Reliability of Determination of Bony Landmarks of the Distal Femur on MR Images and MRI-Based 3D Models

Background/ Consistent determination of the anatomical landmarks on image or image-based three dimensional (3D) models is a basic requirement for reliable analysis of the human joint kinematics using imaging techniques. We examined the intra- and inter-observer reliability of determination of the medial and lateral epicondyle landmarks on 2D MR images and 3D MRI-based models of the knee. Sixteen coronal plane MRI recordings were taken from 18 healthy knees using a knee coil with T2-weighted fast spin-echo sequence and 512×512 pixel size. They were then processed by the Mimics software to provide the coronal and axial plane views and to create a 3D image-based model of the femur. Each image was reviewed twice, at least one-day apart. The interclass correlation coefficient, standard error of measurement, and coefficient of variation were calculated to assess the intra- and inter-observer reliability of the landmark determination by six experienced radiologists. A mixed model analysis of variance (ANOVA) with two days of observation as the within-subject factor, and observers (six radiologists) and methods (2D vs. 3D) as between-subject factors were used to test the effect of observer, two days of observation and method of evaluation on landmark determination. The results indicated that the interclass correlation coefficients for the intra-observer and inter-observer determination of landmarks on images and image-based 3D models were above 0.97. The standard error of measurement ranged between 0.41 and 0.78 mm for x; 1.35 and 3.43 mm for y; and 1.03 and 4.71 mm for z coordinates. Furthermore, the results showed no significant difference for within and between-subject comparisons of each coordinate of the lateral epicondyle as well as x and z coordinates of the medial epicondyle. For the y coordinate of the medial epicondyle, the p value of within-subject comparison was borderlinely significant (p=0.049). It was concluded that the intra- and inter-observer reliability of the bony landmark determination on both image and image-based 3D models were excellent.