The classification of osteonecrosis in patients with cancer: validation of a new radiological classification system

Aim To validate a new, non-joint-specific radiological classification system that is suitable regardless of the site of the osteonecrosis (ON) in patients with cancer. Material and methods Critical deficiencies in the existing ON classification systems were identified and a new, non-joint-specific r...

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Bibliographic Details
Published in:Clinical radiology 2015-12, Vol.70 (12), p.1439-1444
Main Authors: Niinimäki, T, Niinimäki, J, Halonen, J, Hänninen, P, Harila-Saari, A, Niinimäki, R
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Child
Female
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Neoplasms - complications
Observer Variation
Osteonecrosis - classification
Osteonecrosis - complications
Osteonecrosis - pathology
Radiology
Reproducibility of Results
Sensitivity and Specificity
Young Adult
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Summary:Aim To validate a new, non-joint-specific radiological classification system that is suitable regardless of the site of the osteonecrosis (ON) in patients with cancer. Material and methods Critical deficiencies in the existing ON classification systems were identified and a new, non-joint-specific radiological classification system was developed. Seventy-two magnetic resonance imaging (MRI) images of patients with cancer and ON lesions were graded, and the validation of the new system was performed by assessing inter- and intra-observer reliability. Results Intra-observer reliability of ON grading was good or very good, with kappa values of 0.79–0.86. Interobserver agreement was lower but still good, with kappa values of 0.62–0.77. Ninety-eight percent of all intra- or interobserver differences were within one grade. Interobserver reliability of assessing the location of ON was very good, with kappa values of 0.93–0.98. Conclusion All the available radiological ON classification systems are joint specific. This limitation has spurred the development of multiple systems, which has led to the insufficient use of classifications in ON studies among patients with cancer. The introduced radiological classification system overcomes the problem of joint-specificity, was found to be reliable, and can be used to classify all ON lesions regardless of the affected site.
ISSN:0009-9260
1365-229X
DOI:10.1016/j.crad.2015.08.011