Ratzlaff C, Zhang C, Korzan J, Josey L, Wong H, Cibere J, Prlic H M, Kopec J A, Esdaile J M, Li L C, Barber M, Forster B B
Arthritis Research Centre of Canada, 5591 No. 3 Road, Richmond, BC, V6X 2C7, Canada.
Brigham and Women's Hosp., Harvard Medical School, Boston, MA, USA.
Rheumatol Int. 2016 Mar;36(3):371-6. doi: 10.1007/s00296-015-3361-7. Epub 2015 Oct 3.
The purpose of this study was to evaluate the validity and reliability of a radiographic diagnosis of femoroacetabular impingement (FAI) by a non-radiologist. Symptomatic FAI is prevalent and thought to be a cause of hip osteoarthritis. However, the diagnosis is often delayed by 1-2 years, in large part because radiographic findings are often subtle and clinicians have been unaware of their significance. The purpose of this study was to evaluate the validity of a radiographic diagnosis of FAI by a non-radiologist. A population-based sample of 701 subjects was recruited in Vancouver, Canada. For the current study, 50 subjects were selected-40 randomly from the population sample and 10 from an orthopedic practice with confirmed FAI. An anterior-posterior pelvis and bilateral Dunn radiographs were acquired and read by a fellowship-trained musculoskeletal radiologist and a third-year medical student who received basic training in radiographic signs of FAI. Three radiographic signs were evaluated: the lateral center edge angle, alpha angle and crossover sign. Validity was assessed using sensitivity and specificity, Bland-Altman limits of agreement and kappa. The sample contained 65% women (n = 31), was 62% Caucasian and 38% Chinese and had a mean age of 38.3 years. For correctly diagnosing FAI, the non-radiologist reader had a sensitivity of 0.83 and specificity of 0.87. Intra-rater κ value was 0.72, and prevalence-adjusted bias-adjusted κ was 0.76. This study provides evidence that a non-radiologist can accurately and reliably identify FAI on plain films.
本研究的目的是评估非放射科医生对股骨髋臼撞击症（FAI）进行影像学诊断的有效性和可靠性。有症状的FAI很常见，被认为是髋骨关节炎的一个病因。然而，诊断往往会延迟1至2年，很大程度上是因为影像学表现常常很细微，临床医生一直未意识到其重要性。本研究的目的是评估非放射科医生对FAI进行影像学诊断的有效性。在加拿大温哥华招募了701名基于人群的受试者样本。对于本研究，选取了50名受试者——40名从人群样本中随机选取，10名来自确诊为FAI的骨科诊所。获取了骨盆前后位片和双侧邓氏位片，并由一名接受过肌肉骨骼放射学专科培训的放射科医生以及一名接受过FAI影像学征象基础培训的三年级医学生进行阅片。评估了三个影像学征象：外侧中心边缘角、α角和交叉征。使用敏感性和特异性、Bland-Altman一致性界限和kappa值评估有效性。样本中65%为女性（n = 31），62%为白种人，38%为华裔，平均年龄为38.3岁。对于正确诊断FAI，非放射科医生阅片者的敏感性为0.83，特异性为0.87。评分者内κ值为0.72，患病率调整偏倚调整κ值为0.76。本研究提供了证据表明非放射科医生能够在平片上准确且可靠地识别FAI。
