膝关节剥脱性骨软骨炎：磁共振成像特征的观察者间可靠性研究。
Osteochondritis Dissecans of the Knee: An Interrater Reliability Study of Magnetic Resonance Imaging Characteristics.
机构信息
Investigation performed at the Hospital for Special Surgery, New York, New York, USA, and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
出版信息
Am J Sports Med. 2020 Jul;48(9):2221-2229. doi: 10.1177/0363546520930427. Epub 2020 Jun 25.
BACKGROUND
Imaging characteristics of osteochondritis dissecans (OCD) lesions quantified by magnetic resonance imaging (MRI) are often used to inform treatment and prognosis. However, the interrater reliability of clinician-driven MRI-based assessment of OCD lesions is not well documented.
PURPOSE
To determine the interrater reliability of several historical and novel MRI-derived characteristics of OCD of the knee in children.
STUDY DESIGN
Cohort study (diagnosis); Level of evidence, 3.
METHODS
A total of 42 OCD lesions were evaluated by 10 fellowship-trained orthopaedic surgeons using 31 different MRI characteristics, characterizing lesion size and location, condylar size, cartilage status, the interface between parent and progeny bone, and features of both the parent and the progeny bone. Interrater reliability was determined via intraclass correlation coefficients (ICCs) with 2-way random modeling, Fleiss kappa, or Krippendorff alpha as appropriate for each variable.
RESULTS
Raters were reliable when the lesion was measured in the coronal plane (ICC, 0.77). Almost perfect agreement was achieved for condylar size (ICC, 0.93), substantial agreement for physeal patency (ICC, 0.79), and moderate agreement for joint effusion (ICC, 0.56) and cartilage status (ICC, 0.50). Overall, raters showed significant variability regarding interface characteristics (ICC, 0.25), progeny (ICC range, 0.03 to 0.62), and parent bone measurements and qualities (ICC range, -0.02 to 0.65), with reliability being moderate at best for these measurements.
CONCLUSION
This multicenter study determined the interrater reliability of MRI characteristics of OCD lesions in children. Although several measurements provided acceptable reliability, many MRI features of OCD that inform treatment decisions were unreliable. Further work will be needed to refine the unreliable characteristics and to assess the ability of those reliable characteristics to predict clinical lesion instability and prognosis.
背景
通过磁共振成像（MRI）量化的剥脱性骨软骨炎（OCD）病变的影像学特征常用于指导治疗和预后。然而，临床医生基于 MRI 评估 OCD 病变的可靠性尚未得到充分记录。
目的
确定儿童膝关节 OCD 的几种历史和新型 MRI 特征的观察者间可靠性。
研究设计
队列研究（诊断）；证据水平，3 级。
方法
共有 42 个 OCD 病变由 10 名接受过 fellowship培训的骨科医生使用 31 种不同的 MRI 特征进行评估，这些特征包括病变大小和位置、髁骨大小、软骨状态、父母骨与子代骨之间的界面以及父母和子代骨的特征。通过 2 路随机模型的组内相关系数（ICC）、Fleiss kappa 或 Krippendorff alpha 确定观察者间的可靠性，根据每个变量的适当情况选择。
结果
当病变在冠状面测量时，观察者间具有可靠性（ICC，0.77）。髁骨大小的一致性极好（ICC，0.93），骺板通畅性的一致性高（ICC，0.79），关节积液（ICC，0.56）和软骨状态（ICC，0.50）的一致性好。总体而言，观察者间界面特征（ICC，0.25）、子代骨（ICC 范围，0.03 至 0.62）和父母骨测量值和质量（ICC 范围，-0.02 至 0.65）的变异性显著，这些测量值的可靠性最多为中等。
结论
这项多中心研究确定了儿童 OCD 病变 MRI 特征的观察者间可靠性。尽管有几个测量值具有可接受的可靠性，但许多用于指导治疗决策的 OCD 的 MRI 特征是不可靠的。需要进一步研究来改进不可靠的特征，并评估那些可靠特征预测临床病变不稳定和预后的能力。
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