Intra- und Interobserver Übereinstimmung bei der Beur-teilung der Ellbogengelenkdysplasie in der Computerto-mographie mit Hilfe der IEWG-Graduierung
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Beschreibung
With the help of the present study, CT grading for ED in dogs is validated using the IEWG system. The aim of the work is to supplement the prescribed radiologi-cal examinations with CT examinations for even better breeding selection in the future in particularly challenging or questionable cases, as pathologies in this compound joint can be visualized more precisely and comprehensively using this procedure.
The present study is a retrospective study in which 174 elbow joints were evalu-ated twice for grading in a blinded manner by two independent examiners (HVD1, HVD2, and KvP1, KvP2) with different levels of experience. In addition, these and two other independent examiners (HVD3, KvP3, CP and AA) with different levels of experience carry out the evaluation from a random selection of 34 elbow joints once. The combination of repeated assessments by two examiners and the one-time assessment by four examiners offers a comprehensive opportunity to assess the reliability, reproducibility and validity of the assessments. The combination allows more comprehensive and reliable conclusions to be drawn, which ensures the validity of the study.
Using the evaluation scheme, the cross-sectional images are examined on the PCM for fissures, fracture lines and fragments with displacement, on the sub-chondral bone of the PCM for inhomogeneous areas, at the incisura radialis ul-nae for irregularities and bone cysts, on the medial humeral condyle for round-oval subchondral radiolucencies and subchondral sclerosis, examined in the sagittal and dorsal sectional plane for steps > 5 mm, and at the anconeal process for cartilage remnants. In addition, special findings such as osteophytes, arthrosis or minor incongruities can be noted, which help with a more precise classification into an ED grade. The overall result is finally classified from ED 0 to ED 3 based on the ED score according to the IEWG guidelines. The final decision is then made as to whether the dog should be assessed as positive or negative (“POS/NEG”) for ED according to this classification. Statistically, the results are calculated and evaluated based on the percentage agreement and the coeffi-cients Cohen's Kappa and Fleiss Kappa.
Not only the very good agreement of almost all points, but especially the very good percentage and clear to almost complete agreement with regard to the final classification (“POS/NEG”), whether an ED is present or not, is validated CT grad-ing for ED in dogs.
Subjectivity and experience of the observers seem to have an influence on devia-tions, which applies especially to the points “fissure” and “fragment with disloca-tion” on the PCM. This is particularly important because it has a direct impact on the result of the CT grading. The points “irregular” and “bone cyst” on the radial notch of the ulnae are also primarily characterized by subjectivity in the assess-ment, but alone do not have a significant influence on the final result. This means that when using subjective criteria, training with more experienced exam-iners can be helpful in order to achieve results that are as homogeneous as pos-sible.
In summary, it can be said that CT is a suitable imaging method for the detection and classification of ED, even if some structures can only be assessed very sub-jectively. The grading scheme used in the present study can be used by both ex-perienced and inexperienced reviewers. Training by an experienced assessor is advantageous, as over-interpretation by less experienced examiners could possi-bly occur. In the future, the use of CT grading may help increase diagnostic relia-bility and lead to a definitive classification into ED-negative and ED-positive. This could eliminate the current classification of ED into three grades.
Autor*in
Helen Viktoria Düringer
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Dysplasie Hund CT IEWG International Elbow Working Group Ellenbogen dysplasie