1° Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy.
Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy.
Knee Surg Sports Traumatol Arthrosc. 2021 Feb;29(2):333-341. doi: 10.1007/s00167-020-05957-y. Epub 2020 Apr 3.
The aim of this study was to propose and validate a new six-item topographical classification of knee bone marrow lesions in coronal MRI images, to provide an easy-to-use aid to describe their location in a more reproducible and accurate way.
This study was conducted in four phases. The first was to do a literature search for methods of describing bone marrow lesions in MRI of the knee. The second was creation of a six-area topographic classification of bone marrow lesions in coronal MRI of the knee. The third phase was selection of cases with bone marrow lesions on knee MRI performed in a single hospital between January of 2017 and December of 2018. The fourth phase was categorization of the bone marrow lesions' location according to the new proposed classification by three independent examiners, two orthopedic surgeons and one radiologist. Patient's demographic data and associated lesions were collected. The inter-observer and intra-observer reliability of the proposed classification was then calculated.
MRI examination of 4000 patients were studied and in 520 patients a total of 666 bone marrow lesions were identified and their location classified using the new system. The inter-observer and intra-observer reliability analysis found a Fleiss' Kappa value of 0.96 (0.95-0.97) and 0.97 (0.96-0.97), respectively, confirming the high reproducibility of the proposed classification.
The proposed six-location classification of bone marrow lesions is highly reproducible and can help researchers develop studies and share information in a more accurate and reliable way. The correct classification of bone marrow lesions can lead to a more accurate description of this pathology and help clinicians to propose appropriate therapies for this group of patients.
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本研究旨在提出并验证一种新的膝关节冠状位 MRI 图像骨髓病变的六部位拓扑分类方法，为更准确、更易操作的描述病变位置提供一种简便方法。
本研究分四个阶段进行。第一阶段为检索膝关节 MRI 骨髓病变的描述方法。第二阶段为膝关节冠状位 MRI 骨髓病变的六部位拓扑分类。第三阶段为选择 2017 年 1 月至 2018 年 12 月在单家医院进行膝关节 MRI 检查并发现骨髓病变的病例。第四阶段为三位独立观察者（两位骨科医生和一位放射科医生）根据新提出的分类对骨髓病变位置进行分类。收集患者的人口统计学数据和相关病变。然后计算新提出分类的观察者间和观察者内可靠性。
研究了 4000 例 MRI 检查患者，在 520 例患者中，共发现 666 个骨髓病变，并使用新系统对其位置进行分类。观察者间和观察者内可靠性分析发现 Fleiss' Kappa 值分别为 0.96（0.95-0.97）和 0.97（0.96-0.97），证实了新分类的高度可重复性。
提出的骨髓病变六部位分类具有高度可重复性，可帮助研究人员以更准确、更可靠的方式开展研究和共享信息。正确的骨髓病变分类可以更准确地描述这种病理学，并帮助临床医生为这组患者提出适当的治疗方案。
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