How consistent are clinicians in grading APJ OA on rads and CBCT?

VRU 2023- 64(4): 585-592

December 18, 2023

Interobserver agreement of lateral and oblique radiography and standing cone beam CT of the caudal cervical articular process joints of horses

Background: Caudal cervical articular process joint osteoarthritis (CAPJ OA) is a common cause of poor performance in horses, but the diagnosis can be challenging due to the limitations of imaging modalities.

Study: This study investigated the interobserver agreement between clinicians and modalities in grading the severity of CAPJ OA on lateral and oblique radiographs and standing cone beam computed tomography (CBCT).

Methods: Seventeen horses underwent lateral and oblique radiography and CBCT of the CAPJs of C5-C6 and C6-C7. Four blinded specialists graded the images using 3-point scales. Cohen’s kappa analysis was used to evaluate the interobserver agreement and the agreement between modalities.

Results: Agreement between clinicians’ grades was moderate for lateral radiographs (0.49), and fair for oblique radiographs (0.23) and CBCT (0.36). Agreement between grades of CAPJ OA was fair for all pairs of modalities. There was a higher likelihood of observing higher grades with lateral radiographs than with CBCT or oblique radiographs, and a higher likelihood of observing higher grades at C6-C7 than at C5-C6.

Limitations: The study used unvalidated grading schemes for oblique radiographs and CBCT, and did not include post-mortem evaluation for comparison. The study also did not explore the correlation between imaging findings and clinical signs of CAPJ OA.

Conclusions: The study revealed that the interpretation of CAPJ OA on radiographs and CBCT is variable among clinicians and modalities, and that lateral radiographs may overestimate the degree of CAPJ OA. The study suggests the need for improved diagnostic criteria and objective measures for grading CAPJ OA.

Lateral radiographic image of C6-C7 in which half of the observers considered this image to be consistent with moderate to severe (grade 3) CAPJ OA and half of the observers considered this image to be consistent with mild (grade 2) CAPJ OA. Acquired with 90 kVp, 40 mAs, using a 10:1 grid (Canon, Version 2.16.0.31, Canon, Glen Mills, PA).

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