Wilkinson C E, Carr A J, Doherty M
Academic Rheumatology, University of Nottingham, Nottingham City Hospital, Nottingham NG5 1PB, UK.
Ann Rheum Dis. 2005 Oct;64(10):1467-73. doi: 10.1136/ard.2004.033282. Epub 2005 Apr 7.
To (a) develop further logically derived line drawing atlases (LDAs) for grading radiographic knee osteoarthritis (OA); and (b) determine which is superior using metrological criteria.
A series of LDAs (-3 to +3, -4 to +4, and -5 to +5) were produced by (a) incorporating additional grades for osteophyte and joint space width (JSW) above the 0-3 pilot LDA, over an equivalent range of disease; and (b) adding negative grades for JSW. 121 sets of bilateral knee radiographs (standing, anteroposterior plus flexed skyline), plus serial views of 68 tibiofemoral joints (TFJs) and 36 patellofemoral joints were scored twice by one observer for each LDA. Minimum JSW of 50 radiograph sets was directly measured and awarded a categorical grade dependent upon the boundaries of each LDA grade. Time taken to grade 30 randomly selected knee radiograph sets was measured.
Intraobserver reproducibility was similar for all LDAs, (weighted kappa: JSW = 0.85-0.87; osteophyte = 0.77-0.79), with no deterioration with increasing grades. Criterion validity favoured the -5 to +5 LDA, which was also quickest to use. All atlases showed similar responsiveness (standardised response mean: medial TFJ JSW = 0.78-0.83; medial femoral osteophyte = 0.61-0.73), with most sites compromised by small sample size, little change in score, and high variation between subjects.
A set of LDAs was created illustrating the full range of normality/abnormality likely to be encountered in a community study of knee pain or OA. Despite superior validity and equivalent reproducibility, improved responsiveness of the -5 to +5 LDA was not confirmed.
(a) 进一步开发用于对膝关节骨关节炎（OA）进行放射学分级的逻辑推导线条图图谱（LDA）；(b) 使用计量标准确定哪一种图谱更优。
通过以下方式制作了一系列LDA（-3至+3、-4至+4以及-5至+5）：(a) 在与试点LDA（0至3）相同的疾病范围内，针对骨赘和关节间隙宽度（JSW）纳入高于0至3级的额外分级；(b) 为JSW添加负分级。一名观察者对121套双侧膝关节X线片（站立位，前后位加屈膝天际线位）以及68个胫股关节（TFJ）和36个髌股关节的系列影像，对每个LDA进行了两次评分。直接测量了50套X线片的最小JSW，并根据每个LDA分级的界限给予分类分级。测量了对30套随机选择的膝关节X线片进行分级所需的时间。
所有LDA的观察者内重复性相似（加权kappa值：JSW = 0.85 - 0.87；骨赘 = 0.77 - 0.79），且不会随分级增加而变差。标准效度支持-5至+5的LDA，其使用起来也是最快的。所有图谱显示出相似的反应性（标准化反应均值：内侧TFJ的JSW = 0.78 - 0.83；股骨内侧骨赘 = 0.61 - 0.73），大多数部位受到样本量小、评分变化小以及个体间差异大的影响。
创建了一组LDA，展示了在膝关节疼痛或OA的社区研究中可能遇到的正常/异常的全范围情况。尽管-5至+5的LDA具有更高的效度和相当的重复性，但其改善的反应性未得到证实。
