Beason Austin M, Koehler Ryan J, Sanders Rosemary A, Rode Brooke E, Menge Travis J, McCullough Kirk A, Glass Natalie A, Hettrich Carolyn M, Cox Charles L, Bollier Matthew J, Wolf Brian R, Spencer Edwin E, Grant John A, Bishop Julie Y, Jones Grant L, Barlow Jonathan D, Baumgarten Keith M, Kelly John D, Sennett Brian J, Zgonis Milt, Abboud Joseph A, Namdari Surena, Allen Christina, Kuhn John E, Sullivan Jaron P, Wright Rick W, Brophy Robert H, Smith Matthew V, Dunn Warren R
Investigation performed at the Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Orthop J Sports Med. 2019 Aug 9;7(8):2325967119862501. doi: 10.1177/2325967119862501. eCollection 2019 Aug.
In the setting of anterior shoulder instability, it is important to assess the reliability of orthopaedic surgeons to diagnose pathologic characteristics on the 2 most common imaging modalities used in clinical practice: standard plain radiographs and magnetic resonance imaging (MRI).
To assess the intra- and interrater reliability of diagnosing pathologic characteristics associated with anterior shoulder instability using standard plain radiographs and MRI.
Cohort study (diagnosis); Level of evidence, 3.
Patient charts at a single academic institution were reviewed for anterior shoulder instability injuries. The study included 40 sets of images (20 radiograph sets, 20 MRI series). The images, along with standardized evaluation forms, were distributed to 22 shoulder/sports medicine fellowship-trained orthopaedic surgeons over 2 points in time. Kappa values for inter- and intrarater reliability were calculated.
The overall response rate was 91%. For shoulder radiographs, interrater agreement was fair to moderate for the presence of glenoid lesions (κ = 0.49), estimate of glenoid lesion surface area (κ = 0.59), presence of a Hill-Sachs lesion (κ = 0.35), and estimate of Hill-Sachs surface area (κ = 0.50). Intrarater agreement was moderate for radiographs (κ = 0.48-0.57). For shoulder MRI, interrater agreement was fair to moderate for the presence of glenoid lesions (κ = 0.44), glenoid lesion surface area (κ = 0.35), Hill-Sachs lesion (κ = 0.33), Hill-Sachs surface area (κ = 0.28), humeral head edema (κ = 0.41), and presence of a capsulolabral injury (κ = 0.36). Fair agreement was found for specific type of capsulolabral injury (κ = 0.21). Intrarater agreement for shoulder MRI was moderate for the presence of glenoid lesion (κ = 0.59), presence of a Hill-Sachs lesion (κ = 0.52), estimate of Hill-Sachs surface area (κ = 0.50), humeral head edema (κ = 0.51), and presence of a capsulolabral injury (κ = 0.53), and agreement was substantial for glenoid lesion surface area (κ = 0.63). Intrarater agreement was fair for determining the specific type of capsulolabral injury (κ = 0.38).
Fair to moderate agreement by surgeons was found when evaluating imaging studies for anterior shoulder instability. Agreement was similar for identifying pathologic characteristics on radiographs and MRI. There was a trend toward better agreement for the presence of glenoid-sided injury. The lowest agreement was observed for specific capsulolabral injuries.
在前肩不稳的情况下，评估骨科医生在临床实践中最常用的两种影像学检查方式（标准X线平片和磁共振成像（MRI））下诊断病理特征的可靠性很重要。
评估使用标准X线平片和MRI诊断与前肩不稳相关的病理特征时，评估者间和评估者内的可靠性。
队列研究（诊断）；证据等级，3级。
回顾了一家学术机构中有关前肩不稳损伤的患者病历。该研究包括40组图像（20组X线片，20个MRI序列）。这些图像以及标准化评估表在两个时间点分发给了22名接受过肩部/运动医学专科培训的骨科医生。计算评估者间和评估者内可靠性的Kappa值。
总体回复率为91%。对于肩部X线片，评估者间对于盂唇病变的存在（κ = 0.49）、盂唇病变表面积的估计（κ = 0.59）、Hill-Sachs损伤的存在（κ = 0.35）以及Hill-Sachs表面积的估计（κ = 0.50）的一致性为一般到中等。X线片的评估者内一致性为中等（κ = 0.48 - 0.57）。对于肩部MRI，评估者间对于盂唇病变的存在（κ = 0.44）、盂唇病变表面积（κ = 0.35）、Hill-Sachs损伤（κ = 0.33）、Hill-Sachs表面积（κ = 0.28）、肱骨头水肿（κ = 0.41）以及关节囊盂唇损伤的存在（κ = 0.36）的一致性为一般到中等。对于关节囊盂唇损伤的特定类型，一致性为一般（κ = 0.21）。肩部MRI的评估者内一致性对于盂唇病变的存在（κ = 0.59）、Hill-Sachs损伤的存在（κ = 0.52）、Hill-Sachs表面积的估计（κ = 0.50）、肱骨头水肿（κ = 0.51）以及关节囊盂唇损伤的存在（κ = 0.53）为中等，对于盂唇病变表面积的一致性为高度（κ = 0.63）。对于确定关节囊盂唇损伤的特定类型，评估者内一致性为一般（κ = 0.38）。
在评估前肩不稳的影像学检查时，外科医生的一致性为一般到中等。在X线片和MRI上识别病理特征的一致性相似。对于盂唇侧损伤的存在，有一致性更好的趋势。对于特定的关节囊盂唇损伤，一致性最低。
