Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy.
Musculoskeletal Radiology Unit, Varelli Institute, Naples, Italy.
Radiol Med. 2023 Jan;128(1):93-102. doi: 10.1007/s11547-022-01577-3. Epub 2022 Dec 23.
The aim of this multicentric study was to assess which imaging method has the best inter-reader agreement for glenoid bone loss quantification in anterior shoulder instability. A further aim was to calculate the inter-method agreement comparing bilateral CT with unilateral CT and MR arthrography (MRA) with CT measurements. Finally, calculations were carried out to find the least time-consuming method.
A retrospective evaluation was performed by 9 readers (or pairs of readers) on a consecutive series of 110 patients with MRA and bilateral shoulder CT. Each reader was asked to calculate the glenoid bone loss of all patients using the following methods: best fit circle area on both MRA and CT images, maximum transverse glenoid width on MRA and CT, CT PICO technique, ratio of the maximum glenoid width to height on MRA and CT, and length of flattening of the anterior glenoid curvature on MRA and CT. Using Pearson's correlation coefficient (PCC), the following agreement values were calculated: the inter-reader for each method, the inter-method for MRA with CT quantifications and the inter-method for CT best-fit circle area and CT PICO. Statistical analysis was carried out to compare the time employed by the readers for each method.
Inter-reader agreement PCC mean values were the following: 0.70 for MRA and 0.77 for CT using best fit circle diameter, 0.68 for MRA and 0.72 for CT using best fit circle area, 0.75 for CT PICO, 0.64 for MRA and 0.62 for CT anterior straight line and 0.49 for MRA and 0.43 for CT using length-to-width ratio. CT-MRA inter-modality PCC mean values were 0.9 for best fit circle diameter, 0.9 for best fit circle area, 0.62 for anterior straight line and 0.94 for length-to-width methods. PCC mean value comparing unilateral CT with PICO CT methods was 0.8. MRA best fit circle area method was significantly faster than the same method performed on CT (p = 0.031), while no significant difference was seen between CT and MRA for remaining measurements.
CT PICO is the most reliable imaging method, but both CT and MRA can be reliably used to assess glenoid bone loss. Best fit circle area CT and MRA methods are valuable alternative measurement techniques.
本多中心研究旨在评估哪种影像学方法在评估肩关节前向不稳定的肩盂骨丢失方面具有最佳的读者间一致性。进一步的目的是通过比较双侧 CT 与单侧 CT 以及 MR 关节造影（MRA）与 CT 测量值来计算方法间的一致性。最后，计算出最耗时最少的方法。
9 位（或读者对）对 110 例 MRA 和双侧肩部 CT 的连续患者系列进行回顾性评估。每位读者均被要求使用以下方法计算所有患者的肩盂骨丢失量：在 MRA 和 CT 图像上使用最佳拟合圆面积，MRA 和 CT 上的最大横径宽度，CT PICO 技术，MRA 和 CT 上的最大肩盂宽度与高度的比值，以及 MRA 和 CT 上的前关节盂曲率变平的长度。使用 Pearson 相关系数（PCC）计算以下一致性值：每种方法的读者间一致性，MRA 与 CT 定量的方法间一致性以及 CT 最佳拟合圆面积和 CT PICO 的方法间一致性。对每位读者使用每种方法的时间进行了统计学分析。
读者间的 PCC 平均值如下：MRA 的 0.70 和 CT 的最佳拟合圆直径为 0.77，MRA 的 0.68 和 CT 的最佳拟合圆面积为 0.72，CT PICO 的 0.75，MRA 的 0.64 和 CT 的前直线为 0.62，MRA 的 0.49 和 CT 的最佳拟合圆面积为 0.43。CT-MRA 间模态 PCC 平均值分别为 0.9 的最佳拟合圆直径，0.9 的最佳拟合圆面积，0.62 的前直线和 0.94 的长度-宽度比。单侧 CT 与 PICO CT 方法的 PCC 平均值为 0.8。MRA 最佳拟合圆面积法明显快于 CT 上的相同方法（p=0.031），而 CT 与 MRA 之间的其余测量值无明显差异。
CT PICO 是最可靠的成像方法，但 CT 和 MRA 均可可靠地用于评估肩盂骨丢失。最佳拟合圆面积 CT 和 MRA 方法是有价值的替代测量技术。
