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成人の後天性扁平足変形症における体重支持型X線写真とコーンビームCT検査
Weight-bearing radiographs and cone-beam computed tomography examinations in adult acquired flatfoot deformity.
PMID: 32475795 DOI: 10.1016/j.fas.2020.04.011.
抄録
背景:
成人後天性扁平足変形（AAFD）の2次元X線写真上での最適な特性評価は困難な場合があります。重量支持型コーンビームCT(CBCT)は、このような動的変形の3次元(3D)構造の詳細の特徴付けを改善する可能性がある。我々は、重さを伴うX線写真と重さを伴うCBCT画像の間でAAFDの測定値を比較し、検証した。
BACKGROUND: Optimal characterization of Adult acquired flatfoot deformity (AAFD) on two-dimensional radiograph can be challenging. Weightbearing Cone Beam CT (CBCT) may improve characterization of the three-dimensional (3D) structural details of such dynamic deformity. We compared and validated AAFD measurements between weightbearing radiograph and weightbearing CBCT images.
方法:
臨床的に柔軟性のあるAAFDと診断された患者20名（20フィート、右/左：15/5、男性/女性：12/8、平均年齢：52.2歳）をプロスペクティブに募集し、体重をかけて背側板（DP）と側方のX線写真、および体重をかけてCBCTを実施した。2名の足部外科医と足関節外科医が、副矢状面と軸方向面でAAFD測定を行った（側方X線写真とDPX線写真）。観察者内および観察者間の信頼度は、クラス内相関（ICC）およびCohenのカッパにより算出した。また、体重支持型X線写真と体重支持型CBCTの測定値の平均値も比較した。
METHODS: 20 patients (20 feet, right/left: 15/5, male/female: 12/8, mean age: 52.2) with clinical diagnosis of flexible AAFD were prospectively recruited and underwent weightbearing dorsoplantar (DP) and lateral radiograph as well as weightbearing CBCT. Two foot and ankle surgeons performed AAFD measurements at parasagittal and axial planes (lateral and DP radiographs, respectively). Intra- and Inter-observer reliabilities were calculated by Intraclass correlation (ICC) and Cohen's kappa. Mean values of weightbearing radiograph and weightbearing CBCT measurements were also compared.
結果:
内側楔状第一中足骨角を除いて、体重支持型X線写真測定では適切な観察者間信頼性（範囲：0.61～0.96）が観察された。以下の測定では、体重支持型X線写真と体重支持型CBCT測定の間に中程度から非常に良好な観察者間信頼性が観察された。舟状角（ICC:0.47）、内側楔状第一中足骨-ギャップ（ICC:0.58）、立方体-床間距離（ICC:0.68）、踵骨傾斜角（ICC:0.7）、軸方向Talonavicular-coverage-angle（ICC:0.56）、軸方向Talus-第一中足骨-angle（ICC:0.62）の測定について、中程度の良好な観察者間信頼性が観察された。体重をかけたX線写真と体重をかけたCBCT画像を比較すると、傍矢状のTalus-first-metatatarsal-angle、medial-cuneiform-first-metatarsal-angle、medial-cuneiform-to-floor-distance、navicular-to-floor-distanceの平均値に統計学的に有意な差が観察された（P < 0.05）。
RESULTS: Except for medial-cuneiform-first-metatarsal-angle, adequate intra-observer reliability (range:0.61-0.96) was observed for weightbearing radiographic measurements. Moderate to very good interobserver reliability between weightbearing radiograph and weightbearing CBCT measurements were observed for the following measurements: Naviculocuneiform-angle (ICC:0.47), Medial-cuneiform-first-metatarsal-gapping (ICC:0.58), cuboid-to-floor-distance (ICC:0.68), calcaneal-inclination-angle(ICC:0.7), axial Talonavicular-coverage-angle(ICC:0.56), axial Talus-first-metatarsal-angle(ICC:0.62). Comparing weightbearing radiograph and weightbearing CBCT images, statistically significant differences in the mean values of parasagittal talus-first-metatarsal-angle, medial-cuneiform-first-metatarsal-angle, medial-cuneiform-to-floor-distance and navicular-to-floor-distance was observed (P < 0.05).
結論:
ある種の体重支持型X線写真と体重支持型CBCTの測定値の間には、中程度から非常に良好な相関関係が観察されたが、多くのAAFD測定値の間には有意差が観察された。
CONCLUSION: Moderate to very good correlation was observed between certain weightbearing radiograph and weightbearing CBCT measurements, however, significant difference was observed between a number of AAFD measurements, which suggest that 2D radiographic evaluation could potentially underestimate the severity of AAFD, when compared to 3D weightbearing CT assessment.
Copyright © 2020 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.