在患有髋关节疾病的儿童和青少年中，通过MRI测量股骨扭转角与CT一样可靠且可重复。
Measurement of Femoral Version by MRI is as Reliable and Reproducible as CT in Children and Adolescents With Hip Disorders.
作者信息
Hesham Khalid, Carry Patrick M, Freese Krister, Kestel Lauryn, Stewart Jamie R, Delavan Joshua A, Novais Eduardo N
机构信息
Departments of *Orthopaedic Surgery †Orthopaedic Surgery, Musculoskeletal Research Center ‡Radiology, Children's Hospital Colorado, Aurora, CO.
出版信息
J Pediatr Orthop. 2017 Dec;37(8):557-562. doi: 10.1097/BPO.0000000000000712.
BACKGROUND
Femoral version measurement techniques based on magnetic resonance imaging (MRI) studies have been developed as an alternative to the high levels of ionizing radiation associated with computed tomography (CT)-based methods. Previous studies have not evaluated the reliability, repeatability, and accuracy of MRI-based femoral version measurements in an adolescent population.
METHODS
Subjects who underwent MRI and CT studies for clinical suspicion of hip pain secondary to hip dysplasia or femoroacetabular impingement between 2011 and 2013 were identified. Rapid sequence femoral version images were obtained from MRI Hip dGEMRIC and/or postarthrogram studies. Femoral version images were also obtained from bilateral CT lower extremity, without contrast, studies. Measurements were made by 1 fellowship-trained, pediatric hip preservation attending surgeon, 2 pediatric orthopaedic surgical fellows, and 1 fellowship-trained musculoskeletal radiologist on 2 separate occasions. Linear mixed models were used to estimate the reliability and repeatability associated with CT-based and MRI-based measurements (intraclass correlation coefficients) and to estimate the agreement (CT-MRI) between the 2 techniques.
RESULTS
The mean age of 36 subjects was 15.4 years (±4.1 y). Interrater reliability was 0.91 (95% CI, 0.86-0.95) for the CT technique compared with 0.90 (95% CI, 0.86-0.94) for the rapid sequence MRI technique. Intrarater reliability for the CT technique was 0.96 (95% CI, 0.91-0.98) compared with 0.95 (95% CI, 0.90-0.97) for the MRI technique. The agreement between the MRI-based and CT-based techniques (bias: 1.9 degrees, limits of agreement: -11.3 to 14.9 degrees) was similar to the agreement between consecutive MRI measurements (bias: 0.4 degrees, limits of agreement: -7.8 to 8.6 degrees) as well as consecutive CT measurements (bias: 0.5 degrees, limits of agreement: -8.8 to 9.9 degrees).
CONCLUSIONS
The interrater and intrarater reliability and repeatability estimates (intraclass correlation coefficient values) associated with both techniques was excellent (>0.90). Acquirement of axial images at the pelvis and knee during MRI for investigation of adolescents with hip pain allows for reliable measurement of femoral version.
LEVEL OF EVIDENCE
Level II-diagnostic study.
背景
基于磁共振成像（MRI）研究的股骨扭转角测量技术已被开发出来，作为基于计算机断层扫描（CT）方法所具有的高剂量电离辐射的替代方法。以往研究尚未评估基于MRI的股骨扭转角测量在青少年人群中的可靠性、可重复性和准确性。
方法
确定2011年至2013年间因临床怀疑髋关节发育不良或股骨髋臼撞击继发髋关节疼痛而接受MRI和CT检查的受试者。从MRI髋关节dGEMRIC和/或关节造影后研究中获取快速序列股骨扭转角图像。还从双侧无造影剂的CT下肢研究中获取股骨扭转角图像。测量由1名接受过专科培训的小儿髋关节保留主治外科医生、2名小儿骨科外科住院医师和1名接受过专科培训的肌肉骨骼放射科医生在2个不同时间进行。使用线性混合模型来估计基于CT和基于MRI测量的可靠性和可重复性（组内相关系数），并估计这两种技术之间的一致性（CT - MRI）。
结果
36名受试者的平均年龄为15.4岁（±4.1岁）。CT技术的评分者间可靠性为0.91（95%CI，0.86 - 0.95），而快速序列MRI技术为0.90（95%CI，0.86 - 0.94）。CT技术的评分者内可靠性为0.96（95%CI，0.91 - 0.98），而MRI技术为0.95（95%CI，0.90 - 0.97）。基于MRI和基于CT的技术之间的一致性（偏差：1.9度，一致性界限： - 11.3至14.9度）与连续MRI测量之间的一致性（偏差：0.4度，一致性界限： - 7.8至8.6度）以及连续CT测量之间的一致性（偏差：0.5度，一致性界限： - 8.8至9.9度）相似。
结论
与这两种技术相关的评分者间和评分者内可靠性及可重复性估计（组内相关系数值）都非常好（>0.90）。在MRI检查期间获取骨盆和膝关节的轴向图像以调查有髋关节疼痛的青少年，可实现对股骨扭转角的可靠测量。
证据水平
II级 - 诊断性研究。
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