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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >A Novel Shorthand Approach to Knee Bone Age Using MRI: A Validation and Reliability Study
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A Novel Shorthand Approach to Knee Bone Age Using MRI: A Validation and Reliability Study

机译：利用MRI的膝关节骨龄的一种新型速记方法：验证和可靠性研究

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Background: Bone-age determination remains a difficult process. An atlas for bone age has been created from knee-ossification patterns on magnetic resonance imaging (MRI), thereby avoiding the need for radiographs and associated costs, radiation exposure, and clinical inefficiency. Shorthand methods for bone age can be less time-consuming and require less extensive training as compared with conventional methods. Purpose: To create and validate a novel shorthand algorithm for bone age based on knee MRIs that could correlate with conventional hand bone age and demonstrate reliability across medical trainees. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: Included in this study were adolescent patients who underwent both knee MRI and hand bone age radiographs within 90 days between 2009 and 2018. A stepwise algorithm for predicting bone age using knee MRI was developed separately for male and female patients, and 7 raters at varying levels of training used the algorithm to determine the bone age for each MRI. The shorthand algorithm was validated using Spearman rho ( r _(S)) to correlate each rater’s predicted MRI bone age with the recorded Greulich and Pyle (G&P) hand bone age. Interrater and intrarater reliability were also calculated using intraclass correlation coefficients (ICCs). Results: A total of 38 patients (44.7% female) underwent imaging at a mean age of 12.8 years (range, 9.3-15.7 years). Shorthand knee MRI bone age scores were strongly correlated with G&P hand bone age ( r _(S) = 0.83; P & .001). The shorthand algorithm was a valid predictor of G&P hand bone age regardless of level of training, as medical students ( r _(S) = 0.75), residents ( r _(S) = 0.81), and attending physicians ( r _(S) = 0.84) performed similarly. The interrater reliability of our shorthand algorithm was 0.81 (95% CI, 0.73-0.88), indicating good to excellent interobserver agreement. Respondents also demonstrated consistency, with 6 of 7 raters demonstrating excellent intrarater reliability (median ICC, 0.86 [range, 0.68-0.96]). Conclusion: This shorthand algorithm is a consistent, reliable, and valid way to determine skeletal maturity using knee MRI in patients aged 9 to 16 years and can be utilized across different levels of orthopaedic and radiographic expertise. This method is readily applicable in a clinical setting and may reduce the need for routine hand bone age radiographs.
机译：背景：骨骼时期确定仍然是一个困难的过程。从磁共振成像（MRI）上的膝盖骨化图案产生了一种骨骼时代的地图集，从而避免了对射线照相和相关成本，辐射暴露和临床效率的需求。与传统方法相比，骨骼时代的速度方法可能减少并且需要更少的培训。目的：根据膝关节MRIS创建和验证一种新的骨龄缩写算法，可以与常规手骨骼年龄相关，并展示医疗学员的可靠性。研究设计：队列研究（诊断）;证据水平：方法：本研究包括在2009年至2018年期间90天内接受膝关节MRI和手骨龄X型X脑照相的青少年患者。用于使用膝关节MRI预测骨骼时代的逐步算法用于男性和女性患者和7名评估者在不同培训水平的患者中使用该算法确定每个MRI的骨骼年龄。使用Spearman Rho（R _（s））验证了速记算法，以将每个Rater的预测MRI骨龄与记录的Greulich和Pyle（G＆amp; P）手骨骼年龄相关联。使用腹部相关系数（ICC）计算Interriter和Intrarberter可靠性。结果：共有38名患者（女性44.7％）接受成像，平均年龄为12.8岁（范围，9.3-15.7岁）。速干膝关节MRI骨龄分数与G＆amp; P手骨龄（R _（s）= 0.83; p＆amp; .001）强烈相关。速记算法是G＆amp的有效预测因素P.不管培训水平如何，作为医学生（R _（s）= 0.75），居民（r _（s）= 0.81），以及主治医生（r _ （s）= 0.84）同样进行。我们的速记算法的Interrarer可靠性为0.81（95％CI，0.73-0.88），表明优良的Interobserver协议。受访者还展示了一致性，7名评估者中有6名，证明了出色的内在可靠性（中位数ICC，0.86 [范围，0.68-0.96]）。结论：这种速记算法是一种一致，可靠的和有效的方法，可使用9至16岁的患者中使用膝关节MRI来确定骨骼成熟度，并且可以在不同水平的骨科和放射线专业知识中使用。该方法很容易适用于临床环境，并可减少对常规手骨龄X型射线照相的需求。

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