Diagnostic accuracy of digital radiography for the diagnosis of osteonecrosis of the femoral head, revisited

Choong Guen Chee, Jungheum Cho, Yu Suhn Kang, Youngjune Kim, Young Joon Lee, Joon Woo Lee, Joong Mo Ahn, Heung Sik Kang

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: The radiographic diagnosis of osteonecrosis of the femoral head (ONFH) is challenging for radiologists. Purpose: To measure the sensitivity and specificity of digital radiography for diagnosing ONFH and to evaluate the diagnostic value of the frog-leg view. Material and Methods: Patients diagnosed with ONFH by magnetic resonance imaging (MRI) (n = 132) and normal controls (n = 69) were included. Two radiologists independently graded the likelihood of ONFH and subchondral fracture on radiographs. First, the anteroposterior (AP) and frog-leg radiographs were assessed as a whole. Subsequently, randomly ordered unilaterally cropped AP radiographs were analyzed. Sensitivity and specificity were measured using MRI as reference standard. A subgroup analysis for pre-collapse ONFH was performed. The effect of within-subject correlation was analyzed using a generalized-estimating-equation approach. Inter-reader agreement was assessed with κ statistics. McNemar’s test was used to determine the additional diagnostic value of the frog-leg view. Results: Among the 402 hips from 201 individuals, 191 were classified as normal, 73 as pre-collapse ONFH, and 138 as post-collapse ONFH. The sensitivity and specificity ranges for ONFH were 76–89% and 77–97%, respectively. For pre-collapse ONFH, the sensitivity and specificity were 52–71% and 78–97%, respectively. The κ ranges for the likelihood of ONFH and pre-collapse ONFH were 0.59–0.66 and 0.35–0.59, respectively. The frog-leg view did not provide additional value for diagnosing ONFH. Conclusion: Diagnostic performance of digital radiography for ONFH revealed low sensitivity and poor-to-moderate inter-reader agreement for diagnosing pre-collapse ONFH. There was no additional value of the frog-leg view.

Original languageEnglish
Pages (from-to)969-976
Number of pages8
JournalActa Radiologica
Volume60
Issue number8
DOIs
StatePublished - 1 Aug 2019

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Radiographic Image Enhancement
Osteonecrosis
Thigh
Anura
Leg
Sensitivity and Specificity
Magnetic Resonance Imaging

Keywords

  • Osteonecrosis
  • digital radiography
  • hip
  • sensitivity and specificity

Cite this

@article{1cb95dea1f2144b6bbd77a0733962933,
title = "Diagnostic accuracy of digital radiography for the diagnosis of osteonecrosis of the femoral head, revisited",
abstract = "Background: The radiographic diagnosis of osteonecrosis of the femoral head (ONFH) is challenging for radiologists. Purpose: To measure the sensitivity and specificity of digital radiography for diagnosing ONFH and to evaluate the diagnostic value of the frog-leg view. Material and Methods: Patients diagnosed with ONFH by magnetic resonance imaging (MRI) (n = 132) and normal controls (n = 69) were included. Two radiologists independently graded the likelihood of ONFH and subchondral fracture on radiographs. First, the anteroposterior (AP) and frog-leg radiographs were assessed as a whole. Subsequently, randomly ordered unilaterally cropped AP radiographs were analyzed. Sensitivity and specificity were measured using MRI as reference standard. A subgroup analysis for pre-collapse ONFH was performed. The effect of within-subject correlation was analyzed using a generalized-estimating-equation approach. Inter-reader agreement was assessed with κ statistics. McNemar’s test was used to determine the additional diagnostic value of the frog-leg view. Results: Among the 402 hips from 201 individuals, 191 were classified as normal, 73 as pre-collapse ONFH, and 138 as post-collapse ONFH. The sensitivity and specificity ranges for ONFH were 76–89{\%} and 77–97{\%}, respectively. For pre-collapse ONFH, the sensitivity and specificity were 52–71{\%} and 78–97{\%}, respectively. The κ ranges for the likelihood of ONFH and pre-collapse ONFH were 0.59–0.66 and 0.35–0.59, respectively. The frog-leg view did not provide additional value for diagnosing ONFH. Conclusion: Diagnostic performance of digital radiography for ONFH revealed low sensitivity and poor-to-moderate inter-reader agreement for diagnosing pre-collapse ONFH. There was no additional value of the frog-leg view.",
keywords = "Osteonecrosis, digital radiography, hip, sensitivity and specificity",
author = "Chee, {Choong Guen} and Jungheum Cho and Kang, {Yu Suhn} and Youngjune Kim and Lee, {Young Joon} and Lee, {Joon Woo} and Ahn, {Joong Mo} and Kang, {Heung Sik}",
year = "2019",
month = "8",
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language = "English",
volume = "60",
pages = "969--976",
journal = "Acta Radiologica",
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Diagnostic accuracy of digital radiography for the diagnosis of osteonecrosis of the femoral head, revisited. / Chee, Choong Guen; Cho, Jungheum; Kang, Yu Suhn; Kim, Youngjune; Lee, Young Joon; Lee, Joon Woo; Ahn, Joong Mo; Kang, Heung Sik.

In: Acta Radiologica, Vol. 60, No. 8, 01.08.2019, p. 969-976.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Diagnostic accuracy of digital radiography for the diagnosis of osteonecrosis of the femoral head, revisited

AU - Chee, Choong Guen

AU - Cho, Jungheum

AU - Kang, Yu Suhn

AU - Kim, Youngjune

AU - Lee, Young Joon

AU - Lee, Joon Woo

AU - Ahn, Joong Mo

AU - Kang, Heung Sik

PY - 2019/8/1

Y1 - 2019/8/1

N2 - Background: The radiographic diagnosis of osteonecrosis of the femoral head (ONFH) is challenging for radiologists. Purpose: To measure the sensitivity and specificity of digital radiography for diagnosing ONFH and to evaluate the diagnostic value of the frog-leg view. Material and Methods: Patients diagnosed with ONFH by magnetic resonance imaging (MRI) (n = 132) and normal controls (n = 69) were included. Two radiologists independently graded the likelihood of ONFH and subchondral fracture on radiographs. First, the anteroposterior (AP) and frog-leg radiographs were assessed as a whole. Subsequently, randomly ordered unilaterally cropped AP radiographs were analyzed. Sensitivity and specificity were measured using MRI as reference standard. A subgroup analysis for pre-collapse ONFH was performed. The effect of within-subject correlation was analyzed using a generalized-estimating-equation approach. Inter-reader agreement was assessed with κ statistics. McNemar’s test was used to determine the additional diagnostic value of the frog-leg view. Results: Among the 402 hips from 201 individuals, 191 were classified as normal, 73 as pre-collapse ONFH, and 138 as post-collapse ONFH. The sensitivity and specificity ranges for ONFH were 76–89% and 77–97%, respectively. For pre-collapse ONFH, the sensitivity and specificity were 52–71% and 78–97%, respectively. The κ ranges for the likelihood of ONFH and pre-collapse ONFH were 0.59–0.66 and 0.35–0.59, respectively. The frog-leg view did not provide additional value for diagnosing ONFH. Conclusion: Diagnostic performance of digital radiography for ONFH revealed low sensitivity and poor-to-moderate inter-reader agreement for diagnosing pre-collapse ONFH. There was no additional value of the frog-leg view.

AB - Background: The radiographic diagnosis of osteonecrosis of the femoral head (ONFH) is challenging for radiologists. Purpose: To measure the sensitivity and specificity of digital radiography for diagnosing ONFH and to evaluate the diagnostic value of the frog-leg view. Material and Methods: Patients diagnosed with ONFH by magnetic resonance imaging (MRI) (n = 132) and normal controls (n = 69) were included. Two radiologists independently graded the likelihood of ONFH and subchondral fracture on radiographs. First, the anteroposterior (AP) and frog-leg radiographs were assessed as a whole. Subsequently, randomly ordered unilaterally cropped AP radiographs were analyzed. Sensitivity and specificity were measured using MRI as reference standard. A subgroup analysis for pre-collapse ONFH was performed. The effect of within-subject correlation was analyzed using a generalized-estimating-equation approach. Inter-reader agreement was assessed with κ statistics. McNemar’s test was used to determine the additional diagnostic value of the frog-leg view. Results: Among the 402 hips from 201 individuals, 191 were classified as normal, 73 as pre-collapse ONFH, and 138 as post-collapse ONFH. The sensitivity and specificity ranges for ONFH were 76–89% and 77–97%, respectively. For pre-collapse ONFH, the sensitivity and specificity were 52–71% and 78–97%, respectively. The κ ranges for the likelihood of ONFH and pre-collapse ONFH were 0.59–0.66 and 0.35–0.59, respectively. The frog-leg view did not provide additional value for diagnosing ONFH. Conclusion: Diagnostic performance of digital radiography for ONFH revealed low sensitivity and poor-to-moderate inter-reader agreement for diagnosing pre-collapse ONFH. There was no additional value of the frog-leg view.

KW - Osteonecrosis

KW - digital radiography

KW - hip

KW - sensitivity and specificity

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DO - 10.1177/0284185118808083

M3 - Article

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SP - 969

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JO - Acta Radiologica

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