腰椎管狭窄症磁共振成像特征读数的可靠性
Reliability of readings of magnetic resonance imaging features of lumbar spinal stenosis.
作者信息
Lurie Jon D, Tosteson Anna N, Tosteson Tor D, Carragee Eugene, Carrino John A, Kaiser Jay, Sequeiros Roberto T Blanco, Lecomte Amy Rosen, Grove Margaret R, Blood Emily A, Pearson Loretta H, Weinstein James N, Herzog Richard
机构信息
Department of Medicine, Dartmouth Medical School, Lebanon, NH 03756, USA.
出版信息
Spine (Phila Pa 1976). 2008 Jun 15;33(14):1605-10. doi: 10.1097/BRS.0b013e3181791af3.
STUDY DESIGN
A reliability assessment of standardized magnetic resonance imaging (MRI) interpretations and measurements.
OBJECTIVE
To determine the intra- and inter-reader reliability of MRI features of lumbar spinal stenosis (SPS), including severity of central, subarticular, and foraminal stenoses, grading of nerve root impingement, and measurements of cross-sectional area of the spinal canal and thecal sac.
SUMMARY OF BACKGROUND DATA
MRI is commonly used to assess patients with spinal stenosis. Although a number of studies have evaluated the reliability of certain MRI characteristics, comprehensive evaluation of the reliability of MRI readings in spinal stenosis is lacking.
METHODS
Fifty-eight randomly selected MR images from patients with SPS enrolled in the Spine Patient Outcomes Research Trial were evaluated. Qualitative ratings of imaging features were performed according to defined criteria by 4 independent readers (3 radiologists and 1 orthopedic surgeon). A sample of 20 MRIs was reevaluated by each reader at least 1 month later. Weighted kappa statistics were used to characterize intra- and inter-reader reliability for qualitative rating data. Separate quantitative measurements were performed by 2 other radiologists. Intraclass correlation coefficients and summaries of measurement error were used to characterize reliability for quantitative measurements.
RESULTS
Intra-reader reliability was higher than inter-reader reliability for all features. Inter-reader reliability in assessing central stenosis was substantial, with an overall kappa of 0.73 (95% CI 0.69-0.77). Foraminal stenosis and nerve root impingement showed moderate to substantial agreement with overall kappa of 0.58 (95% CI 0.53-0.63) and 0.51 (95% CI 0.42-0.59), respectively. Subarticular zone stenosis yielded the poorest agreement (overall kappa 0.49; 95% CI 0.42-0.55) and showed marked variability in agreement between reader pairs. Quantitative measures showed inter-reader intraclass correlation coefficients ranging from 0.58 to 0.90. The mean absolute difference between readers in measured thecal sac area was 128 mm (13%).
CONCLUSION
The imaging characteristics of spinal stenosis assessed in this study showed moderate to substantial reliability; future studies should assess whether these findings have prognostic significance in SPS patients.
研究设计
标准化磁共振成像（MRI）解读与测量的可靠性评估。
目的
确定腰椎管狭窄症（LSS）MRI特征的阅片者内及阅片者间可靠性，包括中央、关节突下及椎间孔狭窄的严重程度、神经根受压分级以及椎管和硬膜囊横截面积的测量。
背景数据总结
MRI常用于评估椎管狭窄患者。尽管多项研究评估了某些MRI特征的可靠性，但缺乏对椎管狭窄MRI读数可靠性的全面评估。
方法
对脊柱患者预后研究试验中纳入的58例LSS患者的随机选择的MR图像进行评估。4名独立阅片者（3名放射科医生和1名骨科医生）根据既定标准对影像特征进行定性评级。20例MRI样本由每位阅片者至少在1个月后重新评估。加权kappa统计用于描述定性评级数据的阅片者内及阅片者间可靠性。另外2名放射科医生进行单独的定量测量。组内相关系数和测量误差总结用于描述定量测量的可靠性。
结果
所有特征的阅片者内可靠性均高于阅片者间可靠性。评估中央狭窄时阅片者间可靠性较高，总体kappa为0.73（95%CI 0.69 - 0.77）。椎间孔狭窄和神经根受压显示中度至高度一致性，总体kappa分别为0.58（95%CI 0.53 - 0.63）和0.51（95%CI 0.42 - 0.59）。关节突下区狭窄一致性最差（总体kappa 0.49；95%CI 0.42 - 0.55），且阅片者对之间的一致性存在显著差异。定量测量显示阅片者间组内相关系数范围为0.58至0.90。阅片者间测量的硬膜囊面积平均绝对差异为128 mm²（13%）。
结论
本研究评估的椎管狭窄影像特征显示出中度至高度可靠性；未来研究应评估这些发现对LSS患者是否具有预后意义。
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