Sherwood David, Haring Richard Sterling, Schirmer Derek, Modic Michael
Department of Orthopedics, University Health Lakewood Medical Center, Kansas City, Missouri, USA.
Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
J Orthop Res. 2023 May;41(5):1123-1130. doi: 10.1002/jor.25449. Epub 2022 Oct 18.
Interrater reliability of Modic changes is subject to variables which affect consistency in reporting. Given the importance of Modic change identification for basivertebral nerve ablation (BVNA) candidacy, interrater reliability for this specific cohort has not yet been reported. Twenty lumbar magnetic resonance images of potential basivertebral nerve candidates were independently reviewed by two neuroradiologists and two interventional spine physiatrists for the presence and characterization of Modic changes. The kappa value of their agreement on the presence of Modic changes was 0.52 (95% confidence interval [CI] 0.37-0.67), whereas agreement on the type of Modic change was 0.51 (95% CI 0.37-0.65). Using an alternative methodology for measuring interrater reliability (Gwet's AC1) yielded the identification of the presence of Modic changes at AC1 0.51 (95% CI 0.36-0.66), whereas agreement on the type of Modic change was AC1 0.75 (95% CI 0.66-0.83). While less common, AC1 may be preferred in the appropriate cohort to kappa as it mitigates some of the pitfalls to which kappa values may be victim. Ultimately, our results are in-line with previous reports of interrater reliability results for Modic changes in other cohorts and should serve to caution those who perform BVNA regarding interrater agreement of the imaging crux of the procedure.
Modic改变的评分者间可靠性受影响报告一致性的变量影响。鉴于Modic改变的识别对于椎体神经消融（BVNA）候选资格的重要性，尚未有关于这一特定队列的评分者间可靠性的报道。两名神经放射科医生和两名介入脊柱物理治疗师对20例潜在椎体神经候选者的腰椎磁共振图像进行了独立评估，以确定是否存在Modic改变及其特征。他们在Modic改变存在与否上的kappa值为0.52（95%置信区间[CI]0.37 - 0.67），而在Modic改变类型上的一致性为0.51（95%CI 0.37 - 0.65）。使用另一种测量评分者间可靠性的方法（Gwet's AC1）得出，在Modic改变存在与否的识别上AC1为0.51（95%CI 0.36 - 0.66），而在Modic改变类型上的一致性为AC1 0.75（95%CI 0.66 - 0.83）。虽然不太常见，但在合适的队列中，AC1可能比kappa更受青睐，因为它减轻了kappa值可能存在的一些缺陷。最终，我们的结果与之前关于其他队列中Modic改变的评分者间可靠性结果的报告一致，应提醒那些进行BVNA的人注意该手术成像关键的评分者间一致性问题。
