Magnetic resonance imaging interpretation in patients with symptomatic lumbar spine disc herniations: comparison of clinician and radiologist readings.
Magnetic resonance imaging interpretation in patients with symptomatic lumbar spine disc herniations: comparison of clinician and radiologist readings.
复制标题
DOI：
10.1097/brs.0b013e31819b390e
复制
发表时间：
2009-04-01
期刊：
影响因子：
3
通讯作者：
Weinstein JN
中科院分区：
文献类型：
--
作者：
Lurie JD;Doman DM;Spratt KF;Tosteson AN;Weinstein JN
对一项临床试验的影像数据进行回顾。目的：比较临床脊柱专家和放射科医生对腰椎间盘突出症患者的腰椎磁共振成像(MRI)的解释。MRI是评估疑似腰椎间盘突出症患者腰椎的首选影像检查方法。指南提供了术语的标准化，以更一致地描述椎间盘突出症。这些指南在临床实践中得到了多大程度的遵循尚不得而知。我们从参加脊柱患者预后研究试验的腰椎间盘突出症患者的放射学报告中提取数据。我们根据指南评估了形态(例如，突出、突出或隔离)的报告频率，当存在时，我们将形态评分与作为试验一部分完成结构化数据表的临床医生的评分进行比较。我们使用符合度百分比和κ统计来评估一致性。有396名患者有足够的数据进行分析。临床医生和放射科医生对突出的存在和水平有很好的一致性(93.4%)，3.3%的医生对水平有不同意见，其中三分之一可以用移行椎体的存在来解释。在临床医生报告的突出(突出、突出或隔离)的3.3%的病例中，放射科医生在MRI上报告没有突出。在42.2%的病例中，放射学报告不清楚地描述了形态。在形态描述清晰的2 14例中，符合较好(κ=0.2 4)，不一致是不对称的(鲍克对称性检验P<；0.0001)，临床医生更多地将异常形态分类。对突出物轴向位置的一致性很好(κ=0.81)。左右两侧不一致的仅占3.3%(κ=0.93)。放射学报告常常不能提供足够的细节来描述椎间盘突出的形态。临床脊柱专家和放射科医生在比较突出椎体水平和水平内位置时，MRI读数之间的一致性很好，但只有在比较突出的形态时才是公平的。
Retrospective review of imaging data from a clinical trial. To compare the interpretation of lumbar spine magnetic resonance imaging (MRIs) by clinical spine specialists and radiologists in patients with lumbar disc herniation. MRI is the imaging modality of choice for evaluation of the lumbar spine in patients with suspected lumbar disc herniation. Guidelines provide standardization of terms to more consistently describe disc herniation. The extent to which these guidelines are being followed in clinical practice is unknown. We abstracted data from radiology reports from patients with lumbar intervertebral disc herniation enrolled in the Spine Patient Outcomes Research Trial. We evaluated the frequency with which morphology (e.g., protrusions, extrusions, or sequestrations) was reported as per guidelines and when present we compared the morphology ratings to those of clinicians who completed a structured data form as part of the trial. We assessed agreement using percent agreement and the κ statistic. There were 396 patients with sufficient data to analyze. Excellent agreement was observed between clinician and radiologist on the presence and level of herniation (93.4%), with 3.3% showing disagreement regarding level, of which a third could be explained by the presence of a transitional vertebra. In 3.3% of the cases in which the clinician reported a herniation (protrusion, extrusion, or sequestration), the radiologist reported no herniation on the MRI. The radiology reports did not clearly describe morphology in 42.2% of cases. In the 214 cases with clear morphologic descriptions, agreement was fair (κ = 0.24) and the disagreement was asymmetric (Bowker’s test of symmetry P < 0.0001) with clinicians more often rating more abnormal morphologic categories. Agreement on axial location of the herniation was excellent (κ = 0.81). There was disagreement between left or right side in only 3.3% of cases (κ = 0.93). Radiology reports frequently fail to provide sufficient detail to describe disc herniation morphology. Agreement between MRI readings by clinical spine specialists and radiologists was excellent when comparing herniation vertebral level and location within level, but only fair comparing herniation morphology.