HIPVASC Results and MRI Update

Team Harry Kim Jennifer Lane Skip Gilbert Jessie Burgess Scott Yang Tim Schrader Molly McGuire Chan-Hee Jo

Purpose Obtain training using the HIPVASC Software Determine inter- and intra-observer correlation coefficients Visual estimation HIPVASC hypoperfusion percentage Determine number of HIPVASC analyses needed to create carpal tunnel syndrome Establish core group to measure IPSG perfusion MRIs with reliability and accuracy

Methods 1 day course, August 24, Dallas, TX Training Sample cases Harry Kim Standardized protocol Sample cases

Methods Each participant given 27 pre-selected MRIs to evaluate Screened for high quality and minimal movement Visual estimation of hypoperfusion 2-3 minutes Scrolling between pre-contrast and subtraction or post-contrast coronal images Measurement of hypoperfusion using HIPVASC software

Methods – HIPVASC Load images Select proper sequence order Scroll through images and determine first and last images that show the femoral head

Methods - HIPVASC For each image Select a Bounding Box Magnify the image Identify the ossified femoral head for each image Draw a line parallel to the physis Select a Bounding Box

Methods – HIPVASC Select the hypovascular area One coronal subtraction of post- contrast image Identify the hypovascular region HIPVASC software to analyze the sequences

Methods Visual estimation of hypovascularity as a percentage Total Non-Vascular Region TNVR (pixels) Total Region of Interest TROI (pixels) Notes Motion artifacts Poor quality subtraction Cannot determine ROI <5% hypoperfused No issues Repeated same measurements at home 4-8 weeks later

Results

Inter-rater correlation coefficient Dr. Kim as “gold standard”

Measurement ICC 95%-L 95%-U P-value VISEST_1.2 vs. VISEST_1.1 0.962 Intra Rater Reliability for visual estimation Measurement ICC 95%-L 95%-U P-value VISEST_1.2 vs. VISEST_1.1 0.962 0.919 0.983 0.000 VISEST_2.2 vs. VISEST_2.1 0.770 0.555 0.888 VISEST_3.2 vs. VISEST_3.1 0.917 0.771 0.966 VISEST_4.2 vs. VISEST_4.1 0.858 0.707 0.933 VISEST_5.2 vs. VISEST_5.1 0.930 0.855 0.968 VISEST_6.2 vs. VISEST_6.1 0.893 0.780 0.950

Measurement ICC 95%-L 95%-U P-value HYPO_1.2 vs. HYPO_1.1 0.887 0.770 Intra Rater Reliability for HIPVASC Measurement ICC 95%-L 95%-U P-value HYPO_1.2 vs. HYPO_1.1 0.887 0.770 0.947 0.000 HYPO_2.2 vs. HYPO_2.1 0.898 0.790 0.952 HYPO_3.2 vs. HYPO_3.1 0.286 0.913 0.003 HYPO_4.2 vs. HYPO_4.1 0.743 0.512 0.874 HYPO_5.2 vs. HYPO_5.1 0.888 0.976 HYPO_6.2 vs. HYPO_6.1 0.841 0.642 0.929

Results The Intra-rater reliability of the assessments of each observer immediately after and 1 month after training was measured by Intraclass Correlation Coefficient (ICC), as a measure of absolute agreement. Intra-rater intraclass correlation coefficients (ICCs) ranged from 0.77 to 0.96 for the visual estimation of hypoperfusion Intra-rater intraclass correlation coefficients (ICCs) ranged from 0.74 to 0.95 for the HIPVASC measurement of hypoperfusion Results indicate good to excellent reliability for both methods of assessing the hypoperfusion of an hips affected by early stage disease.

Future 150+ MRIs in the IPSG database Newly identified “reliable” team to evaluate MRIs Each MRI reviewed by 2 team members

Future Do we want to capture data on the lateral third measurements? What to do with poor quality MRIs? Low quality Movement

Thank You!