Jungmann Pia M, Welsch Götz H, Brittberg Mats, Trattnig Siegfried, Braun Sepp, Imhoff Andreas B, Salzmann Gian M
1 Department of Radiology, Klinikum rechts der Isar, Technische Universitaet Muenchen, Munich, Germany.
2 Department of Radiology, Orthopedic University Hospital Balgrist, Zurich, Switzerland.
Cartilage. 2017 Jul;8(3):272-282. doi: 10.1177/1947603516665444. Epub 2016 Aug 25.
Objective To design a simple magnetic resonance (MR)-based assessment system for quantification of osteochondral defect severity prior to cartilage repair surgery at the knee. Design The new scoring tool was supposed to include 3 different parameters: (1) cartilage defect size, (2) depth/morphology of the cartilage defect, and (3) subchondral bone quality, resulting in a specific 3-digit code. A clearly defined numeric score was developed, resulting in a final score of 0 to 100. Defect severity grades I through IV were defined. For intra- and interobserver agreement, defects were assessed by 2 independent readers on preoperative knee MR images of n = 44 subjects who subsequently received cartilage repair surgery. For statistical analyses, mean values ± standard deviation (SD), interclass correlation coefficients (ICC), and linear weighted kappa values were calculated. Results The mean total Area Measurement And DEpth & Underlying Structures (AMADEUS) score was 48 ± 24, (range, 0-85). The mean defect size was 2.8 ± 2.6 cm. There were 36 of 44 full-thickness defects. The subchondral bone showed defects in 21 of 44 cases. Kappa values for intraobserver reliability ranged between 0.82 and 0.94. Kappa values for interobserver reliability ranged between 0.38 and 0.85. Kappa values for AMADEUS grade were 0.75 and 0.67 for intra- and interobserver agreement, respectively. ICC scores for the AMADEUS total score were 0.97 and 0.96 for intra- and interobserver agreement, respectively. Conclusions The AMADEUS score and classification system allows reliable severity encoding, scoring and grading of osteochondral defects on knee MR images, which is easily clinically applicable in daily practice.
目的 设计一种基于磁共振成像（MR）的简单评估系统，用于在膝关节软骨修复手术前量化骨软骨损伤的严重程度。 设计 新的评分工具应包括3个不同参数：（1）软骨损伤大小，（2）软骨损伤的深度/形态，以及（3）软骨下骨质量，从而得出一个特定的三位数编码。制定了一个明确的数字评分，最终得分为0至100分。定义了I至IV级损伤严重程度等级。为评估观察者内和观察者间的一致性，由2名独立阅片者对n = 44例随后接受软骨修复手术的受试者的术前膝关节MR图像上的损伤进行评估。进行统计分析时，计算了平均值±标准差（SD）、组内相关系数（ICC）和线性加权kappa值。 结果 平均总面积测量及深度与下层结构（AMADEUS）评分为48±24（范围为0 - 85）。平均损伤大小为2.8±2.6 cm。44例中有36例为全层损伤。44例中有21例软骨下骨存在损伤。观察者内可靠性的kappa值在0.82至0.94之间。观察者间可靠性的kappa值在0.38至0.85之间。AMADEUS分级的kappa值在观察者内一致性和观察者间一致性方面分别为0.75和0.67。AMADEUS总分的ICC评分在观察者内一致性和观察者间一致性方面分别为0.97和0.96。 结论 AMADEUS评分和分类系统能够对膝关节MR图像上的骨软骨损伤进行可靠的严重程度编码、评分和分级，在日常临床实践中易于应用。
