Department of Radiology and Diagnostic Imaging, 2A2.41 WC Mackenzie Health Sciences Centre, University of Alberta, 8440-112 Street, Edmonton, AB, T6G 2B7, Canada.
Eur Radiol. 2019 Mar;29(3):1489-1495. doi: 10.1007/s00330-018-5699-1. Epub 2018 Aug 29.
Developmental dysplasia of the hip (DDH) diagnosis by two-dimensional ultrasound (2DUS) can have poor inter-rater reliability. 3D ultrasound (3DUS) may be more reliably performed, particularly by novice users. We compared intra- and inter-rater reliability between expert and novice operators performing 2DUS and 3DUS for DDH.
Infants with suspected DDH were assessed with 2DUS and 3DUS. Novice operators had 1.5 h of training and Experts had 5-15 years' experience. Images included two 2DUS static and two 3DUS sweep images per operator. Image quality was assessed by 5-point system (yes/no: full femoral head; full acetabular roof; horizontal iliac wing; os ischium; absent motion/artifact). 2DUS indices (alpha angle, coverage) were measured centrally by a blinded reader with 2 years DDH US experience. 3DUS was post-processed by semi-automated custom software generating acetabular surface models, indices and estimated probability of DDH. Gold-standard diagnosis of each hip as normal, borderline or dysplastic was based on radiologist review of expert 2DUS.
Thirty infants, mean age 10.8 weeks were enrolled. Quality scores were 2.7±1.2 Novice versus 4.9±0.3 Expert for 2DUS (p = 0.04), and 4.2±1.0 Novice versus 4.9±0.3 Expert for 3DUS (p = 0.99). Inter-rater reliability was poor for 2DUS (ICC=0.10 for alpha angle, 0.04 for acetabular coverage) and moderate to high for 3DUS (ICC=0.73-0.83 for alpha angle, 0.55 for acetabular coverage). Intra-rater reliability and diagnostic accuracy was higher for 3DUS than 2DUS.
Novice operators can perform 3DUS for DDH with reliability and accuracy approaching expert sonographers. Novices perform 2DUS with poor reliability and accuracy.
• Novice/expert inter-rater reliability improved from poor with 2DUS to moderate/high with 3DUS. • Novice operators using 3DUS correctly classified 57/58 (98%) of infant hips. • DDH can be reliably assessed by novice operators using 3DUS.
二维超声（2DUS）对发育性髋关节发育不良（DDH）的诊断可能存在较差的观察者间可靠性。三维超声（3DUS）的操作可能更可靠，尤其是对于新手用户。我们比较了专家和新手操作者在 DDH 中进行 2DUS 和 3DUS 的观察者内和观察者间可靠性。
对疑似 DDH 的婴儿进行 2DUS 和 3DUS 评估。新手操作者接受了 1.5 小时的培训，而专家则具有 5-15 年的经验。每位操作者包括两张 2DUS 静态图像和两张 3DUS 扫查图像。图像质量采用 5 分制系统（是/否：全股骨头；全髋臼顶；水平髂骨翼；坐骨体；无运动/伪影）进行评估。由一位具有 2 年 DDH US 经验的盲法读者对 2DUS 指标（α角、覆盖范围）进行中心测量。3DUS 由半自动化定制软件进行后处理，生成髋臼表面模型、指标和估计的 DDH 概率。每个髋关节的金标准诊断为正常、边界或发育不良，基于放射科医生对专家 2DUS 的评估。
共纳入 30 名婴儿，平均年龄为 10.8 周。质量评分分别为 2.7±1.2 分（新手）和 4.9±0.3 分（专家）用于 2DUS（p=0.04），以及 4.2±1.0 分（新手）和 4.9±0.3 分（专家）用于 3DUS（p=0.99）。2DUS 的观察者间可靠性较差（α角 ICC=0.10，髋臼覆盖 ICC=0.04），而 3DUS 的观察者间可靠性为中度至高度（α角 ICC=0.73-0.83，髋臼覆盖 ICC=0.55）。3DUS 的观察者内可靠性和诊断准确性均高于 2DUS。
新手操作者可以使用 3DUS 进行 DDH 的可靠性和准确性接近专家超声医师。新手操作者使用 2DUS 的可靠性和准确性较差。
新手/专家观察者间可靠性从 2DUS 的差提高到 3DUS 的中/高度。
新手操作者使用 3DUS 正确分类了 58/58（98%）婴儿髋关节。
新手操作者可以使用 3DUS 可靠地评估 DDH。
