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Intra- and inter-rater reliabilities and differences of kyphotic angle measurements on ultrasound images versus radiographs for children with adolescent idiopathic scoliosis: a preliminary study

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Abstract

Purpose

To develop a new method based on 3D ultrasound information to measure the kyphotic angle (KA) on ultrasound (US) images in adolescents with idiopathic scoliosis (AIS) and to evaluate the intra-rater and inter-rater reliabilities and accuracy of the US measurements.

Methods

Twenty subjects with AIS (17F, 3 M, aged 13.7 ± 2.2 years old) were recruited. One 20 + years experienced rater (R3) measured the KA on radiographs twice using the Cobb method. Two raters (R1, R2), both have at least 1-year experience measured US images twice using the new spinous processes method. The intraclass correlation coefficients (ICC[2,1]) of the intra-rater and inter-rater reliabilities of US KA measurements were calculated. An equation based on US KA measurements to calculate the radiographic KA was generated.

Results

The intra-rater reliability ICC[2,1] (R3) of the X-ray measurement was 0.92 and US KA measurements for R1 and R2 were 0.94 and 0.95, respectively. The inter-rater reliability ICC[2,1] for R1 versus R2 were 0.85 and 0.86, respectively. The mean absolute differences (MAD) of US versus radiography measurements were 4.2 ± 3.0° (R1 vs R3) and 5.0 ± 4.1° (R2 vs R3), respectively. The radiographic equivalent KA = 0.82 × US KA – 5.6°. When using this equation, the overall MAD between US and radiographic KA was 2.9 ± 1.6°.

Conclusions

The ultrasound spinous process method was reliable to measure the KA. Although there was a systematic bias on the US measurements, after the correction, the MAD of the US and radiographic KA was 2.9 ± 1.6°. Using US allows clinicians to monitor KA without exposing children to ionizing radiation.

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Acknowledgements

The authors would like to thank the financial support from the Women and Children’s Health Research Institute (WCHRI) and the Scoliosis Research Society.

Funding

This study was supported by the Women and Children's Health Research Institute (WCHRI) and the Scoliosis Research Society.

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Authors and Affiliations

  1. Department of Biochemistry, University of Alberta, Edmonton, T6G 2H7, Canada

    Tehzeeb Sayed

  2. Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, T6G 2B7, Canada

    Mahdieh Khodaei

  3. Glenrose Rehabilitation Hospital, Edmonton, AB, T5G 0B7, Canada

    Doug Hill

  4. Department of Electrical and Computer Engineering, University of Alberta, Donadeo ICE 11-263, 9211-116 Street NW, Edmonton, AB, T6G 1H9, Canada

    Edmond Lou

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  1. Tehzeeb Sayed
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  2. Mahdieh Khodaei
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  3. Doug Hill
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  4. Edmond Lou
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Contributions

TS, MK, DH, EL: made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data; or the creation of new software used in the work. TS, MK, DH, EL: drafted the work or revised it critically for important intellectual content. MK, DH, EL: approved the version to be published. MK, DH, EL: agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Edmond Lou.

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The authors declared that there is no conflict of interest.

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Ethics approval was granted by the University of Alberta Health Research Ethics Board.

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All participants and their guardians signed the assents and parental consent forms prior to participation.

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Patients signed informed consent regarding publishing their data and photographs.

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Sayed, T., Khodaei, M., Hill, D. et al. Intra- and inter-rater reliabilities and differences of kyphotic angle measurements on ultrasound images versus radiographs for children with adolescent idiopathic scoliosis: a preliminary study. Spine Deform 10, 501–507 (2022). https://doi.org/10.1007/s43390-021-00466-5

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