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Inter- and intrareader variability in the interpretation of two radiographic classification systems for juvenile rheumatoid arthritis

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Abstract

Objective

To evaluate the inter- and intrareader variability for interpretation of a modified Larsen's radiographic classification system for juvenile rheumatoid arthritis (JRA) focused on osteochondral lesions and a conventional Larsen's classification system, compared to a reference MR scoring system of corresponding images.

Materials and methods

Seventy-five radiographs of 60 children with JRA, performed within a short interval of time from the MR examinations, were independently evaluated by three experienced radiologists, three diagnostic imaging residents and three rheumatologists, in two separate sessions, according to the two different classification methods, blinded to the corresponding MR images.

Results

The inter- and intrareader concordance rates between the two radiographic classification systems and the MR-related radiographs were respectively poor and poor/moderate. The interobserver range of weighted kappa values for the conventional and the modified Larsen's system respectively was 0.25–0.37 vs 0.19–0.39 for radiologists, 0.25–0.37 vs 0.18–0.30 for residents and 0.19–0.51 vs 0.17–0.29 for rheumatologists. The intrareader rate ranged from 0.17–0.55 for radiologists, 0.2–0.56 for residents, and 0.14–0.59 for rheumatologists.

Conclusion

Although the proposal of a new radiographic classification system for JRA focused on osteochondral abnormalities sounds promising, the low inter- and intrareader concordance rates with an MR-related radiographic system makes the clinical applicability of such a radiographic system less suitable.

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Acknowledgements

We thank Creusa Dal Bo for her help in the statistical analysis and Edson Amaro Jr, MD for his valuable suggestions. This work was partially supported by an award (salary support) to Andrea S. Doria, M.D., from FAPESP (Fundação de Amparo à Pesquisa do Estado de São Paulo).

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Authors and Affiliations

  1. Department of Diagnostic Imaging, Heart Institute (InCor) and Radiology Institute (InRad), Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brazil

    Andréa S. Doria, Cláudio C. de Castro, Renato A. Sernik, Luís F. Vitule, Paula R. Arantes, Leandro Lucato, Marco A. N. Germano & Giovanni G. Cerri

  2. Division of Rheumatology, Children's Institute, Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brazil

    Maria Helena B. Kiss

  3. Division of Rheumatology, Department of Pediatrics, Faculdade de Medicina da Universidade Federal de Uberlândia MG, Uberlândia, Brazil

    Carlos H. M. Silva

  4. Division of Rheumatology, Hospital Heliópolis, São Paulo, Brazil

    Cristiano A. F. Zerbini

Authors
  1. Andréa S. Doria
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  2. Cláudio C. de Castro
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  3. Maria Helena B. Kiss
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  4. Renato A. Sernik
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  5. Luís F. Vitule
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  6. Carlos H. M. Silva
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  7. Cristiano A. F. Zerbini
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  8. Paula R. Arantes
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  9. Leandro Lucato
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  10. Marco A. N. Germano
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  11. Giovanni G. Cerri
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Corresponding author

Correspondence to Andréa S. Doria.

Additional information

This manuscript was presented as a scientific exhibit at the 43rd SPR Meeting in Naples, Florida

A commentary onthis paper is available at http://dx.doi.org/10.1007/s00247-003-0957-y

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Doria, A.S., de Castro, C.C., Kiss, M.H.B. et al. Inter- and intrareader variability in the interpretation of two radiographic classification systems for juvenile rheumatoid arthritis. Pediatr Radiol 33, 673–681 (2003). https://doi.org/10.1007/s00247-003-0912-y

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  • DOI: https://doi.org/10.1007/s00247-003-0912-y

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