Reliability of standing weight-bearing (0.25T) MR imaging findings and positional changes in the lumbar spine
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To test the reliability and absolute agreement of common degenerative findings in standing positional magnetic resonance imaging (pMRI).
Methods and materials
Low back pain patients with and without sciatica were consecutively enrolled to undergo a supine and standing pMRI. Three readers independently evaluated the standing pMRI for herniation, spinal stenosis, spondylolisthesis, HIZ lesions and facet joint effusion. The evaluation included a semi-quantitative grading of spinal stenosis, foraminal stenosis and spinal nerve root compression. The standing pMRI images were evaluated with full access to supine MRI. In case lower grades or the degenerative findings were not present in the supine images, this was reported separately as position-dependent changes. A subsample of 20 pMRI examinations was reevaluated after two months. The reproducibility was assessed by inter- and intra-reader reliability (kappa statistic) and absolute agreement between readers.
Fifty-six patients were included in this study. There was fair-to-substantial inter-reader reliability (κ 0.47 to 0.82) and high absolute agreement (72.3% to 99.1%) for the pMRI findings. The intra-reader assessment showed similar reliability and agreement (κ 0.36 to 0.85; absolute agreement: 62.5% to 98.8%). Positional changes between the supine and standing position showed a fair-to-moderate inter- and intra-reader reliability (κ 0.25 to 0.52; absolute agreement: 97.0% to 99.1).
Evaluation of the lumbar spine for degenerative findings by standing pMRI has acceptable reproducibility; however, positional changes from the supine to the standing position as an independent outcome should be interpreted with caution because of lower reliability, which calls for further standardisation.
KeywordsMagnetic resonance imaging Positional MRI Weight bearing Lumbar spine G-scan Reliability
This study was supported by unrestricted grants from The Oak Foundation (grant no. OCAY-13-309), Savværksejer Jeppe Juhl og Hustru Ovita Juhls Mindelegat, Minister Erna Hamiltons Legat for Videnskab og Kunst and the Danish Rheumatism Association. The funding sources did not influence the study design, collection, analysis and interpretation of data, writing or decision to submit the manuscript for publication. We would also like to thank Prof. Robin Christensen for statistical support and methodological feedback.
Compliance with ethical standards
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Conflict of interest
M.B. and P.H. have received funding for congress fees and traveling expenses from ESAOTE in 2016. All other authors declare that they have no conflicts of interest.
- 4.Splendiani A, Perri M, Grattacaso G, Di Tunno V, Marsecano C, Panebianco L, et al. Magnetic resonance imaging (MRI) of the lumbar spine with dedicated G-scan machine in the upright position: a retrospective study and our experience in 10 years with 4305 patients. Radiol Med Springer Milan. 2016;121:38–44.CrossRefGoogle Scholar
- 11.Alyas F, Sutcliffe J, Connell D, Saifuddin A. Morphological change and development of high-intensity zones in the lumbar spine from neutral to extension positioning during upright MRI. Clin Radiol Royal Coll Radiol. 2010;65:176–80.Google Scholar
- 16.Fardon DF, Milette PC. Nomenclature and classification of lumbar disc pathology. Recommendations of the Combined Task Forces of the North American Spine Society, American Society of Spine Radiology, and American Society of Neuroradiology. Spine (Phila Pa 1976). 2001;26:E93–113.CrossRefGoogle Scholar
- 18.Carrino J A, Lurie JD, Tosteson AN a, Tosteson TD, Carragee EJ, Kaiser J, et al. lumbar spine: reliability of MR imaging findings. Radiology 2009;250:161–170.Google Scholar
- 28.Fu MC, Buerba RA, Long WD, Blizzard DJ, Lischuk AW, Haims AH, et al. Interrater and intrarater agreements of magnetic resonance imaging findings in the lumbar spine: significant variability across degenerative conditions. Spine J Elsevier Inc. 2014;14:2442–8.Google Scholar