Abstract：
BACKGROUND: Catastrophic injury has a low incidence but leads to the death of many Thoroughbred racehorses.
OBJECTIVE: To determine sensitivity, specificity, and reliability for third metacarpal condylar stress fracture risk assessment from digital radiographs (DR) and standing computed tomography (sCT).
METHODS: Controlled ex vivo experiment.
METHODS: A blinded set of metacarpophalangeal joint DR and sCT images were prepared from 31 Thoroughbreds. Four observers evaluated the condyles and parasagittal grooves (PSG) of the third metacarpal bone for the extent of dense bone and lucency/fissure and assigned a risk assessment grade for condylar stress fracture based on imaging features. Sensitivity and specificity for detection of subchondral structural changes in the condyles and PSG, and for risk assessment for condylar stress fracture were determined by comparison with a reference assessment based on sCT and joint surface examination. Agreement between observers and the reference assessment and reliability between observers were determined. Intra-observer repeatability was also assessed.
RESULTS: Sensitivity for detection of structural change was lower than specificity for both imaging methods and all observers. For agreement with the reference assessment of structural change, correlation coefficients were generally below 0.5 for DR and 0.49-0.82 for sCT. For horses categorised as normal risk on reference assessment, observer assessment often agreed with the reference. Sensitivity for risk assessment was lower than specificity for all observers. For horses with a reference assessment of high risk of injury, observers generally underestimated risk. Diagnostic sensitivity of risk assessment was improved with sCT imaging, particularly for horses categorised as having elevated risk of injury from the reference assessment. Assessment repeatability and reliability was better with sCT than DR.
CONCLUSIONS: The ex vivo study design influenced DR image sets.
CONCLUSIONS: Risk assessment through screening with diagnostic imaging is a promising approach to improve injury prevention in racing Thoroughbreds. Knowledge of sensitivity and specificity of fetlock lesion detection provides the critical guidance needed to improve racehorse screening programs. We found improved detection of MC3 subchondral structural change and risk assessment for condylar stress fracture with sCT ex vivo.
OBJECTIVE: To determine sensitivity, specificity, and reliability for third metacarpal condylar stress fracture risk assessment from digital radiographs (DR) and standing computed tomography (sCT).
METHODS: Controlled ex vivo experiment.
METHODS: A blinded set of metacarpophalangeal joint DR and sCT images were prepared from 31 Thoroughbreds. Four observers evaluated the condyles and parasagittal grooves (PSG) of the third metacarpal bone for the extent of dense bone and lucency/fissure and assigned a risk assessment grade for condylar stress fracture based on imaging features. Sensitivity and specificity for detection of subchondral structural changes in the condyles and PSG, and for risk assessment for condylar stress fracture were determined by comparison with a reference assessment based on sCT and joint surface examination. Agreement between observers and the reference assessment and reliability between observers were determined. Intra-observer repeatability was also assessed.
RESULTS: Sensitivity for detection of structural change was lower than specificity for both imaging methods and all observers. For agreement with the reference assessment of structural change, correlation coefficients were generally below 0.5 for DR and 0.49-0.82 for sCT. For horses categorised as normal risk on reference assessment, observer assessment often agreed with the reference. Sensitivity for risk assessment was lower than specificity for all observers. For horses with a reference assessment of high risk of injury, observers generally underestimated risk. Diagnostic sensitivity of risk assessment was improved with sCT imaging, particularly for horses categorised as having elevated risk of injury from the reference assessment. Assessment repeatability and reliability was better with sCT than DR.
CONCLUSIONS: The ex vivo study design influenced DR image sets.
CONCLUSIONS: Risk assessment through screening with diagnostic imaging is a promising approach to improve injury prevention in racing Thoroughbreds. Knowledge of sensitivity and specificity of fetlock lesion detection provides the critical guidance needed to improve racehorse screening programs. We found improved detection of MC3 subchondral structural change and risk assessment for condylar stress fracture with sCT ex vivo.
摘要：
背景：灾难性损伤发生率低，但导致许多纯种赛马死亡。
目的：为了确定灵敏度，特异性，从数字X光片（DR）和站立计算机断层扫描（sCT）评估第三掌骨髁突应力性骨折风险的可靠性。
方法:对照离体实验。
方法：从31只纯种犬准备了一组盲的掌指关节DR和sCT图像。四名观察者评估了第三掌骨的髁和矢状旁沟（PSG）的致密骨和通畅/裂隙的程度，并根据影像学特征分配了髁应力性骨折的风险评估等级。检测髁和PSG软骨下结构变化的敏感性和特异性，通过与基于sCT和关节表面检查的参考评估进行比较，确定了con突应力骨折的风险评估。确定了观察员之间的协议和参考评估以及观察员之间的可靠性。还评估了观察者内部的可重复性。
结果：对于两种成像方法和所有观察者，检测结构变化的灵敏度均低于特异性。为了与结构变化的参考评估达成一致，DR的相关系数通常低于0.5，sCT的相关系数通常低于0.49-0.82。对于在参考评估中被归类为正常风险的马，观察者的评估通常与参考意见一致。所有观察者的风险评估敏感性均低于特异性。对于具有高受伤风险参考评估的马，观察人士普遍低估了风险。sCT成像提高了风险评估的诊断敏感性，特别是对于从参考评估中被归类为受伤风险升高的马。sCT评估的可重复性和可靠性优于DR。
结论：离体研究设计影响DR图像集。
结论：通过诊断影像学筛查进行风险评估是改善赛马纯种伤害预防的一种有希望的方法。了解fetlock病变检测的敏感性和特异性提供了改进赛马筛查计划所需的关键指导。我们发现改进的MC3软骨下结构变化的检测和sCT离体髁突应力性骨折的风险评估。
目的：为了确定灵敏度，特异性，从数字X光片（DR）和站立计算机断层扫描（sCT）评估第三掌骨髁突应力性骨折风险的可靠性。
方法:对照离体实验。
方法：从31只纯种犬准备了一组盲的掌指关节DR和sCT图像。四名观察者评估了第三掌骨的髁和矢状旁沟（PSG）的致密骨和通畅/裂隙的程度，并根据影像学特征分配了髁应力性骨折的风险评估等级。检测髁和PSG软骨下结构变化的敏感性和特异性，通过与基于sCT和关节表面检查的参考评估进行比较，确定了con突应力骨折的风险评估。确定了观察员之间的协议和参考评估以及观察员之间的可靠性。还评估了观察者内部的可重复性。
结果：对于两种成像方法和所有观察者，检测结构变化的灵敏度均低于特异性。为了与结构变化的参考评估达成一致，DR的相关系数通常低于0.5，sCT的相关系数通常低于0.49-0.82。对于在参考评估中被归类为正常风险的马，观察者的评估通常与参考意见一致。所有观察者的风险评估敏感性均低于特异性。对于具有高受伤风险参考评估的马，观察人士普遍低估了风险。sCT成像提高了风险评估的诊断敏感性，特别是对于从参考评估中被归类为受伤风险升高的马。sCT评估的可重复性和可靠性优于DR。
结论：离体研究设计影响DR图像集。
结论：通过诊断影像学筛查进行风险评估是改善赛马纯种伤害预防的一种有希望的方法。了解fetlock病变检测的敏感性和特异性提供了改进赛马筛查计划所需的关键指导。我们发现改进的MC3软骨下结构变化的检测和sCT离体髁突应力性骨折的风险评估。
