scholarly journals Independent Reliability Analysis of a New Classification for Pyogenic Spondylodiscitis

2020 ◽  
pp. 219256822091909
Author(s):  
Gaston Camino Willhuber ◽  
Alfredo Guiroy ◽  
Juan Zamorano ◽  
Nelson Astur ◽  
Marcelo Valacco
Keyword(s):  
Reliability Analysis ◽  
Interobserver Agreement ◽  
Random Sequence ◽  
Diagnostic Study ◽  
Intraobserver Agreement ◽  
Resonance Imaging ◽  
New Classification ◽  
Level Of Evidence ◽  
Pyogenic Spondylodiscitis

Study Design: Diagnostic study, level of evidence III. Objective: Pyogenic spondylodiscitis can cause deformity, neurological compromise, disability, and death. Recently, a new classification of spondylodiscitis based on magnetic resonance imaging was published. The objective of this study is to perform an independent reliability analysis of this new classification. Methods: We selected 35 cases from our database of different spine centers in Latin America and from the literature; 8 observers evaluated the classification and graded the scenarios according to the methodological grading of the classification developed by Pola et al. Cases were sent to the observers in a random sequence after 3 weeks to assess intraobserver reliability. The interobserver and intraobserver reliabilities were performed with Fleiss and Cohen statistics, respectively. Results: The overall Fleiss κ value for interobserver agreement was substantial, with 0.67 (95% CI = 0.43-0.91) in the first reading and 0.67 (95% CI = 0.45-0.89) in second reading for the main types of classification. The Cohen κ value for intraobserver agreement was also substantial, with 0.68 (95% CI = 0.45-0.92). The interobserver agreement analysis for the subtypes of this classification was overall substantial, with 0.60 (95% CI = 0.37-0.83) in the first reading and 0.61 (95% CI = 0.41-0.81) in the second reading. The overall intraobserver agreement for subtypes of the classification was also substantial, with 0.63 (95% CI = 0.34-0.93). Conclusion: The new classification developed by Pola et al showed substantial interobserver and intraobserver agreements. More studies are required to validate the usefulness of this classification especially in clinical practice.

scholarly journals Interobserver reliability of the classification of capitellar osteochondritis dissecans using magnetic resonance imaging

2019 ◽  
Vol 12 (4) ◽  
pp. 284-293 ◽  
Author(s):  
Rens Bexkens ◽  
F. Joseph Simeone ◽  
Denise Eygendaal ◽  
Michel PJ van den Bekerom ◽  
Luke S Oh ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Osteochondritis Dissecans ◽  
Interobserver Agreement ◽  
Interobserver Reliability ◽  
Lateral Wall ◽  
Magnetic Resonance Images ◽  
Resonance Imaging ◽  
Instability Criteria

Aim (1) To determine the interobserver reliability of magnetic resonance classifications and lesion instability criteria for capitellar osteochondritis dissecans lesions and (2) to assess differences in reliability between subgroups. Methods Magnetic resonance images of 20 patients with capitellar osteochondritis dissecans were reviewed by 33 observers, 18 orthopaedic surgeons and 15 musculoskeletal radiologists. Observers were asked to classify the osteochondritis dissecans according to classifications developed by Hepple, Dipaola/Nelson, Itsubo, as well as to apply the lesion instability criteria of DeSmet/Kijowski and Satake. Interobserver agreement was calculated using the multirater kappa (k) coefficient. Results Interobserver agreement ranged from slight to fair: Hepple (k = 0.23); Dipaola/Nelson (k = 0.19); Itsubo (k = 0.18); DeSmet/Kijowksi (k = 0.16); Satake (k = 0.12). When classifications/instability criteria were dichotomized into either a stable or unstable osteochondritis dissecans, there was more agreement for Hepple (k = 0.52; p = .002), Dipaola/Nelson (k = 0.38; p = .015), DeSmet/Kijowski (k = 0.42; p = .001) and Satake (k = 0.41; p < .001). Overall, agreement was not associated with the number of years in practice or the number of osteochondritis dissecans cases encountered per year (p > .05). Conclusion One should be cautious when assigning grades using magnetic resonance classifications for capitellar osteochondritis dissecans. When making treatment decisions, one should rather use relatively simple distinctions (e.g. stable versus unstable osteochondritis dissecans; lateral wall intact versus not intact), as these are more reliable.

Interrater and Intrarater Reliability of the Kuntz et al New Deformity Classification System

Neurosurgery ◽  
2012 ◽  
Vol 71 (1) ◽  
pp. 47-57 ◽  
Author(s):  
Martin Thaler ◽  
Ricarda Lechner ◽  
Michaela Gstöttner ◽  
Matthias Luegmair ◽  
Michael Liebensteiner ◽  
...  
Keyword(s):  
Classification System ◽  
Interobserver Agreement ◽  
Intraobserver Agreement ◽  
Spinal Alignment ◽  
Intrarater Reliability ◽  
Surgical Interventions ◽  
Apical Vertebral Rotation ◽  
Age Dependent ◽  
The Mean

Abstract BACKGROUND: Kuntz et al recently introduced a new system for classifying spinal deformities. This classification of spinal deformity was developed from age-dependent deviations from the neutral upright spinal alignment. OBJECTIVE: To determine the interobserver and intraobserver reliabilities of the new Kuntz et al system for classifying scoliosis. METHODS: Fifty consecutive patients were evaluated. Three observers independently assigned a major structural curve, minor structural curve, curve type, apical vertebral rotation, spinal balance, and pelvic alignment to each curve following the guidelines described by Kuntz et al. Assignment of the curves was repeated 4 weeks later, with the curves presented in a different blinded order. The Kendall W and Holsti agreement coefficients were used to determine the interobserver and intraobserver agreement. RESULTS: The intraobserver value of agreement for all parameters was 0.85 (range, 0.28-1.0), and the mean Kendall W coefficient was 0.89 (range, 0.5-0.97), demonstrating perfect reliability. The interobserver agreement averaged 0.7 (range, 0.251-1.0). The mean Kendall W coefficient was 0.67 (range, 0.19-1.0), demonstrating substantial reliability. The average time for classification of 1 curve was approximately 8.4 minutes. CONCLUSION: The new Kuntz et al deformity classification system is comparable to the Lenke et al system in terms of reliability. However, the Kuntz et al classification system provides no recommendations for surgical interventions. It is more complex and time-consuming and therefore may be of limited value in daily clinical practice.

Magnetic resonance imaging investigation of radio-lunate relations: use in assessing distal radial fracture reduction

2016 ◽  
Vol 42 (3) ◽  
pp. 271-274
Author(s):  
G. Medlock ◽  
J. M. Wohlgemut ◽  
I. M. Stevenson ◽  
A. J. Johnstone
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Fracture Reduction ◽  
Distal Radial Fracture ◽  
Diagnostic Study ◽  
Radial Fracture ◽  
Resonance Imaging ◽  
Dorsal Cortex ◽  
Level Of Evidence ◽  
Outer Border

Reformatted magnetic resonance imaging scans of 27 normal wrists were examined in incremental degrees of rotation around the central axis of the radial shaft to 30° in both directions from true lateral. A line was superimposed on the outer border of the radial dorsal cortex and continued distally to the carpal region. Measurements were made from the superior pole of the lunate to this line. This distance did not change significantly with rotation. This allows a quick and accurate way of assessing distal radial fracture reduction from poorly taken lateral radiographs. In addition, the relevant landmarks are not obscured by implants or casts. Level of evidence: III, diagnostic study

scholarly journals How Reliable is the Radiographic Diagnosis of Mild Madelung Deformity?

2017 ◽  
Vol 07 (03) ◽  
pp. 227-231 ◽  
Author(s):  
Thierry Guitton ◽  
David Ring ◽  
Sebastian Farr ◽  
Keyword(s):  
Online Survey ◽  
Interobserver Agreement ◽  
Study Group ◽  
Diagnostic Study ◽  
Level Of Evidence ◽  
Madelung Deformity ◽  
The Mean ◽  
Sensitivity Specificity ◽  
Relationship Of ◽  
The Relationship

Background Patients with Madelung deformity exhibit a spectrum of mild to severe deformity and distortion of wrist geometry. It may be difficult to reliably distinguish mild Madelung deformity from normal. Purpose This study thus tested the reliability of the diagnosis of mild Madelung deformity on a single posteroanterior (PA) radiograph. Materials and Methods An online survey was sent to hand and wrist surgeons of the Science of Variation Study Group for evaluation of 25 PA wrist radiographs comprising five adults with suspected mild Madelung deformity and 20 radiographs without any evident wrist pathology. Interobserver agreement was evaluated both via average percent agreement and Fleiss' kappa. To evaluate the relationship of rater characteristics and accuracy, a linear regression model was computed. Results The interobserver agreement among the 69 participating surgeons was low (Κ = 0.12). The overall sensitivity, specificity, and accuracy were 0.30, 0.86, and 0.75, respectively. The mean confidence was 7.4 ± 0.4 for mild Madelung and 7.8 ± 0.5 for normal (p = 0.112). The observers' confidence level was the only factor which had a mild but significant effect on the accuracy of the ratings. Conclusion The diagnosis of mild Madelung deformity on a single PA radiograph is unreliable. Level of Evidence The level of evidence is II, diagnostic study.

scholarly journals Novel Semiquantitative Bone Marrow Oedema Score and Fracture Score for the Magnetic Resonance Imaging Assessment of the Active Charcot Foot in Diabetes

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
L. Meacock ◽  
N. L. Petrova ◽  
Ana Donaldson ◽  
A. Isaac ◽  
A. Briody ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Bone Marrow ◽  
Magnetic Resonance ◽  
Interobserver Agreement ◽  
Bone Volume ◽  
Foot And Ankle ◽  
Intraobserver Agreement ◽  
Charcot Foot ◽  
Resonance Imaging ◽  
Mri Scans

There are no accepted methods to grade bone marrow oedema (BMO) and fracture on magnetic resonance imaging (MRI) scans in Charcot osteoarthropathy. The aim was to devise semiquantitative BMO and fracture scores on foot and ankle MRI scans in diabetic patients with active osteoarthropathy and to assess the agreement in using these scores. Three radiologists assessed 45 scans (Siemens Avanto 1.5T, dedicated foot and ankle coil) and scored independently twenty-two bones (proximal phalanges, medial and lateral sesamoids, metatarsals, tarsals, distal tibial plafond, and medial and lateral malleoli) for BMO (0—no oedema, 1—oedema < 50% of bone volume, and 2—oedema > 50% of bone volume) and fracture (0—no fracture, 1—fracture, and 2—collapse/fragmentation). Interobserver agreement and intraobserver agreement were measured using multilevel modelling and intraclass correlation (ICC). The interobserver agreement for the total BMO and fracture scores was very good (ICC = 0.83, 95% confidence intervals (CI) 0.76, 0.91) and good (ICC = 0.62; 95% CI 0.48, 0.76), respectively. The intraobserver agreement for the total BMO and fracture scores was good (ICC = 0.78, 95% CI 0.6, 0.95) and fair to moderate (ICC = 0.44; 95% CI 0.14, 0.74), respectively. The proposed BMO and fracture scores are reliable and can be used to grade the extent of bone damage in the active Charcot foot.

Conventional Radiographs and Magnetic Resonance Imaging for the Analysis of Trochlear Dysplasia: The Influence of Selected Levels on Magnetic Resonance Imaging

2017 ◽  
Vol 45 (5) ◽  
pp. 1059-1065 ◽  
Author(s):  
Philippe Matthias Tscholl ◽  
Florian Wanivenhaus ◽  
Sandro F. Fucentese
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Distal Femur ◽  
Trochlear Dysplasia ◽  
Joint Line ◽  
Low Grade ◽  
Resonance Imaging ◽  
Level Of Evidence ◽  
Dejour Classification

Background: Trochlear dysplasia is one of the most important risk factors for recurrent patellar instability. It is defined on true lateral conventional radiographs (CR) and axial magnetic resonance imaging (MRI). The type of trochlear dysplasia is decisive for surgical treatment; however, low agreement between CR and MRI has been reported. Purpose: To compare the Dejour classification of trochlear dysplasia on CR and axial MRI using differing levels defined in the literature. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: The 4-type classification of trochlear dysplasia by Dejour was used to analyze 228 knees with recurrent patellar dislocations on true lateral CR and axial MRI. The 2-type modification of the Dejour classification was also similarly analyzed. Measurements on axial MRI were performed at 3 different levels: MR1, the most proximal level where the intercondylar notch forms a “Roman arch”; MR2, 3 cm above the joint line; and MR3, the midpatellar height. Results: MR1 was measured at a mean distance of 29 ± 3.5 mm and MR3 at a mean of 38 ± 5.8 mm above the joint line. MR1 and MR2 were always measured on the cartilaginous trochlea, whereas 52% of MR3 was found more proximally. Overall agreement was fair between CR and MR1/MR2 (31.1%/25.4%, respectively) and highest for MR3 (45.2%; P < .01). The highest agreement (81.8%) was found for MR3 with the 2-type trochlear dysplasia classification (low-grade trochlear dysplasia: type A vs high-grade trochlear dysplasia: types B, C, and D) and lower for MR1 (67.5%) and MR2 (62.0%). Conclusion: Trochlear dysplasia measured on CR and MRI shows only fair agreement, especially when the supratrochlear region of the distal femur is not analyzed on axial MRI. MRI analysis that considers the cartilaginous trochlea only tends to underestimate the severity of dysplasia according to Dejour. For a more precise evaluation of trochlear dysplasia, the entire distal femur should be analyzed on axial MRI.

scholarly journals INTEROBSERVER REPRODUCIBILITY ASSESSMENT OF THE NEW AOSPINE CLASSIFICATION FOR SUBAXIAL CERVICAL LESIONS

2021 ◽  
Vol 20 (1) ◽  
pp. 8-13
Author(s):  
Leandro Vinícius Vital ◽  
Rogério Lúcio Chaves de Resende ◽  
Jefferson Soares Leal ◽  
Renato de Melo Guimarães ◽  
Ângelo Ribeiro Vaz de Faria
Keyword(s):  
Interobserver Agreement ◽  
Diagnostic Study ◽  
Cervical Lesions ◽  
Level Of Evidence ◽  
Tomographic Images ◽  
Cervical Fractures ◽  
Subaxial Cervical Spine ◽  
Traumatic Lesions ◽  
Level Of Significance ◽  
Level Of Agreement

ABSTRACT Objective: To evaluate the interobserver agreement of the new AOSpine classification for subaxial cervical fractures. Methods: A descriptive study, which11 traumatic lesions of the subaxial cervical spine (through radiographic and tomographic images), were evaluated by 16 observers being: 6 senior surgeons, 4 fellows in spinal surgery and 6 physicians residents in Orthopedics and Traumatology by the new AOSpine classification, with subsequent statistical analysis of the results. An agreement analysis was performed using the Kappa coefficient, both individually and in combination, with an interpretation of the index performed using the standardized model for Landis and Koch. To determine the level of significance of the analyzes, values less than 0.05 were considered statistically significant. Results: In general, the level of agreement among the examiners was considered reasonable. The lesions “A0 (F3)”, “A4 (F3)”, “B1”, “B3”, “B3 (F3)”, “C”, “C (F3)” and “F3”showed a low level of agreement between the examiners. The level of reasonable agreement was obtained between fractures “A0”, “A1”, “A4”, “B2” and “C (F4)”. The only fracture that presented a moderate level of agreement was the “C (F4 BL)” lesion. This result indicates that the referred injury was the fracture of the subaxial column that presented the best level of agreement among the 16 examiners in the present study. Conclusions: The results of the study indicate an intermediate agreement of the new AOSpine classification for subaxial cervical lesion and point to the need to carry out studies that seek to evaluate this new classification in order to better evaluate its strengths and weaknesses, contributing for its improvement. Level of evidence III; Diagnostic study - investigation of a diagnostic test.

scholarly journals New classification of osteochondral lesions of the talus in adults

2021 ◽  
Vol 15 (1) ◽  
pp. 77-82
Author(s):  
Jorge Batista ◽  
German Joannas ◽  
Leandro Casola ◽  
Lucas Logioco ◽  
Guillermo Arrondo
Keyword(s):  
Mechanical Axis ◽  
Osteochondral Lesions ◽  
Associated Injuries ◽  
New Classification ◽  
Lateral Instability ◽  
Level Of Evidence ◽  
Chronic Instability ◽  
Hindfoot Deformities ◽  
Limb Deformities

Osteochondral lesions (OCL) of the ankle in adults are frequent lesions that mainly affect the cartilage and the subchondral bone, are relatively common, and have varied etiologies. However, in 50% of patients, these lesions may occur concomitantly with chronic instability of the ankle associated with lower limb deformities, acute sprains of the ankle, or fractures. We propose a classification into four types of lesions (traumatic, non-traumatic, with lateral instability of the ankle, and with mechanical axis defects), focusing not only on the diagnosis and treatment of OCL but also on associated injuries, such as instability and/or supramalleolar and hindfoot deformities. Level of Evidence V; Therapeutic Studies; Expert Opinion.

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