Chung Ni, Cheng Yi-Hong, Po Hiu-Lam, Ng Wai-Kit, Cheung Kam-Ching, Yung Ho-Yin, Lai Yau-Ming
Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong, China.
J Orthop Translat. 2018 Oct 26;15:81-90. doi: 10.1016/j.jot.2018.09.005. eCollection 2018 Oct.
Computed radiography (CR), digital radiography (DR) and biplanar radiography (EOS™ imaging system) are common imaging tools for radiographic evaluation of adolescent idiopathic scoliosis (AIS). The effect of imaging methods in relation to later-on Cobb angle measurements on radiographs is not yet quantified. The study aimed to examine the compatibility between CR, DR and EOS for scoliotic quantification by evaluating the reliability, agreement of different imaging methods, and assessing the prediction performance for EOS measurement from that of CR and DR.
A flexible spine phantom was used to simulate 32 different scoliotic curves ranging from 10° to 60°. Each curvature was imaged using DR, CR and EOS systems accordingly. Each of the six observers independently measured Cobb angle twice on each image at a two-week interval. Intraclass correlation coefficient (model 2 and 3), Bland-Altman plot and linear regression analysis were completed to evaluate the reliability, agreement, and the prediction of Cobb angle measurement, respectively.
Reliability analysis showed excellent intra-observer reliability (Intraclass correlation coefficient >0.9) for each observer and good inter-observer reliability (Intraclass correlation coefficient = 0.84 for EOS; 0.739 for CR; 0.877 for DR) for each method. Bland-Altman plots demonstrated good agreement between imaging methods without fixed or proportional bias. Excellent coefficient of determination was achieved, with 0.980 for CR versus EOS measurements, and 0.973 for DR versus EOS measurements.
Radiographs produced by all of the three methods can provide reliable and accurate Cobb angle measurements for scoliosis assessments. None of the methods systemically underestimates or overestimates the Cobb angle measurement. Additionally, all of the evaluated methods are satisfactory in obtaining images for Cobb angle measurement in AIS. However, the 3D post-processing techniques offered by EOS should also be taken into consideration as it takes a vital role in treatment and monitoring of 3D deformity in the case of scoliosis.
In view of the limited availability of biplanar radiography (EOS™ imaging system), computed radiography and digital radiography are demonstrated to be reliable alternatives in scoliosis monitoring as evident in the reliability, agreement and prediction of Cobb angle measurement.
计算机X线摄影（CR）、数字X线摄影（DR）和双平面X线摄影（EOS™成像系统）是青少年特发性脊柱侧凸（AIS）影像学评估的常用成像工具。成像方法对后续X线片上Cobb角测量的影响尚未量化。本研究旨在通过评估不同成像方法的可靠性、一致性，并评估从CR和DR测量结果预测EOS测量结果的性能，来检验CR、DR和EOS在脊柱侧凸量化方面的兼容性。
使用一个柔性脊柱模型模拟32种不同的脊柱侧凸曲线，范围从10°到60°。每种曲率分别使用DR、CR和EOS系统进行成像。六位观察者中的每一位在两周的间隔内，对每张图像独立测量两次Cobb角。完成组内相关系数（模型2和3）、Bland-Altman图和线性回归分析，分别评估Cobb角测量的可靠性、一致性和预测性。
可靠性分析显示，每位观察者的观察者内可靠性极佳（组内相关系数>0.9），每种方法的观察者间可靠性良好（EOS的组内相关系数=0.84；CR的组内相关系数=0.739；DR的组内相关系数=0.877）。Bland-Altman图显示成像方法之间具有良好的一致性，无固定或比例偏差。获得了出色的决定系数，CR与EOS测量的决定系数为0.980，DR与EOS测量的决定系数为0.973。
所有这三种方法产生的X线片都能为脊柱侧凸评估提供可靠且准确的Cobb角测量结果。没有一种方法会系统性地低估或高估Cobb角测量值。此外，所有评估方法在获取AIS患者Cobb角测量的图像方面都令人满意。然而，也应考虑EOS提供的3D后处理技术，因为它在脊柱侧凸病例的3D畸形治疗和监测中起着至关重要的作用。
鉴于双平面X线摄影（EOS™成像系统）的可用性有限，计算机X线摄影和数字X线摄影在脊柱侧凸监测中被证明是可靠的替代方法，这在Cobb角测量的可靠性、一致性和预测性方面很明显。
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