Comparison of Magnetic Resonance Imaging and Radiographs for Evaluation of Carpal Osteoarthritis
Comparison of Magnetic Resonance Imaging and Radiographs for Evaluation of Carpal Osteoarthritis
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DOI：
10.1055/s-0036-1592140
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发表时间：
2017-05-01
影响因子：
0.7
通讯作者：
Wolfe, Scott W.
中科院分区：
文献类型：
--
作者：
Li, Angela E.;Lee, Steve K.;Wolfe, Scott W.
本研究旨在评估影像学和磁共振成像（MRI）对舟月骨晚期塌陷（SLAC）和舟骨骨不连晚期塌陷（SNAC）患者骨关节炎分级的观察者之间和观察者内部的可靠性，并确定MRI是否比x线片更有可能检测腕骨关节炎。方法由2名手外科医生和2名放射科医师对46例SLAC和SNAC关节炎患者的x线片和MR资料进行回顾性分析，并根据7个腕关节骨关节炎的严重程度进行分级。使用加权kappa分析评估观察者之间和观察者内部的信度。计算比值比来比较MRI与x线片在确定中度或重度骨关节炎方面的可能性。结果MRI的可靠性指标高于x线片。对于所有患者的放射学评估，观察者之间的一致性为中等，观察者内部的一致性也为中等。对于MRI，观察者之间的一致是实质性的，观察者内部的一致几乎是完美的。在所有合并SLAC和SNAC患者的关节中，MRI显示中度骨关节炎的可能性是x线片的2.42倍。在SLAC患者中，MRI显示放射月关节中度骨关节炎的可能性是x线片的11.73倍。在SNAC患者中，MRI与x线片显示的中度骨关节炎没有差异。结论MRI对腕骨关节炎的诊断比x线片更可靠。MRI在显示骨关节炎中度变化方面比x线片更敏感，尤其是在SLAC关节炎患者的放射月状关节。这对SLAC/SNAC关节炎的手术治疗和术前规划具有指导意义。MRI应纳入SLAC和SNAC关节炎患者的诊断检查和评估。
Background We sought to evaluate the interobserver and intraobserver reliability of radiographs and magnetic resonance imaging (MRI) for grading of osteoarthritis in patients with scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC), and to determine whether MRI is more likely than radiographs to detect carpal osteoarthritis.Methods Radiographs and MR studies of 46 patients with SLAC and SNAC arthritis were reviewed by two hand surgeons and two radiologists and were graded according to severity of osteoarthritis at seven carpal joints. Interobserver and intraobserver reliability was assessed using a weighted kappa analysis. Odds ratios were calculated to compare the likelihood of MRI versus radiographs in the determination of moderate or severe osteoarthritis.Results Measures of reliability were higher for MRI than radiographs. For radiographic assessment of all patients combined, interobserver agreement was moderate and intraobserver agreement was also moderate. For MRI, interobserver agreement was substantial and intraobserver agreement was almost perfect. In all joints combined for patients with SLAC and SNAC, MRI was 2.42 times more likely to demonstrate moderate osteoarthritis compared with radiographs. In patients with SLAC, MRI was 11.73 times more likely than radiographs to show moderate osteoarthritis at the radiolunate joint. In patients with SNAC, there was no difference in demonstration of moderate osteoarthritis on MRI compared with radiographs.Conclusion Carpal osteoarthritis can be more reliably assessed on MRI than radiographs. MRI is more sensitive at demonstrating moderate changes of osteoarthritis than radiographs, especially at the radiolunate joint in patients with SLAC arthritis. This has implications for surgical management of SLAC/SNAC arthritis and preoperative planning. MRI should be included in the diagnostic workup and evaluation of patients with SLAC and SNAC arthritis.