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2016 ; 11
(ä): 13
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A reliability and validity study for Scolioscan: a radiation-free scoliosis
assessment system using 3D ultrasound imaging
#MMPMID27299162
Zheng YP
; Lee TT
; Lai KK
; Yip BH
; Zhou GQ
; Jiang WW
; Cheung JC
; Wong MS
; Ng BK
; Cheng JC
; Lam TP
Scoliosis Spinal Disord
2016[]; 11
(ä): 13
PMID27299162
show ga
BACKGROUND: Radiographic evaluation for patients with scoliosis using Cobb method
is the current gold standard, but radiography has radiation hazards. Several
groups have recently demonstrated the feasibility of using 3D ultrasound for the
evaluation of scoliosis. Ultrasound imaging is radiation-free, comparatively more
accessible, and inexpensive. However, a reliable and valid 3D ultrasound system
ready for clinical scoliosis assessment has not yet been reported. Scolioscan is
a newly developed system targeted for scoliosis assessment in clinics by using
coronal images of spine generated by a 3D ultrasound volume projection imaging
method. The aim of this study is to test the reliability of spine deformity
measurement of Scolioscan and its validity compared to the gold standard Cobb
angle measurements from radiography in adolescent idiopathic scoliosis (AIS)
patients. METHODS: Prospective study divided into two stages: 1) Investigation of
intra- and inter- reliability between two operators for acquiring images using
Scolioscan and among three raters for measuring spinal curves from those images;
2) Correlation between the Cobb angle obtained from radiography by a medical
doctor and the spine curve angle obtained using Scolioscan (Scolioscan angle).
The raters for ultrasound images and the doctors for evaluating radiographic
images were mutually blinded. The two stages of tests involved 20 (80 % females,
total of 26 angles, age of 16.4?±?2.7 years, and Cobb angle of 27.6?±?11.8°) and
49 (69 % female, 73 angles, 15.8?±?2.7 years and 24.8?±?9.7°) AIS patients,
respectively. Intra-class correlation coefficients (ICC) and Bland-Altman plots
and root-mean-square differences (RMS) were employed to determine correlations,
which interpreted based on defined criteria. RESULTS: We demonstrated a very good
intra-rater and intra-operator reliability for Scolioscan angle measurement with
ICC larger than 0.94 and 0.88, respectively. Very good inter-rater and
inter-operator reliability was also demonstrated, with both ICC larger than 0.87.
For the thoracic deformity measurement, the RMS were 2.5 and 3.3° in the intra-
and inter-operator tests, and 1.5 and 3.6° in the intra- and inter-rater tests,
respectively. The RMS differences were 3.1, 3.1, 1.6, 3.7° in the intra- and
inter-operator and intra- and inter-rater tests, respectively, for the lumbar
angle measurement. Moderate to strong correlations (R(2)?>?0.72) were observed
between the Scolioscan angles and Cobb angles for both the thoracic and lumbar
regions. It was noted that the Scolioscan angle slightly underestimated the
spinal deformity in comparison with Cobb angle, and an overall regression
equation y?=?1.1797x (R(2)?=?0.76) could be used to translate the Scolioscan
angle (x) to Cobb angle (y) for this group of patients. The RMS difference
between Scolioscan angle and Cobb angle was 4.7 and 6.2°, with and without the
correlation using the overall regression equation. CONCLUSIONS: We showed that
Scolioscan is reliable for measuring coronal deformity for patients with AIS and
appears promising in screening large numbers of patients, for progress
monitoring, and evaluation of treatment outcomes. Due to it being radiation-free
and relatively low-cost, Scolioscan has potential to be widely implemented and
may contribute to reducing radiation dose during serial monitoring.