title: Reliability of magnetic resonance imaging readings for lumbar disc herniation in the Spine Patient Outcomes Research Trial (SPORT).
abstract: METHODS
  Assessment of the reliability of standardized magnetic resonance imaging (MRI) interpretations and measurements.
  
  
  OBJECTIVE
  To determine the intra- and inter-reader reliability of MRI parameters relevant to patients with intervertebral disc herniation (IDH), including disc morphology classification, degree of thecal sac compromise, grading of nerve root impingement, and measurements of cross-sectional area of the spinal canal, thecal sac, and disc fragment.
  
  
  BACKGROUND
  MRI is increasingly used to assess patients with sciatica and IDH, but the relationship between specific imaging characteristics and patient outcomes remains uncertain. Although other studies have evaluated the reliability of certain MRI characteristics, comprehensive evaluation of the reliability of readings of herniated disc features on MRI is lacking.
  
  
  METHODS
  Sixty randomly selected MR images from patients with IDH enrolled in the Spine Patient Outcomes Research Trial were each rated according to defined criteria by 4 independent readers (3 radiologists and 1 orthopedic surgeon). Quantitative measurements were performed separately by 2 other radiologists. A sample of 20 MRIs was re-evaluated by each reader at least 1 month later. Agreement for rating data were assessed with kappa statistics using linear weights. Reliability of the quantitative measurements was assessed using intraclass correlation coefficients (ICCs) and summaries of measurement error.
  
  
  RESULTS
  Inter-reader reliability was substantial for disc morphology [overall kappa 0.81 (95% confidence interval (CI): 0.78, 0.85)], moderate for thecal sac compression [overall kappa 0.54 (95% CI: 0.37, 0.68)], and moderate for grading nerve root impingement [overall kappa 0.47 (95% CI: 0.36, 0.56)]. Quantitative measures showed high ICCs of 0.87 to 0.96 for spinal canal and thecal sac cross-sectional areas. Measures of disc fragment area had moderate ICCs of 0.65 to 0.83. Mean absolute differences between measurements ranged from approximately 15% to 20%.
  
  
  CONCLUSIONS
  Classification of disc morphology showed substantial intra- and inter-reader agreement, whereas thecal sac and nerve root compression showed more moderate reader reliability. Quantitative measures of canal and thecal sac area showed good reliability, whereas measurement of disc fragment area showed more modest reliability.
authors.affiliation: Department of Medicine, Dartmouth Medical School, Lebanon, New Hampshire 03756, USA. jon.d.lurie@dartmouth.edu
authors.forename: Jon D
authors.initials: JD
authors.lastname: Lurie
authors.forename: Anna N A
authors.initials: AN
authors.lastname: Tosteson
authors.forename: Tor D
authors.initials: TD
authors.lastname: Tosteson
authors.forename: Eugene
authors.initials: E
authors.lastname: Carragee
authors.forename: John A
authors.initials: JA
authors.lastname: Carrino
authors.forename: John
authors.initials: J
authors.lastname: Carrino
authors.forename: Jay
authors.initials: J
authors.lastname: Kaiser
authors.forename: Roberto T Blanco
authors.initials: RT
authors.lastname: Sequeiros
authors.forename: Amy Rosen
authors.initials: AR
authors.lastname: Lecomte
authors.forename: Margaret R
authors.initials: MR
authors.lastname: Grove
authors.forename: Emily A
authors.initials: EA
authors.lastname: Blood
authors.forename: Loretta H
authors.initials: LH
authors.lastname: Pearson
authors.forename: Richard
authors.initials: R
authors.lastname: Herzog
authors.forename: James N
authors.initials: JN
authors.lastname: Weinstein
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007403:Intervertebral Disc / Q000473:pathology*; D007405:Intervertebral Disc Displacement / Q000150:complications / Q000473:pathology*; D008159:Lumbar Vertebrae / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011237:Predictive Value of Tests; D011843:Radiculopathy / Q000209:etiology / Q000473:pathology; D016032:Randomized Controlled Trials as Topic; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D013115:Spinal Canal / Q000473:pathology