Department of Rehabilitation Medicine, University of Kansas Medical Center, 3901 Rainbow Boulevard, Mailstop 1046, Kansas City, KS, 66160, USA.
Department of Rehabilitation Medicine, University of Kansas Medical Center, Kansas City, KS, USA.
Osteoarthritis Cartilage. 2021 Nov;29(11):1540-1548. doi: 10.1016/j.joca.2021.07.011. Epub 2021 Jul 29.
The patellofemoral joint is frequently affected by osteoarthritis (PFOA) and is incompletely imaged on radiographs (XR). Weight-Bearing CT (WBCT) could offer advantages for visualization. This study determined the sensitivity, specificity, and accuracy of axial WBCT and lateral XR for detection of PFOA features in comparison with cartilage damage on MRI.
A convenience sample of 60 right knees from the MOST cohort were analyzed. WBCT and XR were read for OARSI JSN score and MRI for MOAKS cartilage score by two experienced musculoskeletal radiologists blinded to participant. Using MOAKS scoring on MRI (referent standard), the sensitivity, specificity and accuracy of patellofemoral OARSI JSN scores based on WBCT and XR were compared.
The mean ± SD age and BMI for the participants included (66.7% women) were 67.6 ± 9.8 years and 30.0 ± 5.3 kg/m respectively. WBCT demonstrated significantly greater sensitivity (0.85-0.97 on WBCT vs 0.47-0.57 on XR) and accuracy (0.85-0.92 on WBCT vs 0.48-0.57 on XR) for all parameters except lateral full-thickness cartilage loss (McNemar's test p-values all <0.001). There was moderate-to-strong and low-to-moderate agreement between PFOA findings on WBCT and XR, respectively, and semi-quantitative scores of PF cartilage on MRI. Inter-rater reliability for XR JSN [weighted kappa = 0.83 (0.64, 1.0)], WBCT JSN [kappa = 0.60 (0.48, 0.72)] and MRI MOAKS-CM [kappa = 0.70 (0.61, 0.79)] readings were good.
WBCT demonstrates significantly greater sensitivity and accuracy than radiographs for identification of PFOA. Given the same Relative Radiation Level as XR and improved visualization, WBCT holds promise to improve understanding of the weight-bearing patellofemoral joint.
髌股关节常受骨关节炎（PFOA）影响，且在 X 光片（XR）上成像不完全。负重 CT（WBCT）在可视化方面可能具有优势。本研究比较了 MRI 上软骨损伤的情况下，评估轴向 WBCT 和外侧 XR 对 PFOA 特征检测的敏感性、特异性和准确性。
对 MOST 队列的 60 个右膝进行了方便样本分析。由两名经验丰富的肌肉骨骼放射科医生对 WBCT 和 XR 进行 OARSI JSN 评分和 MRI 进行 MOAKS 软骨评分阅读，两位放射科医生均对参与者不知情。使用 MRI 上的 MOAKS 评分（参考标准），比较基于 WBCT 和 XR 的髌股 OARSI JSN 评分的敏感性、特异性和准确性。
参与者的平均年龄和 BMI（66.7%为女性）分别为 67.6 ± 9.8 岁和 30.0 ± 5.3kg/m²。WBCT 显示出更高的敏感性（0.85-0.97 与 0.47-0.57）和准确性（0.85-0.92 与 0.48-0.57），除了外侧全层软骨缺失外（McNemar 检验的 p 值均<0.001）。WBCT 和 XR 之间以及 WBCT 和 MRI 之间的 PF 软骨半定量评分之间存在中度到高度和低度到中度的一致性。对于 XR JSN [加权 kappa=0.83（0.64，1.0）]、WBCT JSN [kappa=0.60（0.48，0.72）]和 MRI MOAKS-CM [kappa=0.70（0.61，0.79）]的阅读，观察者间可靠性良好。
与 XR 相比，WBCT 对 PFOA 的识别具有更高的敏感性和准确性。考虑到与 XR 相同的相对辐射水平和改善的可视化效果，WBCT 有望提高对负重髌股关节的理解。
