Department of Radiology, University Hospital, LMU Munich, Germany.
Department of Radiology and Biomedical Imaging, University of California, San Francisco, USA.
J Hand Surg Eur Vol. 2023 Jul;48(7):619-624. doi: 10.1177/17531934231153966. Epub 2023 Feb 16.
Correctly identifying carpal collapse is important for adequate treatment of Kienböck's disease. This study aimed to assess the accuracy of traditional radiographic indices in detecting carpal collapse to differentiate between Lichtman stages IIIa and IIIb. In 301 patients, carpal height ratio, revised carpal height ratio, Ståhl index and radioscaphoid angle were measured on plain radiographs by two blinded observers. As a reference standard, Lichtman stages were determined by an expert radiologist using CT and MR imaging. The interobserver agreement was excellent. In the differentiation between Lichtman stages IIIa and IIIb, measurements of indices showed moderate to good sensitivity (0.60-0.95) and low specificity (0.09-0.69) using normal cut-off values from the literature, while receiver operating curve analysis revealed poor area under the curve (58-66%). Traditional radiographic indices showed poor diagnostic performance in detecting carpal collapse in Kienböck's disease and did not reach sufficient accuracy in the differentiation between Lichtman stages IIIa and IIIb. III.
正确识别腕骨塌陷对于充分治疗月骨缺血性坏死症至关重要。本研究旨在评估传统影像学指标在检测腕骨塌陷方面的准确性，以区分 Lichtman Ⅲa 期和Ⅲb 期。在 301 例患者中，两名盲法观察者在平片上测量腕骨高度比、改良腕骨高度比、Ståhl 指数和舟月骨角。以专家放射科医生使用 CT 和 MRI 成像确定的 Lichtman 分期作为参考标准。观察者间的一致性极好。在区分 Lichtman Ⅲa 期和Ⅲb 期时，使用文献中的正常截断值，各指数的测量值显示出中等至良好的敏感性（0.60-0.95）和低特异性（0.09-0.69），而受试者工作特征曲线分析显示曲线下面积较差（58%-66%）。传统影像学指标在检测月骨缺血性坏死症中的腕骨塌陷方面表现出较差的诊断性能，并且在区分 Lichtman Ⅲa 期和Ⅲb 期方面没有达到足够的准确性。
