THE EFFECT OF A TECHNICAL QUALITY ASSESSMENT OF HIP‐EXTENDED RADIOGRAPHS ON INTEROBSERVER AGREEMENT IN THE DIAGNOSIS OF CANINE HIP DYSPLASIA

Experienced and inexperienced observers evaluated the assessability of 50 radiographs (25 dogs) and determined the hip status (dysplasia/nondysplasia and final scoring according Fédération Cynologique Internationale [FCI]‐criteria) individually. A radiographic technical quality assessment was performed in a separate reading session. Interobserver agreement in determining dysplasia/nondysplasia and FCI‐scoring did not significantly increase with the increasing quality of a radiograph, irrespective whether these observers are experienced or not. There was a significant agreement between the technical quality assessment and assessability (P<0.0005). Despite the effort to objectify radiographic quality and to present high‐quality radiographs to observers, interobserver agreement on dysplasia/nondysplasia and final scoring, remains low, even in the experienced group. Although increased radiographic quality narrows the range of scoring, the range remains unacceptably high.     

Interobserver agreement in the diagnosis of canine hip dysplasia using the standard ventrodorsal hip-extended radiographic method

OBJECTIVES: To determine the agreement between observers and to investigate the effect of observer experience in diagnosing canine hip dysplasia and providing final scoring of hips using the standard ventrodorsal hip-extended radiographic method. The agreement of the final scoring, with a presumed correct assessment based on the Norberg angle, is also investigated. METHODS: Thirty observers were requested to read 50 ventrodorsal hip-extended radiographs of 25 dogs according to Federation Cynologique International criteria. Groups of experienced (nine members) and inexperienced (21 members) observers were used. RESULTS: For providing the distinction between dysplastic versus non-dysplastic dogs, the average interobserver agreement was 72 per cent and was significantly higher (P<0.0001) than the score that could be expected by chance without any agreement between observers. For providing the final score (A, B, C, D or E), an average interobserver agreement of 43.6 per cent was found. In the experienced group, an agreement score of 76 per cent was found for the distinction between AB versus non-AB and an agreement score of 81 per cent was found for the distinction between C versus non-C. The agreement score was significantly higher (P<0.0001) for the experienced group than for the inexperienced group in all cases. Agreement between the presumed correct assessment based on the Norberg angle and the observer's evaluation was low (P=0.35), irrespective of whether the observers were experienced (71.8 per cent correct assessments) or inexperienced (69 per cent correct assessments). CLINICAL SIGNIFICANCE: Although interobserver agreement is low, observer experience increases agreement.     

Assessment of low-cost teleradiology for grading elbow dysplasia.

Teleradiology involves the creation of a radiographic image that is then transmitted electronically. It has been shown that low-cost teleradiology has a high level of agreement when comparing the original radiograph to the digital image. However, there has been little investigation of the effect of digitization on the score allocated by a grading scheme. Radiographs of 60 canine elbows were selected, each in three projections (mediolateral flexed, mediolateral neutral, craniocaudal). Each radiograph was photographed at 3 megapixel (3 M) and 6 megapixel (6 M) resolution using a digital camera. The images were placed in groups (radiographs, 3 M and 6 M) and randomized. Each elbow was independently graded by a radiologist and an orthopedic surgeon using the BVA elbow scoring scheme, with the different image sets interpreted separately. Intra and interobserver agreement was compared using a kappa analysis. The radiologist had substantial intraobserver agreement for repeated grading of radiographs, and moderate agreement for the other intraobserver tests (3 M vs. radiographs, 6 M vs. radiographs, 3 vs. 6 M). The surgeon had moderate to substantial agreement for the intraobserver tests. There was reduced interobserver agreement for all image groups. These results suggest that low-cost teleradiology may only allow moderate accuracy when used for grading schemes, and this may affect its use for breed scoring schemes. However, there appears to be an inherent subjectivity present in the elbow-grading scheme, seen in both intra and interobserver analysis. Therefore, further study of teleradiology using a different scoring model (e.g., hip dysplasia) may be indicated.     

Detection of joint effusion on radiographs of horses

Joint effusion is one of the classic radiographic signs of osteoarthritis, but no information is available regarding clinicians' ability to detect joint effusion radiographically. This study determined the accuracy and precision of experienced and inexperienced observers in detecting joint effusion of the distal interphalangeal (DIP), metacarpophalangeal (MCP) and midcarpal joints on radiographs. Fresh cadaverous forelimbs were loaded in a material testing machine to mimic a standing horse. The joints were gradually distended and lateromedial and dorsopalmar radiographs were acquired. The images were assessed by three experienced and three inexperienced observers. This study showed that the sensitivity was high for both groups for all joints and projections. Specificity was high for the experienced group but low for the inexperienced group. There was a significant positive correlation between joint distension and severity of joint effusion when reported by experienced observersfor most views (except DIP joint), but only for the MCP joint for inexperienced observers. Interoperator agreement was poor to fair for the experienced group and poor for the inexperienced group. In conclusion, the accuracy and precision of grading joint effusion on radiographs was highly subjective and related to experience.     

Comparison of two radiographic techniques for evaluation of hip joint laxity in 10 breeds of dogs

OBJECTIVE: To evaluate hip joint laxity in 10 breeds of dogs via 2 radiographic techniques. ANIMALS: 500 clinically normal dogs. DESIGN: Prospective study. PROCEDURE: Radiographs obtained via routine hip joint evaluations performed in sedated dogs of 10 popular breeds were randomly selected from a database. Measurements of distraction index (DI) and hip-extended index (HEI) on 1 hip joint radiograph randomly chosen from each dog were made. RESULTS: Mean age of dogs was 20.7 months. Mean HEI was 0.17 (range, 0.0 to 0.72) and mean DI was 0.44 (range, 0.07 to 0.96). Borzois had uniformly tight hip joints as judged by use of both methods and were considered the gold standard by which hip joint laxity was judged (all Borzois had DI < or = 0.32). Overall, DI was significantly greater than HEI. Within each breed, mean DI was always greater than mean HEI. Significant differences were detected among breeds for HEI; however, compared with DI, the magnitude of differences among breeds was less. CONCLUSIONS AND CLINICAL RELEVANCE: Distraction radiography detected the greatest range and magnitude of passive hip laxity in the 10 breeds of dogs. The difference in values between breeds known to have high prevalence of canine hip dysplasia and those in Borzois was greater for DI than for HEI. Breeds must be evaluated individually because of inherent differences in hip joint laxity.     

Intra- and interobserver measurement variability of tibial plateau slope from lateral radiographs in dogs

Measurement of the tibial plateau slope from lateral hind-limb radiographs is a preoperative requirement when performing tibial plateau leveling osteotomy (TPLO) for repair of the cruciate-deficient stifle in dogs. Two measurements of the tibial plateau slope in 312 stifles of 156 dogs were taken from lateral radiographs by each of three observers with varying degrees of experience in the measurement method. Intraobserver variability was +/-3.4 degrees, and interobserver variability was +/-4.8 degrees. No significant differences were identified for the intraobserver measurements; however, in evaluating interobserver variability, a significant difference was found between the inexperienced observer and the two experienced observers.     

REPEATABILITY AND RELIABILITY OF GLOMERULAR FILTRATION RATE DETERMINATION VIA GAMMA CAMERA UPTAKE OF TC‐99M‐DTPA IN CATS WITH CHRONIC KIDNEY DISEASE

Measurement of glomerular filtration rate (GFR) via gamma camera uptake of 99mTc‐diethylenetriaminepentaacetic acid is a standard method for quantifying renal function. Aims of this retrospective, observer agreement study were to determine intra‐ and interobserver variation in GFR values for cats with chronic kidney disease and to determine whether renal insufficiency classification changed between observers. Guideline cut‐points were established for the difference in repeated GFRs to differentiate changes caused by therapeutic effect vs. inherent variation. Included cats had a diagnosis of chronic kidney disease and had undergone GFR examinations between the years of 2010 and 2013. Twenty‐nine GFR studies were sampled. Each study was read twice, 6 months apart, by two veterinary radiologists and one radiology resident. Modified Bland–Altman plots were used to investigate differences between readings 1 and 2 by observer and between pairs of observers by reading. Reliability of clinical classification was assessed through comparisons between readings and observers. Measurements were not systematically different between readings for the experienced observers but were higher in reading 1 than reading 2 for the inexperienced observer. Measurements were not systematically different between the experienced observers in reading 1 or between any two observers in reading 2. Reliability for GFR measurements was high among experienced observers; variations in GFR measurements rarely led to differences in clinical classification. Results suggested that, for experienced observers, changes in GFR values following treatment in cats with chronic kidney disease between ?0.4 and 0.4 mL/min/kg may be due to inherent variability rather than treatment effect.     

DIAGNOSTIC SENSITIVITY AND INTEROBSERVER AGREEMENT OF RADIOGRAPHY AND ULTRASONOGRAPHY FOR DETECTING TROCHLEAR RIDGE OSTEOCHONDROSIS LESIONS IN THE EQUINE STIFLE

Osteochondrosis lesions commonly occur on the femoral trochlear ridges in horses and radiography and ultrasonography are routinely used to diagnose these lesions. However, poor correlation has been found between radiographic and arthroscopic findings of affected trochlear ridges. Interobserver agreement for ultrasonographic diagnoses and correlation between ultrasonographic and arthroscopic findings have not been previously described. Objectives of this study were to describe diagnostic sensitivity and interobserver agreement of radiography and ultrasonography for detecting and grading osteochondrosis lesions of the equine trochlear ridges, using arthroscopy as the reference standard. Twenty‐two horses were sampled. Two observers independently recorded radiographic and ultrasonographic findings without knowledge of arthroscopic findings. Imaging findings were compared between observers and with arthroscopic findings. Agreement between observers was moderate to excellent (κ 0.48–0.86) for detecting lesions using radiography and good to excellent (κ 0.74–0.87) for grading lesions using radiography. Agreement between observers was good to excellent (κ 0.78–0.94) for detecting lesions using ultrasonography and very good to excellent (κ 0.86–0.93) for grading lesions using ultrasonography. Diagnostic sensitivity was 84–88% for radiography and 100% for ultrasonography. Diagnostic specificity was 89–100% for radiography and 60–82% for ultrasonography. Agreement between radiography and arthroscopy was good (κ 0.64–0.78). Agreement between ultrasonography and arthroscopy was very good to excellent (κ 0.81–0.87). Findings from this study support ultrasound as a preferred method for predicting presence and severity of osteochondrosis lesions involving the femoral trochlear ridges in horses.     

THE EFFECT OF ANESTHESIA ON THE RADIOGRAPHIC APPEARANCE OF THE COXOFEMORAL JOINTS

The effect of anesthesia on the radiographic appearance of the coxofemoral joints was evaluated by taking pelvic radiographs of thirty dogs. Each dog was radiographed twice, once under general anesthesia and once without anesthesia. The radiographs were submitted to the Orthopedic Foundation for Animals independently of one another to be evaluated for signs of hip dysplasia. Results suggest there was no statistical difference between the two groups of dogs. Twenty five dogs received the same reading. Three dogs received readings that were worse by one grade while under anesthesia and two dogs received readings that were one grade better while under anesthesia. This study failed to demonstrate any changes due to anesthesia on the radiographic appearance of the coxofemoral joints. Anesthesia may, however, be beneficial for proper positioning and to decrease unnecessary patient, and personnel exposure to radiation.     

The intra‐ and intertester repeatability of radiographic elbow incongruity grading is high in chondrodystrophic dog breeds

Elbow incongruity is a form of elbow dysplasia that causes osteoarthritis, pain, and lameness, and it is common in chondrodystrophic dog breeds. The objective of this retrospective secondary analysis study was to evaluate the intra‐ and interobserver repeatability of a novel radiographic incongruity grading system for assessing elbow incongruity in three chondrodystrophic dog breeds—the dachshund, Skye Terrier, and Glen of Imaal Terrier. We conducted an observer agreement study that included 220 mediolateral antebrachial radiographs from 110 dogs with the elbow in 90° flexion. The radiographs were independently assessed by three observers at three time points, using a four‐stepped grading scale. The proportion of agreement and Kappa coefficient were calculated. Both the intra‐ and interobserver proportions of agreement were substantial when three grades were required to be identical (.705‐.777 and .609, respectively), and almost perfect for two identical grades (.991‐1.000 and .991, respectively). Some differences in repeatability between breeds were noted; specifically, the intraobserver repeatability was higher in the dachshund, and the interobserver repeatability was lower in the Glen of Imaal Terrier. Our study showed that the radiographic imaging protocol and incongruity grading system have high repeatability when assessing elbow incongruity in chondrodystrophic dog breeds.     

IDENTIFICATION AND PREVALENCE OF ERRORS AFFECTING THE QUALITY OF RADIOGRAPHS SUBMITTED TO AUSTRALIAN THOROUGHBRED YEARLING SALE REPOSITORIES

We aimed to identify common mistakes made when radiographing yearling sale horses. Radiographic examinations from repositories at eight yearling sales held in Australia in 2003 were assessed by one of four veterinary radiology specialists. Each radiographic examination consisted of a maximum of 34 radiographs. Each radiograph was assessed for errors associated with movement, exposure, positioning, labeling or marker placement, and processing, and categorized as either ideal, less than ideal or nondiagnostic. In addition, from the first 800 sets catalogued, 167 were selected randomly and read twice by the four radiologists for agreement analysis. A total of 81,297 radiographs were examined for errors affecting quality. Positioning errors were the most common reason for radiographs to be considered nondiagnostic (2432/81,297; 3%), with the flexed lateromedial (LM) metacarpophalangeal joint, LM metatarsophalangeal joint, and the dorsomedial palmarolateral (DMPaLO) carpal views being the most frequently involved. Overexposure (14,357/81,297; 17.7%) was the most common reason for radiographs being categorized as less than ideal with the LM stifle view the most represented. Agreement within and between radiologists for reporting errors in positioning of the flexed LM metacarpophalangeal joint, LM metatarsophalangeal joint, and DMPaLO carpal views varied from slight to almost perfect. The low repeatability within radiologists on some views suggests that before declaring a radiograph nondiagnostic it is worth considering rereading it at another time. Care should be taken in positioning of the flexed LM metacarpophalangeal, LM metatarsophalangeal, and DMPaLO carpus views to maximize radiograph quality.     

Intra‐ and interobserver agreement in the interpretation of navicular bones on radiographs and computed tomography scans

Reasons for performing study: Criteria for the radiographic evaluation of navicular bones in horses have been published to standardise classification of radiographic signs. However, intra‐ and interobserver agreement have not been established. Objective: To determine intra‐ and interobserver agreement in the evaluation of radiographic and computed tomographic (CT) navicular changes. It was hypothesised that: 1) intraobserver agreement would be better than interobserver agreement; 2) agreement would be better for CT than for radiography; and 3) pathological changes would be recognised with greater certainty with CT. Methods: Radiographs and CT scans of 60 cadaver navicular bones were evaluated by 3 observers using published criteria. A subset of 30 studies was evaluated twice by one observer. Agreement was tested using the kappa statistic. Certainty about pathological changes was evaluated by giving the observers the option to choose ‘not sure’. Results: Agreement varied from poor to almost perfect for radiographic evaluation and from poor to substantial for CT evaluation. For radiographic evaluation mean interobserver agreement was fair, as it was for CT evaluation. For radiographic evaluation mean intraobserver agreement was moderate as it was for CT evaluation. Pathological changes were evaluated with greater certainty on CT scans compared to radiographs; however, this was not associated with improved agreement. Conclusions: Variations in classification of navicular lesions in radiographic and CT studies were considerable between and within observers and challenge the use of such studies for diagnostic and prognostic purposes. Potential relevance: The results of this study allowed the identification of evaluation criteria with sufficient precision to be useful for navicular bone evaluation.     

Influence of anaesthesia on canine hip dysplasia score

Hip dysplasia (HD) scores, based on the five grades, as defined by the Fédération Cynologique Internationale, were compared between anaesthetized (group 1, n = 3839) and non-sedated non-anaesthetized dogs (group 2, n = 1517). Each dog was radiographed in the standard ventro-dorsal hip joint extended position. Each radiograph was evaluated by the same reader blinded regarding the dog's status of anaesthesia. Results showed that there was a significant difference in hip dysplasia prevalence between group 1 (22%) compared with group 2 (9%) (P < 0.005). This difference was the result of a lower rate of hip-joint laxity assessment and the measurement of Norberg-Olsson angle <105 degrees in group 2 compared with group 1. The acetabular and femoral morphologies were not significantly different between the groups. The data confirm that the scoring of dogs for HD on standard radiographs with the hip joints extended is influenced by anaesthesia.     

HIP DYSPLASIA: A FELINE POPULATION STUDY

The study population consisted of cats presented to the University of Missouri-Columbia Veterinary Medical Teaching Hospital from January 1, 1991 through December 31, 1995. Ventrodorsal radiographs including the pelvic region were evaluated for radiographic evidence of hip dysplasia. Each radiograph was evaluated independently by three board-certified veterinary radiologists and a consensus normal of dysplastic evaluation was determined. There were 684 cats from 12 breeds. The data derived from this study indicate the frequency of feline hip dysplasia in this population to be about 6.6% (45/684) and that the incidence appears to be breed dependent. Also, the radiographic appearance of hip dysplasia in cats is different than in dogs. A shallow acetabulum with remodeling and proliferation involving the cranio-dorsal acetabular margin were the most common radiographic signs. Minimal remodeling of the femoral neck was seen.     

THE GENETICS AND EARLY PREDICTION OF HIP DYSPLASIA

SUMMARY: Four breeds of dog and crosses amongst these breeds were compared with regard to their hip dysplasia status. Both radiographic hip dysplasia at 15 months and joint laxity at 8 weeks were recorded. The prediction of radiographic hip dysplasia by joint laxity was significantly improved when breed differences were included in the prediction equation. The uses of joint laxity measurements and the genetic control of hip dysplasia are discussed.     

Role of the Orthopedic Foundation for Animals in the control of canine hip dysplasia.

The objectives of the Dysplasia Control Registry, the procedure for submitting radiographs, and the radiographic evaluation process are described. The results from the radiographic evaluation of 321,183 dogs are reported by hip phenotypic ratings and breed frequency of canine hip dysplasia. Breeds at risk are documented. Comparison of dogs born between 1981 and 1988 with those born between 1972 and 1980 demonstrated that the frequency of canine hip dysplasia was reduced in 79% of breeds, and the frequency of excellent hips was increased in 88% of the breeds. Reliability of preliminary hip evaluations of dogs under 24 months of age is reported to vary by breed, and the results of 9,161 preliminary evaluations are documented.     

RADIOGRAPHIC AND COMPUTED TOMOGRAPHIC DETERMINATION OF FEMORAL VARUS AND TORSION IN THE DOG

Diagnosis and quantification of femoral varus and femoral torsion using radiographs is technically challenging due to the difficulty in determining proper positioning. The purpose of this study is to describe a computed tomographic technique for determination of femoral varus and femoral torsion and to compare this technique, and standard radiography, to anatomic preparation, for the measurement of femoral varus and femoral torsion in normal dogs. Nine canine cadavers, visually and radiographically free of orthopedic disease of the hip and stifle joints, were utilized for analysis. Femoral varus was determined using a craniocaudal radiograph, a craniocaudal radiograph obtained after confirming accurate positioning using horizontal beam fluoroscopy, and computed tomography (CT). Femoral torsion (expressed as angle of version) was determined using an axial radiographic projection obtained from distal to proximal and CT. Each femur was dissected free of soft tissues, and direct determination of femoral varus and femoral torsion was performed using digital photographic images. All radiologic and photographic images were digitally measured to quantify the magnitude of femoral varus and femoral torsion. For femoral varus, no difference ( P =0.149) between the three different imaging techniques and the anatomic preparation was identified. For femoral torsion, no difference ( P =0.059) between the two imaging techniques and the anatomic preparation was identified. Well positioned radiographs and the described computed tomographic method are both as accurate as anatomic preparation for the measurement of both femoral varus and femoral torsion in normal dogs.     

Clinical efficacy and safety of dexmedetomidine and buprenorphine, butorphanol or diazepam for canine hip radiography

OBJECTIVES: To investigate the usefulness of dexmedetomidine for restraint and sedation during hip radiographic examination of hip-extended or stress-radiography views when combined with either buprenorphine, butorphanol or diazepam. METHODS: One hundred and twenty-seven client-owned clinically healthy golden retrievers or rottweilers were enrolled in a clinical trial that compared hip-extended and PennHIP methods for diagnosing hip dysplasia and were randomly allocated to receive dexmedetomidine or medetomidine in combination with buprenorphine, butorphanol or diazepam. Subjective assessments were made for response to pain, response to noise, palpebral reflex, muscle tone and overall quality of sedation; non-invasive physiological variables were also recorded. RESULTS: Overall quality of sedation was graded as good or excellent for dogs administered with a combination of butorphanol or diazepam. However, more dogs that received a combination involving buprenorphine had overall a relatively poorer quality of sedation and required additional administration of buprenorphine before the radiographic procedure could commence. Once sedated, clinically sufficient muscle relaxation accompanied by a very low proportion of dogs responding to pain or noise stimuli were observed in all treatment groups. Heart and respiratory rate, and procedure and recovery times were similar for all treatment groups, and no adverse events were observed during the study. CLINICAL SIGNIFICANCE: Dexmedetomidine sedative protocols, particularly in combination with butorphanol and diazepam, can be used effectively and safely in dogs for radiographic procedures.     

COMPARISON OF NONCONTRAST COMPUTED TOMOGRAPHY AND HIGH‐FIELD MAGNETIC RESONANCE IMAGING IN THE EVALUATION OF GREAT DANES WITH CERVICAL SPONDYLOMYELOPATHY

Computed tomography (CT) provides excellent bony detail, whereas magnetic resonance (MR) imaging is superior in evaluating the neural structures. The purpose of this prospective study was to assess interobserver and intermethod agreement in the evaluation of cervical vertebral column morphology and lesion severity in Great Danes with cervical spondylomyelopathy by use of noncontrast CT and high‐field MR imaging. Fifteen client‐owned affected Great Danes were enrolled. All dogs underwent noncontrast CT under sedation and MR imaging under general anesthesia of the cervical vertebral column. Three observers independently evaluated the images to determine the main site of spinal cord compression, direction and cause of the compression, articular process joint characteristics, and presence of foraminal stenosis. Overall intermethod agreement, intermethod agreement for each observer, overall interobserver agreement, and interobserver agreement between pairs of observers were calculated by use of kappa (κ) statistics. The highest overall intermethod agreements were obtained for the main site of compression and direction of compression with substantial agreements (κ = 0.65 and 0.62, respectively), whereas the lowest was obtained for right‐sided foraminal stenosis (κ = 0.39, fair agreement). For both imaging techniques, the highest and lowest interobserver agreements were recorded for the main site of compression and degree of articular joint proliferation, respectively. While different observers frequently agree on the main site of compression using both imaging techniques, there is considerable variation between modalities and among observers when assessing articular process characteristics and foraminal stenosis. Caution should be exerted when comparing image interpretations from multiple observers.     

Use of the caudolateral curvilinear osteophyte as an early marker for future development of osteoarthritis associated with hip dysplasia in dogs

OBJECTIVE: To determine the relationship between the caudolateral curvilinear osteophyte (CCO) and osteoarthritis associated with hip dysplasia in dogs. DESIGN: Longitudinal cohort study. ANIMALS: 48 Labrador Retrievers from 7 litters. PROCEDURE: In each of 24 sex- and size-matched pairs fed the same diet, a restricted-fed dog was fed 25% less than a control dog for life. The dogs' hips were evaluated in the standard ventrodorsal hip-extended radiographic projection at 16, 30, and 52 weeks of age and then yearly for life. Histologic examination of hip joint tissues was performed on 45 dogs. RESULTS: Median age at death was 11.2 years. Adjusting for feeding group, dogs with a CCO were 3.7 times as likely to develop radiographic signs of osteoarthritis than those without a CCO. Stratified by diet, 100% of the control dogs with a CCO developed radiographic signs of osteoarthritis and 55% of restricted-fed dogs with a CCO developed radiographic signs of osteoarthritis. The CCO was the first radiographic change seen in 22 of 29 (76%) dogs with osteoarthritis. Overall, 35 of 37 (95%) dogs with a CCO had histopathologic lesions of osteoarthritis. CONCLUSIONS AND CLINICAL RELEVANCE: Results indicate a relationship between a CCO on the femoral neck and subsequent development of radiographic signs of osteoarthritis in Labrador Retrievers evaluated over their life span. A CCO is an important early radiographic indication of osteoarthritis associated with canine hip dysplasia.