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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.51-year-old man demonstrated traumatic lesions at L1 and L4 bodies on T2- (A) and T1-weighted sagittal images (B) with epidural hemorrhage at L3-5 level (arrows, A, B). L1 lesion revealed bulging of posterior cortex on T2-weighted axial scan (C, arrows), which was agreed to be burst injury by all readers during first review and by five during second review. However, no consensus was reached about PLC integrity on T2-weighted short time inversion recovery sagittal images (D, E, arrow), which produced variety of scores for PLC intergtity ("intact" by two readers; "indeterminate" by four in first and "intact" by three; "indeterminate" by two; and "injured" by one during second review). In contrast, PLC integrity (E, dashed arrow) of L4 body lesion was not evaluated using thoracolumbar injury classification system and was originally classified as most severe injury level.
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Figure 4: Case of disagreement about posterior ligamentous complex (PLC) integrity by readers.51-year-old man demonstrated traumatic lesions at L1 and L4 bodies on T2- (A) and T1-weighted sagittal images (B) with epidural hemorrhage at L3-5 level (arrows, A, B). L1 lesion revealed bulging of posterior cortex on T2-weighted axial scan (C, arrows), which was agreed to be burst injury by all readers during first review and by five during second review. However, no consensus was reached about PLC integrity on T2-weighted short time inversion recovery sagittal images (D, E, arrow), which produced variety of scores for PLC intergtity ("intact" by two readers; "indeterminate" by four in first and "intact" by three; "indeterminate" by two; and "injured" by one during second review). In contrast, PLC integrity (E, dashed arrow) of L4 body lesion was not evaluated using thoracolumbar injury classification system and was originally classified as most severe injury level.

Mentions: Forty-one patients in the first review and 38 in the second review were regarded as having PLC status by all readers. Among the cases of disagreement, 27 patients in the first review and 29 in the second review were thought to be "intact" or "indeterminate", and nine in the first review and five in the second review were considered "indeterminate" or "injured". Moreover, four patients in the first review and six in the second review were regarded as "intact" or "injured" with disagreement. Unlike injury morphology, in which only two in the first review and six in the second review had various injury morphology scores, 19 cases in the first review and 22 in the second review showed a wide range of PLC integrity scores (Table 4, Figs. 1, 4). Disrupted PLC was the agreed condition by all readers for four of 14 patients in the first review and three of 18 in the second review with a suspected distraction injury by any reader.


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.51-year-old man demonstrated traumatic lesions at L1 and L4 bodies on T2- (A) and T1-weighted sagittal images (B) with epidural hemorrhage at L3-5 level (arrows, A, B). L1 lesion revealed bulging of posterior cortex on T2-weighted axial scan (C, arrows), which was agreed to be burst injury by all readers during first review and by five during second review. However, no consensus was reached about PLC integrity on T2-weighted short time inversion recovery sagittal images (D, E, arrow), which produced variety of scores for PLC intergtity ("intact" by two readers; "indeterminate" by four in first and "intact" by three; "indeterminate" by two; and "injured" by one during second review). In contrast, PLC integrity (E, dashed arrow) of L4 body lesion was not evaluated using thoracolumbar injury classification system and was originally classified as most severe injury level.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 4: Case of disagreement about posterior ligamentous complex (PLC) integrity by readers.51-year-old man demonstrated traumatic lesions at L1 and L4 bodies on T2- (A) and T1-weighted sagittal images (B) with epidural hemorrhage at L3-5 level (arrows, A, B). L1 lesion revealed bulging of posterior cortex on T2-weighted axial scan (C, arrows), which was agreed to be burst injury by all readers during first review and by five during second review. However, no consensus was reached about PLC integrity on T2-weighted short time inversion recovery sagittal images (D, E, arrow), which produced variety of scores for PLC intergtity ("intact" by two readers; "indeterminate" by four in first and "intact" by three; "indeterminate" by two; and "injured" by one during second review). In contrast, PLC integrity (E, dashed arrow) of L4 body lesion was not evaluated using thoracolumbar injury classification system and was originally classified as most severe injury level.
Mentions: Forty-one patients in the first review and 38 in the second review were regarded as having PLC status by all readers. Among the cases of disagreement, 27 patients in the first review and 29 in the second review were thought to be "intact" or "indeterminate", and nine in the first review and five in the second review were considered "indeterminate" or "injured". Moreover, four patients in the first review and six in the second review were regarded as "intact" or "injured" with disagreement. Unlike injury morphology, in which only two in the first review and six in the second review had various injury morphology scores, 19 cases in the first review and 22 in the second review showed a wide range of PLC integrity scores (Table 4, Figs. 1, 4). Disrupted PLC was the agreed condition by all readers for four of 14 patients in the first review and three of 18 in the second review with a suspected distraction injury by any reader.

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