurements

Objective: To investigate the reliability of length measurements of the mandible by comparing orthopantomograms (OPTs) with lateral cephalograms. Design: Observational study. Setting: OPTs and lateral cephalograms were taken of 20 human dry skulls. Four orthodontists and four maxillofacial surgeons located landmarks on all radiographs using a computer program for cephalometric measurements. Intraobserver and interobserver variability in locating landmarks was assessed, as well as positioning of the skulls prior to radiography between the x-ray assistants. Magnification differences between the left and right side of the mandible on the OPT were determined for five skulls. Kappa statistics were used to calculate the intraclass correlation coefficient for intraobserver and interobserver differences. An F test was used to assess differences between methods and between type of observer. Results: No significant differences were found in the magnification factor of the left and right side of the mandible. Compared with a lateral cephalogram, the OPT had comparable reliability in measuring mandibular distances condylion-gonion, gonion-menton, and condylion-menton. No significant differences were observed between the x-ray assistants in taking the OPTs and lateral cephalograms or in repositioning the skulls. Significant differences were found between orthodontists and maxillofacial surgeons for landmark measurements. Conclusion: An OPT is as reliable as a lateral cephalogram for linear measurements of the mandible (condylion-gonion, gonion-menton, and condylion-menton).

scholarly journals Comparison of MRI and colonoscopy in determining tumor height in rectal cancer

2017 ◽  
Vol 6 (1) ◽  
pp. 131-137 ◽  
Author(s):  
Lotte Jacobs ◽  
David B Meek ◽  
Joost van Heukelom ◽  
Thomas L Bollen ◽  
Peter D Siersema ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Intraclass Correlation ◽  
Rectal Tumor ◽  
Height Measurement ◽  
Treatment Allocation ◽  
Large Variability ◽  
Magnetic Resonance Imaging Mri ◽  
Preoperative Work Up ◽  
Work Up

Background and aim Endoscopy and magnetic resonance imaging (MRI) are used routinely in the diagnostic and preoperative work-up of rectal cancer. We aimed to compare colonoscopy and MRI in determining rectal tumor height. Methods Between 2002 and 2012, all patients with rectal cancer with available MRIs and endoscopy reports were included. All MRIs were reassessed for tumor height by two abdominal radiologists. To obtain insight in techniques used for endoscopic determination of tumor height, a survey among regional endoscopists was conducted. Results A total of 211 patients with rectal cancer were included. Tumor height was significantly lower when assessed by MRI than by endoscopy with a mean difference of 2.5 cm (95% CI: 2.1–2.8). Although the agreement between tumor height as measured by MRI and endoscopy was good (intraclass correlation coefficient (ICC) 0.7 (95% CI: 0.7–0.8)), the 95% limits of agreement varied from –3.0 cm to 8.0 cm. In 45 patients (21.3%), tumors were regarded as low by MRI and middle–high by endoscopy. MRI inter- and intraobserver agreements were excellent with an ICC of 0.8 (95% CI: 0.7–0.9) and 0.9 (95% CI: 0.9–1.0), respectively. The survey showed no consensus among endoscopists as to how to technically measure tumor height. Conclusion This study showed large variability in rectal tumor height as measured by colonoscopy and MRI. Since MRI measurements showed excellent inter- and intraobserver agreement, we suggest using tumor height measurement by MRI for diagnostic purposes and treatment allocation.

scholarly journals ADOLESCENT IDIOPATHIC SCOLIOSIS AND SIMILAR CONDITIONS: NEW TOOL TO MEASURE THE CORONAL PLANE

2018 ◽  
Vol 17 (4) ◽  
pp. 281-285
Author(s):  
Enguer Beraldo Garcia ◽  
Guilherme Brescia Payão ◽  
Liliane Faria Garcia ◽  
Enguer Beraldo Garcia Jr ◽  
Marcos Felipe Camarinha ◽  
...  
Keyword(s):  
Idiopathic Scoliosis ◽  
Postoperative Period ◽  
Central Line ◽  
Coronal Plane ◽  
Fixation Method ◽  
Preoperative Period ◽  
Level Of Evidence ◽  
Proximal Extension ◽  
The Difference ◽  
Third Line

ABSTRACT Objective: To create a method to measure the overall coronal plane of the spine, called the sacral clavicular angle (SCA). Methods: A line is drawn at the base of the sacrum; a second central line is drawn perpendicular to the first one in the proximal extension of the spine. A third line is drawn passing through the intersections of the superior points of the clavicles with the two second ribs, forming two angles, the greater of which is measured. Therefore, the degrees exceeding 90° are the SCA values. This tool was tested retrospectively in a study of 46 patients with idiopathic scoliosis who underwent short, apical, single or multiple fixations. Third generation instrumentation was used and the SCA was evaluated in the pre- and postoperative periods, which were compared with another group of 46 patients treated with the traditional technique. Results: Patients submitted to the traditional fixation method presented a median SCA of 3° in the preoperative period, and in the postoperative period, the SCA remained in 3°. Therefore, there was a 0% reduction. Patients submitted to short, apical, single or multiple fixation method presented a median preoperative SCA of 6°, and a postoperative median SCA of 1°, a reduction of approximately 83%. Conclusions: The group treated with short, apical, single or multiple instrumentation presented a reduction in the SCA of approximately 83% in the postoperative period compared to the preoperative period. The difference between preoperative and postoperative values was considered statistically significant. Level of Evidence II; Retrospective study.

Comparative Results of Percutaneous Calcaneal Osteotomy in Correction of Hindfoot Deformities

2018 ◽  
Vol 40 (3) ◽  
pp. 276-281 ◽  
Author(s):  
Natalia Gutteck ◽  
Alexander Zeh ◽  
David Wohlrab ◽  
Karl-Stefan Delank
Keyword(s):  
Wound Healing ◽  
Standard Technique ◽  
Percutaneous Technique ◽  
Level Of Evidence ◽  
Calcaneal Osteotomy ◽  
Scale Scores ◽  
Oblique Incision ◽  
Hindfoot Deformities ◽  
Wound Healing Problems ◽  
The Difference

Background: Calcaneal osteotomies are often required in the correction of hindfoot deformities. The traditional open techniques, which include a lateral or oblique incision, are occasionally associated with wound healing problems and neurovascular injury. Methods: A total of 122 consecutive patients who underwent a calcaneal osteotomy for hindfoot realignment treatment were included. Fifty-eight patients were operated using an open incision technique and 64 patients (66 feet) using a percutaneous technique. Clinical and radiologic assessments were performed preoperatively, at 6 weeks, and 1 year postoperatively. Results: The American Orthopaedic Foot & Ankle Society scale scores and visual analog scale pain scores improved in both groups postoperatively. The difference between the groups was not significant. The results of the radiologic measurements pre- and postoperatively were not significantly different. No pseudarthrosis occurred in either group. The comparison of both groups showed a significantly lower risk for wound healing problems in the percutaneous group. The hospitalization time was significantly shorter in the percutaneous group. Conclusion: Because of the excellent results with the percutaneous calcaneal osteotomy, the authors feel encouraged to establish this procedure as a standard technique for calcaneus osteotomy, especially patients at high risk for wound healing problems. Level of Evidence: Level III, comparative series.

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