三维超声用于青少年特发性脊柱侧凸评估的信度与效度研究

Three-dimensional ultrasound assessments of coronal curvature in patients with adolescent idiopathic scoliosis: reliability and validity study

目的:探索三维超声成像技术在临床上评估和测量青少年特发性脊柱侧凸(AIS)患者椎体侧凸角度的可行性;通过与磁共振成像(MRI)的测量方法比较,评价三维超声测量结果的信度与效度。方法:16例AIS女性患者在同一上午进行三维超声和MRI的全脊柱扫描。将三维超声和MRI的图像进行随机分配,两位评测者随机抽取图像进行测量;所有图像均需进行3次测量,每次测量间隔1周,且测量过程中对两位评测者采取盲法。在冠状面上,三维超声成像采用椎板中心法(COL)测量AIS的椎体侧凸角度;而MRI成像采用Cobb方法。通过计算组内相关系数(ICC[2,k])评价三维超声测量方法的信度;通过与MRI测量结果比较,采用配对t检验及Pearson相关系数,评价三维超声测量方法的效度。结果:在冠状面上,三维超声成像COL测量方法评估AIS患者椎体侧凸角度具有较高的评测者内和评测者间信度(ICC[2,K]>0.9,P<0.05)。三维超声成像COL测量方法和MRI成像Cobb测量方法评估AIS椎体侧凸角度的结果之间没有显著性差异(P<0.05);两种测量方法具有较高的相关性(r>0.9)。结论:三维超声成像技术可用于评估AIS患者椎体在冠状面上的侧凸角度,具有较高的信度和效度。

Objective： To explore the possibility by using the 3-D ultrasound method to assess the coronal curvature in the subjects with AIS under the clinical setting, and to evaluate its reliability and validity with the concurrent MRI methods.Method： Sixteen female subjects with AIS were recruited from the Prince of Wales Hospital, Hong Kong. The ultrasound examination was performed using a 3-D ultrasound unit. To compare with the ultrasound assessments, magnetic resonance imaging（MRI） examination was conducted on the same morning. The 3-D ultrasound and MRI images were randomly allocated to the two raters for data collection and coronal curvature measurements. The center of laminae（COL） method was used to measure the spinal curvature in the coronal plane of 3-D ultrasound images, compared with the Cobb method in MRI. To assess the reliability of 3-D ultrasound measurements, the intra-class correlation coefficients（ICC）, mean absolute deviation（MAD）, standard deviation（SD） and standard error of measurement（SEM） were measured. Additionally, in order to evaluate the validity of 3-D ultrasound assessments, paired Student＇s t-test, Bland-Altman statistics and Pearson correlation coefficient were analysed between 3-D ultrasound and MRI measurements for the patients with AIS. The level of significance was set as 0.05.Result： The COL method showed high intra-and inter-rater reliabilities（both with ICC[2,K]0.9, P〈0.05） for measuring the coronal curvature by 3-D ultrasound. Compared with Cobb method in MRI, COL method in 3-D CUS showed no significant difference（P〈0.05） when measuring coronal curvature at supine position. Moreover, Bland-Altman method demonstrated an agreement between the two methods and the Pearson＇s correlation coefficient（r） was high（r0.9） in all the sample categories.Conclusion： The radiation-free 3-D ultrasound was presented to be a reliable valid method for measuring spinal curvature in the coronal plane in the patients with AIS under clinical setting.