Coste J, Judet O, Barre O, Siaud J R, Cohen de Lara A, Paolaggi J B
Department of Rheumatology, Ambroise Paré Hospital, Boulogne, France.
J Clin Epidemiol. 1994 Apr;47(4):375-81. doi: 10.1016/0895-4356(94)90158-9.
In order to assess the variability in interpreting lumbar CT-scans, two radiologists and two rheumatologists examined the same set of 40 CT-scans and evaluated the presence of primary abnormalities using pre-established criteria. Inter- and intraobserver concordance was assessed using kappa statistics. Interpretation of herniated nucleus pulposus appeared reliable in this study (interobserver and intraobserver kappa statistics approximately 0.7 and 0.9, respectively). Conversely, significant variability of interpretation was seen in many findings often considered important in benign low-back pain or sciatica. Particularly low levels of agreement (interobserver kappa statistics lower to 0.20) were found for facet joint osteoarthritis and spinal stenosis. Since herniated nucleus pulposus appeared as the only reliable CT finding, lumbar CT ordering should therefore be currently restricted to confirmation and localization of herniated nucleus pulposus, especially when surgery or any other invasive intervention is planned to treat prolonged sciatica.
为了评估腰椎CT扫描解读的变异性，两名放射科医生和两名风湿病学家检查了同一组40份CT扫描，并使用预先制定的标准评估原发性异常的存在情况。使用kappa统计量评估观察者间和观察者内的一致性。在本研究中，髓核突出的解读似乎是可靠的（观察者间和观察者内kappa统计量分别约为0.7和0.9）。相反，在许多通常被认为对良性腰痛或坐骨神经痛很重要的发现中，发现解读存在显著变异性。对于小关节骨关节炎和椎管狭窄，一致性水平特别低（观察者间kappa统计量低于0.20）。由于髓核突出似乎是唯一可靠的CT表现，因此目前腰椎CT检查应仅限于髓核突出的确认和定位，特别是在计划进行手术或任何其他侵入性干预以治疗长期坐骨神经痛时。
