Abstract
BackgroundNon-ionizing radiation imaging assessment has been advocated for the patients with adolescent idiopathic scoliosis (AIS). As one of the radiation-free methods, ultrasound imaging has gained growing attention in scoliosis assessment over the past decade. The center of laminae (COL) method has been proposed to measure the spinal curvature in the coronal plane of ultrasound image. However, the reliability and validity of this ultrasound method have not been validated in the clinical setting.ObjectivesTo evaluate the reliability and validity of clinical ultrasound imaging on lateral curvature measurements of AIS with their corresponding magnetic resonance imaging (MRI) measurements.MethodsThirty curves (ranged 10.2°–68.2°) from sixteen patients with AIS were eligible for this study. The ultrasound scan was performed using a 3-D ultrasound unit within the same morning of MRI examination. Two researchers were involved in data collection of these two examinations. The COL method was used to measure the coronal curvature in ultrasound image, compared with the Cobb method in MRI. The intra- and inter-rater reliability of the COL method was evaluated by intra-class correlation coefficient (ICC). The validity of this method was analyzed by paired Student’s t-test, Bland–Altman statistics and Pearson correlation coefficient. The level of significance was set as 0.05.ResultsThe COL method showed high intra- and inter-rater reliabilities (both with ICC (2, K) >0.9, p<0.05) to measure the coronal curvature. Compared with Cobb method, COL method showed no significant difference (p<0.05) when measuring coronal curvature. Furthermore, Bland-Altman method demonstrated an agreement between these two methods, and Pearson’s correlation coefficient (r) was high (r>0.9, p<0.05).ConclusionThe ultrasound imaging could provide a reliable and valid measurement of spinal curvature in the coronal plane using the COL method. Further research is needed to validate the proposed ultrasound measurement in larger clinical trial and to optimize the ultrasound scanning and measuring procedure.
Highlights
Adolescent idiopathic scoliosis (AIS) is a three-dimensional spinal deformity characterized by lateral curvature and vertebral rotation of spine
In standing posterior-anterior radiographs, the spinal curvature can be assessed with the Cobb method, which was adopted by the Scoliosis Research Society (SRS) as the standard reference method to diagnose and monitor AIS [3]
MADa: mean absolute difference; SDb: standard deviation; SEMc: standard error of measurement; ICCd: intra-class correlation coefficient; CId: confidence intervals doi:10.1371/journal.pone.0135264.t002. These results suggested that the center of laminae (COL) method in ultrasound presented high intra- and interrater reliability when measuring the coronal curvature in AIS subjects at the supine position, compared with the Cobb method in magnetic resonance imaging (MRI)
Summary
Adolescent idiopathic scoliosis (AIS) is a three-dimensional spinal deformity characterized by lateral curvature and vertebral rotation of spine. It occurs in approximately 3% of adolescents with unknown reasons [1, 2]. The radiographic assessment of scoliotic spine continues to be the most widely used method in a scoliosis clinic. Radiographic assessment of scoliotic spine is limited in the coronal and sagittal planes, which represent a simplification of the true 3-dimensional (3-D) spinal deformity involved in scoliosis. Non-ionizing radiation imaging assessment has been advocated for the patients with adolescent idiopathic scoliosis (AIS). The reliability and validity of this ultrasound method have not been validated in the clinical setting.
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