Degenerative findings in lumbar spine MRI: an inter-rater reliability study involving three raters

Abstract

Background: For diagnostic procedures to be clinically useful, they must be reliable. The interpretation of lumbar spine MRI scans is subject to variability and there is a lack of studies where reliability of multiple degenerative pathologies are rated simultaneously. The objective of our study was to determine the inter-rater reliability of three independent raters evaluating degenerative pathologies seen with lumbar spine MRI. Methods: Fifty-nine people, 35 patients with low back pain (LBP) or LBP and leg pain and 24 people without LBP or leg pain, received an MRI of the lumbar spine. Three raters (one radiologist and two chiropractors) evaluated the MRIs for the presence and severity of eight degenerative spinal pathologies using a standardized format: Spondylolisthesis, scoliosis, annular fissure, disc degeneration, disc contour, nerve root compromise, spinal stenosis and facet joint degeneration. Findings were identified and classified at disc level according to type and severity. Raters were instructed to evaluate all study sample persons once to assess inter-rater reliability (fully crossed design). Reliability was calculated using Gwet's Agreement Coefficients (AC 1 and AC 2 ) and Cohen's Kappa (κ) and Conger's extension of Cohen's. Gwet's probabilistic benchmarking method to the Landis and Koch scale was used. MRI-findings achieving substantial reliability was considered acceptable. Results: Inter-rater reliability for all raters combined, ranged from (Gwet's AC 1 or AC 2 ): 0.64-0.99 and according to probabilistic benchmarking to the Landis and Koch scale equivalent to moderate to almost perfect reliability. Overall reliability level for individual pathologies was almost perfect reliability for spondylolisthesis, spinal stenosis, scoliosis and annular fissure, substantial for nerve root compromise and disc degeneration, and moderate for facet joint degeneration and disc contour. Conclusion: Inter-rater reliability for 3 raters, evaluating 177 disc levels, was found to be overall acceptable for 6 out of 8 degenerative MRI-findings in the lumbar spine. Ratings of facet joint degeneration and disc contour achieved moderate reliability and was considered unacceptable.

Assessment of the association between paraspinal muscle degeneration and quality of life in patients with degenerative lumbar scoliosis

“…Paravertebral muscles (PVMs) and ligaments provide dynamic stability to the lumbar spine (4). Previous studies have focused on the degeneration of intervertebral discs and small joints but did not examine the role of PVMs in supporting spinal balance (5)(6)(7)(8). However, the association between PVMs and scoliosis remains to be elucidated.…”

Development of a standardized histopathology scoring system for human intervertebral disc degeneration: an Orthopaedic Research Society Spine Section Initiative

“…Another interest is the need to have standardization of MRI phenotypes that will help establish clinical importance of structural features of IVD degeneration. As previously mentioned, there is tremendous variation between rater reliability of MRI phenotypes and the definition of such phenotypes 95‐98 . This discrepancy may account for the inconsistent association and predictive utility of such phenotypes in relation to the LBP profile and disability 95 .…”

“…As previously mentioned, there is tremendous variation between rater reliability of MRI phenotypes and the definition of such phenotypes. [95][96][97][98] This discrepancy may account for the inconsistent association and predictive utility of such phenotypes in relation to the LBP profile and disability. 95 As such, international consortia have been formed to help provide a common language and standardization of MRI and other imaging phenotypes.…”

Distribution Patterns of Degeneration of the Lumbar Spine in a Cohort of 200 Patients with an Indication for Lumbar MRI

“…Previous analyses have revealed divergent findings with regard to inter-rater and intra-rater reliability of medical evaluation of lumbar MRIs [ 31 , 32 ]. In order to check the results of our investigation, following the compilation of the patient list and the full data entry for the entire study population in the analysis table, a further consultant radiologist reviewed another five patients in each age and sex category without being aware of the results of the primary reader.…”