Department of Rheumatology, Dijon University Hospital, Medicine Faculty, Burgundy University, 3, rue du Faubourg-Raines, 21000 Dijon, France.
Joint Bone Spine. 2011 Oct;78(5):499-505. doi: 10.1016/j.jbspin.2010.10.014. Epub 2010 Dec 22.
The objectives were to evaluate improvement in reliability of joint space width (JSW) measurements, according to the previous experience of the readers in hip osteoarthritis (OA).
Fifty radiographs in hip OA patients from a randomized controlled trial (ECHODIAH) were read 12 times by two readers with different levels of experience in radiographic interpretation. Intra-reader reliability and inter-reader reliability were assessed through calculation of the smallest detectable difference (SDD) and the intra-class correlation coefficient (ICC).
Intra-reader reliability: for the experienced reader, no significant change in SDD was observed with repeated JSW measurements. For the junior reader, the SDD decreased significantly from 0.90 mm to 0.65 mm (P=0.002). A plateau of SDD was reached after reading 200 to 300 radiographs, with a value close to the mean SDD of the experienced reader (0.67 mm). ICCs were high (>0.88) for both the senior and the junior readers. Inter-reader reliability: no improvement in inter-reader reliability was noted with repeated measurements of JSW (SDD=0.81 mm). However, no additional training sessions were performed. ICCs were high (>0.85).
This study indicated for the first time a learning curve in analyzing JSW in hip OA for an inexperienced reader. After analyzing 200 to 300 radiographs, the junior reader reached an intra-reader reliability similar to the experienced reader. Moreover, the information brought by the ICC was not sufficient, suggesting that the SDD should be systematically reported in studies evaluating OA radiographic progression, on top of the ICC, to help in interpreting the JSW reliability.
本研究旨在评估髋关节骨关节炎（OA）患者的关节间隙宽度（JSW）测量可靠性的改善情况，该评估基于读者先前在髋关节 OA 方面的经验。
12 次重复测量 50 例来自 ECHODIAH 随机对照试验的髋关节 OA 患者的放射学图像，由两名在放射学解释方面经验不同的读者进行阅读。通过计算最小可检测差异（SDD）和组内相关系数（ICC）评估内-读者可靠性和读者间可靠性。
内-读者可靠性：对于经验丰富的读者，重复 JSW 测量时 SDD 无显著变化。对于初级读者，SDD 从 0.90mm 显著降低至 0.65mm（P=0.002）。阅读 200 至 300 张放射学图像后，SDD 达到平台期，接近经验丰富读者的平均 SDD（0.67mm）。高级和初级读者的 ICC 均较高（>0.88）。读者间可靠性：重复 JSW 测量时读者间可靠性未见改善（SDD=0.81mm）。但是，未进行额外的培训课程。ICC 较高（>0.85）。
本研究首次表明，在分析髋关节 OA 的 JSW 时，经验不足的读者存在学习曲线。在分析 200 至 300 张放射学图像后，初级读者达到了与经验丰富读者相似的内-读者可靠性。此外，ICC 提供的信息不足，建议在评估 OA 放射学进展的研究中，除 ICC 外，还应系统报告 SDD，以帮助解释 JSW 可靠性。
