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Improved accuracy of diagnosis of lumbar intra and/or extra-foraminal stenosis by use of three-dimensional MR imaging: comparison with conventional MR imaging

  • Original Article
  • Published:
Journal of Orthopaedic Science

Abstract

Background

The purposes of this study were to assess the reliability of 3-dimensional magnetic resonance (MR) imaging (3D MRI) and conventional MRI (CMRI) for detection of lumbar intra and/or extra-foraminal stenosis (LIEFS) and to compare the diagnostic accuracy of the 2 imaging modalities.

Methods

A total of 60 sets of 3D MR and CMR images from 20 healthy volunteers and 40 LIEFS patients were qualitatively rated according to defined criteria by 3 independent, blinded readers. Kappa statistics were used to characterize intra and inter-reader reliability for qualitative rating of data. Multireader, multicase analysis was used to compare lumbar foraminal stenosis detection between the 2 modalities.

Results

Intra-reader agreement for 3D MRI was excellent, with kappa = 0.90; that for CMRI was good, with kappa = 0.78. Average inter-reader agreement for 3D MRI was good, with kappa = 0.79, whereas that for CMRI was moderate, with kappa = 0.41. Average area under the ROC curve values (1st reading/2nd reading) for detection of lumbar foraminal stenosis using 3D MRI and CMRI were 0.99/0.99 and 0.94/0.92, respectively. Detection of LIEFS with 3D MRI was significantly better than with CMRI (P = 0.0408/0.0294).

Conclusions

These results suggest that CMRI was of limited use for detection of the presence of LIEFS. Isolated imaging with CMRI may risk overlooking the presence of LIEFS. In contrast, reliability of 3D MRI for detection of LIEFS was good. Furthermore, readers’ performance in the diagnosis of LIEFS can be improved by use of 3D MRI. Therefore, 3D MRI is recommended when using imaging for diagnosis of LIEFS.

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Acknowledgments

The authors wish to thank Dr Hiroko Ihara, Dr Misato Okouchi, and Mr Yuji Nakao in Wakayama-minami radiology clinic for their technical assistance and for collecting data, and Dr Junji Shiraishi in School of Health Sciences, Kumamoto University for his comment on the study design and interpretation of the data.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama, 641-8510, Japan

    Hiroshi Yamada, Hiroshi Iwasaki, Toru Endo, Motohiro Okada, Shinichi Nakao, Hiroshi Hashizume, Akihito Minamide, Yukihiro Nakagawa, Hideto Nishi, Syunji Tsutsui & Munehito Yoshida

  2. Wamayama-Minami Radiology Clinic, Wakayama, Japan

    Masaki Terada

  3. Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical and Research Center, Graduate School of Medicine, The University of Tokyo, Bunkyō, Japan

    Hiroyuki Oka

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  1. Hiroshi Yamada
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  2. Masaki Terada
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Correspondence to Hiroshi Yamada.

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Yamada, H., Terada, M., Iwasaki, H. et al. Improved accuracy of diagnosis of lumbar intra and/or extra-foraminal stenosis by use of three-dimensional MR imaging: comparison with conventional MR imaging. J Orthop Sci 20, 287–294 (2015). https://doi.org/10.1007/s00776-014-0677-1

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  • DOI: https://doi.org/10.1007/s00776-014-0677-1

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