title: Oblique reformation in cervical spine computed tomography: a new look at an old friend.
abstract: METHODS
  Cervical spine computed tomograms were evaluated for neural foraminal stenosis in both the standard axial plane and the oblique reformatted plane.
  
  
  OBJECTIVE
  To assess whether oblique reformation of cervical spine computed tomograms reduces interobserver variability in the evaluation of neural foraminal stenosis.
  
  
  BACKGROUND
  Radiographic assessment of neural foraminal stenosis is subjective, may vary among observers, and can affect surgical planning.
  
  
  METHODS
  The cervical spine images from 19 patients with various degrees of neural foraminal stenosis were reformatted in an oblique plane perpendicular to the long axis of the right and left neural foramens. Seven independent observers graded the degree of foraminal stenosis (none, mild [1-25%], moderate [26-75%], or severe [>75%]) and their confidence level (definite, probable, possible) on both the axial images and the oblique reformations.
  
  
  RESULTS
  The ages of the 12 male (mean, 67.5 +/- 13.24 years) and 7 female (mean, 62.7 +/- 14.79 years) patients ranged from 39 to 83 years. Interobserver variability was assessed with chi2 analysis. Rates of agreement on degree of stenosis (chi2 = 19.94; df= 9; P< 0.02) were significantly higher for oblique reformations. Confidence ratings also were significantly higher for oblique reformations (chi2 = 18.19; df= 7; P< 0.02).
  
  
  CONCLUSIONS
  Oblique reformation of cervical spine images significantly reduces the degree of interobserver variability and increases observer confidence in the assessment of neural foraminal stenosis. Oblique reformations should be considered in the routine evaluation of neural foraminal stenosis.
authors.affiliation: Department of Radiology, University of Arizona Health Sciences Center, Tucson, Arizona, USA. roberts.catherine@mayo.edu
authors.forename: Catherine C
authors.initials: CC
authors.lastname: Roberts
authors.forename: N Troy
authors.initials: NT
authors.lastname: McDaniel
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Krupinski
authors.forename: William K
authors.initials: WK
authors.lastname: Erly
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D009333:Neck; D015588:Observer Variation; D012189:Retrospective Studies; D013130:Spinal Stenosis / Q000145:classification / Q000000981:diagnostic imaging*; D013131:Spine / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed / Q000379:methods*