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Published on: December 9, 2015
Reliability of serial bone scintigraphy classification according to Conway in Legg-Calvé-Perthes disease
Anja Van Campenhout1, Pierre Moens, Guy Fabry
1Department of Orthopaedics, University Hospitals Leuven, Pellenberg, Belgium. anja.vancampenhout@uz.kuleuven.ac.be
Insights
Serial bone scintigraphy for Legg-Calvé-Perthes disease (LCP) shows moderate reliability. This early prognostic tool
Area of Science:
- Pediatric Orthopedics
- Nuclear Medicine
- Skeletal Imaging
Background:
- Legg-Calvé-Perthes disease (LCP) is a hip disorder affecting children.
- Serial bone scintigraphy is utilized for early prognosis in LCP.
- No prior studies have assessed the reliability of scintigraphic classifications for LCP.
Purpose of the Study:
- To evaluate the intra- and inter-observer reliability of the Conway classification for serial bone scintigraphy in Legg-Calvé-Perthes disease.
- To compare the reliability of scintigraphic classification with established radiological methods.
Main Methods:
- Forty pediatric hips diagnosed with LCP disease underwent serial technetium scintigraphy.
- Six observers independently classified the scintigraphic patterns twice, with a minimum one-month interval.
- Unweighted kappa coefficients were calculated to determine reliability.
Main Results:
- Moderate intra-observer reliability was found (kappa = 0.573).
- Moderate inter-observer reliability was observed (kappa = 0.525).
- Scintigraphic reliability was superior to Catterall classification and head-at-risk factors but inferior to Herring classification.
Conclusions:
- Serial bone scintigraphy for LCP demonstrates only moderate intra- and inter-observer reliability.
- While useful for early prognosis, the Conway classification's reliability necessitates careful consideration.
- Further refinement of scintigraphic assessment criteria may be warranted to improve diagnostic consistency.
Abstract:
Serial bone scintigraphy in Legg-Calvé-Perthes disease (LCP) has a good early prognostic value. So far, no intra- and inter-observer reliability study on this classification has been published. Serial technetium scintigraphy of the hips was performed in 40 children with LCP disease, and the hips were classified based on their scintigraphic patterns according to Conway. Forty hips were classified twice by six observers. The two assessments were made in a different order, with a minimum time interval of one month. Unweighted kappa coefficients were calculated. Only moderate reliability was measured: intra-observer reliability: kappa = 0.573 and inter-observer reliability: kappa = 0.525. Serial bone scintigraphy in LCP has an inter- and intra-observer reliability that is only moderate. The reliability is better than that observed for the radiological Catterall classification and head-at-risk factors, but worse than the reliability of the radiological Herring classification.
