Risch Lucie, Wochatz Monique, Messerschmidt Janin, Engel Tilman, Mayer Frank, Cassel Michael
University Outpatient Clinic, Sports Medicine and Sports Orthopedics, University of Potsdam, Potsdam, Germany.
J Ultrasound Med. 2018 Mar;37(3):737-744. doi: 10.1002/jum.14414. Epub 2017 Sep 28.
The reliability of quantifying intratendinous vascularization by high-sensitivity Doppler ultrasound advanced dynamic flow has not been examined yet. Therefore, this study aimed to investigate the intraobserver and interobserver reliability of evaluating Achilles tendon vascularization by advanced dynamic flow using established scoring systems.
Three investigators evaluated vascularization in 67 recordings in a test-retest design, applying the Ohberg score, a modified Ohberg score, and a counting score. Intraobserver and interobserver agreement for the Ohberg score and modified Ohberg score was analyzed by the Cohen κ and Fleiss κ coefficients (absolute), Kendall τ b coefficient, and Kendall coefficient of concordance (W; relative). The reliability of the counting score was analyzed by intraclass correlation coefficients (ICC) 2.1 and 3.1, the standard error of measurement (SEM), and Bland-Altman analysis (bias and limits of agreement [LoA]).
Intraobserver and interobserver agreement (absolute/relative) ranged from 0.61 to 0.87/0.87 to 0.95 and 0.11 to 0.66/0.76 to 0.89 for the Ohberg score and from 0.81 to 0.87/0.92 to 0.95 and 0.64 to 0.80/0.88 to 0.93 for the modified Ohberg score, respectively. The counting score revealed an intraobserver ICC of 0.94 to 0.97 (SEM, 1.0-1.5; bias, -1; and LoA, 3-4 vessels). The interobserver ICC for the counting score ranged from 0.91 to 0.98 (SEM, 1.0-1.9; bias, 0; and LoA, 3-5 vessels).
The modified Ohberg score and counting score showed excellent reliability and seem convenient for research and clinical practice. The Ohberg score revealed decent intraobserver but unexpected low interobserver reliability and therefore cannot be recommended.
高灵敏度多普勒超声高级动态血流定量评估肌腱内血管化的可靠性尚未得到检验。因此，本研究旨在使用既定的评分系统，探讨通过高级动态血流评估跟腱血管化的观察者内和观察者间可靠性。
三名研究者采用重测设计，对67份记录中的血管化情况进行评估，应用奥伯格评分、改良奥伯格评分和计数评分。通过Cohen κ系数和Fleiss κ系数（绝对）、Kendall τ b系数以及Kendall一致性系数（W；相对）分析奥伯格评分和改良奥伯格评分的观察者内和观察者间一致性。通过组内相关系数（ICC）2.1和3.1、测量标准误差（SEM）以及Bland-Altman分析（偏差和一致性界限[LoA]）分析计数评分的可靠性。
奥伯格评分的观察者内和观察者间一致性（绝对/相对）范围分别为0.61至0.87/0.87至0.95以及0.11至0.66/0.76至0.89，改良奥伯格评分的观察者内和观察者间一致性范围分别为0.81至0.87/0.92至0.95以及0.64至0.80/0.88至0.93。计数评分显示观察者内ICC为0.94至0.97（SEM，1.0 - 1.5；偏差，-1；LoA，3 - 4条血管）。计数评分的观察者间ICC范围为0.91至0.98（SEM，1.0 - 1.9；偏差，0；LoA，3 - 5条血管）。
改良奥伯格评分和计数评分显示出极佳的可靠性，似乎便于研究和临床实践。奥伯格评分显示出良好的观察者内可靠性，但观察者间可靠性意外较低，因此不推荐使用。
