van Leeuwen Wouter F, Janssen Stein J, Guitton Thierry G, Chen Neal, Ring David
1 Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
2 Department of Plastic Surgery, University Medical Center Groningen, The Netherlands.
Hand (N Y). 2017 Nov;12(6):573-578. doi: 10.1177/1558944716677538. Epub 2016 Nov 30.
The appearance of early Kienböck disease on radiographs and magnetic resonance imaging (MRI) may be difficult to distinguish from other conditions that affect the lunate. We aimed to assess the interobserver agreement in the diagnosis of early Kienböck disease when evaluated on different imaging modalities.
Forty-three hand surgeon members of the Science of Variation Group were randomized to evaluate radiographs and 35 hand surgeons to evaluate radiographs and MRI scans of 26 patients for the presence of Kienböck disease, the lunate type, and the ulnar variance. We used Fleiss' kappa analysis to assess the interobserver agreement for categorical variables and compared the κ values between the 2 groups.
We found that agreement on the diagnosis of early Kienböck disease was fair (κ, 0.36) among observers who evaluated radiographs alone and moderate (κ, 0.58) among observers who evaluated MRI scans in addition to radiographs, and that the difference in κ values was not statistically significant ( P = .057). Agreement did not differ between observers based on imaging modality with regard to the assessment of the lunate type ( P = .75) and ulnar variance ( P = .15).
We found, with the numbers evaluated, a notable but nonsignificant difference in agreement in favor of observers who evaluated MRI scans in addition to radiographs compared with radiographs alone. Surgeons should be aware that the diagnosis of Kienböck disease in the precollapse stages is not well defined, as evidenced by the substantial interobserver variability.
早期月骨无菌性坏死在X线片和磁共振成像（MRI）上的表现可能难以与其他影响月骨的疾病相区分。我们旨在评估在不同成像方式下评估早期月骨无菌性坏死时观察者间的一致性。
将43名变异科学小组的手外科医生随机分组，分别评估X线片，另外35名手外科医生评估26例患者的X线片和MRI扫描，以确定是否存在月骨无菌性坏死、月骨类型和尺骨变异。我们使用Fleiss卡方分析评估分类变量的观察者间一致性，并比较两组之间的κ值。
我们发现，仅评估X线片的观察者对早期月骨无菌性坏死诊断的一致性为中等（κ=0.36），而除X线片外还评估MRI扫描的观察者一致性为中等（κ=0.58），且κ值差异无统计学意义（P=0.057）。在评估月骨类型（P=0.75）和尺骨变异（P=0.15）方面，基于成像方式的观察者之间的一致性没有差异。
就评估数量而言，我们发现，与仅评估X线片相比，除X线片外还评估MRI扫描的观察者在一致性方面存在显著但无统计学意义的差异。外科医生应意识到，塌陷前期月骨无菌性坏死的诊断并不明确，观察者之间存在很大差异就是证明。
