Pediatric radiology · 2026
Correlation of examiner judgement and radiological digital pictures in infants with upper cervical spine dysfunction: a cross-sectional study.
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Peter Jan, Csato Miklos, Paravicini Inga, Wehrli Martina, Schweinhardt Petra, Langenfeld Anke
Аннотация
BACKGROUND: This study aimed to (1) assess the inter-rater reliability of lateral atlantodental distance measurements in digital open-mouth radiographs of infants with upper cervical spine dysfunction, and (2) investigate correlations between lateral atlantodental distance values and clinical findings.
METHODS: 72 digital radiographs of the odontoid region from infants aged 3-12 months were analyzed (Aug 2021-Dec 2023). Lateral atlantodental distance was measured bilaterally by three independent raters. Inter-rater reliability and measurement precision was assessed using intraclass correlation coefficients (ICC), standard error of measurement (SEM), and minimal detectable change (MDC). Side differences were evaluated using paired t-tests. Mean lateral atlantodental distance values were further examined for their association with the clinically assessed side of cervical rotational malposition using logistic regression and receiver operating characteristic (ROC) analysis.
RESULTS: Inter-rater reliability was excellent for right (ICC=0.91 [95% CI: 0.86 - 0.94]) and left (ICC=0.91 [95% CI: 0.86 - 0.95]). The SEM was 0.62 mm for both sides, the MDC was 1.72 mm (right) and 1.73 mm (left). In infants with left-sided cervical rotational malposition, lateral atlantodental distance was significantly greater on the left side, whereas in infants with right-sided cervical rotational malposition, lateral atlantodental distance was significantly greater on the right side. Right-sided lateral atlantodental distance was a significant predictor of clinically assessed right-sided cervical rotational malposition (OR 1.80, 95% CI 1.14-2.84, P=0.01). ROC analysis demonstrated moderate discriminatory performance (AUC = 0.74), meaning that the model is reasonably capable of distinguishing patients with right-sided cervical rotational malposition from those without.
CONCLUSIONS: Although lateral atlantodental distance measurements showed excellent inter-rater reliability, the SEM was relatively large compared with the small absolute values of the measurements (in millimeters), which limits the ability to detect subtle side-to-side asymmetries. Lateral atlantodental distance should be interpreted as a reproducible radiographic finding associated with cervical rotational malposition rather than as an independent diagnostic marker or pathognomonic sign in infants.
TRIAL REGISTRATION: ClinicalTrials.gov ID NCT04981782 (28.07.2021).
METHODS: 72 digital radiographs of the odontoid region from infants aged 3-12 months were analyzed (Aug 2021-Dec 2023). Lateral atlantodental distance was measured bilaterally by three independent raters. Inter-rater reliability and measurement precision was assessed using intraclass correlation coefficients (ICC), standard error of measurement (SEM), and minimal detectable change (MDC). Side differences were evaluated using paired t-tests. Mean lateral atlantodental distance values were further examined for their association with the clinically assessed side of cervical rotational malposition using logistic regression and receiver operating characteristic (ROC) analysis.
RESULTS: Inter-rater reliability was excellent for right (ICC=0.91 [95% CI: 0.86 - 0.94]) and left (ICC=0.91 [95% CI: 0.86 - 0.95]). The SEM was 0.62 mm for both sides, the MDC was 1.72 mm (right) and 1.73 mm (left). In infants with left-sided cervical rotational malposition, lateral atlantodental distance was significantly greater on the left side, whereas in infants with right-sided cervical rotational malposition, lateral atlantodental distance was significantly greater on the right side. Right-sided lateral atlantodental distance was a significant predictor of clinically assessed right-sided cervical rotational malposition (OR 1.80, 95% CI 1.14-2.84, P=0.01). ROC analysis demonstrated moderate discriminatory performance (AUC = 0.74), meaning that the model is reasonably capable of distinguishing patients with right-sided cervical rotational malposition from those without.
CONCLUSIONS: Although lateral atlantodental distance measurements showed excellent inter-rater reliability, the SEM was relatively large compared with the small absolute values of the measurements (in millimeters), which limits the ability to detect subtle side-to-side asymmetries. Lateral atlantodental distance should be interpreted as a reproducible radiographic finding associated with cervical rotational malposition rather than as an independent diagnostic marker or pathognomonic sign in infants.
TRIAL REGISTRATION: ClinicalTrials.gov ID NCT04981782 (28.07.2021).