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MRI Inter-Reader and Intra-Reader Reliabilities for Assessing Injury Morphology and Posterior Ligamentous Complex Integrity of the Spine According to the Thoracolumbar Injury Classification System and Severity Score.

Lee GY, Lee JW, Choi SW, Lim HJ, Sun HY, Kang Y, Chai JW, Kim S, Kang HS - Korean J Radiol (2015)

Bottom Line: Inter-reader and intra-reader agreements were determined and analyzed according to the number of years of radiologist experience.No significant difference in inter-reader agreement was observed according to the number of years of radiologist experience.The reliability of MRI for assessing thoracolumbar spinal injuries according to the TLICS was moderate for injury morphology and fair to moderate for PLC integrity, which may not be influenced by radiologist' experience.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Seoul National University Bundang Hospital, Seongnam 463-707, Korea.

ABSTRACT

Objective: To evaluate spine magnetic resonance imaging (MRI) inter-reader and intra-reader reliabilities using the thoracolumbar injury classification system and severity score (TLICS) and to analyze the effects of reader experience on reliability and the possible reasons for discordant interpretations.

Materials and methods: Six radiologists (two senior, two junior radiologists, and two residents) independently scored 100 MRI examinations of thoracolumbar spine injuries to assess injury morphology and posterior ligamentous complex (PLC) integrity according to the TLICS. Inter-reader and intra-reader agreements were determined and analyzed according to the number of years of radiologist experience.

Results: Inter-reader agreement between the six readers was moderate (k = 0.538 for the first and 0.537 for the second review) for injury morphology and fair to moderate (k = 0.440 for the first and 0.389 for the second review) for PLC integrity. No significant difference in inter-reader agreement was observed according to the number of years of radiologist experience. Intra-reader agreements showed a wide range (k = 0.538-0.822 for injury morphology and 0.423-0.616 for PLC integrity). Agreement was achieved in 44 for the first and 45 for the second review about injury morphology, as well as in 41 for the first and 38 for the second review of PLC integrity. A positive correlation was detected between injury morphology score and PLC integrity.

Conclusion: The reliability of MRI for assessing thoracolumbar spinal injuries according to the TLICS was moderate for injury morphology and fair to moderate for PLC integrity, which may not be influenced by radiologist' experience.

No MeSH data available.


Related in: MedlinePlus

Case of disagreement about posterior ligamentous complex (PLC) integrity by readers.49-year-old man showed burst injury of L1 body on T2-weighted sagittal image (A) with bulging contour of posterior cortex on T2-weighted axial scan (B, arrows), which was agreed by all readers during first and second reviews. Suspicious increase of signal intensity was detected along PLC on T2-weighted short time inversion recovery sagittal image (C, arrow), which became disagreement during first ("intact" by one; "indeterminate" by four; "injured" by one) and second reviews ("intact" by one; "indeterminate" by five readers).
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Figure 1: Case of disagreement about posterior ligamentous complex (PLC) integrity by readers.49-year-old man showed burst injury of L1 body on T2-weighted sagittal image (A) with bulging contour of posterior cortex on T2-weighted axial scan (B, arrows), which was agreed by all readers during first and second reviews. Suspicious increase of signal intensity was detected along PLC on T2-weighted short time inversion recovery sagittal image (C, arrow), which became disagreement during first ("intact" by one; "indeterminate" by four; "injured" by one) and second reviews ("intact" by one; "indeterminate" by five readers).

Mentions: Inter-reader agreement between the six readers was moderate for the TLICS score for injury morphology (k = 0.538 for the first and 0.537 for the second review) and fair to moderate for PLC integrity (k = 0.440 for the first and 0.389 for the second review). After grouping the readers according to experience, the inter-reader agreement between two readers was spread widely, such as moderate to substantial agreement for injury morphology (k = 0.509-0.664) and fair to substantial for PLC integrity (k = 0.349-0.618) regardless of the radiologist's years of experience (Table 2). No difference in inter-reader agreement was detected over time. Intra-reader agreements were moderate to almost perfect for injury morphology (k = 0.538-0.822) and moderate to substantial for PLC integrity (k = 0.423-0.646) without a difference according to years of experience (Table 3). The majority of the 100 patients had a compression or burst injury (injury morphology scores 1-2) (Figs. 1, 2). All readers agreed that 44 patients in the first and 45 in the second reviews had the same injury morphology (Table 4). However, the readers failed to agree on the injury morphology of > 50% of the patients after the first and second reviews, in which the majority had compression vs. burst injuries (Table 4). The readers had difficulties distinguishing between burst and distraction injury in nine patients on the first and seven patients on the second review (Fig. 3). Two patients in the first review and six in the second review received various scores for all injury morphology types by the six readers, including the compression, burst, translation/rotation, and distraction injury patterns.


MRI Inter-Reader and Intra-Reader Reliabilities for Assessing Injury Morphology and Posterior Ligamentous Complex Integrity of the Spine According to the Thoracolumbar Injury Classification System and Severity Score.

Lee GY, Lee JW, Choi SW, Lim HJ, Sun HY, Kang Y, Chai JW, Kim S, Kang HS - Korean J Radiol (2015)

Case of disagreement about posterior ligamentous complex (PLC) integrity by readers.49-year-old man showed burst injury of L1 body on T2-weighted sagittal image (A) with bulging contour of posterior cortex on T2-weighted axial scan (B, arrows), which was agreed by all readers during first and second reviews. Suspicious increase of signal intensity was detected along PLC on T2-weighted short time inversion recovery sagittal image (C, arrow), which became disagreement during first ("intact" by one; "indeterminate" by four; "injured" by one) and second reviews ("intact" by one; "indeterminate" by five readers).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4499555&req=5

Figure 1: Case of disagreement about posterior ligamentous complex (PLC) integrity by readers.49-year-old man showed burst injury of L1 body on T2-weighted sagittal image (A) with bulging contour of posterior cortex on T2-weighted axial scan (B, arrows), which was agreed by all readers during first and second reviews. Suspicious increase of signal intensity was detected along PLC on T2-weighted short time inversion recovery sagittal image (C, arrow), which became disagreement during first ("intact" by one; "indeterminate" by four; "injured" by one) and second reviews ("intact" by one; "indeterminate" by five readers).
Mentions: Inter-reader agreement between the six readers was moderate for the TLICS score for injury morphology (k = 0.538 for the first and 0.537 for the second review) and fair to moderate for PLC integrity (k = 0.440 for the first and 0.389 for the second review). After grouping the readers according to experience, the inter-reader agreement between two readers was spread widely, such as moderate to substantial agreement for injury morphology (k = 0.509-0.664) and fair to substantial for PLC integrity (k = 0.349-0.618) regardless of the radiologist's years of experience (Table 2). No difference in inter-reader agreement was detected over time. Intra-reader agreements were moderate to almost perfect for injury morphology (k = 0.538-0.822) and moderate to substantial for PLC integrity (k = 0.423-0.646) without a difference according to years of experience (Table 3). The majority of the 100 patients had a compression or burst injury (injury morphology scores 1-2) (Figs. 1, 2). All readers agreed that 44 patients in the first and 45 in the second reviews had the same injury morphology (Table 4). However, the readers failed to agree on the injury morphology of > 50% of the patients after the first and second reviews, in which the majority had compression vs. burst injuries (Table 4). The readers had difficulties distinguishing between burst and distraction injury in nine patients on the first and seven patients on the second review (Fig. 3). Two patients in the first review and six in the second review received various scores for all injury morphology types by the six readers, including the compression, burst, translation/rotation, and distraction injury patterns.

Bottom Line: Inter-reader and intra-reader agreements were determined and analyzed according to the number of years of radiologist experience.No significant difference in inter-reader agreement was observed according to the number of years of radiologist experience.The reliability of MRI for assessing thoracolumbar spinal injuries according to the TLICS was moderate for injury morphology and fair to moderate for PLC integrity, which may not be influenced by radiologist' experience.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Seoul National University Bundang Hospital, Seongnam 463-707, Korea.

ABSTRACT

Objective: To evaluate spine magnetic resonance imaging (MRI) inter-reader and intra-reader reliabilities using the thoracolumbar injury classification system and severity score (TLICS) and to analyze the effects of reader experience on reliability and the possible reasons for discordant interpretations.

Materials and methods: Six radiologists (two senior, two junior radiologists, and two residents) independently scored 100 MRI examinations of thoracolumbar spine injuries to assess injury morphology and posterior ligamentous complex (PLC) integrity according to the TLICS. Inter-reader and intra-reader agreements were determined and analyzed according to the number of years of radiologist experience.

Results: Inter-reader agreement between the six readers was moderate (k = 0.538 for the first and 0.537 for the second review) for injury morphology and fair to moderate (k = 0.440 for the first and 0.389 for the second review) for PLC integrity. No significant difference in inter-reader agreement was observed according to the number of years of radiologist experience. Intra-reader agreements showed a wide range (k = 0.538-0.822 for injury morphology and 0.423-0.616 for PLC integrity). Agreement was achieved in 44 for the first and 45 for the second review about injury morphology, as well as in 41 for the first and 38 for the second review of PLC integrity. A positive correlation was detected between injury morphology score and PLC integrity.

Conclusion: The reliability of MRI for assessing thoracolumbar spinal injuries according to the TLICS was moderate for injury morphology and fair to moderate for PLC integrity, which may not be influenced by radiologist' experience.

No MeSH data available.


Related in: MedlinePlus