Faculty of Health Sciences, Discipline of Physiotherapy, University of Sydney, Sydney, Australia.
Department of Radiology Westmead Hospital and Western Clinical School, Discipline of Medical Imaging, Sydney Medical School, University of Sydney, Sydney, Australia.
Clin Rheumatol. 2018 Apr;37(4):1091-1098. doi: 10.1007/s10067-017-3888-y. Epub 2017 Nov 6.
This work aimed to assess inter-rater reliability and agreement of a magnetic resonance imaging (MRI)-based Kellgren and Lawrence (K&L) grading for patellofemoral joint osteoarthritis (OA) and to validate it against the MRI Osteoarthritis Knee Score (MOAKS). MRI scans from people aged 45 to 75 years with chronic knee pain participating in a randomised clinical trial evaluating dietary supplements were utilised. Fifty participants were randomly selected and scored using the MRI-based K&L grading using axial and sagittal MRI scans. Raters conducted inter-rater reliability, blinded to clinical information, radiology reports and other rater results. Intra- and inter-rater reliability and agreement were evaluated using the intra-class correlation coefficient (ICC) and Cohen's weighted kappa. There was a 2-week interval between the first and second readings for intra-rater reliability. Validity was assessed using the MOAKS and evaluated using Spearman's correlation coefficient. Intra-rater reliability of the K&L system was excellent: ICC 0.91 (95% CI 0.82-0.95); weighted kappa (ĸ = 0.69). Inter-rater reliability was high (ICC 0.88; 95% CI 0.79-0.93), while agreement between raters was moderate (ĸ = 0.49-0.57). Validity analysis demonstrated a strong correlation between the total MOAKS features score and the K&L grading system (ρ = 0.62-0.67) but weak correlations when compared with individual MOAKS features (ρ = 0.19-0.61). The high reliability and good agreement show consistency in grading the severity of patellofemoral OA with the MRI-based K&L score. Our validity results suggest that the scale may be useful, particularly in the clinical environment. Future research should validate this method against clinical findings.
本研究旨在评估基于磁共振成像（MRI）的 Kellgren 和 Lawrence（K&L）分级在髌股关节骨关节炎（OA）中的评估者间可靠性和一致性，并将其与 MRI 骨关节炎膝关节评分（MOAKS）进行验证。使用了来自参加评估膳食补充剂的随机临床试验的 45 至 75 岁慢性膝关节疼痛人群的 MRI 扫描。随机选择 50 名参与者，并使用基于 MRI 的 K&L 分级系统对其进行评分，使用轴向和矢状面 MRI 扫描。评估者在不了解临床信息、放射学报告和其他评估者结果的情况下进行评估者间可靠性。使用组内相关系数（ICC）和 Cohen 加权 kappa 评估组内和组间可靠性和一致性。在组内可靠性评估中，两次阅读之间间隔两周。使用 MOAKS 进行有效性评估，并使用 Spearman 相关系数进行评估。K&L 系统的组内可靠性极好：ICC 为 0.91（95%CI 0.82-0.95）；加权 kappa（ĸ=0.69）。评估者间可靠性较高（ICC 为 0.88；95%CI 0.79-0.93），而评估者间的一致性为中等（ĸ=0.49-0.57）。验证分析表明，总 MOAKS 特征评分与 K&L 分级系统之间存在很强的相关性（ρ=0.62-0.67），但与个别 MOAKS 特征相比相关性较弱（ρ=0.19-0.61）。高可靠性和良好的一致性表明，基于 MRI 的 K&L 评分与髌股 OA 的严重程度分级具有一致性。我们的有效性结果表明，该量表可能有用，特别是在临床环境中。未来的研究应该针对临床发现来验证这种方法。
