Fayad Fouad, Lefevre-Colau Marie-Martine, Drapé Jean-Luc, Feydy Antoine, Chemla Nathalie, Quintéro Nathalie, Rannou François, Poiraudeau Serge, Fermanian Jacques, Revel Michel
Department of Physical Medicine and Rehabilitation, Cochin Hospital, AP-HP, Paris Descartes University, 75679 Paris Cedex 14, France.
Joint Bone Spine. 2009 May;76(3):286-9. doi: 10.1016/j.jbspin.2008.09.012. Epub 2008 Dec 31.
The purpose of this study was to determine the intra- and interobserver reliability of a modified Modic classification for bone marrow changes seen on lumbar spine magnetic resonance imaging (MRI), taking into consideration mixed signals.
Lumbar MRI scans from 94 patients with low back pain were assessed independently by 2 spine specialists (senior [senior1], junior) and a radiologist (senior2). One reviewer (senior1) assessed the MR images twice at a three-week interval for evaluation of intraobserver reliability. Senior2 and junior reviewers assessed the MR images once. Pure edema endplate signal changes were classified as Modic type I, and pure fatty endplate changes as Modic type II. A mixture of types I and II but predominantly edema signal changes was classified as Modic I-2 and a mixture of types I and II but predominantly fatty changes was classified as Modic II-1.
The intraobserver agreement was excellent (weighted kappa 0.85). The interobserver agreement was moderate to substantial (weighted kappa range 0.56-0.74). Interobserver reliability depended on the experience of the observer, thus highlighting the importance of a learning curve.
This study shows that the modified Modic classification is reliable and easy to apply for observers with different clinical experience. The inclusion of mixed marrow changes in the modified classification may have clinical and therapeutic implications.
本研究旨在确定在考虑混合信号的情况下，腰椎磁共振成像（MRI）上所见骨髓改变的改良Modic分类在观察者内和观察者间的可靠性。
由2名脊柱专科医生（资深医生[资深1]、初级医生）和1名放射科医生（资深2）独立评估94例腰痛患者的腰椎MRI扫描结果。一名评估者（资深1）在三周的间隔内对MR图像进行了两次评估，以评估观察者内的可靠性。资深2和初级评估者对MR图像进行了一次评估。单纯水肿终板信号改变分类为Modic I型，单纯脂肪终板改变分类为Modic II型。I型和II型混合但以水肿信号改变为主的分类为Modic I-2，I型和II型混合但以脂肪改变为主的分类为Modic II-1。
观察者内一致性极佳（加权kappa值为0.85）。观察者间一致性为中等至高度（加权kappa值范围为0.56 - 0.74）。观察者间的可靠性取决于观察者的经验，从而突出了学习曲线的重要性。
本研究表明，改良的Modic分类对于具有不同临床经验的观察者来说是可靠且易于应用的。改良分类中纳入混合骨髓改变可能具有临床和治疗意义。
