Abstract
Purpose
This study aimed to investigate the intra- and inter-observer reliability of the axial vertebral rotation (AVR) measurements of adolescent idiopathic scoliosis (AIS) using the center of lamina (COL) method on ultrasound transverse images.
Methods
Three cadaver vertebrae were scanned with 42 AVR configurations by both ultrasound and radiograph. In this in vitro study, four observers measured the AVR using the COL method on ultrasound transverse images and three observers measured the AVR using the Stokes’ method on radiographs. In the in vivo study, 13 AIS subjects were recruited. Eighteen spinal curvatures were identified and 48 vertebrae were selected for the AVR measurements. Two observers performed the AVR measurements on both the ultrasound images and radiographs. All measurements were performed twice with 1 week interval apart to reduce memory bias. The intraclass correlation coefficient (ICC), mean absolute differences (MAD), and standard deviation (SD) were used to analyze the intra- and inter-observer reliability of the AVR measurements. The Bland–Altman plot was used to analyze the 95 % limit of the differences between the two methods.
Results
The proposed COL method had high intra- and inter-observer reliability on both the in vitro and in vivo studies (ICCs > 0.91, MADs < 1.4°) and agreed well with the experimental setup (ICCs > 0.96, MADs < 2.3°). The COL method showed good agreement with the Stokes’ method for the in vitro study (ICC 0.84–0.85, MAD 4.5°–5.0°), while poor agreement for the in vivo study (ICC 0.49–0.54, MAD 2.7°–3.5°).
Conclusions
The pilot study indicated the proposed COL method was a simple and reliable method to evaluate the AVR on ultrasound images. Standardization of the posture during ultrasound scan and taking radiograph is important.
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References
Cobb J (1948) Outline for the study of scoliosis. Instr Course Lect 5:261–275
Drerup B (1985) Improvements in measuring vertebral rotation from the projections of the pedicles. J Biomech 18:369–378
Kuklo TR, Potter BK, Lenke LG (2005) Vertebral rotation and thoracic torsion in adolescent idiopathic scoliosis: what is the best radiographic correlate? J Spinal Disord Tech 18:139–147
Nash CL Jr, Moe JH (1969) A study of vertebral rotation. J Bone Joint Surg Am 51:223–229
Perdriolle R, Vidal J (1985) Thoracic idiopathic scoliosis curve evaluation and prognosis. Spine 10:785–791
Stokes IA, Bigalow LC, Moreland MS (1986) Measurement of axial rotation of vertebrae in scoliosis. Spine 11:213–218
Cerny P, Marik I, Pallova I (2014) The radiographic method for evaluation of axial vertebral rotation—presentation of the new method. Scoliosis 9(1):11. doi:10.1186/1748-7161-9-11
Al-Aubaidi Z, Lebel D, Oudjhane K, Zeller R (2013) Three-dimensional imaging of the spine using the EOS system: is it reliable? A comparative study using computed tomography imaging. J Pediatr Orthop B. 22(5):409–412. doi:10.1097/BPB.0b013e328361ae5b
Aaro S, Dahlborn M (1981) Estimation of vertebral rotation and the spinal and rib cage deformity in scoliosis by computer tomography. Spine 6:460–467
Ho EK, Upadhyay SS, Chan FL, Hsu LC, Leong JC (1993) New methods of measuring vertebral rotation from computed tomographic scans. An intraobserver and interobserver study on girls with scoliosis. Spine 18:1173–1177
Birchall D, Hughes DG, Hindle J, Robinson L, Williamson JB (1997) Measurement of vertebral rotation in adolescent idiopathic scoliosis using three-dimensional magnetic resonance imaging. Spine 22:2403–2407
Yazici M, Acaroglu ER, Alanay A, Deviren V, Cila A, Surat A (2001) Measurement of vertebral rotation in standing versus supine position in adolescent idiopathic scoliosis. J Pediatr Orthop 21:252–256
Suzuki S, Yamamuro T, Shikata J, Shimizu K, Iida H (1989) Ultrasound measurement of vertebral rotation in idiopathic scoliosis. J Bone Joint Surg Br 71:252–255
Burwell RG, Aujla KK, Cole AA, Kirby AS, Pratt KK, Webb JK, Moulton A (2002) Anterior universal spine system for adolescent idiopathic scoliosis: a follow-up study using scoliometer, real-time ultrasound and radiographs. Stud Health Technol Inform. 91:473–476
Burwell RG, Aujla RK, Freeman BJ et al (2008) The posterior skeletal thorax: rib-vertebral angle and axial vertebral rotation asymmetries in adolescentidiopathic scoliosis. Stud Health Technol Inform. 140:263–268
Chen W, Lou EHM, Le LH (2011) Using ultrasound imaging to identify landmarks in vertebra models to assess spinal deformity. Conf Proc IEEE Eng Med Biol Soc. doi:10.1109/IEMBS.2011.6092096
Chen W, Le L, Lou E (2012) Ultrasound imaging of spinal vertebrae to study scoliosis. Open J Acoust 2:95–103. doi:10.4236/oja.2012.23011
Zheng R, Chan A, Chen W et al (2015) Intra- and inter-rater reliability of coronal curvature measurement for adolescent idiopathic scoliosis using ultrasonic imaging method-a pilot study. Spine Deform 3:151–158. doi:10.1016/j.jspd.2014.08.008
Young M, Hill DL, Zheng R, Lou E (2015) Reliability and accuracy of ultrasound measurements with and without the aid of previous radiographs in adolescent idiopathic scoliosis (AIS). Eur Spine J. doi:10.1007/s00586-015-3855-8
Zhang J, Lou E, Hill D, Raso J, Wang Y, Le L, Shi X (2010) Computer-aided assessment of scoliosis on posteroanterior radiographs. Med Biol Eng Compu 48:185–195. doi:10.1007/s11517-009-0556-7
Shrout PE, Fleiss JL (1979) Intraclass correlations: uses in assessing rater reliability. Psychol Bull 86:420–428
McGraw KO, Wong SP (1996) Forming inferences about some intraclass correlation coefficients. Psychol Methods 1:30–46
Currier DP (1990) Elements of research in physical therapy, 3rd edn. Williams & Wilkins, Baltimore, pp 160–171
Bland JM, Altman DG (1999) Measuring agreement in method comparison studies. Stat Methods Med Res 8:135–160
Gocen S, Aksu MG, Baktiroglu L, Ozcan O (1998) Evaluation of computed tomographic methods to measure vertebral rotation in adolescent idiopathic scoliosis: an intraobserver and interobserver analysis. J Spinal Disord 11:210–214
Vrtovec T, Pernus F, Likar B (2009) A review of methods for quantitative evaluation of axial vertebral rotation. Eur Spine J 18:1079–1090. doi:10.1007/s00586-009-0914-z
Acknowledgments
This study was supported through funding provided by Natural Sciences and Engineering Research Council of Canada and the Women and Children’s Health Research Institute.
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Chen, W., Le, L.H. & Lou, E.H.M. Reliability of the axial vertebral rotation measurements of adolescent idiopathic scoliosis using the center of lamina method on ultrasound images: in vitro and in vivo study. Eur Spine J 25, 3265–3273 (2016). https://doi.org/10.1007/s00586-016-4492-6
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DOI: https://doi.org/10.1007/s00586-016-4492-6