Texas Children's Hospital.
Baylor College of Medicine, Houston, TX.
J Pediatr Orthop. 2024 Jul 1;44(6):e485-e489. doi: 10.1097/BPO.0000000000002670. Epub 2024 Mar 28.
Hip dysplasia reportedly occurs in up to 12% of the general population and may be higher in patients with adolescent idiopathic scoliosis (AIS). When using lateral center edge angle (LCEA) measurements to help identify hip dysplasia, it is uncertain if this measurement can be performed reliably on scoliosis radiographs due to parallax. The purpose of this study is to evaluate the reliability of measuring LCEA on scoliosis radiographs compared with standard pelvis radiographs.
This study evaluated 40 hips on 20 patients (mean age 12.5 years ± 3.1; 50% Female) who received PA scoliosis radiographs and AP pelvis radiographs within 1 year of each other. Review was performed by 4 pediatric radiologists (2 general, 2 MSK), 2 pediatric orthopaedic surgeons, and 1 research fellow. Radiographic measurement of the LCEA for each hip was first performed on the scoliosis radiograph. After a minimum of 3 days, the LCEA was measured on a pelvis radiograph of the same individual obtained within 1 year of the scoliosis radiograph. Pearson coefficient was used to measure agreement between scoliosis and pelvis radiograph measurements. Intraclass correlation coefficient (ICC) was used to evaluate intraobserver and interobserver agreement. ICC values <0.5 were classified as poor reliability, 0.5 to 0.75 were classified moderate, 0.75 to 0.90 were classified good, and >0.9 indicated excellent reliability.
The mean difference between scoliosis and pelvis radiographs was 54 ± 79 days. There was good-to-excellent interobserver agreement on LCEA measurements made between readers on scoliosis radiographs (ICC: 0.94, 95% CI: 0.90-0.96, P <0.001) and pelvis radiographs (ICC: 0.91, 95% CI: 0.83-0.95, P <0.001), and moderate-to-excellent intraobserver agreement for scoliosis radiographs (ICC range: 0.68 to 0.98; P <0.001) and pelvis radiographs (ICC range: 0.62 to 0.96; P <0.001). There was a strong correlation between LCEA measurements made on scoliosis and pelvis radiographs ( r2 =0.66, P <0.001), and the intermodality agreement between scoliosis and pelvis radiograph LCEA measurements were moderate to good (ICC range: 0.68 to 0.89, P <0.001).
Overall, there was good-to-excellent agreement between readers on scoliosis and pelvis radiographs, respectively, and moderate-to-excellent intraobserver agreement between LCEA measurements made on scoliosis radiographs and pelvis radiographs, respectively. LCEA measurements made on scoliosis radiographs strongly correlated to the measurements made on pelvis radiographs, and the intermodality ICC was also considered moderate to good. Dedicated pelvis radiographs may not be necessary during scoliosis workup and follow-up surveillance, thereby decreasing radiation exposure, cost, and improving patient care workflow.
Level IV-diagnostic study.
据报道髋关节发育不良在普通人群中的发生率高达 12%，在青少年特发性脊柱侧凸（AIS）患者中可能更高。当使用外侧中心边缘角（LCEA）测量来帮助识别髋关节发育不良时，由于视差，尚不确定是否可以在脊柱侧凸 X 光片上可靠地进行此测量。本研究的目的是评估与标准骨盆 X 光片相比，在脊柱侧凸 X 光片上测量 LCEA 的可靠性。
本研究评估了 20 名患者（平均年龄 12.5 岁±3.1；50%为女性）的 40 个髋关节，这些患者在彼此 1 年内分别接受了 PA 脊柱侧凸 X 光片和 AP 骨盆 X 光片检查。由 4 位儿科放射科医生（2 位普通放射科医生，2 位 MSK 放射科医生）、2 位儿科矫形外科医生和 1 位研究研究员进行了回顾性研究。首先在脊柱侧凸 X 光片上对每个髋关节的 LCEA 进行放射学测量。至少 3 天后，在与脊柱侧凸 X 光片相同的个体的 1 年内获得的骨盆 X 光片上测量 LCEA。使用 Pearson 系数测量脊柱侧凸和骨盆 X 光片测量值之间的一致性。采用组内相关系数（ICC）评估观察者内和观察者间的一致性。ICC 值<0.5 为可靠性差，0.5-0.75 为可靠性中等，0.75-0.90 为可靠性良好，>0.9 为可靠性极好。
脊柱侧凸和骨盆 X 光片之间的平均差异为 54±79 天。在阅读者对脊柱侧凸 X 光片（ICC：0.94，95%CI：0.90-0.96，P<0.001）和骨盆 X 光片（ICC：0.91，95%CI：0.83-0.95，P<0.001）上进行的 LCEA 测量方面，观察者间具有极好到极好的一致性，在脊柱侧凸 X 光片（ICC 范围：0.68 至 0.98；P<0.001）和骨盆 X 光片（ICC 范围：0.62 至 0.96；P<0.001）上具有中度到极好的观察者内一致性。LCEA 在脊柱侧凸和骨盆 X 光片上的测量值之间具有很强的相关性（ r2=0.66，P<0.001），脊柱侧凸和骨盆 X 光片 LCEA 测量值之间的模态间一致性为中度到极好（ICC 范围：0.68 至 0.89，P<0.001）。
总体而言，在分别阅读脊柱侧凸和骨盆 X 光片的阅读者之间以及在分别对脊柱侧凸 X 光片和骨盆 X 光片上进行的 LCEA 测量之间，观察者内具有极好到极好的一致性，观察者内具有中度到极好的一致性。在脊柱侧凸 X 光片上进行的 LCEA 测量与在骨盆 X 光片上进行的测量具有很强的相关性，模态间 ICC 也被认为是中度到良好。在脊柱侧凸评估和随访监测期间，可能不需要专门的骨盆 X 光片，从而减少辐射暴露、成本，并改善患者护理工作流程。
IV 级诊断研究。
