Doria A S, Lundin B, Miller S, Kilcoyne R, Dunn A, Thomas S, Rivard G, Moineddin R, Babyn P S
Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada.
Haemophilia. 2008 Mar;14(2):303-14. doi: 10.1111/j.1365-2516.2007.01602.x. Epub 2007 Dec 28.
We assessed the reliability and construct validity of the Compatible MRI scale for evaluation of elbows, and compared the diagnostic performance of MRI and radiographs for assessment of these joints. Twenty-nine MR examinations of elbows from 27 boys with haemophilia A and B [age range, 5-17 years (mean, 11.5)] were independently read by four blinded radiologists on two occasions. Three centres participated in the study: (Toronto, n = 24 examinations; Atlanta, n = 3; Cuiaba, n = 2). The number of previous joint bleeds and severity of haemophilia were reference standard measures. The inter-reader reliability of MRI scores was substantial (ICC = 0.73) for the additive (A)-scale and excellent (ICC = 0.83) for the progressive (P)-scale. The intrareader reliability was excellent for both P-scores (ICC = 0.91) and A-scores (ICC = 0.93). The total P- and A-scores correlated poorly (r = 0.36) or moderately (r = 0.54), but positively, with clinical-laboratory measurements. The total MRI scores demonstrated high accuracy for discrimination of presence or absence of arthropathy [P-scale, area-under-the-curve (AUC) = 0.94 +/- 0.05; A-scale, AUC = 0.89 +/- 0.06], as did the soft tissue scores of both scales (P-scale, AUC = 0.90 +/- 0.06; A-scale, AUC = 0.86 +/- 0.06). Areas-under-the-curve used to discriminate severe disease demonstrated high accuracy for both P-MRI scores (AUC = 0.83 +/- 0.09) and A-MRI scores (AUC = 0.87 +/- 0.09), but non-diagnostic ability to discriminate mild disease. Similar results were noted for radiographic scales. In conclusion, both MRI scales demonstrated substantial to excellent reliability and accuracy for discrimination of presence/absence of arthropathy, and severe/non-severe disease, but poor to moderate convergent validity for total scores and non-diagnostic discriminant validity for mild/non-mild disease. Compared with radiographic scores, MRI scales did not perform better for discrimination of severity of arthropathy.
我们评估了用于肘部评估的兼容MRI量表的可靠性和结构效度，并比较了MRI和X线片在评估这些关节方面的诊断性能。对27名患有甲型和乙型血友病男孩（年龄范围5 - 17岁，平均11.5岁）的29次肘部MR检查，由4名不知情的放射科医生在两个不同时间独立进行解读。三个中心参与了该研究：（多伦多，24次检查；亚特兰大，3次检查；库亚巴，2次检查）。既往关节出血次数和血友病严重程度作为参考标准指标。MRI评分的阅片者间信度，对于累加（A）量表而言较高（组内相关系数ICC = 0.73），对于递进（P）量表而言极好（ICC = 0.83）。阅片者内信度对于P评分（ICC = 0.91）和A评分（ICC = 0.93）均极好。P总分和A总分与临床实验室测量值的相关性较差（r = 0.36）或中等（r = 0.54），但为正相关。MRI总分在区分是否存在关节病方面显示出高准确性[P量表，曲线下面积（AUC）= 0.94±0.05；A量表，AUC = 0.89±0.06]，两个量表的软组织评分也是如此（P量表，AUC = 0.90±0.06；A量表，AUC = 0.86±0.06）。用于区分严重疾病的曲线下面积，对于P - MRI评分（AUC = 0.83±0.09）和A - MRI评分（AUC = 0.87±0.09）均显示出高准确性，但在区分轻度疾病方面无诊断能力。X线片量表也有类似结果。总之，两种MRI量表在区分是否存在关节病以及严重/非严重疾病方面均显示出较高至极好的可靠性和准确性，但总分的聚合效度较差至中等，对于轻度/非轻度疾病的判别效度无诊断性。与X线片评分相比，MRI量表在区分关节病严重程度方面并未表现得更好。
