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Three-dimensional CT evaluation of oculoauriculovertebral spectrum patients use of Katsumata’s asymmetry index

Dreidimenstionale computertomographische Evaluierung von OVAS(Okulo-Aurikulo-Vertebrales Spektrum)-Patienten Einsatz des Asymmetrie-Index nach Katsumata

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Abstract

Objectives

To evaluate patients with oculoauriculovertebral spectrum (OAVS) malformations based on Katsumata’s asymmetry index and to assess the usefulness of the scores thus obtained in identifying degrees and sites of asymmetry.

Methods

Multislice spiral computed tomography (MSCT) datasets of 8 female and 12 male OAVS patients aged 5.7–23.9 years were retrospectively analyzed. After three-dimensional reconstruction, central and bilateral anatomical landmarks were identified within a coordinate system defined by the sella, nasion, and dens axis. MSCT datasets of 20 clinically symmetrical patients were used to define the cutoff values for asymmetry. Based on the mean asymmetry scores and their standard deviations, the severities and sites of asymmetry were evaluated and processed for visual presentation in charts.

Results

Both interrater (ICC 0.7070–0.9984) and intrarater (FVU 0.0014–0.2930) reliability was very high. The calculated asymmetry scores added up to mean values and standard deviations that were higher by factors of around 1.5–2.5 than reported by Katsumata et al. More anatomical landmarks were rated as asymmetric in OAVS patients showing unilateral agenesis of an external acoustic pore than in OAVS patients without such agenesis: in the former patients, statistically significant asymmetries compared to the control group were present at the L1M (coronal pulp cavity of the lower first molar), CoP (coronoid process), and Co (condylion superius) landmarks, whereas the latter group showed such significant asymmetries at the CoP and Co landmarks. Likewise, more patients with unilateral agenesis showed asymmetries at the level of the maxilla. Highly variable severities of asymmetry were found in both subgroups of OAVS patients.

Conclusion

Katsumata’s asymmetry index can yield well-structured and illustrative views of landmark distribution, thus, suitably allowing for qualitative asymmetry evaluation of OAVS cases and identification of the skeletal regions involved.

Zusammenfassung

Zielsetzung

Ziele der vorliegenden Arbeit waren die Untersuchung von Patienten mit einer Fehlbildung des Okulo-Aurikulo-Vertebralen Spektrums (OAVS) anhand des Asymmetrie-Index nach Katsumata sowie die Evaluierung des Grades und der Lokalisation der Asymmetrie.

Methode

Aus vorhandenen MSCT (Mehrschicht-Spiral-Computertomographie)-Datensätzen wurden retrospektiv 20 Datensätze von Patienten mit OAVS (8 weiblich, 12 männlich, Range 5,7–23,9 Jahre) ausgewählt. Nach dreidimensionaler Rekonstruktion der Datensätze wurde die Position uni- und bilateraler Referenzpunkte innerhalb eines durch Sella, Nasion und Dens axis definierten Koordinatensystems ermittelt. Die Berechnung des Asymmetrie-Index nach Katsumata wurde anhand von MSCT-Datensätzen klinisch symmetrischer Patienten (n = 20) durchgeführt. Anschließend wurden die Asymmetrie-Indizes berechnet und der Grad sowie die Lokalisation der Asymmetrie rechnerisch und graphisch bestimmt. Weiterhin wurden Intra- und Interuntersucherfehler ermittelt

Ergebnisse

Die Inter- und Intrarater-Reliabilität war sehr hoch (ICC: 0,7070–0,9984 FVU: 0,0014–0,2930). Die Mittelwerte und Standardabweichungen für die Berechnung des Asymmetrie-Index waren je nach anatomischen Punkt etwa 1,5- bis 2,5-mal höher als in der Untersuchung von Katsumata. Bei Patienten, bei denen nur ein Porus acusticus externus angelegt war, wurden mehr Punkte als asymmetrisch bzw. markant asymmetrisch beurteilt (Signifikanzen bei L1M, CoP und Co) als bei Patienten mit 2 knöchernen Gehörgängen (Signifikanzen bei CoP und Co). Zudem wiesen Patienten mit nur einem Porus häufiger Asymmetrien im Bereich der Maxilla auf. Der Asymmetriegrad innerhalb der beiden Patientengruppen war sehr variabel.

Schlussfolgerung

Aufgrund der übersichtlichen graphischen Darstellung relevanter anatomischer Punkte eignet sich der Asymmetrie-Index nach Katsumata für die qualitative Beurteilung einer Asymmetrie sowie die Lokalisation der betroffenen skelettalen Regionen.

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Acknowledgments

This study was financially supported by the German Orthodontic Society.

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Authors and Affiliations

  1. Department of Orthodontics and Orofacial Orthopedics, Zahnklinik 3-Kieferorthopädie, Universitätsklinikum Erlangen, Glückstrasse 11, 91054, Erlangen, Germany

    Elisabeth Hofmann, Stefanie Steinhäuser-Andresen & Ursula Hirschfelder

  2. Department of Medical Biometry, Informatics and Epidemiology, Rheinische Friedrichs-Wilhelms University, Bonn, Germany

    Matthias Schmid

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  1. Elisabeth Hofmann
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  4. Ursula Hirschfelder
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Correspondence to Elisabeth Hofmann.

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Conflict of interest

E. Hofmann, M. Schmid, S. Steinhäuser-Andresen, and U. Hirschfelder state that there are no conflicts of interest.

All studies on humans described in the present manuscript were carried out with the approval of the responsible ethics committee and in accordance with national law and the Helsinki Declaration of 1975 (in its current, revised form). Informed consent was obtained from all patients included in studies.

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Dr. Elisabeth Hofmann.

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Hofmann, E., Schmid, M., Steinhäuser-Andresen, S. et al. Three-dimensional CT evaluation of oculoauriculovertebral spectrum patients use of Katsumata’s asymmetry index. J Orofac Orthop 77, 176–184 (2016). https://doi.org/10.1007/s00056-016-0022-8

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