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Semiautomatic superimposition improves radiological assessment of curve flexibility in scoliosis

  • Musculoskeletal
  • Published:
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Abstract

Objective

Assessment of scoliotic curve flexibility and stiffness is essential for planning surgical treatment in adolescent idiopathic scoliosis (AIS). Measurement of curve flexibility is currently insufficiently precise. The purpose of this study was to introduce and validate a novel method of superimposing radiographs for more reliable measurement of curve flexibility.

Material and methods

Two independent radiologists measured Cobb angles separately on standard anterior-posterior (AP) (n = 48) and supine bending radiographs (n = 48), in patients with AIS, who were randomly included from a surgical database. The same readers repeated the measurements after the bending radiographs were semi-automatically superimposed on the AP radiographs by fusing the caudad end vertebra. Curve flexibility was calculated. Inter-reader agreement between the two independent readers was calculated using interclass correlation coefficient (ICC).

Results

A moderate inter-reader agreement was achieved in the upper curve (ICC = 0.57) and a good agreement in the lower curve (ICC = 0.72) with the standard method of assessing curve flexibility. With the use of the semiautomatic superimposition, however, almost perfect agreement was achieved for both the upper and the lower curves flexibilities (ICC = 0.93 and 0.97, respectively).

Conclusion

The introduced semi-automatic superimposition technique for measurement of scoliotic curve flexibility in AIS is more precise and reliable than the current standard method.

Key Points

• A technique using semiautomatic superimposition of anterior-posterior and bending radiographs is introduced

• Almost perfect agreement was achieved for scoliotic curves flexibilities measurements

• This method is more precise and reliable than the current standard method

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Acknowledgments

The authors would like to thank the ETH of Zurich and particularly Zoé Goey from the Computer Vision Laboratory for the production and support of the software. The scientific guarantor of this publication is Thomas Frauenfelder. The authors of this manuscript declare relationships with the following company: ETH, Zurich, Switzerland. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. One of the authors has significant statistical expertise. Institutional Review Board approval was not required because of the retrospective study design. Written informed consent was not required for this study because of its retrospective design. Methodology: retrospective, observational, performed at two institutions.

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Authors and Affiliations

  1. Institute of Diagnostic and Interventional Radiology, University Hospital of Zurich, Raemistrasse 101, 8091, Zurich, Switzerland

    Nadja A. Farshad-Amacker, T. D. Nguyen, G. Andreisek & T. Frauenfelder

  2. Orthopeadic and Spine Surgery, Balgrist Unversity Hospital, Zurich, Switzerland

    M. Farshad & K. Min

Authors
  1. Nadja A. Farshad-Amacker
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  2. T. D. Nguyen
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  3. M. Farshad
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  4. G. Andreisek
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  5. K. Min
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  6. T. Frauenfelder
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Corresponding author

Correspondence to Nadja A. Farshad-Amacker.

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Farshad-Amacker, N.A., Nguyen, T.D., Farshad, M. et al. Semiautomatic superimposition improves radiological assessment of curve flexibility in scoliosis. Eur Radiol 25, 860–864 (2015). https://doi.org/10.1007/s00330-014-3433-1

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  • DOI: https://doi.org/10.1007/s00330-014-3433-1

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