Burton N J, Toscano M J, Barr F J, Owen M R
Department of Clinical Veterinary Science, University of Bristol, Langford House, Langford, Bristol BS40 5DU.
J Small Anim Pract. 2008 Nov;49(11):572-6. doi: 10.1111/j.1748-5827.2008.00611.x. Epub 2008 Aug 5.
The objectives of this study were to quantify the sensitivity and specificity of visual assessment of radiographs of the canine elbow in detecting ulnar trochlear notch sclerosis, to establish interobserver and intra-observer variation for the presence and grade of sclerosis and to quantify the effect of radiographic exposure on observer grading.
Mediolateral elbow radiographs were obtained from Labrador retrievers (n=34) aged between six and 18 months. Radiographs from dogs with an arthroscopic diagnosis of fragmented medial coronoid process (n=17) and those from a control population (n=17) were subjected to observer grading for the presence or absence of and the grade of ulnar trochlear notch sclerosis. Interobserver and intra-observer variation and observer sensitivity and specificity were calculated. Digital data from the ulnar trochlear notch were correlated with mean observer grade to quantify the effect of radiographic exposure on observer grade.
Interobserver agreement was "fair" (kappa=0.251 to 0.369) and intra-observer agreement was "moderate" to "substantial" (kappa=0.462 to 0.667). The sensitivity of observer assessment was 72 per cent with a specificity of 22 per cent. Mean observer grade was not significantly correlated with the degree of radiographic exposure (P=0.70).
Ulnar trochlear notch sclerosis is a phenomenon associated with fragmented medial coronoid process. However, interobserver agreement in grading this feature is only fair, being identified by observers with moderate sensitivity but with relatively poor specificity. This low specificity may predispose to overdiagnosis in clinical cases. Intra-observer agreement is moderate to substantial, suggesting that individuals can reliably quantify this radiological feature on multiple occasions. The ability of observers to assess the degree of sclerotic change is not significantly affected by radiographic exposure.
本研究的目的是量化犬肘部X线片视觉评估在检测尺骨滑车切迹硬化方面的敏感性和特异性，确定观察者间和观察者内关于硬化存在情况及分级的差异，并量化X线曝光对观察者分级的影响。
获取6至18月龄拉布拉多犬（n = 34）的肘部内外侧X线片。对经关节镜诊断为内侧冠状突碎片的犬（n = 17）和对照组犬（n = 17）的X线片进行观察者分级，以确定尺骨滑车切迹硬化的有无及分级。计算观察者间和观察者内差异以及观察者的敏感性和特异性。将尺骨滑车切迹的数字数据与观察者平均分级相关联，以量化X线曝光对观察者分级的影响。
观察者间一致性为“中等”（kappa = 0.251至0.369），观察者内一致性为“中等”至“高度”（kappa = 0.462至0.667）。观察者评估的敏感性为72%，特异性为22%。观察者平均分级与X线曝光程度无显著相关性（P = 0.70）。
尺骨滑车切迹硬化是一种与内侧冠状突碎片相关的现象。然而，观察者在对该特征进行分级时的一致性仅为中等，观察者识别该特征的敏感性中等，但特异性相对较差。这种低特异性可能导致临床病例中的过度诊断。观察者内一致性为中等至高度，表明个体能够在多个场合可靠地量化这一放射学特征。观察者评估硬化改变程度的能力不受X线曝光的显著影响。
