Is the EOS imaging system as accurate as conventional radiography in grading osteoarthritis of the knee?
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Is the EOS imaging system as accurate as conventional radiography in grading osteoarthritis of the knee? Vanessa Kristina Anna Koliogiannis 1 & Martina Brandlhuber 1 & Viktoria Messerschmidt 1 & Robert Stahl 2 & Carolin Melcher 3 & Regina Schinner 1 & Christof Birkenmaier 4 & Jens Ricke 1 & Andrea Baur-Melnyk 1 Received: 27 January 2020 / Revised: 2 July 2020 / Accepted: 12 August 2020 # European Society of Radiology 2020
Abstract Objectives The EOS imaging system allows for the acquirement of long-leg radiographic images in a standing position without stitching artifacts or projection bias and at a comparatively low-radiation-dose exposure. The aim of our study was to compare the accuracy of EOS images of the lower limb to conventional radiographs (CR) of the knee in a.p. view for the grading of osteoarthritis (OA). Methods One hundred forty-two patients who had undergone EOS of the lower limb and radiography of the knee on the same day were included. For the grading of OA, the Kellgren and Lawrence score (KL) score and the Osteoarthritis Research Society International (OARSI) system were used. Additionally, the joint space was measured and compared between the two techniques. EOS images were compared to conventional anteroposterior radiographs of the knee which constitute the gold standard. Results Measurements of the joint space showed very good intra-class correlation. The calculated weighted kappa for the KL score of EOS versus CR was excellent. The comparison of the different parameters of the OARSI score showed superb weighted kappa scores between 0.9 and 0.96 (α < 0.001) for the parameters osteophytes and joint space narrowing. The parameter deformity showed a good agreement between EOS and radiographs (sensitivity 93.6%; specificity 100%). For the sclerosis parameter, an overall sensitivity of 71.3% and a specificity of 99.3% were calculated. Conclusions The grading of OA using the KL score as well as the quantitative assessment of joint space width can be performed on EOS images in a.p. view as reliably as on CR. Subchondral sclerosis of the lateral and medial femur condyle or tibia is sometimes not as evident on EOS images. Key Points • Grading of OA may be performed as reliably with EOS images in a.p. view as with conventional radiographs in a.p. view. • EOS can be safely used for primary assessment of osteoarthritis of the knee. • In the preoperative setting for knee replacement surgery, conventional radiographs in two or three planes of the knee should still be acquired in addition to long-leg EOS images. Keywords X-rays . Osteoarthritis of knee . Diagnostic imaging . Radiography . Standing position
* Vanessa Kristina Anna Koliogiannis [email protected]
Abbreviations CR Conventional radiography KL Kellgren and Lawrence score OA Osteoarthritis OARSI Osteoarthritis Research Society International SD Standard deviation
1
Department of Radiology, University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
2
Department of Neuroradiology, University
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