Reliability of semiquantitative assessment of osteophytes and subchondral cysts on tomosynthesis images by radiologists with different levels of expertise

Tomosynthesis Is Equivalent to Computed Tomography for Evaluating Osseous Integration After Anterior Cruciate Ligament Reconstruction

Purpose

To compare tomosynthesis and computed tomography (CT) for evaluating bone plug integration after anterior cruciate ligament (ACL) reconstruction with a bone–patellar tendon–bone (BPTB) graft.

Methods

Data of consecutive adult patients who underwent ACL reconstruction with BPTB were analyzed. Bone integration between the bone plug and bone tunnel was evaluated by tomosynthesis and CT, which were both performed 3 months postoperatively. The obtained data for both modalities were reconstructed with slice thickness of 2 mm. Evaluation of bone integration were separately performed using coronal- and sagittal-reconstructed images for the femur and tibia. The ratio of bone integration between the reconstructed slices in which bone grafting was involved, for both tomosynthesis and CT, was investigated by 2 blinded examiners. The equivalence of tomosynthesis to CT was tested by comparing the bone integration ratio for both modalities. The accuracy of diagnosing bone union using tomosynthesis and CT was also investigated.

Results

The diagnostic accuracy of tomosynthesis and CT exceeded 80%. Interobserver agreement of bone integration in the sagittal plane on the femoral side was 0.92 (intraclass correlation coefficient) for CT and 0.76 (intraclass correlation coefficient) for tomosynthesis.

Conclusions

Although it showed poor reliability, tomosynthesis was equivalent to CT in evaluating bone plug integration after ACL reconstruction with BPTB.

Level of Evidence

Level II, diagnostic study.

Radiological glenohumeral osteoarthritis in long-term type 1 diabetes. Prevalence and reliability of three classification systems. The Dialong shoulder study

OBJECTIVE

In the present study, we evaluate the intra- and interrater agreement of radiological glenohumeral OA using three different classification systems and estimate the prevalence of radiological and clinical glenohumeral OA in patients with type 1 diabetes mellitus (DM1), for over 45 years and controls (The Dialong study).

MATERIALS AND METHODS

We included 102 patients with DM1 (49% women, mean age, 61.9 years) and 73 controls (57% women, mean age, 62.6 years). Anterior-posterior shoulder radiographs were interpreted by two observers applying the Kellgren-Lawrence (K-L), Samilson-Prieto (S-P) and Samilson-Prieto Allain (S-PA) classifications.

RESULTS

The interrater agreement was moderate (weighted kappa, 0.46 to 0.48) for all classifications and the intrarater agreement mainly substantial (0.48-0.86) for both observers. The agreed prevalence of radiological OA was 26 and 18% (OR 1.6 (0.8 to 3.3), p = 0.22, 44 and 26% (OR 2.2 (1.2 to 4.2), p = 0.02) and 30 and 17% (OR 2.1 (1.0 to 4.5), p = 0.05) for the K-L, S-P and S-PA classifications respectively in the diabetes and control groups. The prevalence of moderate or severe radiological OA was 1 to 6% and clinical OA 1 to 2% with no difference between the groups.

CONCLUSION

The prevalence of radiological glenohumeral OA was higher in the diabetes group with the Samilson-Prieto classification systems, but not associated with clinical OA. The interrater agreement was moderate. We recommend the Samilson-Prieto Allain classification for glenohumeral OA to avoid interpretation of osteophytes < 1 mm as OA in patient groups with a low pre-test likelihood of glenohumeral OA.

Imaging in Osteoarthritis

With technologic advances and the availability of sophisticated computer software and analytical strategies, imaging plays an increasingly important role in understanding the disease process of osteoarthritis (OA). Radiography has limitations in that it can visualize only limited features of OA, such as osteophytes and joint space narrowing, but remains the most commonly used modality for establishing an imaging-based diagnosis of OA. This article describes the roles and limitations of different imaging modalities and discusses the optimum imaging protocol, imaging diagnostic criteria of OA, differential diagnoses, and what the referring physician needs to know.

Value of tomosynthesis for lesion evaluation of small joints in osteoarthritic hands using the OARSI score

OBJECTIVE

To determine the diagnostic performance of tomosynthesis in depicting osteoarthritic lesions in comparison to conventional radiographs, with use of computed tomography (CT) as standard-of-reference.

METHODS

Imaging of 12 cadaveric hands was performed with tomosynthesis in dorso-palmar (dp) projection, conventional radiographs (dp) and multi-detector CT. Distal interphalangeal joint (DIP)II, DIPIII, proximal interphalangeal joint (PIP)II, PIPIII, first carpometacarpal (CMC) and scaphotrapezotrapezoidal joint (STT) were graded by two independent readers using the Osteoarthritis Research Society International (OARSI) score. The mean score for each feature was calculated for all modalities. Additional wrists were evaluated for presence of calcium pyrophosphate disease (CPPD). CT served as reference-standard. Inter-reader agreement (ICC) was calculated.

RESULTS

Comparing tomosynthesis and conventional radiographs to CT, the sensitivity for the presence of osteophytes was 95,7% vs 65,2%; for joint space narrowing 95,8% vs 52,1%; for subchondral sclerosis 61,5% vs 51,3%; for lateral deformity 83.3% vs 83,3%; and for subchondral cysts 45,8% vs 29,2%. Erosions were not present. While tomosynthesis showed no significant difference in OARSI score grading to CT (mean OARSI-score CT: 16.8, SD = 10.6; mean OARSI-score Tomosynthesis: 16.3, SD = 9.6; P = 0.84), conventional radiographs had significant lower mean OARSI scores (mean OARSI-score X-ray: 11.1, SD = 8.3; P = 0.04). Inter-reader agreement for OARSI scoring was excellent (ICC = 0.99). CPPD calcifications present in CT, were also visible with tomosynthesis, but not with conventional radiography.

CONCLUSION

In conclusion, tomosynthesis depicts more osteoarthritic changes in the small joints of the hand than conventional radiography using the OARSI scoring system and CT as the standard of reference.

Imaging for osteoarthritis

Osteoarthritis (OA) is a widely prevalent disease worldwide and, with an increasing ageing society, is a challenge for the field of physical and rehabilitation medicine. Technologic advances and implementation of sophisticated post-processing instruments and analytic strategies have resulted in imaging playing a more and more important role in understanding the disease process of OA. Radiography is still the most commonly used imaging modality for establishing an imaging-based diagnosis of OA. The need for an effective non-surgical OA treatment is highly desired, but despite on-going research efforts no disease-modifying OA drugs have been discovered or approved to date. MR imaging-based studies have revealed some of the limitations of radiography. The ability of MR to image all relevant joint tissues within the knee and to visualize cartilage morphology and composition has resulted in MRI playing a key role in understanding the natural history of the disease and in the search for new therapies. Our review will focus on the roles and limitations of radiography and MRI with particular attention to knee OA. The use of other modalities (e.g. ultrasound, nuclear medicine, computed tomography (CT), and CT/MR arthrography) in clinical practice and OA research will also be briefly described. Ultrasound may be useful to evaluate synovial pathology in osteoarthritis, particularly in the hand.

Use of Tomosynthesis for Detection of Bone Erosions of the Foot in Patients With Established Rheumatoid Arthritis: Comparison With Radiography and CT

OBJECTIVE

The purpose of this study was to compare tomosynthesis with radiography for the detection of bone erosions of the foot in patients with established rheumatoid arthritis (RA) using MDCT as a reference standard.

SUBJECTS AND METHODS

Eighteen consecutive patients with established RA were included. Each patient underwent radiography, tomosynthesis, and CT examinations of the feet on the same day. Two radiologists independently determined the number of bone erosions and the Sharp-van der Heijde score with each of the three imaging modalities.

RESULTS

On a total of 216 joints from 18 patients, 216 bone erosions were detected on CT, 215 on tomosynthesis, and 181 with radiography. The mean (± SD) Sharp-van der Heijde score was equivalent for tomosynthesis (18.8 ± 16.8) and CT (19.8 ± 18.5) but was statistically lower for radiography (16.4 ± 18.0) (p = 0.030). The respective overall sensitivity, specificity, accuracy, positive predictive value, and negative predictive value for tomosynthesis were 80%, 75%, 78%, 76%, and 80%, whereas the respective corresponding values for radiography were 66%, 81%, 74%, 77%, and 71%. The radiation burden of tomosynthesis was almost equivalent to that of radiography.

CONCLUSION

Tomosynthesis has a higher sensitivity than radiography to detect bone erosions of the foot in patients with established RA and imparts an almost equivalent radiation burden.

Evaluation of the diagnostic accuracy of four-view radiography and conventional computed tomography analysing sacral and pelvic fractures in dogs

OBJECTIVE

The purpose of our study was (1) to determine whether four-view radiography of the pelvis is as reliable and accurate as computed tomography (CT) in diagnosing sacral and pelvic fractures, in addition to coxofemoral and sacroiliac joint subluxation or luxation, and (2) to evaluate the effect of the amount of training in reading diagnostic imaging studies on the accuracy of diagnosing sacral and pelvic fractures in dogs.

METHODS

Sacral and pelvic fractures were created in 11 canine cadavers using a lateral impactor. In all cadavers, frog-legged ventro-dorsal, lateral, right and left ventro-45°-medial to dorsolateral oblique frog leg ("rollover 45-degree view") radiographs and a CT of the pelvis were obtained. Two radiologists, two surgeons and two veterinary students classified fractures using a confidence scale and noted the duration of evaluation for each imaging modality and case. The imaging results were compared to gross dissection.

RESULTS

All evaluators required significantly more time to analyse CT images compared to radiographic images. Sacral and pelvic fractures, specifically those of the sacral body, ischiatic table, and the pubic bone, were more accurately diagnosed using CT compared to radiography. Fractures of the acetabulum and iliac body were diagnosed with similar accuracy (at least 86%) using either modality.

CLINICAL SIGNIFICANCE

Computed tomography is a better method for detecting canine sacral and some pelvic fractures compared to radiography. Computed tomography provided an accuracy of close to 100% in persons trained in evaluating CT images.