Observer variability and sensitivity of radiographic diagnosis of canine medial coronoid disease^[*]

Summary

Objective: Medial coronoid disease (MCD) is a very common form of elbow joint disease and it’s radiographic diagnosis can be challenging since it is frequently based on the detection of rather subtle primary or secondary changes than on a large primary lesion. We hypothesized that accuracy of radiographic diagnosis of MCD is highly dependent on training and experience level. Methods: Radiographs of 102 canine elbows were evaluated for MCD by four observers with different levels of training and experience. All elbows underwent CT scans and arthroscopy. Sensitivity and specificity of radiographic and CT interpretation was determined using arthroscopy as a gold standard. Interobserver and intraobserver agreement (reliability and repeatability) were assessed by using Cohen’s Kappa (κ) statistic. Results: The sensitivity (92.4–96.7%) of the two experienced observers was almost comparable to that of CT (100%) and significantly higher than that of the two less experienced observers (77.2–80.4%). Reliability of the radiographic diagnosis of MCD was better between observers with higher experience level (κ = 0.74) than between observers of lower or different experience levels (κ =0.07–0.42). Repeatability was better in experienced (κ = 0.73–0.88) than in less experienced observers (κ = 0.31–0.42). Conclusion: Our results confirm that training and experience play important roles in reaching high sensitivity, reliability and repeatability for the radiographic diagnosis of MCD. Clinical relevance: Although radiography is inferior to CT in imaging of the medial coronoid process itself, sensitivity of radiographic diagnosis MCD can be significantly improved with observer experience almost reaching that of CT. Therefore, it is advised that radiographic screening for MCD should be performed by specialists experienced in the radiographic evaluation of elbow joint disease.

Zusammenfassung

Ziel: Die Koronoiderkrankung (MCD) ist eine sehr häufig auftretende Form der Ellbogengelenkerkrankung. Ihre Röntgendiagnose gestaltet sich häufig schwierig, da sie in vielen Fällen mehr auf der subjektiven Interpretation von geringen oder sekundären Veränderungen als auf der Detektion der primären Läsion selbst beruht. Ziel der Studie war, den Einfluss des Ausbildungs-und Erfahrungsgrades des Auswerters auf die Exaktheit der Röntgendiagnose MCD zu untersuchen. Methoden: Vier Auswerter mit verschiedenem Ausbildungs-und Erfahrungsgrad werteten Röntgenaufnahmen von 102 Hundeellbogen im Hinblick auf MCD aus. Für alle Ellbogen lagen die Ergebnisse der computertomographischen (CT) und arthroskopischen Untersuchung vor. Als Goldstandard zur Bestimmung der Sensitivität und Spezifität der Röntgen-und CTDiagnose diente die Arthroskopiediagnose. Die Inter-und Intraauswerterkonkordanz der Röntgendiagnose MCD wurden mithilfe des Cohen’s Kappa (κ) Statistiktest ermittelt. Ergebnisse: Die Sensitivität (92,4–96,7%) der beiden erfahrensten Auswerter war fast vergleichbar hoch mit der der CT (100%) und signifikant höher als die der weniger erfahrenen Auswerter (77,2–80,4%). Die Interauswerterkonkordanz (Verlässlichkeit) zwischen den beiden erfahreneren Auswertern (κ = 0,74) war besser als zwischen Auswertern mit weniger oder unterschiedlich großer Erfahrung (κ = 0,07–0,42). Ebenso ergab sich zwischen erfahrenen Auswertern eine bessere Intraauswerterkonkordanz (Wiederholbarkeit) (κ = 0,73–0,88) als zwischen weniger erfahrenen Auswertern (κ = 0,31–0,42). Schlussfolgerung: Ausbildung und Erfahrung des Auswerters spielen eine entscheidende Rolle, um die Röntgendiagnose MCD mit hoher Sensitivität, hoher Verlässlichkeit und Wiederholbarkeit stellen zu können. Klinische Relevanz: Obwohl das Röntgen im Gegensatz zur CT keine überlagerungsfreie Darstellung des medialen Koronoids ermöglicht, kann durch eine entsprechende Auswertererfahrenheit die Sensitivität der Röntgendiagnose signifikant verbessert werden und fast die Sensitivität der CT-Diagnose erreichen. Folglich sollte bei Hunden das “Röntgenscreening” für MCD von Spezialisten durchgeführt werden.

Key words

Fragmented medial coronoid process - intraobserver agreement - interobserver agreement - radiographic assessment and sensitivity - arthros-copy - computed tomography - dog

Schlüsselwörter

Koronoiderkrankung - radiologische Beurteilung - Interauswerterübereinstimmung - Intraauswerterübereinstimmung - Arthroskopie - Computertomographie - Hund

^* Dedicated to Prof. Dr. Ulrike Matis.

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