Observer variability in assessing lumbar spinal stenosis severity on magnetic resonance imaging and its relation to cross-sectional spinal canal area
Observer variability in assessing lumbar spinal stenosis severity on magnetic resonance imaging and its relation to cross-sectional spinal canal area
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DOI：
10.1097/00007632-200205150-00014
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发表时间：
2002-05-15
期刊：
影响因子：
3
通讯作者：
Turner, DA
中科院分区：
文献类型：
--
作者：
Speciale, AC;Pietrobon, R;Turner, DA
研究设计。回顾性分析腰椎管狭窄程度的磁共振成像分级，采用常见的临床形式。评估与椎管横截面积相比，用于腰椎管狭窄患者分级的磁共振图像在观察者间和观察者内的可靠性。背景资料摘要。目前，医生在磁共振成像上将腰椎管狭窄程度分为轻度、中度和重度。不幸的是，对于这些定义的标准还没有达成共识。15例腰椎管狭窄患者的磁共振图像扫描由7名观察员对L1-L2和L5-S1之间的中央、外侧隐窝和股孔狭窄程度进行盲目评分。采用加权kappa统计来分析观察者之间和观察者内部的一致性。计算数字化椎管面积测量值。采用线性回归模型对分级系统预测横截面积的可靠性进行了评估。平均观察者间kappa评分为0.26。在不同的专业中，放射科医生的观察者间信度较高（0.40），其次是神经外科医生（0.21）和骨科医生（0.15）。平均观察者kappa评分为0.11，合并类别后上升至1.43 （P = 0.001）。中枢性狭窄的分类高度预测椎管面积（P < 0.001）。调查结果表明，所有观察员的意见只有相当程度的一致。然而，各种阅读器预测中央狭窄程度的能力是很高的。进一步的研究应评估基于共识的、标准化的磁共振图像分类，旨在提高观察者之间的共识。
Study Design. Magnetic resonance image grading of lumbar spinal stenosis severity was analyzed retrospectively using a common clinical format.Objective. To assess the interobserver and intraobserver reliability of magnetic resonance image used to grade patients with lumbar spinal stenosis, as compared with cross-sectional spinal canal area.Summary of Background Data. Physicians currently classify the degree of lumbar spinal stenosis on magnetic resonance imaging as mild, moderate, or severe. Unfortunately, there is no consensus on criteria for these definitions.Methods. The magnetic resonance image scans of 15 patients with lumbar stenosis were blindly rated by seven observers for the degree of central, lateral recess, and forarninal stenosis between L1-L2 and L5-S1. Weighted kappa statistics were performed to analyze the inter- and intraobserver agreement. Digitized spinal canal area measurements were calculated. Linear regression models were used to assess the reliability of the grading system in predicting the cross-sectional area.Results. The average interobserver kappa score was 0.26. Within different specialties, the interobserver reliability was higher among radiologists (0.40), followed by neurosurgeons (0.21) and orthopedic surgeons (0.15). The average intraobserver kappa score was 0.11, rising to 1.43 after categories were combined (P = 0.001). The classification of central stenosis highly predicted spinal canal area (P < 0.001).Conclusions. The findings indicate only a fair level of agreement among all observers. However, the ability of the various readers to predict the degree of central stenosis was high. Further studies should evaluate a consensus-based, standardized magnetic resonance image classification aimed at improved agreement among observers.