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. 2022 Jan 15;23(1):51.
doi: 10.1186/s12891-021-04949-4.

Reliability of preoperative MRI findings in patients with lumbar spinal stenosis

Hasan Banitalebi  1   2 , Ansgar Espeland  3   4 , Masoud Anvar  5 , Erland Hermansen  6   7 , Christian Hellum  8 , Jens Ivar Brox  9 , Tor Åge Myklebust  10   11 , Kari Indrekvam  4   12 , Helena Brisby  13   14 , Clemens Weber  15   16 , Jørn Aaen  7   17 , Ivar Magne Austevoll  12 , Oliver Grundnes  18 , Anne Negård  19   20
Affiliations

Reliability of preoperative MRI findings in patients with lumbar spinal stenosis

Hasan Banitalebi et al. BMC Musculoskelet Disord. .

Abstract

Background: Magnetic Resonance Imaging (MRI) is an important tool in preoperative evaluation of patients with lumbar spinal stenosis (LSS). Reported reliability of various MRI findings in LSS varies from fair to excellent. There are inconsistencies in the evaluated parameters and the methodology of the studies. The purpose of this study was to evaluate the reliability of the preoperative MRI findings in patients with LSS between musculoskeletal radiologists and orthopaedic spine surgeons, using established evaluation methods and imaging data from a prospective trial.

Methods: Consecutive lumbar MRI examinations of candidates for surgical treatment of LSS from the Norwegian Spinal Stenosis and Degenerative Spondylolisthesis (NORDSTEN) study were independently evaluated by two musculoskeletal radiologists and two orthopaedic spine surgeons. The observers had a range of experience between six and 13 years and rated five categorical parameters (foraminal and central canal stenosis, facet joint osteoarthritis, redundant nerve roots and intraspinal synovial cysts) and one continuous parameter (dural sac cross-sectional area). All parameters were re-rated after 6 weeks by all the observers. Inter- and intraobserver agreement was assessed by Gwet's agreement coefficient (AC1) for categorical parameters and Intraclass Correlation Coefficient (ICC) for the dural sac cross-sectional area.

Results: MRI examinations of 102 patients (mean age 66 ± 8 years, 53 men) were evaluated. The overall interobserver agreement was substantial or almost perfect for all categorical parameters (AC1 range 0.67 to 0.98), except for facet joint osteoarthritis, where the agreement was moderate (AC1 0.39). For the dural sac cross-sectional area, the overall interobserver agreement was good or excellent (ICC range 0.86 to 0.96). The intraobserver agreement was substantial or almost perfect/ excellent for all parameters (AC1 range 0.63 to 1.0 and ICC range 0.93 to 1.0).

Conclusions: There is high inter- and intraobserver agreement between radiologists and spine surgeons for preoperative MRI findings of LSS. However, the interobserver agreement is not optimal for evaluation of facet joint osteoarthritis.

Trial registration: www.ClinicalTrials.gov identifier: NCT02007083 , registered December 2013.

Keywords: Interobserver agreement; Intraobserver agreement; Lumbar spinal stenosis; MRI; Reliability.

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Conflict of interest statement

None.

Figures

Fig. 1
Fig. 1
The flow chart of the study demonstrates the inclusion process for the study and causes of the exclusions. LSS: Lumbar Spinal Stenosis, SST: Spinal Stenosis Trial
Fig. 2
Fig. 2
Frequency distribution of the categorical parameters: a foraminal stenosis according to Lee et al. b central canal morphology according to Schizas et al. c facet joint osteoarthritis according to Weishaupt et al. d redundancy of the cauda equina and e intraspinal synovial cysts. The values for a, b and c are dichotomised. Category 0 indicates absent or mild pathology and category 1 indicates moderate or severe pathology
Fig. 3
Fig. 3
Bland-Altman plots demonstrating the degree of agreement and variability of the measurements of the dural sac cross-sectional area (DSCA) between observers 1 and 2 (a), 1 and 3 (b), 1 and 4 (c), 2 and 3 (d), 2 and 4 (e) and 3 and 4 (f). The solid horizontal lines show the mean differences, and the dashed lines show 95% limits of agreement
See this image and copyright information in PMC

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