Department of Radiology, Haukeland University Hospital, Jonas Liesvei 65, 5021 Bergen, Norway.
Neuroradiology. 2012 Jul;54(7):699-707. doi: 10.1007/s00234-011-0963-y. Epub 2011 Sep 23.
Limited reliability data exist for localised magnetic resonance imaging (MRI) findings relevant to planning of treatment with lumbar disc prosthesis and later outcomes. We assessed the reliability of such findings in chronic low back pain patients who were accepted candidates for disc prosthesis.
On pretreatment MRI of 170 patients (mean age 41 years; 88 women), three experienced radiologists independently rated Modic changes, disc findings and facet arthropathy at L3/L4, L4/L5 and L5/S1. Two radiologists rerated 126 examinations. For each MRI finding at each disc level, agreement was analysed using the kappa statistic and differences in prevalence across observers using a fixed effects model.
All findings at L3/L4 and facet arthropathy at L5/S1 had a mean prevalence <10% across observers and were not further analysed, ensuring interpretable kappa values. Overall interobserver agreement was generally moderate or good (kappa 0.40-0.77) at L4-S1 for Modic changes, nucleus pulposus signal, disc height (subjective and measured), posterior high-intensity zone (HIZ) and disc contour, and fair (kappa 0.24) at L4/L5 for facet arthropathy. Posterior HIZ at L5/S1 and severely reduced subjective disc height at L4/L5 differed up to threefold in prevalence between observers (p < 0.0001). Intraobserver agreement was mostly good or very good (kappa 0.60-1.00).
In candidates for disc prosthesis, mostly moderate interobserver agreement is expected for localised MRI findings.
与腰椎间盘假体治疗计划和后期结果相关的局部磁共振成像 (MRI) 发现的可靠性数据有限。我们评估了接受椎间盘假体治疗的慢性腰痛患者中这些发现的可靠性。
在 170 名患者（平均年龄 41 岁；88 名女性）的术前 MRI 上，三位经验丰富的放射科医生独立评估了 Modic 改变、椎间盘表现和 L3/L4、L4/L5 和 L5/S1 的小关节病。两名放射科医生重新评估了 126 次检查。对于每个 MRI 发现，在每个椎间盘水平上，使用κ统计量分析了一致性，并使用固定效应模型分析了观察者之间的流行率差异。
所有观察者之间的 Modic 改变、L5/S1 的小关节病的平均患病率均<10%，因此不再进行分析，以确保可解释的κ值。总体而言，观察者之间的一致性通常为中度或良好（κ值为 0.40-0.77），L4-S1 的 Modic 改变、髓核信号、椎间盘高度（主观和测量）、后高信号区（HIZ）和椎间盘轮廓；观察者之间的一致性为中度（κ值为 0.24），L4/L5 的小关节病的后部 HIZ 和主观椎间盘高度明显降低。L5/S1 的后部 HIZ 和 L4/L5 的严重主观椎间盘高度降低在观察者之间的流行率差异高达三倍（p<0.0001）。观察者内的一致性大多为良好或非常好（κ值为 0.60-1.00）。
在接受椎间盘假体治疗的患者中，局部 MRI 发现的观察者之间的一致性预计为中度。
