iothalamate-meglumine and Osteoarthritis

To assess the multirater agreement of the modified Outerbridge system for the grading of predefined areas of femorotibial cartilage at CT arthrography with multiple readers, with varying experience.. Five readers with varying experience (two junior radiologists, three musculoskeletal radiologists including two experts in cartilage imaging) separately analyzed 962 cartilage sectors from pre-divided knee CT arthrograms with femorotibial osteoarthritis (Kellgren/Lawrence=3). Each cartilage area was graded twice by each reader, at a three-month interval, according to the modified 5-grade Outerbridge system. Interobserver and intraobserver agreement were assessed. After the second reading, 121 areas exhibiting the highest interobserver disagreement were reviewed in consensus to determine the sources of disagreement.. The global interobserver agreement was fair (k=0.35), and increased with the grade (from k=0.14 to k=0.76 from grade 0-4). The intraobserver agreement varied with the readers' experience from moderate (k=0.59) to almost perfect (k=0.92). The majority of cases of disagreement (44%) was due to difficulties in assessing the normal variations of cartilage thickness, including diffuse cartilage thinning (23%) and normal variants of cartilage thickness (22%). 32% of cases of disagreement were due to retrospectively avoidable interpretation errors.. The multirater agreement of the modified Outerbridge system is only fair when readers of different level of experience are taken into account, and interobserver agreement increases with readers' experience. However, interobserver agreement is substantial for grade 4 lesions. We report normal variations of cartilage thickness that may improve observer agreement in reporting cartilage lesions.

Topics: Aged; Aged, 80 and over; Arthrography; Cartilage, Articular; Clinical Competence; Contrast Media; Female; Femur; Humans; Iothalamate Meglumine; Iothalamic Acid; Knee Joint; Male; Middle Aged; Multidetector Computed Tomography; Observer Variation; Osteoarthritis; Radiographic Image Enhancement; Reproducibility of Results; Retrospective Studies; Severity of Illness Index; Tibia

Paraosteoarthropathy (POA) is a frequent disabling orthopedic complication after severe central neurological impairment. The hip is the most frequently affected joint (32.1%) followed by the elbow and the shoulder (25%).. To evaluate coraco- and costoclavicular paraosteoarthropathy in patients with severe central neurological disorders.. We report a series of five consecutive patients with severe central neurological disorders who developed a POA of the clavicular region (coracoclavicular or costoclavicular POA). Every patient underwent a clinical, radiological, and computed tomographic (CT) examination of the shoulder region.. Four patients had a history of traumatic brain injury (TBI), and one an acute disseminated encephalomyelitis (ADEM). They developed POA of the clavicular region, although not around the glenohumeral joint. The patients complained of shoulder pain and of moderate limitation of movements. Radiological and CT examinations showed the presence of a bony formation in the coracoclavicular space in four cases and extending from the clavicle to the first rib around the costoclavicular joint in one case.. In patients with severe brain lesions suffering from shoulder pain and moderate limitation of joint movements, POAs of the clavicular region are rare but should be considered.

Topics: Adult; Brain Injuries; Central Nervous System Diseases; Clavicle; Contrast Media; Diagnosis, Differential; Encephalomyelitis, Acute Disseminated; Female; Humans; Iothalamate Meglumine; Male; Middle Aged; Ossification, Heterotopic; Osteoarthritis; Radiographic Image Enhancement; Range of Motion, Articular; Severity of Illness Index; Shoulder Joint; Shoulder Pain; Tomography, Spiral Computed; Tomography, X-Ray Computed