Interobserver and Intraobserver Reproducibility and Reliability of the Huashan Clinical Classification System for Hirayama Disease

Purpose: The Huashan clinical classification system for Hirayama disease has recently been proposed and has been found useful for diagnosis and treatment. So far, however, there has been little in-depth evaluation of its reliability. Thus, this study aimed to assess the reproducibility and reliability of the system.Methods: Patients diagnosed with Hirayama disease between 2019 and 2020 were recruited. Seven spine surgeons from four different institutions, including an experienced group of three and an inexperienced group of four, were trained as observers of the Huashan clinical classification system for Hirayama disease, and these surgeons classified the recruited patients using the system. Then, 2 months later, they repeated the classification on the same patients in a different order. The interobserver and intraobserver agreement between the results was analyzed using percentage agreement and weighted kappa (κ) statistics.Results: A total of 60 patients were included in the analysis. For all the observers, experienced observers, and inexperienced observers, the agreement percentages were, respectively, 78.5% (κ = 0.76), 80.0% (κ = 0.78), and 78.9% (κ = 0.77), indicating substantial interobserver reproducibility. For distinguishing typical (Types I and II) and atypical (Type III) Hirayama disease among the different groups of observers, the percentage agreement ranged from 95.6 to 98.9% (κ = 0.74–0.92), indicating substantial to nearly perfect reproducibility. For suggesting conservative treatment (Types I and III) or surgery (Type II), the percentage agreement ranged from 93.3 to 96.4% (κ = 0.81–0.90), indicating nearly perfect reproducibility. As for intraobserver agreement, the percentage agreement ranged from 68.3 to 81.7% (κ = 0.65–0.79), indicating substantial reliability.Conclusion: The Huashan clinical classification system for Hirayama disease was easy to learn and apply in a clinical environment, showing excellent reproducibility and reliability. Therefore, it would be promising to apply and promote this system for the precise and individualized future treatment of Hirayama disease.

Interobserver reproducibility of contrast-enhanced ultrasound in diabetic nephropathy

Objective: To investigate the interobserver reproducibility of contrast-enhanced ultrasound (CEUS) in patients with diabetic nephropathy. Methods: A total of 40 patients with diabetic nephropathy were enrolled in this retrospective study. We measured peak intensity (PEAK), time-to-peak (TP), area under the curve (AUC) and mean transit time (MTT) of renal CEUS in each patient. Each parameter was performed by two independent observers. The interobserver reproducibility was assessed using intraclass correlation coefficients (ICCs) with 95% confidence intervals (CIs) and Bland–Altman plots by mean difference with 95% limits of agreement (LOAs). Results: The parameters of the left and right kidneys showed moderate or good reliability. The best was the left kidney AUC parameters (ICC,0.945),with a 95% CI of 0.896–0.971.The Bland–Altman plots showed that the mean differences between the right renal parameters (PEAK, TP, AUC and MTT) obtained between the observers 1 and 2 were −6.63%,2.54%,−11.30%,−2.22%, and the 95% LOAs are −30.78 to 17.52%, −30.15 to 35.23%, −43.95 to 21.35%, −44.50 to 40.06%. While the left ones were −2.89%, 0.32%, −8.26%, 1.25% , and the 95% LOAs were −38.50 to 32.72%, −31.98 to 32.62%, −57.89 to 41.37%, −37.21 to 39.71%, respectively. Conclusion: Quantitative CEUS can show good interobserver reproducibility, which is better for the right kidney. It seems necessary to establish standardized techniques for obtaining contrast-enhanced quantitative analysis of renal blood perfusion. Advances in knowledge: Quantitative assessment of renal perfusion by CEUS in patients with diabetic nephropathy provides diagnostic information. Furthermore, renal perfusion assessment in patients with diabetic nephropathy using CEUS has good reproducibility.

High Tibial Osteotomy With Miniaci Planning Using Manual and Semiautomated Digital Measures

Background: Inadequate deformity analysis and planning before high tibial osteotomy (HTO) may result in correction errors with unsatisfactory clinical results. Indications: The purpose of this article is to describe the deformity analysis and preoperative planning before HTO. This surgery is effective for young patients with compartmental mild knee osteoarthritis. A partial deformity analysis without considering the femoral or intra-articular deformity may lead to overcorrection or excessive joint line obliquity. Preoperative planning using the Miniaci method with manual or semiautomated digital measures may help to prevent these types of errors. Technique Description: Landmarks are used at the proximal femoral side, distal condyles, proximal tibial plateau, and talus borders to define angles automatically on PeekMed software. Fujisawa point is determined to be 50% of the length of the proximal tibia, and Miniaci method is performed after defining the weightbearing line. The method can be performed manually or semiautomatically with the software. In this last case, the optimal procedure to be done to correct the malalignment is proposed by the software which automatically does the opening of the osteotomy to match the desired weightbearing axis and displays the size of the wedge in millimeters. Results: The intraobserver and interobserver reproducibility were performed by 2 different analyses and 2 different observers. The precision of the measures was confirmed based on computed tomographic (CT) scan 3-dimensional measures defined as the gold standard. All the intraobserver and interobserver reproducibility correlation coefficients and precision were satisfactory compared with the gold standard. Hip-knee-ankle angle may vary because of weightbearing situations between CT and long-axis x-rays. Discussion/Conclusion: The interest of semiautomated software for angular value measurements is now well recognized, and the inclusion of anatomical landmarks allows accurate and reproducible angular value measurements. Automatic knee osteotomy planning analyzes the metaphyseal deformity of both the tibia and the femur, and the software suggests the optimal procedure with the degree of openness to obtain the desired mechanical axis without creating excessive joint line obliquity

Cerebral amyloid angiopathy-related acute lobar intra-cerebral hemorrhage: diagnostic value of plain CT

Background Diagnosing probable cerebral amyloid angiopathy (CAA) after lobar intra-cerebral hemorrhage (l-ICH) currently relies on the MR-based modified Boston criteria (mBC). However, MRI has limited availability and the mBC have moderate sensitivity, with isolated l-ICH being classified as “possible CAA”. A recent autopsy-based study reported potential value of finger-like projections (FLP) and subarachnoid hemorrhage (SAH) on acute CT. Here we assessed these markers’ performance in a cohort most of whom survived the index episode. Methods We included all patients from a prospective pathology database with non-traumatic l-ICH, admission CT and available tissue sample showing no alternative cause. CT was assessed by two blinded independent neuroradiologists. Interobserver reproducibility was almost perfect for SAH and substantial for FLP. Results Sixteen patients were eligible [age 65.8 ± 7.2 yrs; hematoma volume: 39(26, 71)mls; hematoma evacuation sample 15 patients; autopsy one patient]. MRI was available in 11 patients. ICH-related death affected six patients. Aβ40–42 immunohistochemistry revealed CAA in seven patients (44%). SAH and FLP were present in 12/16 (75%) and 10/16 (62%) patients, respectively. SAH had 100% sensitivity for CAA but low specificity; FLP had lower performance. Using either pathology or MRI as reference standard yielded essentially similar results. All patients with possible CAA on MRI but CAA on pathology had SAH. Conclusions In patients with moderate-size l-ICH who mostly survived the index event, SAH had perfect sensitivity and better performance than FLP. In addition, SAH appeared to add onto MRI in possible CAA, the clinically most relevant scenario. Studies in larger samples are however warranted.

REPRODUCIBILITY OF THE CLASSIFICATION OF PROXIMAL HUMERAL OSSIFICATION IN IDIOPATHIC SCOLIOSIS

ABSTRACT Objective To evaluate the intra- and interobserver reproducibility of the classification of proximal humeral ossification in patients with idiopathic scoliosis. Methods Observational, descriptive, cross-sectional study. Radiographs (anteroposterior) of 29 patients diagnosed with idiopathic scoliosis were chosen and investigated at the Spine Surgery Outpatient Clinic of the Department of Orthopedics and Traumatology of the Hospital Getúlio Vargas, Recife, Pernambuco. These radiographs were evaluated and classified by 9 spinal orthopedic surgeons at two moments, with a minimum interval of 30 days, for analysis of the intraobserver and interobserver reproducibility of the classification of proximal humeral ossification used as a predictor of peak growth velocity. Results Intraobserver reproducibility achieved moderate to substantial concordance with the kappa index. In the analysis of interobserver reproducibility using the Fleiss’ kappa method, a reasonable to moderate concordance was observed, except for in stage 5, in which concordance ranged from substantial to almost perfect. Conclusion In this study, the reproducibility of the Li classification in most of the stages was reasonable to moderate for the interobserver assessment and moderate to substantial for the intraobserver assessment, which differs from the current literature. Level of evidence III; Diagnostic studies – Investigation of a diagnostic test.

Quantitative Analysis of Multimodal Skeletal SPECT/CT Reconstructions in Diagnosing Medication-related Osteonecrosis of the Jaw

Aim Our goal was to assess visual and quantitative aspects of multimodal skeletal SPECT/CT reconstructions (recon) in differentiating necrotic and healthy bone of patients with suspected MRONJ. Methods Prior to surgery, 20 patients with suspected MRONJ underwent SPECT/CT of the jaw 3–4 hours after injection of Tc-99m-DPD (622±112.4 MBq). SPECT/CT data were reconstructed using the multimodal xSPECT Bone and xSPECT Quant algorithms as well as the OSEM-algorithm FLASH 3D. For analysis, we divided the jaw into 12 separate regions. Both xSPECT Bone and FLASH 3D datasets were scored on a four-point scale (VIS xSPECT; VIS F3D), based on the intensity of localized tracer uptake. In F3D and xSPECT Quant datasets, local tracer uptake of each region was recorded as semi-quantitative uptake ratio (SQR F3D) or SUVs, respectively. ROC analysis was performed. Postoperative histologic results served as gold standard. Results VIS F3D, VIS xSPECT and SQR F3D did not differ significantly in diagnostic accuracy (VIS xSPECT sensitivity=0.64; specificity=0.89). Of the quantitative parameters, SUVpeak yielded the best interobserver reproducibility. SUVpeak was 9.9±7.1 (95%CI: 7.84–11.95) in MRONJ regions, as opposed 3.6±1.8 (95% CI:3.36–3.88) elsewhere, with a cutpoint of 4.5 (sensitivity=0.83; specificity=0.80). Absolute quantitation significantly surpassed VIS and SQR (p<0.05) in accuracy and interobserver agreement (SUVpeak: κ=0.92; VIS xSPECT: κ=0.61; SQR F3D κ=0.66). Conclusion Absolute quantitation proved significantly more accurate than visual and semi-quantitative assessment in diagnosing MRONJ, with higher interobserver agreement.

INTRA- AND INTEROBSERVER REPRODUCIBILITY OF THE RADIOGRAPHIC EVALUATION OF CRANIAL PARAMETERS

ABSTRACT Objective: To evaluate the intra- and interobserver reproducibility of radiographic cranial parameters. Method: A study of the reproducibility of the radiographic cranial parameters (cranial incidence, cranial tilt, cranial slope and spinocervical angle) of 40 patients by 4 observers with different levels of experience. Results: Cranial incidence (CI) showed poor intraobserver concordance; for the other cranial parameters, good to excellent concordance was observed. In the assessment of interobserver concordance, all the parameters analyzed showed statistical significance, with good CI concordance. Conclusion: Cranial parameters are easily reproducible by orthopedists with different levels of experience. CI showed good interobserver concordance, but only reasonable intraobserver concordance among more experienced observers. Level of evidence IV; Diagnostic Study.