Tramś Ewa, Liszka Maciej, Kuliński Krzysztof, Malesa Kamila, Tyrakowski Marcin, Białecki Jerzy, Kamiński Rafał
Department of Musculoskeletal Trauma and Orthopaedics, Centre of Postgraduate Medical Education Gruca Orthopaedic and Trauma Teaching Hospital Otwock Poland.
Department of Orthopedics, Centre of Postgraduate Medical Education Gruca Orthopaedic and Trauma Teaching Hospital Otwock Poland.
J Exp Orthop. 2025 Jun 5;12(2):e70293. doi: 10.1002/jeo2.70293. eCollection 2025 Apr.
The purpose of this study was to compare five different femoral torsion measurement methods using computed tomography (CT) and magnetic resonance imaging (MRI), and to develop an MRI-based rotational profiling technique that is comparable to and as repeatable as CT.
This prospective study evaluates patients who underwent lower limb rotational profile assessment by MRI and CT between June 2022 and October 2023. Five different measurement methods (Reikerås, Lee, Tomczak, Murphy and Jarrett) were compared to determine the best agreement. The Reikerås method was selected and further evaluated for intraobserver and interobserver reliability, as well as the learning curve, using intraclass correlation coefficients (ICCs). Reliability was assessed using ICCs, while agreement was evaluated through Bland-Altman analysis. Additionally, receiver operating characteristic (ROC) curve analysis with the area under the curve (AUC) was performed.
ICCs for the agreement between MRI and CT measurements indicated strong reliability (0.904 ± 0.022). The ICCs for intraobserver and interobserver reliability were 0.887 ± 0.026 and 0.871 ± 0.0471, respectively. Bland-Altman plots revealed a mean difference of -0.98° with limits of agreement ranging from -7.89° to 5.93°. The optimal cut-off point for CT referral was calculated based on ROC curve analysis of MR-based femoral torsion assessment, identified using the Youden index, at 19.67°, with an AUC of 0.998 ± 0.003, indicating excellent diagnostic accuracy. The learning curve showed an optimal ICC > 0.966 after 63 readings.
The Reikerås MRI measurement method could replace CT, especially in the paediatric population, as it has shown high agreement, comparable reliability and reproducibility. The cut-off point for this method is 19.67°.
Level II.
本研究旨在比较使用计算机断层扫描（CT）和磁共振成像（MRI）的五种不同的股骨扭转测量方法，并开发一种基于MRI的旋转轮廓分析技术，该技术与CT具有可比性且可重复性相同。
诊断性研究
这项前瞻性研究评估了2022年6月至2023年10月期间接受MRI和CT下肢旋转轮廓评估的患者。比较了五种不同的测量方法（雷克拉斯、李、托姆扎克、墨菲和贾勒特）以确定最佳一致性。选择雷克拉斯方法并使用组内相关系数（ICC）进一步评估观察者内和观察者间的可靠性以及学习曲线。使用ICC评估可靠性，通过布兰德-奥特曼分析评估一致性。此外，进行了曲线下面积（AUC）的受试者工作特征（ROC）曲线分析。
MRI和CT测量之间一致性的ICC表明具有高度可靠性（0.904±0.022）。观察者内和观察者间可靠性的ICC分别为0.887±0.026和0.871±0.0471。布兰德-奥特曼图显示平均差异为-0.98°，一致性界限为-7.89°至5.93°。基于MRI的股骨扭转评估的ROC曲线分析计算出CT转诊的最佳截断点，使用约登指数确定为19.67°，AUC为0.998±0.003，表明诊断准确性极佳。学习曲线显示在63次读数后最佳ICC>0.966。
雷克拉斯MRI测量方法可以替代CT，特别是在儿科人群中，因为它显示出高度一致性、可比的可靠性和可重复性。该方法的截断点为19.67°。
二级。
