Abstract：
OBJECTIVE: To assess the applicability of a semiquantitative index for symptomatic minor instability of the lateral elbow (SMILE).
METHODS: CT arthrograms of consecutive patients with lateral elbow pain who underwent ultrasound-guided CT arthrography at our orthopedic center between April 2019 and May 2022 were included. Images were acquired at 100 kVp and 80 mAs. An expert radiologist (R1) and a radiology resident (R2) retrospectively performed an independent, blinded evaluation of the arthrograms to assess the presence of imaging findings suggestive of elbow instability. The SMILE index (0-8) was obtained adding (I) radial head chondromalacia (0 - 1); (II) humeral capitellum chondromalacia (0 - 1); (III) humeral trochlear ridge chondromalacia (0 - 1); (IV) annular ligament laxity (0 - 2); (V) synovial thickening (0 - 1); (VI) humeroradial joint asymmetry (0 - 1); and (VII) capsular tear (0 - 1). R1 repeated the assessment after 14 days. Cohen\'s weighted κ statistic and raw concordance were used to appraise reproducibility.
RESULTS: Eighty patients (median age 49 years, interquartile range 40-53 years, 49, 61% males) underwent CT arthrography at our center, and 10 (12%) of them underwent bilateral elbow examination, leading to 90 included CT arthrograms. Median SMILE index was 4 (IQR: 2-5) for R1, 4 (IQR: 2-5) for R2, and 4 (IQR: 2-5) for the second assessment by R1. Intra-reader agreement was excellent (κ = 0.94, concordance 87%), while inter-reader agreement was substantial (κ = 0.75, concordance 67%).
CONCLUSIONS: The proposed SMILE index showed good reproducibility; further studies are warranted to correlate our index with clinical and surgical data.
CONCLUSIONS: Our scoring system allows a standardized evaluation of patients with lateral elbow pain and instability suitable for application into clinical practice, complementing the orthopedic surgeon\'s clinical diagnosis with imaging findings that may aid treatment choices.
CONCLUSIONS: • Lateral elbow pain is often interpreted clinically as lateral epicondylitis, but it can also encompass intra-articular pathology. • The proposed arthrographic index allows comprehensive quantification of lateral elbow pathology with good reproducibility and application times. • Our index provides the orthopedic surgeon with information regarding intra-articular findings, aiding treatment choices.
METHODS: CT arthrograms of consecutive patients with lateral elbow pain who underwent ultrasound-guided CT arthrography at our orthopedic center between April 2019 and May 2022 were included. Images were acquired at 100 kVp and 80 mAs. An expert radiologist (R1) and a radiology resident (R2) retrospectively performed an independent, blinded evaluation of the arthrograms to assess the presence of imaging findings suggestive of elbow instability. The SMILE index (0-8) was obtained adding (I) radial head chondromalacia (0 - 1); (II) humeral capitellum chondromalacia (0 - 1); (III) humeral trochlear ridge chondromalacia (0 - 1); (IV) annular ligament laxity (0 - 2); (V) synovial thickening (0 - 1); (VI) humeroradial joint asymmetry (0 - 1); and (VII) capsular tear (0 - 1). R1 repeated the assessment after 14 days. Cohen\'s weighted κ statistic and raw concordance were used to appraise reproducibility.
RESULTS: Eighty patients (median age 49 years, interquartile range 40-53 years, 49, 61% males) underwent CT arthrography at our center, and 10 (12%) of them underwent bilateral elbow examination, leading to 90 included CT arthrograms. Median SMILE index was 4 (IQR: 2-5) for R1, 4 (IQR: 2-5) for R2, and 4 (IQR: 2-5) for the second assessment by R1. Intra-reader agreement was excellent (κ = 0.94, concordance 87%), while inter-reader agreement was substantial (κ = 0.75, concordance 67%).
CONCLUSIONS: The proposed SMILE index showed good reproducibility; further studies are warranted to correlate our index with clinical and surgical data.
CONCLUSIONS: Our scoring system allows a standardized evaluation of patients with lateral elbow pain and instability suitable for application into clinical practice, complementing the orthopedic surgeon\'s clinical diagnosis with imaging findings that may aid treatment choices.
CONCLUSIONS: • Lateral elbow pain is often interpreted clinically as lateral epicondylitis, but it can also encompass intra-articular pathology. • The proposed arthrographic index allows comprehensive quantification of lateral elbow pathology with good reproducibility and application times. • Our index provides the orthopedic surgeon with information regarding intra-articular findings, aiding treatment choices.
摘要：
目的：评估半定量指标对有症状的轻度肘关节外侧不稳定（SMILE）的适用性。
方法：纳入2019年4月至2022年5月在我们的骨科中心接受超声引导CT关节造影的连续肘部外侧疼痛患者的CT关节造影。在100kVp和80mAs下获取图像。放射科专家（R1）和放射科住院医师（R2）回顾性地进行了独立的，对关节造影进行盲法评估，以评估是否存在提示肘关节不稳定的影像学发现。获得的SMILE指数（0-8）加上（I）radial头软骨软化症（0-1）；（II）肱骨小头软骨软化症（0-1）；（III）肱骨滑车脊软骨软化症（0-1）；（IV）环状韧带松弛（0-2）；（V）滑膜增厚（0-1）；（VI-1）关节不R1在14天后重复评估。Cohen的加权κ统计量和原始一致性用于评估可重复性。
结果：80名患者（平均年龄49岁，四分位数间距40-53年，49，61%的男性)在我们中心接受了CT关节造影，其中10人(12%)接受了双侧肘部检查，导致90包括CT关节造影。R1的中位SMILE指数为4（IQR：2-5），R2为4（IQR：2-5），R1的第二次评估为4（IQR：2-5）。读者内部一致性非常好(κ=0.94，一致性87%)，而读者之间的一致性是相当大的(κ=0.75，一致性67%)。
结论：建议的SMILE指数显示出良好的可重复性；需要进一步的研究将我们的指数与临床和手术数据相关联。
结论：我们的评分系统允许对肘部外侧疼痛和不稳定患者进行标准化评估，适合应用于临床实践，补充整形外科医生的临床诊断与影像学发现，可能有助于治疗选择。
结论：•肘关节外侧疼痛在临床上通常被解释为外上髁炎，但它也可以包括关节内病理。•所提出的关节造影指数允许以良好的再现性和应用时间对肘关节外侧病变进行全面量化。•我们的索引为整形外科医生提供有关关节内发现的信息，帮助治疗选择。
方法：纳入2019年4月至2022年5月在我们的骨科中心接受超声引导CT关节造影的连续肘部外侧疼痛患者的CT关节造影。在100kVp和80mAs下获取图像。放射科专家（R1）和放射科住院医师（R2）回顾性地进行了独立的，对关节造影进行盲法评估，以评估是否存在提示肘关节不稳定的影像学发现。获得的SMILE指数（0-8）加上（I）radial头软骨软化症（0-1）；（II）肱骨小头软骨软化症（0-1）；（III）肱骨滑车脊软骨软化症（0-1）；（IV）环状韧带松弛（0-2）；（V）滑膜增厚（0-1）；（VI-1）关节不R1在14天后重复评估。Cohen的加权κ统计量和原始一致性用于评估可重复性。
结果：80名患者（平均年龄49岁，四分位数间距40-53年，49，61%的男性)在我们中心接受了CT关节造影，其中10人(12%)接受了双侧肘部检查，导致90包括CT关节造影。R1的中位SMILE指数为4（IQR：2-5），R2为4（IQR：2-5），R1的第二次评估为4（IQR：2-5）。读者内部一致性非常好(κ=0.94，一致性87%)，而读者之间的一致性是相当大的(κ=0.75，一致性67%)。
结论：建议的SMILE指数显示出良好的可重复性；需要进一步的研究将我们的指数与临床和手术数据相关联。
结论：我们的评分系统允许对肘部外侧疼痛和不稳定患者进行标准化评估，适合应用于临床实践，补充整形外科医生的临床诊断与影像学发现，可能有助于治疗选择。
结论：•肘关节外侧疼痛在临床上通常被解释为外上髁炎，但它也可以包括关节内病理。•所提出的关节造影指数允许以良好的再现性和应用时间对肘关节外侧病变进行全面量化。•我们的索引为整形外科医生提供有关关节内发现的信息，帮助治疗选择。
