Ditzler Matthew G, Kan J Herman, Artunduaga Maddy, Jadhav Siddharth P, Bell Bryce R, Zhang Wei, Orth Robert C
Pediatric Radiology, Texas Children's Hospital, 6701 Fannin St., Houston, TX, 77030, USA.
Department of Orthopedics, Texas Children's Hospital, Houston, TX, USA.
Pediatr Radiol. 2018 Nov;48(12):1779-1785. doi: 10.1007/s00247-018-4196-7. Epub 2018 Jul 5.
Glenoid version angles are measured to objectively follow changes related to glenohumeral dysplasia in the setting of brachial plexus birth palsy. Measuring glenoid version on cross-sectional imaging was initially described by Friedman et al. in 1992. Recent literature for non-dysplastic shoulders advocates time-consuming reconstructions and reformations for an accurate assessment of glenoid version.
To compare Friedman's original method for measuring glenoid version to a novel technique we developed ("modified Friedman") with the reference standard of true axial reformations.
With institutional review board approval, we retrospectively examined 30 normal and dysplastic shoulders obtained from magnetic resonance imaging examinations of 30 patients with an established diagnosis of brachial plexus birth palsy between January 2012 and September 2017. Four pediatric radiologists performed glenoid version measurements using Friedman's method, the modified Friedman method and a previously described true axial reformation method. The modified Friedman technique better accounts for scapular positioning by selecting a reference point related to the acromion-scapular body interface. Inter-rater reliability and inter-method agreement were assessed using intraclass correlation, paired t-tests and mixed linear model analysis. Equivalence tests between methods were performed per reader.
Glenoid version measurements were significantly different when comparing Friedman's method to true axial reformations in normal (-10.8±5.7° [mean±standard deviation] vs. -8.8±5.3°; P≤0.001) and dysplastic shoulders (-34.6±17.7° vs. -28.1±17.5°; P≤0.001). Glenoid version measurements were not significantly different when comparing the modified Friedman's method to true axial reformations in normal (-6.3±5.8° vs. -8.8±5.3°; P=0.06) and dysplastic shoulders (-29.0±18.3° vs. -28.1±17.5°; P=0.06). Friedman's method was not equivalent to true axial reformations for measurements in dysplastic shoulders for all readers (P=0.68, 0.81, 0.86, 0.99); the modified Friedman method was equivalent to of true axial reformations for measurements in dysplastic shoulders for 3 of 4 readers (P≤0.001, P≤0.001, P≤0.001, P=0.10).
In glenohumeral dysplasia, the modified Friedman method and post-processed true axial reformations provide statistically similar and reproducible values. We propose that our modified Friedman technique can be performed in lieu of post-processed true axial reformations to generate glenoid version measurements.
测量肩胛盂倾斜角度是为了客观地跟踪臂丛神经产瘫情况下与盂肱发育不良相关的变化。1992年，弗里德曼等人首次描述了在横断面成像上测量肩胛盂倾斜角度的方法。最近关于非发育不良肩部的文献主张采用耗时的重建和重组技术来准确评估肩胛盂倾斜角度。
将弗里德曼测量肩胛盂倾斜角度的原始方法与我们开发的一种新技术（“改良弗里德曼法”）与真正的轴向重组参考标准进行比较。
经机构审查委员会批准，我们回顾性研究了2012年1月至2017年9月间30例已确诊臂丛神经产瘫患者的磁共振成像检查中获得的30个正常和发育不良的肩部。四位儿科放射科医生使用弗里德曼法、改良弗里德曼法和先前描述的真正轴向重组法进行肩胛盂倾斜角度测量。改良弗里德曼技术通过选择与肩峰 - 肩胛体界面相关的参考点，更好地考虑了肩胛骨的位置。使用组内相关、配对t检验和混合线性模型分析评估评分者间的可靠性和方法间的一致性。对每位读者进行方法间的等效性测试。
在正常肩部（-10.8±5.7°[平均值±标准差]对-8.8±5.3°；P≤0.001）和发育不良肩部（-34.6±17.7°对-28.1±17.5°；P≤0.001）中，将弗里德曼法与真正的轴向重组法进行比较时，肩胛盂倾斜角度测量结果存在显著差异。在正常肩部（-6.3±5.8°对-8.8±5.3°；P = 0.06）和发育不良肩部（-29.0±18.3°对-28.1±17.5°；P = 0.06）中，将改良弗里德曼法与真正的轴向重组法进行比较时，肩胛盂倾斜角度测量结果无显著差异。对于所有读者，在发育不良肩部的测量中，弗里德曼法与真正的轴向重组法不等效（P = 0.68、0.81、0.86、0.99）；改良弗里德曼法在4位读者中的3位读者测量发育不良肩部时与真正的轴向重组法等效（P≤0.001、P≤0.001、P≤0.001、P = 0.10）。
在盂肱发育不良中，改良弗里德曼法和后处理的真正轴向重组提供了统计学上相似且可重复的值。我们建议可以使用我们的改良弗里德曼技术代替后处理的真正轴向重组来生成肩胛盂倾斜角度测量值。
