Reliability of a Novel Semiautomated Ultrasound Segmentation Technique for Assessing Average Regional Femoral Articular Cartilage Thickness

in Journal of Sport Rehabilitation
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Context: Ultrasound imaging is a clinically feasible tool to assess femoral articular cartilage and may have utility in tracking early knee osteoarthritis development. Traditional assessment techniques focus on measurements at a single location, which can be challenging to adopt for novice raters. Objective: To introduce a novel semiautomated ultrasound segmentation technique and determine the intrarater and interrater reliability of average regional femoral articular cartilage thickness and echo intensity of a novice and expert rater. Design: Descriptive observational study. Setting: Orthopedic clinic. Patients or Other Participants: Fifteen participants (mean [SD]; age 23.5 [4.6] y, height = 172.6 [9.3] cm, mass = 79.8 [15.7] kg) with a unilateral history of anterior cruciate ligament reconstruction participated. Intervention: None. Main Outcome Measures: One rater captured anterior femoral cartilage images of the participants’ contralateral knees using a transverse suprapatellar ultrasound assessment. The total femoral cartilage cross-sectional area of each image was segmented by a novice and expert rater. A novel custom program automatically separated the cartilage segmentations into medial, lateral, and intercondylar regions to determine the cross-sectional area and cartilage length. The average cartilage thickness in each region was calculated by dividing the cross-sectional area by the cartilage length. Echo intensity was calculated as the average gray-scale pixel value of each region. Two-way random effect intraclass correlations coefficient (ICC) for absolute agreement were used to determine the interrater reliability between a novice and expert rater, as well as the intrarater reliability of the novice rater. Results: The novice rater demonstrated excellent intrarater (ICC [2,k] range = .993–.997) and interrater (ICC [2,k] range = .944–.991) reliability with the expert rater of all femoral articular cartilage average thickness and echo intensity regions. Conclusions: The novel semiautomated average cartilage thickness and echo-intensity assessment is efficient, systematic, and reliable between an expert and novice rater with minimal training.

Lisee and Kuenze are with the Department of Kinesiology, College of Education, Michigan State University, East Lansing, MI, USA. McGrath is with the School of Integrative Physiology and Athletic Training, College of Health Professions and Biomedical Sciences, University of Montana, Missoula, MT, USA. Kuenze is with the Department of Orthopedics, College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA. Zhang is with the Department of Computer Science & Networking, Wentworth Institute of Technology, Boston, MA, USA. Zhang, Driban, and Harkey are with the Division of Rheumatology, Allergy & Immunology, Tufts Medical Center, Boston, MA, USA. Salzler is with the Department of Orthopaedics, Tufts Medical Center, Boston, MA, USA. Harkey is also with the Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA.

Lisee (liseecar@msu.edu) is corresponding author.

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