Development and Preliminary Validation of a Digital Overlay-based Learning Module for Semiquantitative Evaluation of Magnetic Resonance Imaging Lesions in Osteoarthritis of the Hip

Walter P Maksymowych; Meaghan Pitts; Matthew J Budak; David Gracey; Robert G Lambert; David McDougall; Marcus Pianta; Winston J Rennie; Stephanie Wichuk; Naomi Winn; Jacob L Jaremko

doi:10.3899/jrheum.141574

Development and Preliminary Validation of a Digital Overlay-based Learning Module for Semiquantitative Evaluation of Magnetic Resonance Imaging Lesions in Osteoarthritis of the Hip

J Rheumatol. 2016 Jan;43(1):232-8. doi: 10.3899/jrheum.141574. Epub 2015 Jun 15.

Affiliations

¹ From the Departments of Medicine and Radiology, University of Alberta, Edmonton, Alberta, Canada; Craigavon Area Hospital, Southern Health and Social Care Trust, Craigavon, UK; St. Vincent's Hospital, Victoria, Australia; University Hospitals of Leicester, Leicester; University of Manchester, Manchester, UK.W.P. Maksymowych, FRCPC, Professor, Department of Medicine, University of Alberta; M. Pitts, FRCPC, Fellow, Department of Radiology, University of Alberta; M.J. Budak, FRCPC, Fellow, Department of Radiology, University of Alberta; D. Gracey, FRCR, Consultant Radiologist, Craigavon Area Hospital, Southern Health and Social Care Trust; R.G. Lambert, FRCPC, Professor, Department of Radiology, University of Alberta; D. McDougall, FRCPC, Fellow, Department of Radiology, University of Alberta; M. Pianta, FRCR, Consultant Radiologist, St. Vincent's Hospital, Victoria, Australia; W.J. Rennie, FRCR, Consultant Radiologist, University Hospitals of Leicester; S. Wichuk, BSc, Research Associate, Department of Medicine, University of Alberta; N. Winn, FRCR, Consultant Radiologist, University of Manchester; J.L. Jaremko, FRCPC, Assistant Professor, Department of Radiology, University of Alberta. [email protected].
² From the Departments of Medicine and Radiology, University of Alberta, Edmonton, Alberta, Canada; Craigavon Area Hospital, Southern Health and Social Care Trust, Craigavon, UK; St. Vincent's Hospital, Victoria, Australia; University Hospitals of Leicester, Leicester; University of Manchester, Manchester, UK.W.P. Maksymowych, FRCPC, Professor, Department of Medicine, University of Alberta; M. Pitts, FRCPC, Fellow, Department of Radiology, University of Alberta; M.J. Budak, FRCPC, Fellow, Department of Radiology, University of Alberta; D. Gracey, FRCR, Consultant Radiologist, Craigavon Area Hospital, Southern Health and Social Care Trust; R.G. Lambert, FRCPC, Professor, Department of Radiology, University of Alberta; D. McDougall, FRCPC, Fellow, Department of Radiology, University of Alberta; M. Pianta, FRCR, Consultant Radiologist, St. Vincent's Hospital, Victoria, Australia; W.J. Rennie, FRCR, Consultant Radiologist, University Hospitals of Leicester; S. Wichuk, BSc, Research Associate, Department of Medicine, University of Alberta; N. Winn, FRCR, Consultant Radiologist, University of Manchester; J.L. Jaremko, FRCPC, Assistant Professor, Department of Radiology, University of Alberta.

PMID: 26077400
DOI: 10.3899/jrheum.141574

Abstract

Objective: To develop and validate a knowledge transfer (KT) module aimed at enhancing feasibility and reliability of semiquantitative assessment of bone marrow lesions (BML) and synovitis-effusion using the Hip Inflammation Magnetic Resonance Imaging Scoring System (HIMRISS).

Methods: Three radiologists naive to the HIMRISS method reviewed the manuscript describing the method and then scored MRI scans from 16 patients with hip OA obtained at baseline and 8 weeks after intraarticular injection of corticosteroid. Readers then reviewed a KT module comprising an instructional presentation and 8 reference DICOM (digital imaging and communications in medicine) cases scored by 3 readers with expertise in the HIMRISS method, and then used electronic overlay software to score scans from 23 patients with OA. The same format was followed with a second group of 3 readers naive to HIMRISS using a KT module revised to incorporate the overlay with a Web-based DICOM viewer to enhance feasibility. Interobserver reliability was assessed with the intraclass correlation coefficient (ICC).

Results: In both exercises, reliability for baseline scores was excellent for femoral BML, very good for acetabular BML, and good for synovitis-effusion (overall ICC = 0.91, 0.89, 0.62, respectively) even without prior calibration using the KT module. However, reliability for detecting change was substantially worse than for expert readers, especially for acetabular BML and synovitis-effusion (overall ICC = 0.59 vs 0.19, and 0.42 vs 0.25, respectively). Reliability improved for detection of change in these lesions, especially after reader calibration with the revised KT module.

Conclusion: Development and validation of a systematic method for KT may enhance external validation of certain imaging instruments.

Keywords: INFLAMMATION; INSTRUMENT; KNOWLEDGE TRANSFER; MAGNETIC RESONANCE IMAGING; OSTEOARTHRITIS; VALIDATION.

Publication types

Comparative Study
Evaluation Study
Validation Study

MeSH terms

Aged
Education, Medical / methods
Female
Humans
Image Interpretation, Computer-Assisted*
Magnetic Resonance Imaging / methods*
Male
Middle Aged
Osteoarthritis, Hip / pathology*
Sensitivity and Specificity
Severity of Illness Index*