1. HIPVASC Results and MRI Update

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

3. 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

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

5. 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

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

7. 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

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

9. 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

10. Results

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

12. 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

13. 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

14. 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 to 0.96 for the visual estimation of hypoperfusion
Intra-rater intraclass correlation coefficients (ICCs) ranged from 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.

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

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

17. Thank You!