Interobserver and intraobserver reliability of maximum canal compromise and spinal cord compression for evaluation of acute traumatic cervical spinal cord injury
Interobserver and intraobserver reliability of maximum canal compromise and spinal cord compression for evaluation of acute traumatic cervical spinal cord injury
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DOI：
10.1097/01.brs.0000224164.43912.e6
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发表时间：
2006-07-01
期刊：
影响因子：
3
通讯作者：
Vaccaro, Alexander R.
中科院分区：
文献类型：
--
作者：
Fehlings, Michael G.;Furlan, Julio C.;Vaccaro, Alexander R.
研究设计.前瞻性、盲法验证研究，客观、定量测量评估急性颈脊髓损伤（SCI）患者的最大椎管损害（MCC）和最大脊髓压迫（MSCC）。探讨MCC和MSCC在急性创伤性颈脊髓损伤患者中的观察者内和观察者间的可靠性。到目前为止，很少有可靠的定量放射学方法来评估急性脊髓损伤的脊髓压迫程度。MCC和MSCC分别在正中矢状位CT和T2加权MR图像上评估，似乎具有潜在的临床和预后价值。迄今为止，这些评估工具的验证仅限于一个机构的少数观察员。然而，迄今为止，没有研究集中在这些放射学参数的可靠性之间的一个大队列的脊柱外科医生从北美和国外。这种类型的验证是至关重要的，允许更广泛地使用这些结果的措施在研究和临床实践中。选择10例急性创伤性颈脊髓损伤患者的颈椎正中矢状位MRI和CT图像。共有28名脊柱外科医生使用校准标尺在两种情况下独立估计CT MCC、T1加权MRI MCC和T2加权MRI MSCC。在第一轮测量中，观察员仅使用书面说明来估计放射学参数。第二套测量是在关于方法的互动教学会议之后获得的。改变第二组测量的图像顺序。结果。使用参数和非参数统计的分析表明，CT MCC、T1加权MRI MCC和T2加权MSCC的观察者内可靠性较高，组间相关系数（ICC）分别为0.92、0.95和0.97。所有三个放射学参数的观察者间可靠性被认为是中等的，ICC范围为0.35至0.56。我们的研究结果表明MCC和MSCC的观察者内可靠性很高。尽管本研究中所有三个放射学参数的观察者间可靠性均低于0.75，但观察到的差异很小，主要是由于校准标尺的精度限制。对于脊髓压迫程度最小的病例，椎管狭窄（MCC）的测量更为准确。相反，在脊髓严重受压的情况下，MSCC的评估更准确。预计数字成像技术的使用将进一步提高这些结果测量的精度。
Study Design. Prospective, blinded validation study of an objective, quantitative measure to assess maximum canal compromise (MCC) and maximum spinal cord compression (MSCC) in individuals with acute cervical spinal cord injury (SCI).Objective. To examine the intraobserver and interobserver reliability of MCC and MSCC in individuals with acute traumatic cervical SCI.Summary of Background Data. To date, few quantitative reliable radiologic methods for assessing the extent of spinal cord compression in the setting of acute SCI have been reported. MCC and MSCC, as assessed on mid-sagittal CT and T2-weighted MR images, respectively, appear to have potential clinical and prognostic value. To date, the validation of these assessment tools has been limited to a small number of observers at a single institution. However, to date no study has focused on the reliability of these radiologic parameters among a large cohort of spine surgeons from North America and abroad. This type of validation is critical to allow the broader use of these outcome measures in research studies and in clinical practice.Methods. Mid-sagittal MRI and CT images of cervical spine were selected from 10 individuals with acute traumatic cervical SCI. A total of 28 spine surgeons independently estimated CT MCC, T1-weighted MRI MCC, and T2-weighted MRI MSCC on two occasions using a calibrated ruler. In the first round of measurements, the observers estimated the radiologic parameters using only written instructions. The second measurement set was obtained after an interactive teaching session on the methodology. The order of the images was altered for the second set of measurements.Results. Analysis using parametric and nonparametric statistics indicated high intraobserver reliability for CT MCC, T1-weighted MRI MCC, and T2-weighted MSCC with interclass correlation coefficients (ICCs) of 0.92, 0.95, and 0.97, respectively. The interobserver reliability for all three radiologic parameters was considered moderate with ICCs ranging from 0.35 to 0.56.Conclusion. Our results indicate that the intraobserver reliability for the MCC and MSCC was high. Although the interobserver reliability for all three radiologic parameters in the present study was below 0.75, the observed differences were small and largely accounted for by the limitations in the precision of the calibrated ruler. For cases with minimal cord compression, the measurement of canal stenosis (MCC) proved more accurate. In contrast, in cases with severe cord compression, the assessment of MSCC was more accurate. It is anticipated that the use of digital imaging technologies will further enhance the precision of these outcome measures.