TY - JOUR
T1 - Evaluation of accuracy of plain radiography in determining the Risser stage and identification of common sources of errors
AU - Yang, Jae Hyuk
AU - Bhandarkar, Amit Wasudeo
AU - Suh, Seung Woo
AU - Hong, Jae Young
AU - Hwang, Jin Ho
AU - Ham, Chang Hwa
N1 - Funding Information:
This study was supported by a grant from the Korea Healthcare Technology R&D project, Ministry for Health, Welfare & Family Affairs, Republic of Korea (A110416). The authors would like to thank the Ministry of Health, Welfare & Family Affairs for allowing them to perform this research.
PY - 2014/11/19
Y1 - 2014/11/19
N2 - BACKGROUND: Risser's sign is an established radiological marker for predicting growth potential in adolescent idiopathic scoliosis, but the accuracy of Risser's staging has been debated. This research was designed to evaluate the accuracy of Risser's staging and to identify causes of errors in Risser's staging.MATERIALS AND METHODS: Plain radiographs of 89 adolescent idiopathic scoliosis patients were evaluated for Risser's stage using both the Original and French methods. A three-dimensional computed tomography (3D-CT) was used to evaluate the accuracy of the plain radiographs. Inter- and intra-observer reliability of both methods was assessed on radiographs and 3D-CT images using weighted kappa statistics. The concordance rate for Risser's staging between plain radiographs and 3D-CT images were calculated. The various sources of staging differences between the two imaging methods were noted, grouped, and analyzed to identify common error patterns.RESULTS: Intra- and inter-observer staging reliabilities on plain radiography were 0.91 and 0.94, respectively, using the Original method and 0.91 and 0.92, respectively, using the French method. Intra- and inter-observer reliabilities on 3D-CT were 0.98 and 0.99, respectively, using the Original method and 0.97 and 0.99, respectively, using the French method. Mean concordance rates between plain radiography and 3D-CT were 59.76% and 67.42% using the Original and French methods, respectively. Common sources of error leading to misinterpretation of Risser's staging were miscalculation of apophysis excursion, skip ossification, isolated non-linear ossification, micro-fusion, and pseudo-fusion.CONCLUSIONS: Risser's staging by plain radiography is reliable but not accurate. Variations in the iliac apophysis ossification and misinterpretation of apophysis fusion are the main sources of error.
AB - BACKGROUND: Risser's sign is an established radiological marker for predicting growth potential in adolescent idiopathic scoliosis, but the accuracy of Risser's staging has been debated. This research was designed to evaluate the accuracy of Risser's staging and to identify causes of errors in Risser's staging.MATERIALS AND METHODS: Plain radiographs of 89 adolescent idiopathic scoliosis patients were evaluated for Risser's stage using both the Original and French methods. A three-dimensional computed tomography (3D-CT) was used to evaluate the accuracy of the plain radiographs. Inter- and intra-observer reliability of both methods was assessed on radiographs and 3D-CT images using weighted kappa statistics. The concordance rate for Risser's staging between plain radiographs and 3D-CT images were calculated. The various sources of staging differences between the two imaging methods were noted, grouped, and analyzed to identify common error patterns.RESULTS: Intra- and inter-observer staging reliabilities on plain radiography were 0.91 and 0.94, respectively, using the Original method and 0.91 and 0.92, respectively, using the French method. Intra- and inter-observer reliabilities on 3D-CT were 0.98 and 0.99, respectively, using the Original method and 0.97 and 0.99, respectively, using the French method. Mean concordance rates between plain radiography and 3D-CT were 59.76% and 67.42% using the Original and French methods, respectively. Common sources of error leading to misinterpretation of Risser's staging were miscalculation of apophysis excursion, skip ossification, isolated non-linear ossification, micro-fusion, and pseudo-fusion.CONCLUSIONS: Risser's staging by plain radiography is reliable but not accurate. Variations in the iliac apophysis ossification and misinterpretation of apophysis fusion are the main sources of error.
UR - http://www.scopus.com/inward/record.url?scp=85017330368&partnerID=8YFLogxK
U2 - 10.1186/s13018-014-0101-8
DO - 10.1186/s13018-014-0101-8
M3 - Article
C2 - 25407253
AN - SCOPUS:85017330368
SN - 1749-799X
VL - 9
SP - 101
JO - Journal of Orthopaedic Surgery and Research
JF - Journal of Orthopaedic Surgery and Research
ER -