title: Multimodality scoring of chondral injuries in the equine fetlock joint ex vivo.
abstract: We investigate the potential of a prototype multimodality arthroscope, combining ultrasound, optical coherence tomography (OCT) and arthroscopic indentation device, for assessing cartilage lesions, and compare the reliability of this approach with conventional arthroscopic scoring ex vivo.
  
  
  
  Areas of interest (AIs, N = 43) were selected from equine fetlock joints (N = 5). Blind-coded AIs were independently scored by two equine surgeons employing International Cartilage Repair Society (ICRS) scoring system via conventional arthroscope and multimodality arthroscope, in which high-frequency ultrasound and OCT catheters were attached to an arthroscopic indentation device. In addition, cartilage stiffness was measured with the indentation device, and lesions in OCT images scored using custom-made automated software. Measurements and scorings were performed twice in two separate rounds. Finally, the scores were compared to histological ICRS scores.
  
  
  
  OCT and arthroscopic examinations showed the highest average agreements (55.2%) between the scoring by surgeons and histology scores, whereas ultrasound had the lowest (50.6%). Average intraobserver agreements of surgeons and interobserver agreements between rounds were, respectively, for conventional arthroscope (68.6%, 69.8%), ultrasound (68.6%, 68.6%), OCT (65.1%, 61.7%) and automated software (65.1%, 59.3%).
  
  
  
  OCT imaging supplemented with the automated software provided the most reliable lesion scoring. However, limited penetration depth of light limits the clinical potential of OCT in assessing human cartilage thickness; thus, the combination of OCT and ultrasound could be optimal for reliable diagnostics. Present findings suggest imaging and quantitatively analyzing the entire articular surface to eliminate surgeon-related variation in the selection of the most severe lesion to be scored.
authors.affiliation: Department of Applied Physics, University of Eastern Finland, Kuopio, Finland; Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland. Electronic address: jaakko.sarin@uef.fi.
authors.forename: J K
authors.initials: JK
authors.lastname: Sarin
authors.affiliation: Department of Equine Sciences, Utrecht University, Utrecht, The Netherlands. Electronic address: H.Brommer@uu.nl.
authors.forename: H
authors.initials: H
authors.lastname: Brommer
authors.affiliation: Veterinary Teaching Hospital, School of Veterinary Medicine, University of Helsinki, Helsinki, Finland. Electronic address: darguelles@uco.es.
authors.forename: D
authors.initials: D
authors.lastname: Argüelles
authors.affiliation: Department of Applied Physics, University of Eastern Finland, Kuopio, Finland; Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland. Electronic address: Pia.Puhakka@essote.fi.
authors.forename: P H
authors.initials: PH
authors.lastname: Puhakka
authors.affiliation: Department of Applied Physics, University of Eastern Finland, Kuopio, Finland. Electronic address: satu.inkinen@uef.fi.
authors.forename: S I
authors.initials: SI
authors.lastname: Inkinen
authors.affiliation: Department of Applied Physics, University of Eastern Finland, Kuopio, Finland; Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland; Department of Electrical and Computer Engineering, Elizade University, Ondo, Nigeria. Electronic address: isaac.afara@uef.fi.
authors.forename: I O
authors.initials: IO
authors.lastname: Afara
authors.affiliation: Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland. Electronic address: simo.saarakkala@oulu.fi.
authors.forename: S
authors.initials: S
authors.lastname: Saarakkala
authors.affiliation: Department of Applied Physics, University of Eastern Finland, Kuopio, Finland; Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland. Electronic address: juha.toyras@uef.fi.
authors.forename: J
authors.initials: J
authors.lastname: Töyräs
mesh_terms: D000818:Animals; D001182:Arthroscopy / Q000379:methods; D002102:Cadaver; D002358:Cartilage, Articular / Q000000981:diagnostic imaging / Q000473:pathology*; D005387:Finland; D018409:Foot Injuries / Q000000981:diagnostic imaging*; D033023:Foot Joints / Q000000981:diagnostic imaging* / Q000473:pathology; D006736:Horses; D015601:Injury Severity Score; D064847:Multimodal Imaging / Q000379:methods*; D015588:Observer Variation; D015203:Reproducibility of Results; D041623:Tomography, Optical Coherence / Q000379:methods; D018608:Ultrasonography, Doppler / Q000379:methods
keywords: Cartilage; Injury; Reliability; Reproducibility; Scoring