Department of Orthopaedic Surgery, Loma Linda University Health, Loma Linda Drive, Suite 213, 11406, Loma Linda, CA, United States of America.
Division of Orthopaedic Surgery, Jerry L. Pettis VA Medical Center, Loma Linda, CA, United States of America.
Eur Spine J. 2022 Apr;31(4):843-850. doi: 10.1007/s00586-021-07096-5. Epub 2022 Jan 5.
To assess the intra- and inter-observer reliability of the novel vertebral bone quality (VBQ) scoring system.
Four orthopedic surgery residents at various levels of training (PGY1-4) evaluated 100 noncontrast, T1-weighted MRIs of the lumbar spine. VBQ was calculated as quotient of the median of L1-L4 average signal intensity (SI) and the L3 cerebral spinal fluid (CSF) SI, as described by Ehresman et al. All measurements were repeated 2 weeks later. We performed a stratified analysis based on patient history of instrumentation, pathology, and MRI manufacturer/magnet strength to determine their effect on VBQ reliability. Spinal pathologies included compression fracture, burst fracture, vertebral osteomyelitis, epidural abscess, or neoplasm. The interclass correlation coefficient (ICC) two-way mixed model on absolute agreement was used to analyze inter-rater and intra-rater reliability. ICC less than 0.40 was considered poor, 0.40-0.59 as fair, 0.60-0.74 as good, and greater than 0.75 as excellent.
Intra-observer reliability was excellent (≥ 0.75) for all four observers. When stratified by history of spinal instrumentation or spinal pathology, all raters showed excellent intra-observer reliability except one (0.71 and 0.69, respectively). When stratified by MRI manufacturer, intra-observer reliability was ≥ 0.75 for all raters. Inter-observer reliability was excellent (0.91) and remained excellent (≥ 0.75) when stratified by history of spinal instrumentation, spinal pathology, or MRI-manufacturer.
VBQ scores from spine lumbar MRIs demonstrate excellent intra-observer and inter-observer reliability. These scores are reliably reproduced in patients regardless of previous instrumentation, spinal pathology, or MRI manufacturer/magnetic field strength.
评估新型椎体骨质量（VBQ）评分系统的观察者内和观察者间可靠性。
4 名不同培训水平的骨科住院医师（PGY1-4）评估了 100 例非对比 T1 加权腰椎 MRI。VBQ 如 Ehresman 等人所述，计算为 L1-L4 平均信号强度（SI）中位数与 L3 脑脊髓液（CSF）SI 的商。所有测量值均在 2 周后重复。我们进行了基于患者病史、病理学和 MRI 制造商/磁场强度的分层分析，以确定其对 VBQ 可靠性的影响。脊柱病变包括压缩性骨折、爆裂性骨折、椎体骨髓炎、硬膜外脓肿或肿瘤。采用双向混合模型的组内相关系数（ICC）对绝对一致性进行分析，以评估观察者间和观察者内的可靠性。ICC 小于 0.40 被认为是差的，0.40-0.59 是中等的，0.60-0.74 是好的，大于 0.75 是优秀的。
所有 4 名观察者的观察者内可靠性均为优秀（≥0.75）。当按脊柱器械或脊柱病理学史分层时，除 1 名观察者外（分别为 0.71 和 0.69），所有观察者的观察者内可靠性均为优秀。当按 MRI 制造商分层时，所有观察者的观察者内可靠性均≥0.75。当按脊柱器械、脊柱病理学或 MRI 制造商分层时，观察者间可靠性为优秀（0.91），且可靠性仍然优秀（≥0.75）。
腰椎 MRI 的 VBQ 评分显示出良好的观察者内和观察者间可靠性。无论患者先前是否接受过器械治疗、脊柱病理学或 MRI 制造商/磁场强度如何，这些评分都能可靠地再现。
