Comparison of ultrasonographic and computed tomographic imaging of equine thoracolumbar articular process joints

Abstract

Background: Osteoarthritis of the equine thoracolumbar articular process joints (APJs) has been linked to back pain. Changes are commonly diagnosed through nuclear scintigraphy, radiography and ultrasonography (US). Objectives: (1) To assess the agreement of APJ grades between US and computed tomography (CT) images; (2) to assess the effect of location on the agreement of APJ grades between US and CT images. It was hypothesised that: (1) Periarticular modelling and modification of the joint space would have the highest and lowest agreement between US and CT images, respectively; (2) Caudal thoracolumbar APJ grades would have higher agreement between US and CT images than mid thoracic APJs. Study design: Comparative diagnostic imaging study using cadaveric specimens. Methods: Disarticulated thoracolumbar spines of six equids euthanised for reasons unrelated to back pain, underwent US and CT examination of the APJs. Images were assessed for periarticular modelling, modification of the joint space and enlargement of the APJ. Intra-observer, inter-modality and inter-observer agreement using multilevel weighted kappa statistics to evaluate the effects of location, US/CT characteristic and their interaction. Results: Intra-observer agreement of US and CT grades ranged from moderate to perfect. Between T15 and L1, inter-modality agreement (CT vs. US) for periarticular modelling was moderate, and fair for enlargement and modification of the joint space. Inter-observer agreement (US vs. US) of periarticular modelling was substantial between T15 and L1, moderate between L1 and L5 and fair between T10 and T15. Wide confidence intervals (CIs) seen for most grades apart from inter-observer grades of periarticular modelling at T15–L5, introducing a degree of uncertainty into the results. Main limitations: Large prevalence index influenced kappa values, small sample size. Conclusions: Good inter-observer (US vs. US) and inter-modality (CT vs. US) agreement of caudal thoracolumbar APJ periarticular modelling. This US characteristic provides a measure of bone change, therefore supporting the use of diagnostic ultrasound. Inter-modality CIs were wide, highlighting the study and imaging modality limitations.