High Intraobserver Reliability Research Articles

Evaluation of automatic cochlear dimension measurement using ALPACA: a comparative study

Background Cochlear dimension measurements are critical in diagnosing and managing congenital sensorineural hearing loss. Objectives To evaluate the feasibility and reliability of an automated landmark approach for measuring cochlear dimensions (A-, B- and H-values). Material and Methods Cochlear parameters from 100 patients were measured by MPR, manual three-dimensional and ALPACA. We assessed intra- and inter-observer reliability as well as inter-method reliability. Statistical analyses were conducted to detect differences between the right and left ears, as well as to assess the relevance of the values obtained using ALPACA. Results All A-, B-, and H-values measured by the various methods showed a high intra-observer reliability with intra-class correlation coefficients (ICC) ranging from 0.70 to 0.99, and values gained by ALPACA reaching the highest ICC. Inter-method reliability was at a good level with ICC ranging from 0.51 to 0.86. There were no significant differences between the right and left ears’ measured values. Obvious positive correlations existed among cochlear dimensions measured by ALPACA. Conclusions and Significance The ALPACA method can be used to measure cochlear dimensions. Values obtained by the method demonstrate high reliability and consistency with a significant reduction in intra-observer variability compared to results from conventional MPR and manual 3D measurements.

Right ventricular scalloping index as cardiac magnetic resonance-derived marker for diagnosis of arrhythmogenic right ventricular cardiomyopathy.

The cardiac magnetic resonance (CMR) evaluation of right ventricular (RV) morphologic abnormalities in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) is subjective. Here, we aimed to use a quantitative index, the right ventricular scalloping index (RVSI), to standardize the measurement of RV free wall scalloping and aid in the imaging diagnosis. We retrospectively included 15 patients with definite ARVC and 45 age- and sex-matched patients with idiopathic right ventricular outflow tract ventricular arrhythmia (RVOT-VA) as controls. The RVSI was measured from cine images on four-chamber view to evaluate its ability to distinguish between ARVC and RVOT-VA patients. Other cardiac functional parameters including strain analysis were also performed. The RVSI was significantly higher in the ARVC than RVOT-VA group (1.56 ± 0.23 vs 1.30 ± 0.08, p < 0.001). The diagnostic performance of the RVSI was superior to the RV global longitudinal, circumferential, and radial strains, RV ejection fraction, and RV end-diastolic volume index. The RVSI demonstrated high intraobserver and interobserver reliability (intraclass correlation coefficient, 0.94 and 0.96, respectively). RVSI was a strong discriminator between ARVC and RVOT-VA patients (area under curve [AUC], 0.91; 95% CI, 0.82-0.99). A cutoff value of RVSI ≥1.49 provided an accuracy of 90.0%, specificity of 97.8%, sensitivity of 66.7%, positive predictive value (PPV) of 90.9%, and a negative predictive value (NPV) of 89.8%. In a multivariable analysis, a family history of ARVC or sudden cardiac death (odds ratio, 38.71; 95% CI, 1.48-1011.05; p = 0.028) and an RVSI ≥1.49 (odds ratio, 64.72; 95% CI, 4.58-914.63; p = 0.002) remained predictive of definite ARVC. RVSI is a quantitative method with good performance for the diagnosis of definite ARVC.

Evaluation of an objective staging system for assessment of cervical vertebral maturation

BackgroundThe aim of this study was to evaluate an objective method for Cervical Vertebral Maturation (CVM) staging.MethodsAn initial sample of 647 Lateral Cephalometric Radiographs (LCR) were staged according to the CVM (Baccetti et al.) by 4 examiners. The final sample (n = 394) included LCR on which the staging of the 4 investigators matched. The objective staging was performed by a single operator. The sample was divided according to the maturational stages into pre-pubertal, pubertal and post-pubertal groups. Measurements were performed on the cervical vertebrae (C2, C3 and C4). The angle between posterior and superior borders for C3 and C4 was the Superior Wall Inclination Angle (SWIA). Concavity Depth (CD) for C2, C3 and C4, and Body Shape (BS) (ratio of width to height of C3 and C4). Measurements of the 3 groups were compared.ResultsReliability of subjective staging was high (intra-observer reliability, 0.948; inter-observer reliability, 0.967). Good agreement was observed for the outcomes measured. Intra-observer reliability was good (0.918, 0.885 and 0.722 for CD, BS and SWIA, respectively). The same was for the inter-observer reliability results (0.902, 0.889 and 0.728 for CD, BS and SWIA, respectively). Significant differences were observed for mean values of SWIA and BS and median values of CD within maturational stage. Similar findings were observed when the outcomes were compared at different phases (P < 0.001).ConclusionsA standardized, objective staging system using linear, angular measurements and ratios was applied for the determination of cervical vertebral maturation.

Introduction of 3D-classification and its derived surgical sequence of Schatzker type IV tibial plateau fractures

IntroductionSchatzker IV tibial plateau fractures usually have a worse prognosis due to their high variability and the accompanied bony and soft tissue injuries. This study aimed to introduce an injury mechanism-based new classification of Schatzker IV tibial plateau fractures and evaluate its reliability. Additionally, this study aimed to evaluate the outcomes of operative Schatzker IV tibial plateau fractures treated according to the surgical sequences determined by the new classification.Materials and methodsA total of 63 cases of operative Schatzker IV tibial plateau fractures that were treated following the new surgical sequences were enrolled in our study. The CT images of these patients were reviewed and classified twice according to the new 3D classification by 4 independent observers. The reliability of the classification was calculated through kappa analysis. The classification-determined surgical sequence was evaluated by observing the postoperative efficacy during the follow-up.ResultsBoth the intra-observer (the mean k = 0.897, CI 0.806–0.971) and inter-observer (the mean k = 0.883, CI 0.786–0.961) reliability of 3D-classification showed excellent agreement according to Landis and Koch. All the patients were followed up for 6–28 months (average 12.8 months). As for the evaluation of the postoperative efficacy, according to KSS, 53 cases were rated as excellent, 8 cases as good, and 2 cases as fair results.ConclusionsThe new proposed classification showed high intra-observer and inter-observer reliability in our study. The surgical sequence determined by the classification can help surgeons to acquire good reduction and rigid internal fixation. Therefore the new classification of Schatzker IV tibial plateau fractures and the derived surgical sequences are worthy of further popularization and application in clinical trials.

Reliability assessment of new radiographic scales to evaluate radiolucency and bony in-between fin growth of partially cemented all-polyethylene glenoid components

Current methods available for assessment of radiolucency and in-between fin (IBF) growth of a glenoid component have not undergone interobserver reliability testing for an all-polyethylene fluted central peg (FCP) glenoid. The purpose of this study was to evaluate anteroposterior radiographs of an FCP glenoid component at ≥48 months comparing commonly used scales to a new method adapted to the FCP. Our hypothesis was that the new method would result in acceptable intra- and interobserver agreement and a more accurate description of radiographic findings. We reviewed ≥48-month follow-up radiographs of patients treated with a primary aTSA using an FCP glenoid. Eighty-three patients were included in the review. Radiographs were evaluated by 5 reviewers using novel IBF radiodensity and radiolucency assessments and the Wirth and Lazarus methods. To assess intraobserver reliability, a subset of 40 images was reviewed. Kappa statistics were calculated to determine intra- and interobserver reliability; correlations were assessed using Pearson correlation. Interobserver agreement (κ score) was as follows: IBF 0.71, radiolucency 0.68, Wirth 0.48, and Lazarus 0.22. Intraobserver agreement ranges were as follows: IBF radiodensity 0.36-0.67, radiolucency 0.55-0.62, Wirth 0.11-0.73, and Lazarus 0.04-0.46. Correlation analysis revealed the following: IBF to Wirth r=0.93, radiolucency to Lazarus r=0.92 (P value <.001 for all). This study introduces a radiographic assessment method developed specifically for an FCP glenoid component. Results show high interobserver and acceptable intraobserver reliability for the method presented in this study. The new scales provide a more accurate description of radiographic findings, helping to identify glenoid components that may be at risk for loosening.

The Controversial Definition of Normal Toe Alignment.

"Normal" and "abnormal" are frequently used in surgical planning and to evaluate surgical results of the forefoot. However, there is no objectifiable value of metatarsophalangeal angles (MTPAs) 2-5 in the dorsoplantar (DP) view with which to objectively evaluate lesser toe alignment. We aimed to determine which angles are considered to be "normal" by orthopedic surgeons and radiologists. Thirty anonymized radiographs of feet were submitted twice in randomized order to determine the respective MTPAs 2-5. After six weeks, the anonymized radiographs and photographs of the same feet without apparent affiliation were presented again. The terms "normal," "borderline normal," and "abnormal" were assigned by the observers. Viewers considered MTP-2 alignment from 0° to -20° to be normal, and below -30° abnormal; MTP-3, 0° to -15° to be normal and below -30° abnormal; MTP-4, 0° to -10° normal and below -20° abnormal. Between 5° valgus and 15° varus was the range of MTP-5 recognized as normal. High intra-observer but low interobserver reliability with overall low correlation of clinical and radiographic aspects was observed. The assessment of the terms "normal" or "abnormal" are subject to a high degree of variation. Therefore, these terms should be used cautiously.

Reliability of the Modified Radiographic Union Score for Tibia Fractures (mRUST) for Femoral Shaft Fractures.

Evaluate the inter- and intra- observer reliability of the Modified Radiographic Union Score for Tibia Fractures (mRUST) and the effect of rater experience in evaluation of femoral fractures. Retrospective Cohort Study. Setting: Single Level I Trauma CenterPatients/Participants: Patients 18-55 years of age with a femur shaft fracture. Intramedullary nail (IMN) fixation. Inter- and intra- observer reliability using Intraclass Correlation Coefficient (ICC). The overall interobserver reliability was 0.96. Among fellowship trained evaluators, interobserver reliability was 0.94, and it was 0.92 among trainees. The overall intraobserver reliability was 0.98. The intraobserver reliability was 0.97 among fellowship trained evaluators and 0.96 for trainees. These results show high inter- and intraobserver reliability of mRUST in evaluation of radiographic healing for femur shaft fractures treated with IMN. This high reliability was further demonstrated throughout different postoperative healing time frames. Additionally, mRUST appears to be reliable when utilized both by trainees and experienced surgeons for evaluation of femur shaft fractures. Diagnostic Level I. See Instructions for Authors for a complete description of levels of evidence.

AVALIAÇÃO DA MENSURAÇÃO DA CIFOSE NAS FRATURAS DA COLUNA TORACOLOMBAR

ABSTRACT Objectives: Evaluate the reliability and reproducibility of the kyphosis measurement in thoracolumbar spine traumatic fractures by different assessment methods in different types of fractures. Methods: Fifteen fractures of the thoracolumbar spine, previously classified into types A, B, and C according to Magerl’s classification, were evaluated. The value of kyphosis was measured using five different methods: (1) Cobb angle; (2) Gardner’s method; (3) back wall method; (4) angle of adjacent endplates; and (5) wedge angle. The measurements were performed by five independent observers and repeated five times with a minimum interval of two weeks between each evaluation. Results: Intraobserver reliability was excellent among the five observers, evidencing good reproducibility of the methods. The five methods used also showed great intraobserver reliability in the global analysis, with methods one and four being more consistent. Conclusion: Although there is no universal agreement on measuring kyphosis in thoracolumbar fractures, our study concluded that method 1 (Cobb angle) and method 4 (adjacent endplate angle) presented the best interobserver reliabilities. Furthermore, the use of digitized radiographs and a simple computer program allowed the performance of highly reliable and reproducible measurements by all methods, given the high intraobserver reliability. Level of Evidence II; Comparative study.

Sacroiliac joint fusion navigation: how accurate is pin placement?

Sacroiliac joint (SIJ) fusion utilizing intraoperative navigation requires a standard reference frame, which is often placed using a percutaneous pin. Proper placement ensures the correct positioning of SIJ fusion implants. There is currently no grading scheme for evaluation of pin placement into the pelvis. The purpose of this study was to evaluate the occurrence of ideal percutaneous pin placement into the posterior ilium during navigated SIJ fusion. After IRB approval was obtained, electronic medical records and intraoperative computed tomography images of patients who underwent navigated SIJ fusion by the senior author between October 2013 and January 2020 were reviewed. A pin placement grading scheme and the definition of "ideal" placement were developed by the authors and deemed acceptable by fellow attending surgeons. Six attending surgeons completed two rounds of pin placement grading, and statistical analysis was conducted. Of 90 eligible patients, 73.3% had ideal pin placement, 17.8% medial/lateral breach, and 8.9% complete miss. Male patients were 3.7 times more likely to have ideal placement than females (p < 0.05). There was no relationship between BMI, SIJ fusion laterality, or pin placement laterality and ideal placement. Interobserver reliability was 0.72 and 0.70 in the first and second rounds, respectively, and defined as "substantial agreement." Intraobserver reliability ranged from 0.74 (substantial agreement) to 0.92 (almost perfect agreement). Nonideal pin placement occurred in 26.7% of cases, but a true "miss" into the sacrum was rare. Ideal pin placement was more likely in males and was not associated with BMI, SIJ fusion laterality, or pin placement laterality. The grading scheme developed has high intraobserver and interobserver reliability, indicating that it is reproducible and can be used for future studies. When placing percutaneous pins, surgeons must be aware of factors that can decrease placement accuracy, regardless of location.

Comparison of axial and coronal axis MRI kidney volume measurement in pediatric congenital solitary kidney.

Accurate estimation of kidney size and volume in the solitary functioning kidney is crucial because of a higher risk of developing kidney injury. MRI is an accurate method and is suitable for kidney volume measurement. Usually, axial axis images and measurement methods are preferred for kidney volume measurements. However, the anteroposterior diameter of the kidney is smaller than the longitudinal diameter, meaning that imaging in the coronal axis could provide needed information in a shorter time, enabling imaging of younger patients without sedation. Therefore, the purpose of this study was to compare coronal and axial axis kidney volume measurement methods and evaluate intra-observer and inter-observer reliability. Axial axis T2W and coronal axis FIESTA images of kidneys were obtained with 10mm slice thickness and no slice gap in pediatric patients with congenital solitary kidneys. Free-hand manual tracing was used to calculate volumes in both methods. Images were analyzed by two operators with different levels of experience. The expert operator computed solitary kidney volume twice in both methods for the intra-observer reliability, while the beginner operator's measurements were used for the inter-observer reliability. High intra-observer (0.965 for axial and 0.972 for coronal) and inter-observer reliability were revealed (0.964 for axial and 0.963 for the coronal) for both measurement methods. The coronal plane volume measurement method, which has a significantly shorter examination and post-processing time, is a highly reproducible and reliable method that can enable volume measurement with MRI in younger children, as the imaging time will be shortened. A higher resolution version of the Graphical abstract is available as Supplementary information.

The International Hip Dysplasia Institute (IHDI) classification is more informative than the Tönnis classification.

A new, supposedly more reproducible radiographic classification, set to replace the Tönnis classification of hip dislocations, was proposed in 2015: the International Hip Dysplasia Institute (IHDI) classification. To compare the IHDI classification with the Tönnis classification when evaluating the severity of hip dislocations as well as their respective inter- and intra-observer reliability. Since January 2000, Swedish-born children with a hip dislocation were prospectively registered. From this registry, radiographs of 97 hips in 79 patients (91% girls; median age = 7 months), born in 2000-2009, were analyzed. Two observers, one consultant and one resident, classified each hip both by IHDI and Tönnis twice. The IHDI classification had a more even distribution of grades with the majority in grade 2-3. The Tönnis classification graded the majority (77%) of the patients as grade 2 and equally among the other grades. There was moderate inter-observer agreement using both methods calculated with Kappa, 0.61 (95% confidence interval [CI] = 0.44-0.79) for Tönnis and 0.62 (95% CI = 0.49-0.74) for IHDI. The resident calculated Tönnis with weak intra-observer reliability of 0.57 (95% CI = 0.40-0.74) compared to high intra-observer reliability of 0.86 (95% CI = 0.74-0.98) for the consultant. Both observers graded IHDI with high intra-observer reliability. IHDI is more discriminative than the Tönnis classification when evaluating the severity of a hip dislocation in infants.

Assessment of accuracy and reliabilty of measurements obtained on 3D scanned models to conventional models

Aims and Objectives: To conclude on superior method of model fabrication and compare accuracy and the reliability of measurements obtained on 3D scanned models to conventional models. Materials and Methods: A total of 20 orthodontic study models were obtained from the department of orthodontics and dentofacial orthopaedics with a full set of permanent teeth from the right first molar to the left first molar and no anomalies of the crown. The plaster models were measured to the nearest 0.01 mm using the Aerospace Electronic Digital Caliper. Identical plaster models were scanned by placing each arch on the integrated rotary table (dental wings 3SERIES) .The acquired data was then processed and exported in stereo lithographic format using DWOS CAD/CAM software. Digital casts were later measured to the nearest 0.123 mm using 3D-Tool 64-Bit Free Viewer V13. Results: indicated that all measurements for the arch and tooth size measurements for both methods were highly correlated (r . 0.99; P\0.05).Cronbach α value of the data at T1 and T2 from incisal segment ,canine segment and the molar segment measured using the two methods was very close to the ideal value of 1, indicating high intraobserver reliability.

Interobserver and Intraobserver Reliability of Classification Systems for Radiographic Complications After Radial Head Arthroplasty

Although several classifications are used to assess radiographs following radial head arthroplasty (RHA), including the Popovic classification for radiolucency, the Chanlalit classification for stress shielding (SS), the Brooker classification for heterotopic ossification (HO), and the Broberg-Morrey classification for radiocapitellar arthritis, little is known about the reliability of these classification systems. The purpose of this study was to determine the interobserver and intraobserver reliability of these classifications. Six orthopedic surgeons at various levels of training reviewed elbow radiographs of 20 patients who underwent RHA and classified them according to the Popovic, Chanlalit, Brooker, and Broberg-Morrey classifications for radiolucency, SS, HO, and RHA, respectively. Four weeks after initial review, radiographic reviews were repeated. Reliability was measured using the Fleiss kappa and the intraclass correlation coefficient. Agreement was interpreted as none (<0), slight (0.01-0.2), fair (0.21-0.4), moderate (0.41-0.6), substantial (0.61-0.8), and almost perfect (0.81-1) based on agreement among attending surgeons. Among fellowship-trained attending surgeons, interobserver reliability was slight for SS (Chanlalit) and the categorical interpretation of radiolucency (Popovic), fair for radiocapitellar arthritis (Broberg-Morrey) and HO (Brooker), and substantial for the ordinal interpretation of radiolucency (Popovic). Residents had a higher interobserver reliability than attending physicians when using the Brooker classification. Mean intraobserver reliability was fair for SS (Chanlalit) and the categorical interpretation of radiolucency (Popovic), moderate for HO (Brooker) and radiocapitellar arthritis (Broberg-Morrey), and almost perfect for the ordinal interpretation of radiolucency (Popovic). Trainees had higher intraobserver reliability than attending surgeons using the SS (Chanlalit) classification. The number of Popovic zones is reliable for communication between physicians, but caution should be taken with the Brooker, Chanlalit, Broberg-Morrey, and categorical interpretation of the Popovic classifications. All the classifications had better intraobserver than interobserver reliability. Reliability of classification systems for radiographic complications after RHA is less than substantial except the number of zones of radiolucency; therefore, caution is required when drawing conclusions based on these classifications.

Utilizing a mobile platform to obtain quantitative measurements of exophthalmos

ABSTRACT Purpose This study introduces a novel exophthalmometry method utilizing a mobile platform to obtain calibrated quantitative measurements of globe position and compares its reliability to Hertel exophthalmometry. Methods A prospective, comparative study included 50 patients (99 eyes) for a total of 594 mobile measurements. Healthy individuals from the community in Augusta, Georgia, and individuals from a routine oculoplastics clinic at Mayo Clinic in Rochester, Minnesota, were included to represent variety within the population. The main outcome was the inter-modality correlation and agreement between Hertel and mobile exophthalmometry, and the intra-observer and inter-observer reliability with repeated mobile measurements. Results There was no significant difference in the measurements obtained by Hertel exophthalmometry and mobile exophthalmometry. There was a strong linear correlation between Hertel and mobile exophthalmometry with a Pearson Correlation Coefficient of 0.910 and 0.888 for the right and left eyes, respectively (p < .001, 2-tailed). Bland–Altman plot analysis showed excellent agreement between the two modalities. The mobile platform demonstrated high intra-observer reliability with a Cronbach’s alpha of 0.992 and 0.985 for the right and left eyes. An intraclass correlation coefficient of 0.992 (95% CI: 0.987–0.995) for the right eye and 0.986 (95% CI: 0.978–0.991) for the left eye demonstrated excellent reliability between observers. Conclusions Mobile exophthalmometry may be a promising tool for obtaining calibrated quantitative measurements of globe position for situations in which Hertel exophthalmometry is not available. The strong correlation and excellent agreement between Hertel and mobile measurement suggest that mobile exophthalmometry can yield reliable and accurate measurements.

Faces of Pain during Dental Procedures: Reliability of Scoring Facial Expressions in Print Art.

Background: Observational tools have been developed to assess pain in cognitively impaired individuals. It is not known, however, whether these tools are universal enough so that even pain depicted in print art can be assessed reliably. Therefore, the aim of this study was to assess the reliability in scoring facial expressions of pain in dental print art from the 17th, 18th, and 19th century, using a Short Form of the 15-item Pain Assessment in Impaired Cognition (PAIC15-SF) tool. Methods: Seventeen prints of patients undergoing dental procedures were scored twice by two inexperienced observers and an expert and once by a Gold Standard observer. Results: All observers achieved high intra-observer reliability for all four items of the category “facial expressions” and for three items of the category “body movements” (ICC: 0.748–0.991). The remaining two items of the category “body movements”, viz., “rubbing” and “restlessness”, were excluded from further research because it was not possible to calculate a reliable ICC. Overall, the intra-observer reliability of the expert was higher than that of the inexperienced observers. The inter-observer reliability scores varied from poor to excellent (ICC: 0.000–0.970). In comparison to the Gold Standard, the inter-observer reliability of the expert was higher than that of the inexperienced observers. Conclusion: The PAIC15-SF tool is universal enough even to allow reliable assessment of facial expressions of pain depicted in dental print art.

Clinical photographs in the assessment of adult spinal deformity: a comparison to radiographic parameters.

The goal of this study was to reliably predict sagittal and coronal spinal alignment with clinical photographs by using markers placed at easily localized anatomical landmarks. A consecutive series of patients with adult spinal deformity were enrolled from a single center. Full-length standing radiographs were obtained at the baseline visit. Clinical photographs were taken with reflective markers placed overlying C2, S1, the greater trochanter, and each posterior-superior iliac spine. Sagittal radiographic parameters were C2 pelvic angle (CPA), T1 pelvic angle (TPA), and pelvic tilt. Coronal radiographic parameters were pelvic obliquity and T1 coronal tilt. Linear regressions were performed to evaluate the relationship between radiographic parameters and their photographic "equivalents." The data were reanalyzed after stratifying the cohort into low-body mass index (BMI) (< 30) and high-BMI (≥ 30) groups. Interobserver and intraobserver reliability was assessed for clinical measures via intraclass correlation coefficients (ICCs). A total of 38 patients were enrolled (mean age 61 years, mean BMI 27.4 kg/m2, 63% female). All regression models were significant, but sagittal parameters were more closely correlated to photographic parameters than coronal measurements. TPA and CPA had the strongest associations with their photographic equivalents (both r2 = 0.59, p < 0.001). Radiographic and clinical parameters tended to be more strongly correlated in the low-BMI group. Clinical measures of TPA and CPA had high intraobserver reliability (all ICC > 0.99, p < 0.001) and interobserver reliability (both ICC > 0.99, p < 0.001). The photographic measures of spinal deformity developed in this study were highly correlated with their radiographic counterparts and had high inter- and intraobserver reliability. Clinical photography can not only reduce radiation exposure in patients with adult spinal deformity, but also be used to assess deformity when full-spine radiographs are unavailable.

How Should We Grade Cervical Disk Degeneration? A Comparison of Two Popular Classification Systems.

Introduction Despite being originally developed for the evaluation of lumbar disk degeneration, the Pfirrmann classification has emerged as the most popular classification system for cervical disk degeneration. However, with the Suzuki classification, a new classification system that is specifically tailored for the evaluation of cervical disk disease was introduced. In this study, we aim to evaluate differences in inter- and intraobserver reliability of both classifications in a head-to-head comparison. Methods In total, we have evaluated 120 cervical disks within 40 patients via magnetic resonance imaging according to the Pfirrmann and Suzuki classification. The degree of disk degeneration was evaluated by two independent musculoskeletal radiologists. After 6 months, the classification was reassessed to evaluate the intraobserver reliability. The inter- and intraobserver reliabilities were then calculated using Cohen's kappa. Results The inter- and intraobserver reliability provided a significant agreement between all ratings in Pfirrmann as well as the Suzuki classification (p>0.001). The interobserver reliability was determined to be fair in both the Suzuki classification (κ=0.290) and the Pfirrmann classification (κ=0.265). The intraobserver reliability was substantial in the Suzuki classification (κ=0.798), while it was almost perfect in the Pfirrmann classification (κ=0.858). Conclusions Although not designed for the evaluation of cervical disk degeneration, the Pfirrmann classification yielded equal inter- and higher intraobserver reliability. Both classification systems are viable options for the grading of cervical disk degeneration. While the Pfirrmann classification has the advantage of being better established, the Suzuki classification may be clinically superior due to a better representation of cervical disk degeneration and the consideration of disk bulging for the classification of cervical disk degeneration.

Repeatability and Reliability of Quantified Ultrasound Biomicroscopy Image Analysis of the Ciliary Body at the Pars Plicata

Most of the ciliary body and ciliary processes of the eye cannot be directly visualized in vivo because of the posterior location of the pars plicata to the posterior chamber and iris. However, ciliary anatomy can be effectively imaged using ultrasound biomicroscopy (UBM) by placing the probe close to the limbus, perpendicular to this structure. Previous studies measuring ciliary body parameters in meridian UBM images found that these parameters were measured with poor reliability and repeatability. This study evaluates the intra-observer reliability and inter-observer agreement of a standardized protocol for measuring six ciliary parameters in transverse or quadrant UBM images that capture an entire row of ciliary processes. All six ciliary parameters have high intra-observer reliability, with ciliary body thickness, ciliary process length and ciliary process density measurements being the most consistent for each observer. The coefficient of variation for each observer ranged from 1.4%–15%. Inter-observer agreement was also high for all six parameters, with an intra-class correlation coefficient >0.8. Utilizing transverse UBM images of the pars plicata allows for consistent quantitative analysis in control subjects.

A novel evaluation method for Ki-67 immunostaining in paraffin-embedded tissues.

The Ki-67 labeling index is traditionally used to investigate tumor aggressiveness. However, no diagnostic or prognostic value has been associated to the heterogeneous pattern of nuclear positivity. The aims of this study were to develop a classification for the patterns of Ki-67-positive nuclei; to search scientific evidence for the Ki-67 expression and location throughout the cell cycle; and to develop a protocol to apply the classification of patterns of Ki-67-positive nuclei in squamous epithelium with different proliferative activities. Based on empirical observation of paraffin sections submitted to immunohistochemistry for the determination of Ki-67 labeling index and literature review about Ki-67 expression, we created a classification of the patterns of nuclear positivity (NP1, NP2, NP3, NP4, and mitosis). A semi-automatic protocol was developed to identify and quantify the Ki-67 immunostaining patterns in target tissues. Two observers evaluated 7000 nuclei twice to test the intraobserver reliability, and six evaluated 1000 nuclei to the interobserver evaluation. The results showed that the immunohistochemical patterns of Ki-67 are similar in the tumoral and non-tumoral epithelium and were classified without difficulty. There was a high intraobserver reliability (Spearman correlation coefficient > 0.9) and moderate interobserver agreement (k = 0.523). Statistical analysis showed that non-malignant epithelial specimens presented a higher number of NP1 (geographic tongue = 83.8 ± 21.8; no lesion = 107.6 ± 52.7; and mild dysplasia = 86.6 ± 25.8) when compared to carcinoma in Situ (46.8 ± 34.8) and invasive carcinoma (72.6 ± 37.9). The statistical evaluation showed significant difference (p < 0.05). Thus, we propose a new way to evaluate Ki-67, where the pattern of its expression may be associated with the dynamics of the cell cycle. Future proof of this association will validate the use of the classification for its possible impact on cancer prognosis and guidance on personalized therapy.

3D CT evaluation of femoral and tibial tunnels in anatomic double bundle anterior cruciate ligament reconstruction

BackgroundAn anatomical double bundle ACL reconstruction replicates the anatomy of native ACL as the tunnels are made to simulate the anatomy of ACL with AM and PL bundle foot prints. The goal of anatomic ACL reconstruction is to tailor the procedure to each patient’s anatomic, biomechanical and functional demands to provide the best possible outcome. The shift from single bundle to double bundle technique and also from transtibial to transportal method has been to provide near anatomic tunnel positions. PurposeTo determine the position of femoral and tibial tunnels prepared by double bundle ACL reconstruction using three dimensional Computed tomography. Study designA prospective case series involving forty patients with ACL tear who underwent transportal double bundle ACL reconstruction. MethodComputed tomography scans were performed on forty knees that had undergone double bundle anterior cruciate ligament reconstruction. Three-dimensional computed tomography reconstruction models of the knee joint were prepared and aligned into an anatomical coordinate axis system for femur and tibia respectively. Tibial tunnel centres were measured in the anterior-to-posterior and medial-to-lateral directions on the top view of tibial plateau and femoral tunnel centres were measured in posterior to anterior and proximal-to-distal directions with anatomic coordinate axis method. These measurements were compared with published reference data. ResultsAnalysing the Femoral tunnel, the mean posterior-to-anterior distances for anteromedial and posterolateral tunnel centre position were 46.8% ± 7.4% and 34.5% ± 5.0% of the posterior-to-anterior height of the medial wall and the mean proximal-to-distal distances for the anteromedial and posterolateral tunnel centre position were 24.1% ± 7.1% and 61.6% ± 4.8%. On the tibial side, the mean anterior-to-posterior distances for the anteromedial and posterolateral tunnel centre position were 28.8% ± 4.3% and 46.2% ± 3.6% of the anterior-to posterior depth of the tibia measured from the anterior border and the mean medial-to-lateral distances for the anteromedial and posterolateral tunnel centre position were 46.5% ± 2.9% and 50.6% ± 2.8% of the medial-to-lateral width of the tibia measured from the medial border. There is high Inter-observer and Intra-observer reliability (Intra-class correlation coefficient). Discussion and conclusionFemoral AM tunnel was positioned significantly anterior and nearly proximal whereas the femoral PL tunnel was positioned significantly anterior and nearly distal with respect to the anatomic site. Location of tibial AM tunnel was nearly posterior and nearly medial whereas the location of tibial PL tunnel was very similar to the anatomic site Evaluation of location of tunnels through the anatomic co-ordinate axes method on 3D CT models is a reliable and reproducible method. This method would help the surgeons to aim for anatomic placement of the tunnels. It also shows that there is scope for improvement of femoral tunnel in double bundle ACL reconstruction through transportal technique.