School of Information Science and Technology, ShanghaiTech University, Shanghai, China.
Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.
PLoS One. 2018 Jun 18;13(6):e0198792. doi: 10.1371/journal.pone.0198792. eCollection 2018.
The measurements of spinal curvatures using the ultrasound (US) imaging method on children with scoliosis have been comparable with radiography. However, factors influencing the reliability and accuracy of US measurement have not been studied. The purpose of this study is to investigate the effects of curve features and patients' demographics on US measurements and to determine which factors influence the reliability and accuracy. Two hundred children with scoliosis were recruited and scanned with US by one experienced operator and three trainees. One experienced rater measured the proxy Cobb angles from US images twice one week apart and compared the results with clinical radiographic records. The correlation and accuracy between the US and radiographic measurements were subdivided by different curve severities, curve types, subjects' weight status and US acquisition experiences. A total of 326 and 313 curves were recognized from radiographs and US images, respectively. The mean Cobb angles of the 13 missing curves were 17.4±7.4° and 11 at the thoracic region. Among the 16 curves showing large discrepancy (≥6°) between US and radiographic measurements, 7 were main thoracic and 6 were lumbar curves. Twelve had axial vertebral rotation (AVR) greater than 8°. The US scans performed by the experienced operator showed fewer large discrepancy curves, smaller difference and higher correlation than the scans from the trainees (3%, 1.7±1.5°, 0.95 vs 6%, 2.4±1.8°, 0.90). Only 4% missing and 5% large discrepancy curves were demonstrated for US measurements in comparison to radiography. The missing curves were mainly caused by small severity and in the upper spinal region. There was a higher chance of the large discrepancy curves in the main thoracic and lumbar regions with AVR>8°. A skilled operator acquired better US images and led to more accurate measurements especially for those subjects with larger curvatures, AVR and body mass index (BMI).
超声（US）成像方法测量脊柱曲度在脊柱侧凸患儿中与放射学检查相当。然而，影响超声测量可靠性和准确性的因素尚未得到研究。本研究旨在探讨曲线特征和患者人口统计学特征对 US 测量的影响，并确定哪些因素影响可靠性和准确性。招募了 200 名脊柱侧凸患儿，由一名经验丰富的操作人员和三名实习生进行 US 扫描。一名经验丰富的评估者从 US 图像中测量两次代理 Cobb 角，间隔一周，并将结果与临床放射记录进行比较。US 和放射学测量的相关性和准确性按不同的曲线严重程度、曲线类型、受试者的体重状况和 US 采集经验进行细分。从放射学和 US 图像中分别识别出 326 条和 313 条曲线。13 条缺失曲线的平均 Cobb 角为 17.4±7.4°，其中 11 条位于胸段。在 US 和放射学测量差异大于 6°（≥6°）的 16 条曲线中，7 条为主要胸椎曲线，6 条为腰椎曲线。12 条曲线的轴向椎体旋转（AVR）大于 8°。经验丰富的操作人员进行的 US 扫描显示出较小的差异和更高的相关性，曲线差异较大的情况也较少（3%，1.7±1.5°，0.95 与 6%，2.4±1.8°，0.90）。与放射学检查相比，US 测量的缺失曲线和差异较大的曲线分别为 4%和 5%。缺失的曲线主要是由于曲线严重程度较小和位于上脊柱区域。AVR>8°的主要胸椎和腰椎区域的曲线差异较大的可能性较高。熟练的操作人员获得了更好的 US 图像，使测量更加准确，特别是对于那些曲率较大、AVR 和身体质量指数（BMI）较大的患者。
