Schnetzke Marc, Schüler Svenja, Hoffend Johannes, Simon Rainer, Keil Holger, Porschke Felix, Studier-Fischer Stefan, Grützner Paul-Alfred, Guehring Thorsten
Clinic for Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwig-Guttmann-Strasse 13, Ludwigshafen on the Rhine, 67071, Germany.
Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany.
BMC Musculoskelet Disord. 2017 Feb 20;18(1):85. doi: 10.1186/s12891-017-1451-2.
The primary objective of this study was to assess the interobserver and intraobserver agreement on ligamentous injuries on conventional magnetic resonance imaging (MRI) in acute simple elbow dislocation. The secondary objectives were to determine the interobserver agreement on the assessment of joint congruity, joint effusion, loose bodies and chondral lesions on conventional MRI.
Conventional MRIs (1.5 Tesla, elbow specific surface coil) of 30 patients (40.7 years; range 14-72) with simple elbow dislocations were evaluated by four blinded examiners. An analysis of the interobserver agreement of all raters and for several subgroups (radiologists, orthopaedics, experienced, non-experienced) was performed. The examiners assessed the integrity (intact, partial tear, complete tear) of the lateral collateral ligament (LCL), medial collateral ligament (MCL), extensor and flexor tendons, as well as the presence of joint congruity, joint effusion, loose bodies and chondral lesions. Agreement strength, correlation and proportion of exact agreement were determined for interobserver agreement, and intraobserver agreement analyses.
Interobserver agreement of all examiners was fair to moderate for collateral ligaments (LCL: 0.441, MCL: 0.275). Exact agreement of all raters was found in 33.3% for the LCL and in 26.7% for the MCL. The both experienced examiners showed highest agreement strength for the LCL (0.619) and the radiologists showed highest agreement strength for the MCL (0.627), the proportion of exact agreement was 60.0% in both categories. A high proportion of exact agreement regarding joint congruity (90%), joint effusion (100%), loose bodies (96.7%) and chondral lesion (80%) was found among the radiologists. The evaluation of the intraobserver agreement revealed slight to substantial agreement (0.227 to 0.718) for the collateral ligaments.
This study shows difficulties in the evaluation of ligaments by conventional MRI technique as demonstrated by a weak inter- and intraobserver agreement. This should be the basis to develop new MRI quality standards with special focus on coronal oblique reconstructions to improve the evaluation of ligament injuries after simple elbow dislocations.
本研究的主要目的是评估在急性单纯性肘关节脱位的传统磁共振成像（MRI）中，观察者间和观察者内对韧带损伤的一致性。次要目的是确定在传统MRI上对关节一致性、关节积液、游离体和软骨损伤评估的观察者间一致性。
由四名不知情的检查者对30例（40.7岁；范围14 - 72岁）单纯性肘关节脱位患者的传统MRI（1.5特斯拉，肘部专用表面线圈）进行评估。对所有评估者以及几个亚组（放射科医生、骨科医生、有经验的、无经验的）的观察者间一致性进行了分析。检查者评估外侧副韧带（LCL）、内侧副韧带（MCL）、伸肌腱和屈肌腱的完整性（完整、部分撕裂、完全撕裂），以及关节一致性、关节积液、游离体和软骨损伤的情况。确定观察者间一致性以及观察者内一致性分析的一致性强度、相关性和完全一致性比例。
所有检查者对副韧带的观察者间一致性为中等偏下（LCL：0.441，MCL：0.275）。LCL所有评估者的完全一致性为33.3%，MCL为26.7%。两位有经验的检查者对LCL的一致性强度最高（0.619），放射科医生对MCL的一致性强度最高（0.627），这两类中的完全一致性比例均为60.0%。放射科医生之间在关节一致性（90%）、关节积液（100%）、游离体（96.7%）和软骨损伤（80%）方面发现了较高比例的完全一致性。观察者内一致性评估显示副韧带的一致性为轻微到显著（0.227至0.718）。
本研究表明，传统MRI技术在评估韧带方面存在困难这一点已通过观察者间和观察者内的低一致性得到证明。这应该成为制定新的MRI质量标准的基础，特别关注冠状斜位重建，以改善单纯性肘关节脱位后韧带损伤的评估。
